In-shoe Pressure Measurement Research Articles

Comparison of in-shoe plantar pressure between Korean combat boots and running shoes

IntroductionCombat boots are special shoes designed for soldiers to wear during activities in rough terrain, such as long marches or military training. Combat boots have been known to cause high...

In-shoe plantar pressure measurement technologies for the diabetic foot: A systematic review

IntroductionLoss of cutaneous protective sensation and high plantar pressures increase the risk for diabetic foot patients. Trauma and ulceration are imminent threats, making assessment and monitoring essential. This systematic review aims to identify systems and technologies for measuring in-shoe plantar pressures, focusing on the at-risk diabetic foot population. MethodsA systematic search was conducted across four electronic databases (Scopus, Web of Science, PubMed, Oxford Journals) using PRISMA methodology, covering articles published in English from 1979 to 2024. Only studies addressing systems or sensors exclusively measuring plantar pressures inside the shoe were included. ResultsA total of 87 studies using commercially available devices and 45 articles proposing new systems or sensors were reviewed. The prevailing market offerings consist mainly of instrumented insoles. Emerging technologies under development often feature configurations with four, six or eight resistive sensors strategically placed within removable insoles. Despite some variability due to the inherent heterogeneity of human gait, these devices assess plantar pressure, although they present significant differences between them in measurement results. Individuals with diabetic foot conditions appears exhibit elevated plantar pressures, with reported peak pressures reaching approximately 1000 kPa. The results also showed significant differences between the diabetic and non-diabetic groups. ConclusionInstrumented insoles, particularly those incorporating resistive sensor technology, dominate the field. Systems employing eight sensors at critical locations represent a pragmatic approach, although market options extend to systems with up to 960 sensors. Differences between devices can be a critical factor in measurement and highlights the importance of individualized patient assessment using consistent measurement devices.

The virtual pivot point concept improves predictions of ground reaction forces.

Ground reaction forces (GRFs) are essential for the analysis of human movement. To measure GRFs, 3D force plates that are fixed to the floor are used with large measuring ranges, excellent accuracy and high sample frequency. For less dynamic movements, like walking or squatting, portable 3D force plates are used, while if just the vertical component of the GRFs is of interest, pressure plates or in-shoe pressure measurements are often preferred. In many cases, however, it is impossible to measure 3D GRFs, e.g., during athletic competitions, at work or everyday life. It is still challenging to predict the horizontal components of the GRFs from kinematics using biomechanical models. The virtual pivot point (VPP) concept states that measured GRFs during walking intercept in a point located above the center of mass, while during running, the GRFs cross each other at a point below the center of mass. In the present study, this concept is used to compare predicted GRFs from measured kinematics with measured 3D-GRFs, not only during walking but also during more static movements like squatting and inline lunge. To predict the GRFs a full-body biomechanical model was used while gradually changing the positions of the VPP. It is shown that an optimal VPP improves the prediction of GRFs not only for walking but also for inline lunge and squats.

In-Shoe Pressure Measurements in Diabetic Footwear Practice: Success Rate and Facilitators of and Barriers to Implementation.

We aimed to assess the success rate and facilitators of and the barriers to the implementation of in-shoe plantar pressure measurements in footwear practice for people with diabetes at high risk of foot ulceration. Eleven Dutch footwear practices were partly supported in purchasing a pressure measurement system. Over a 2.5-year period, trained shoe technicians evaluated 1030 people with diabetes (range: 13 to 156 across practices). The implementation success and associated facilitators and barriers were evaluated quantitatively using completed measurement forms and pressure measurement data obtained during four monitoring sessions and qualitatively through semi-structured interviews with technicians. Across the 11 practices, the primary target group (people with diabetes and a healed plantar foot ulcer) represented 25-90% of all the patients measured. The results showed that three practices were successful, five moderately successful, and three not successful. The facilitators included support by the company management board, collaboration with a prescribing physician, measurement sessions separate from the outpatient clinic, and a (dedicated) shoe technician experiencing a learning effect. The barriers included investment costs, usability aspects, and limited awareness among shoe technicians. In-shoe plantar pressure measurements can be implemented to a moderate to large degree in diabetic footwear practice. The barriers to and facilitators of implementation are organizational, logistical, financial, or technical, and the barriers are modifiable, supporting future implementation.

Impact of Fatigue on Ergonomic Risk Scores and Foot Kinetics: A Field Study Employing Inertial and In-Shoe Plantar Pressure Measurement Devices.

(1) Background: Occupational fatigue is a primary factor leading to work-related musculoskeletal disorders (WRMSDs). Kinematic and kinetic experimental studies have been able to identify indicators of WRMSD, but research addressing real-world workplace scenarios is lacking. Hence, the authors of this study aimed to assess the influence of physical strain on the Borg CR-10 body map, ergonomic risk scores, and foot pressure in a real-world setting. (2) Methods: Twenty-four participants (seventeen men and seven women) were included in this field study. Inertial measurement units (IMUs) (n = 24) and in-shoe plantar pressure measurements (n = 18) captured the workload of production and office workers at the beginning of their work shift and three hours later, working without any break. In addition to the two 12 min motion capture processes, a Borg CR-10 body map and fatigue visual analog scale (VAS) were applied twice. Kinematic and kinetic data were processed using MATLAB and SPSS software, resulting in scores representing the relative distribution of the Rapid Upper Limb Assessment (RULA) and Computer-Assisted Recording and Long-Term Analysis of Musculoskeletal Load (CUELA), and in-shoe plantar pressure. (3) Results: Significant differences were observed between the two measurement times of physical exertion and fatigue, but not for ergonomic risk scores. Contrary to the hypothesis of the authors, there were no significant differences between the in-shoe plantar pressures. Significant differences were observed between the dominant and non-dominant sides for all kinetic variables. (4) Conclusions: The posture scores of RULA and CUELA and in-shoe plantar pressure side differences were a valuable basis for adapting one-sided requirements in the work process of the workers. Traditional observational methods must be adapted more sensitively to detect kinematic deviations at work. The results of this field study enhance our knowledge about the use and benefits of sensors for ergonomic risk assessments and interventions.

The effect of calcaneus and metatarsal head offloading insoles on healthy subjects' gait kinematics, kinetics, asymmetry, and the implications for plantar pressure management: A pilot study.

The global number of people with diabetes is estimated to reach 643 million by 2030 of whom 19-34% will present with diabetic foot ulceration. Insoles which offload high-risk ulcerative regions on the foot, by removing insole material, are the main contemporary conservative treatment to maintain mobility and reduce the likelihood of ulceration. However, their effect on the rest of the foot and relationship with key gait propulsive and balance kinematics and kinetics has not been well researched. The aim of this study is to investigate the effect of offloading insoles on gait kinematics, kinetics, and plantar pressure throughout the gait cycle. 10 healthy subjects were recruited for this experiment to walk in 6 different insole conditions. Subjects walked at three speeds on a treadmill for 10 minutes while both plantar pressure and gait kinematics, kinetics were measured using an in-shoe pressure measurement insole and motion capture system/force plates. Average peak plantar pressure, pressure time integrals, gait kinematics and centre of force were analysed. The average peak plantar pressure and pressure time integrals changed by -30% (-68% to 3%) and -36% (-75% to -1%) at the region of interest when applying offloading insoles, whereas the heel strike and toe-off velocity changed by 15% (-6% to 32%) and 12% (-2% to 19%) whilst walking at three speeds. The study found that offloading insoles reduced plantar pressure in the region of interest with loading transferred to surrounding regions increasing the risk of higher pressure time integrals in these locations. Heel strike and toe-off velocities were increased under certain configurations of offloading insoles which may explain the higher plantar pressures and supporting the potential of integrating kinematic gait variables within a more optimal therapeutic approach. However, there was inter-individual variability in responses for all variables measured supporting individualised prescription.

An integrated personalized assistive devices approach to reduce the risk of foot ulcer recurrence in diabetes (DIASSIST): study protocol for a multicenter randomized controlled trial

BackgroundPreventing foot ulcers in people with diabetes can increase quality of life and reduce costs. Despite the availability of various interventions to prevent foot ulcers, recurrence rates remain high. We hypothesize that a multimodal treatment approach incorporating various footwear, self-management, and education interventions that matches an individual person’s needs can reduce the risk of ulcer recurrence with beneficial cost-utility. The aim of this study is to assess the effect on foot ulcer recurrence, footwear adherence, and cost-utility of an integrated personalized assistive devices approach in high-risk people with diabetes.MethodsIn a parallel-group multicenter randomized controlled trial, 126 adult participants with diabetes mellitus type 1 or 2, loss of protective sensation based on the presence of peripheral neuropathy, a healed plantar foot ulcer in the preceding 4 years, and possession of any type of custom-made footwear will be included. Participants will be randomly assigned to either enhanced therapy or usual care. Enhanced therapy consists of usual care and additionally a personalized treatment approach including pressure-optimized custom-made footwear, pressure-optimized custom-made footwear for indoor use, at-home daily foot temperature monitoring, and structured education, which includes motivational interviewing and personalized feedback on adherence and self-care. Participants will be followed for 12 months. Assessments include barefoot and in-shoe plantar pressure measurements; questionnaires concerning quality of life, costs, disease, and self-care knowledge; physical activity and footwear use monitoring; and clinical monitoring for foot ulcer outcomes. The study is powered for 3 primary outcomes: foot ulcer recurrence, footwear adherence, and cost-utility, the primary clinical, patient-related, and health-economic outcome respectively.DiscussionThis is the first study to integrate multiple interventions for ulcer prevention into a personalized state-of-the-art treatment approach and assess their combined efficacy in a randomized controlled trial in people with diabetes at high ulcer risk. Proven effectiveness, usability, and cost-utility will facilitate implementation in healthcare, improve the quality of life of high-risk people with diabetes, and reduce treatment costs.Trial registrationClinicalTrials.gov NCT05236660. Registered on 11 February 2022.

3D-Printed Insoles for People with Type 2 Diabetes: An Italian, Ambulatory Case Report on the Innovative Care Model

3D-printed insoles are increasingly used for the management of foot pathologies, and the recent literature reports on various experimental studies dealing with either whole foot orthoses or pads fabricated through 3D-printing processes. In the case of diabetic foot disease, the main aim is to deliver more effective solutions with respect to the consolidated processes to reduce compressive risk forces at specific plantar foot sites. Clinical studies are, however, still limited, at least in peer-review journals. Additionally, in Italy, the manufacturing process of these medical devices has not been formally integrated yet into the list of care processes approved for reimbursement by the public healthcare service. Within the Italian DIAPASON project (DIAbetic PAtients Safe ambulatiON), a feasibility pilot study has been conducted in the territory on 21 patients with diabetic foot complications to assess the pros and cons of an innovative process. The process, which relies on in-shoe pressure measurements and on a patented 3D modeling and printing procedure, includes the prescription, design, manufacturing and testing of 3D-printed personalized insoles. The process has been tested in an ambulatory setting and showed the potential to be also implemented in community settings. In this paper, we report a case study on a single volunteer, and we describe and comment on how the whole process has been proven safe and suitable for the purpose.

E065 Scoping review for the application of centre of pressure for patient or intervention assessment in rheumatoid conditions

Abstract Background/Aims Centre of pressure (COP) is the point on a surface through which a single resultant force appears to act. It has been quantified using various commercially available hardware and software such as force plates, in-shoe and platform pressure measurement systems and used to assess stability and function in gait research. Recently, advancements in technology mean systems are more affordable and portable and therefore may be realistically used within clinic to screen patients or assess intervention effectiveness. However, this would require the translation of research protocols and outcomes to clinical practice with consensus on the effective application of COP data to patient assessment in rheumatology. Our aim was to undertake a scoping review to explore the potential role of COP in patients with rheumatoid conditions. We aimed to determine relevant patient groups, COP technology, protocols, and outcome measures. Methods Three electronic databases were comprehensively searched in August 2022 relating to the key themes of the research question: “centre of pressure” and “arthritis”. Individual search terms were tailored to databases (i.e., MeSH terms and truncation) and combined with Boolean operators. Search results were exported to Microsoft Excel. Initial screening was undertaken to remove duplicates (242 excluded) and paper titles that were unrelated to the topic area (332 excluded). Abstracts of remaining articles (140) were then manually screened by two researchers according to criteria to assess their relevance to the aim. Inclusion criteria included lower-limb arthritis sufferers and quantitative studies with peer-reviewed full-text written in English, published since 1980. Exclusion criteria were the inclusion of post-intervention subjects (i.e., replacement arthroplasty) and literature reviews, editorials, preliminary/pilot studies. Full-text screening was then performed and any discrepancies between individual search results were resolved by a third researcher. Relevant information from the remaining studies was scoped and recorded according to the aim. Results 108 papers were included, and preliminary analysis has identified that 90% included patients with osteo-arthritis and 37% rheumatoid. The focus of articles was the knee joint (69%) and primarily observational studies (61%). COP was used to assess interventions in 36% of papers, 21% were shoes/insoles and 4% activity programs. COP was quantified during walking (41%), standing (49%) and gait-initiation (2%) and primarily using force plates (68%). Pressure technology was used to measure COP in 16% of the research, with commercially available in-shoe (6%) and platform (7%) technology being clearly described in papers. Primary outcome measures quantified displacement (93%), velocity (41%) and variability (21%) qualities using a range of variables. Conclusion COP clearly has a role in research for quantifying stability in patients and changes to gait function in response to interventions. The increasing availability and accessibility of pressure technology facilitates the translation of these to assessment in clinic. Disclosure F.S. Goodwin: Grants/research support; NMAHPs Internship Versus Arthritis (Grant reference 22082). C. Price: None. R. Jones: None.

Reliability of F-Scan® in-shoe plantar pressure measurements in people with diabetes at risk of developing foot ulcers

BackgroundThe provision of therapeutic footwear, to prevent the development of diabetic foot ulcers by re-distributing high peak plantar pressure is frequently prescribed for patients with diabetes. Areas of interest (ROI) are identified by placing boxes on the visualised pressure movie. The aims were to evaluate the inter-reliability of the placements of seven ROI boxes and to explore how the box placement affected peak pressure in the seven ROIs. MethodsPlantar pressure movies from 20 of a total of 40 movies were selected for the analysis. Boxes were placed at ROIs, the heel, the lateral midfoot, the metatarsal phalangeal heads (5, 3–4, 2 and 1) and the hallux. The box placements were registered for the left vertical position (L) and the top horizontal position (T) for each of the ROIs, based on registrations by two certified prosthetists and orthotists. FindingsThe inter correlation coefficient of the placement of the boxes ranged from 1.00 to 0.12 (heel_L and metatarsal phalangeal head 2_L respectively). Of the 14 positions of the boxes; four were excellent, four were good, two were moderate and four were poor. No significant differences in the mean peak pressure corresponding to the box placements were found between the CPOs. InterpretationThe inter-reliability of eight of the 14 registered placements, made by prosthetists and orthotists, of the boxes in Scan® was good to excellent. A variation of 1.00–0.12 was present. Despite the variation, no significant differences in the corresponding mean peak pressure between prosthetists and orthotists was found.

Validity and reliability of the XSENSOR in-shoe pressure measurement system.

In-shoe pressure measurement systems are used in research and clinical practice to quantify areas and levels of pressure underfoot whilst shod. Their validity and reliability across different pressures, durations of load and contact areas determine their appropriateness to address different research questions or clinical assessments. XSENSOR is a relatively new pressure measurement device and warrants assessment. Does the XSENSOR in-shoe pressure measurement device have sufficient validity and reliability for clinical assessments in diabetes? Two XSENSOR insoles were examined across two days with two lab-based protocols to assess regional and whole insole loading. The whole insole protocol applied 50-600 kPa of pressure across the insole surface for 30 seconds and measured at 0, 2, 10 and 30 seconds. The regional protocol used two (3.14 and 15.9 cm2 surface area) cylinders to apply pressures of 50, 110 and 200 kPa to each insole. Three trials of all conditions were averaged. The validity (% difference and Root Mean Square Error: RMSE) and repeatability (Bland Altman, Intra-Class Correlation Coefficient: ICC) of the target pressures (whole insole) and contact area (regional) were outcome variables. Regional results demonstrated mean contact area errors of less than 1 cm2 for both insoles and high repeatability (≥0.939). Whole insole measurement error was higher at higher pressures but resulted in average peak and mean pressures error < 10%. Reliability error was 3-10% for peak pressure, within the 15% defined as an analytical goal. Errors associated with the quantification of pressure are low enough that they are unlikely to influence the assessments of interventions or screening of the at-risk-foot considering clinically relevant thresholds. Contact area is accurate due to a high spatial resolution and the repeatability of the XSENSOR system likely makes it appropriate for clinical applications that require multiple assessments.

Effectiveness of Shock-Absorbing Insole for High-Heeled Shoes on Gait: Randomized Controlled Trials.

This study was carried out to identify the influence of a shock-absorbing insole, developed by the author for use with high-heeled shoes, on walking. The research design included single-blind randomized parallel groups; namely, a group of 26 participants who wore the shock-absorbing insoles and another group of 26 participants who did not wear the insoles, both carried out walking while wearing 7 cm high-heels. During walking, plantar pressure analysis (via in-shoe plantar pressure measurements), surface electrode electromyography (surface EMG), gait analysis, subjective comfort evaluation, and functional movement (functional mobility) analysis were carried out. In order to compare the two groups, statistical verification (paired t-test) was performed. Wearing the shock-absorbing insole with the high-heeled shoes improved posture stability during walking, as well as increasing the walking speed. In addition, the heel pressure, the pressure of the front foot at the inner side, and the shock ability were decreased. For these reasons, the wearers reported higher comfort. Changes in the muscle activities of the tibialis anterior muscle (TA) and the gastrocnemius muscle (GA) heightened the stability of the ankle joints. Overall, the proposed shock-absorbing insole for use with high-heeled shoes improved the postural stability when walking, as well as improving the distribution of pressure on the soles. A decrease in the diverse side-effects of wearing high-heeled shoes can thus be expected.

Evaluation of novel plantar pressure-based 3-dimensional printed accommodative insoles - A feasibility study

BackgroundCustom insoles are commonly prescribed to patients with diabetes to redistribute plantar pressure and decrease the risk of ulceration. Advances in 3D printing have enabled the creation of 3D-printed personalized metamaterials whose properties are derived not only from the base material but also the lattice microstructures within the metamaterial. Insoles manufactured using personalized metamaterials have both patient-specific geometry and stiffnesses. However, the safety and biomechanical effect of the novel insoles have not yet been tested clinically. MethodsIndividuals without ulcer, neuropathy, or deformity were recruited for this study. In-shoe walking plantar pressure at baseline visit was taken and sensels with pressure over 200 kPa was used to define offloading region(s). Three pairs of custom insoles (two 3D printed insoles with personalized metamaterials (Hybrid and Full) designed based on foot shape and plantar pressure mapping and one standard-of-care diabetic insole as a comparator). In-shoe plantar pressure measurements during walking were recorded in a standardized research shoe and the three insoles and compared across all four conditions. FindingsTwelve individuals were included in the final analysis. No adverse events occurred during testing. Maximum peak plantar pressure and the pressure time integral were reduced in the offloading regions in the Hybrid and Full but not in the standard-of-care compared to the research shoe. InterpretationThis feasibility study confirms our ability to manufacture the 3D printed personalized metamaterials insoles and demonstrates their ability to reduce plantar pressure. We have demonstrated the ability to modify the 3D printed design to offload certain parts of the foot using plantar pressure data and a patient-specific metamaterials in the 3D printed insole design. The advance in 3D printed technology has shown its potential to improve current care.

Footsteps required for reliable and valid in-shoe plantar pressure assessment during gait per foot region in people with hallux valgus

BackgroundPlantar pressure assessment is commonly performed to identify pathognomonic gait characteristics and evaluate therapeutics against them in people with various foot disorders. Little is known about the reliability and validity of this assessment in people with hallux valgus (HV) per foot region. Research questionThis study aimed to assess the reliability and validity of the in-shoe plantar pressure measurement method during gait in people with HV and the required number of footsteps, as an intra-subject sample size, to ensure a reliable and valid use of this method. MethodsWith an inserted disposable insole plantar pressure sensor in shoes, 17 females with HV (HV angle > 15°) completed three gait trials over the ground at a comfortable speed. Peak plantar pressure data and its distribution in 15 stance phases on the foot clinically diagnosed with HV in each participant were extracted by dividing the foot into eight regions. The intraclass correlation coefficient per foot region and the number of footsteps required to produce a valid peak plantar pressure and distribution (intraclass correlation coefficient > 0.90) were used to measure reliability. Based on the limit of agreement analysis, the coefficient of variation between the averaged value from each incremental footstep (2–14 footsteps) and 15 reference footsteps was calculated. ResultsThe intraclass correlation coefficient of plantar pressure assessment with the in-shoe sensor was 0.606–0.847 in the eight foot regions in people with HV. Additionally, the number of steps required for a valid assessment ranged from two to nine. Hence, the application of averaged values from more than nine footsteps is recommended for this evaluation. SignificanceThis reference sample size is intended to be used in future studies and clinical settings to determine the efficacy of HV treatment.

Development of a low-cost textile sensor based insole to monitor foot pressure of diabetic patients

A common but preventable complication of diabetes is diabetic foot ulcer. If appropriate care is not provided such foot lesions progress to the most severe diabetic foot complication, like infection, gangrene, amputation and even death. Diabetic neuropathy results abnormal planter pressure points under the foot and triggers the tendency of foot ulcer. The aim of this paper is to present the development of a low cost, power efficient, soft, lightweight and simple in-shoe planter pressure measurement system. The system is capable to determine the average static pressure under ball and heel of the foot. The insole is comfortable due to the use of textile pressure sensor and its simple data acquisition method makes operation easy for the users. An experiment with 10 participants with and without diabetes was carried out to observe the outcome of the system. The practical implication of this study is to minimise the damage caused by foot ulcer by determining the pressure abnormality at earliest with a fully developed cost effective design. The system is capable to identify the difference in average planter pressure values in different groups of participants. To monitor the foot health proactively, the proposed system is found to be a useful device and can successfully scan the planter pressure under ball and heel of the foot.

Assessment of in-shoe pressure: Development of a clinical user guide based on a DELPHI-derived consensus

BackgroundThe F-Scan (F-Scan System by Tekscan, Boston, USA) is an in-shoe pressure measurement device used to provide dynamic pressure, force and timing information to guide appropriate offloading of plantar foot ulcers. Despite the clinical utility of an in-shoe pressure measuring device there are some limitations in the validity and reliability of the output of the F-Scan. The aim of this study was to develop a consensus-based guideline following information provided by experienced clinicians, synthesis of research evidence and manufacturer’s guidelines on the most appropriate use and interpretation of the data generated by the F-Scan to manage plantar foot ulceration. MethodsUsing the Delphi method a series of sixteen consensus statements were developed following a two-step questionnaire utilising clinicians feedback, a review of evidence and the manufacturer’s guidelines. FindingsSeventeen clinicians responded to the first questionnaire and 11 to the second, that included 8 podiatrists and 9 pedorthists working in the public and private sectors. Of the sixteen statements there was strong consensus for ten and moderate consensus for a further four. Only two statements failed to reach consensus and the feedback from the respondents was of great value providing sound clinical rationale for their rejection. InterpretationThe objective of this study has been achieved in developing a clear and concise set of guiding statements (Table 1) to standardise use of the F-Scan. The application of the guiding statements will encourage standardisation of practice with the aim of highlighting the limitations of the system and reducing potential systematic error in measurement from output produced.

Data-driven CAD-CAM vs traditional total contact custom insoles: A novel quantitative-statistical framework for the evaluation of insoles offloading performance in diabetic foot.

Elevated plantar pressures represent a significant risk factor for neuropathic diabetic foot (NDF) ulceration. Foot offloading, through custom-made insoles, is essential for prevention and healing of NDF ulcerations. Objective quantitative evaluation to design custom-made insoles is not a standard method. Aims: 1) to develop a novel quantitative-statistical framework (QSF) for the evaluation and design of the insoles' offloading performance through in-shoe pressure measurement; 2) to compare the pressure-relieving efficiency of traditional shape-based total contact customised insoles (TCCI) with a novel CAD-CAM approach by the QSF. We recruited 30 neuropathic diabetic patients in cross-sectional study design. The risk-regions of interest (R-ROIs) and their areas with in-shoe peak pressure statistically ≥200kPa were identified for each patients' foot as determined on the average of peak pressure maps ascertained per each stance phase. Repeated measures Friedman test compared R-ROIs' areas in three different walking condition: flat insole (FI); TCCI and CAD-CAM insoles. As compared with FI (20.6±12.9 cm2), both the TCCI (7±8.7 cm2) and the CAD-CAM (5.5±7.3 cm2) approaches provided a reduction of R-ROIs mean areas (p<0.0001). The CAD-CAM approach performed better than the TCCI with a mean pressure reduction of 37.3 kPa (15.6%) vs FI. The CAD-CAM strategy achieves better offloading performance than the traditional shape-only based approach. The introduced QSF provides a more rigorous method to the direct 200kPa cut-off approach outlined in the literature. It provides a statistically sound methodology to evaluate the offloading insoles design and subsequent monitoring steps. QSF allows the analysis of the whole foot's plantar surface, independently from a predetermined anatomical identification/masking. QSF can provide a detailed description about how and where custom-made insole redistributes the underfoot pressure respect to the FI. Thus, its usefulness extends to the design step, helping to guide the modifications necessary to achieve optimal offloading insole performances.

Influences Of Sleep Disturbances And Mild Traumatic Brain Injury On Gait Performance Among College Students

Sleep disturbances from stress are common among college students. In addition, student athletes in contact sports (e.g., football and soccer) are at a higher risk of receiving a mild traumatic brain injury (mTBI). Stress-related sleep disturbances and mTBI may provoke cognitive and brain changes associated with gait abnormalities. PURPOSE: to examine the association between stress, sleep disturbances, mTBI and gait performance among college students. METHODS: The control group included 28 college students (11 males, 17 females, age: 22.6±3.2 yrs) and the mTBI group consisted of 12 NCAA Division II men’s and women’s soccer players who indicated a history of concussion (3 males, 9 females, age: 19.6±1.3 yrs). Participants were asked to perform gait analysis with an in-shoe pressure measurement system during and after the midterm exam. Cadence, step time, stride time, stance time and swing time were measured. Meanwhile, 14-days consecutive wrist actigraphy data and three sets of questionnaires were collected to assess their stress, sleep and fatigue. A mixed-design ANOVA was used to compare gait and sleep parameters of mTBI and control groups. RESULTS: The mTBI group had significantly shorter step time (0.54±0.01 vs. 0.58±0.01 s, p=.011) and stance time (0.66±0.01 vs. 0.70±0.01 s, p=.013) compared to the control group. The control group had significantly longer step time and stance time during the midterm exam than after the midterm exam. However, no significant differences of gait parameters were observed for the mTBI group during and after midterm exam. During the exam week, participants in both control and mTBI groups perceived moderate stress and reported 2-3 nights of sleep disturbances. Meanwhile, stress level was positively associated with sleep disturbances, poor daytime functioning, and poor activity correlation. CONCLUSION: Midterm exam as a stressor resulted in sleep disturbances in both mTBI and control groups. This stressor may also cause gait abnormalities of the control group, but not the mTBI group. Another interesting finding is that shorter step time and stance time were observed in the mTBI group. Nevertheless, further studies need to examine whether this is indeed due to mTBI, or the difference between student athletes and non-athletes. Supported by Office of Research and Scholarship at UT Tyler.

Outcomes and potential mechanism of a protocol to optimize foot orthoses in patients with rheumatoid arthritis

BackgroundFoot problems are highly prevalent in patients with rheumatoid arthritis. Treatment of foot problems related to rheumatoid arthritis often consists of custom made foot orthoses. One of the assumed working mechanisms of foot orthoses is redistribution of plantar pressure by creating a larger weight bearing area. Overall, the reported treatment effect of foot orthoses on foot pain in rheumatoid arthritis is small to medium. Therefore, we developed a foot orthoses optimization protocol for evaluation and adaptation of foot orthoses by using the feedback of in-shoe plantar pressure measurements. The objectives of the present study were: 1) to evaluate the 3-months outcomes of foot orthoses developed according to the protocol on pain, physical functioning and forefoot plantar pressure in patients with foot problems related to rheumatoid arthritis, and 2) to determine the relationship between change in forefoot plantar pressure and change in pain and physical functioning.MethodsForty-five patients with foot problems related to rheumatoid arthritis were included and received foot orthoses developed according to the protocol. Outcome measures were assessed at baseline and after three months of wearing foot orthoses in 38 patients. Change scores and effect sizes (ES) were calculated for pain, physical functioning and plantar pressure. In a subgroup of patients with combined forefoot pain and high plantar pressure, the relationship between change in plantar pressure and change in pain and physical functioning was analyzed.ResultsIn the total group of 38 patients, statistically significant changes in pain (ES 0.69), physical functioning (ES 0.82) and forefoot plantar pressure (ES 0.35) were found. In the subgroup (n = 23) no statistically significant relationships were found between change in plantar pressure and change in pain or physical functioning.ConclusionFoot orthoses developed according to a protocol for improving the plantar pressure redistribution properties lead to medium to large improvements in pain and physical functioning. The hypothesis that more pressure reduction would lead to better clinical outcomes could not be proven.

Design of a wireless smart insole using stretchable microfluidic sensor for gait monitoring

Wearable sensor enables continuous and ubiquitous real-time monitoring of the gait pattern of a patient and it eliminates the need of frequent visit to the clinics and the use of costly medical facilities. Attaching gait sensors on body, however, may not be easy as most of the reported gait sensors are made of non-stretchable materials and they are non-conformal to human skin. In this paper, we have presented an in-shoe pressure measurement system that is developed using multiple stretchable microfluidic sensors for monitoring gait parameters ergonomically. The sensor here has employed Eutectic Gallium-Indium (EGaIn) as the conductive liquid to fill up a spiral-patterned microchannel which is encapsulated inside an Ecoflex 00–50 elastomer. Fundamental studies have been performed to investigate the sensor’s behaviours when it is exposed to normal and axial applied forces. As proof-of-concept demonstration of the applicability of the proposed sensor for gait monitoring application, we have measured the localised foot pressure and dynamically by attaching two sensors on a shoe insole for detecting pressure changes around the heel and metatarsal regions. The experiment was then extended to evaluate the strain sensing by measuring the ankle angle. It has been shown that data can be captured wirelessly and displayed on a smartphone using the Bluetooth communication protocol. Owing to its unique and stretchable structure, the sensor is able to distinguish walking and running motions by analysing their stance and swing phases. This work has explored the possibility of applying a microfluidic-based structure for designing a wearable gait sensor that has good flexibility.