In-shoe Pressure Research Articles

Wearable static posturography solution using a novel pressure sensor sole.

Static posturography is an important measurement in the diagnostic workup for patients with postural instability. New wearable sensor technologies enable researchers to use in-shoe pressure soles in the home environment and outdoor applications. In this study a newly developed in-shoe pressure sole was used for calculating the sway path and 95% confidence ellipse area as the standard parameters of typical static posturography. Insole posturography was validated on 24 subjects by a state of the art pressure plate assessment during three static posturography conditions (eyes open, eyes closed and barefoot). The adaptive low pass filtered data resulted in an overall correlation of 0.63 to 0.78 for the sway path and 0.66 to 0.79 for the 95% confidence ellipse area. Individual correlations of up to 0.97 for the sway path and 0.99 for the 95% confidence ellipse area could be obtained. Future applications could utilize the mobile advantage of in-shoe pressure soles and measure static and dynamic posturography in clinical and home environments.

Comparison of plantar pressure in three types of insole given to patients with diabetes at risk of developing foot ulcers – A two-year, randomized trial

BackgroundSpecial insoles and shoes designed to prevent foot ulcers caused by repetitive high pressures are recommended for patients with diabetes who have any of the following risk factors: neuropathy; peripheral vascular disease; foot deformities; previous ulcers; amputation; and skin pathologies. However, there is a need for increased knowledge regarding: a) differences in the peak pressure (PP) and pressure time integral (PTI) for different types of insoles; and b) the properties of the pressure distribution for insoles used over a period of several months. We present the results of a randomized trial to compare the plantar pressures of three commonly used insoles. ObjectivesThe primary objective was to compare the PP and PTI between three types of insoles. The secondary objective was to explore the long-term pattern of peak plantar pressure distribution and variations in specific regions of interest (ROI). The tertiary objective was to investigate the impacts of insole adjustments, how much the insoles were used, and the levels of patient satisfaction. MethodsIn a 2-year trial, 114 patients with type 1 (N = 31) or type 2 (N = 83) diabetes (62 men and 52 women; mean age, 57.7 ± 15.4 years; duration of diabetes, 12.3 ± 11.2 years; neuropathy, 38%), were randomized to be supplied with one of three different insoles. The ethylene vinyl acetate (EVA) insoles were used in outdoor walking shoes. The 35 EVA group (N = 39) received soft custom-made insoles composed of EVA of 35 shore A hardness, the 55 EVA group (N = 37) received custom-made insoles composed of EVA of 55 shore hardness, and the control group (N = 38) received prefabricated insoles composed of a hard core with a top layer of soft 12 shore hardness microfiber. Using F-Scan®, the in-shoe plantar pressures were measured at seven ROI (hallux, metatarsal head 1, metatarsal head 2, metatarsal head 4, metatarsal head 5, lateral aspect of the mid-foot, heel) on five occasions during the study period. The plantar-pressure variables used were PP (main outcome) and PTI. The plantar patterns of load were explored, satisfaction and usage of the insoles were rated by the participants, and insole adjustments were recorded. ResultsA mixed model analysis estimated lower PP values in the heel regions for the 35 EVA and 55 EVA insoles (171 ± 13 and 161 ± 13 kPa, respectively) than for the prefabricated insoles (234 ± 10 kPa) (p < 0.001). Also for some of the other six ROI indications of difference in PP or PTI could be observed. The redistribution of peak plantar pressure for all of the insoles, was stable at the mid-foot, while the proportion of load on the distal area changed during the study period According to the self-reported answers (scale, 0–100), the average usage of the insoles was rated as 79 and satisfaction was rated as 85 (N = 75). Thirty-two percent of the subjects had not received foot care. Fourteen adjustments to insoles were made during the study period, and 86 pairs of insoles were exchanged due to wear, with 49% being exchanged in the 35 EVA group. ConclusionsCustom-made insoles used in combination with stable walking shoes gave lower pressures at the heel region. The variation makes it difficult to detect a systematic difference in plantar pressure for the 6 ROI, if such a difference indeed exists. The levels of satisfaction and usage for all the insoles tested were high. The insoles maintained their pressure redistribution properties over long periods, and few adjustments were needed.

Development and evaluation of a system to assess the effect of footwear on the in shoe plantar pressure and shear during gait

In this paper, we propose a system to assess the effect of footwear on the in-shoe plantar pressure and shear during gait. In our previous study, we developed a system for measuring the plantar pressure and shear inside footwear using specialized shoes and insoles with sensors. In this study, based on the previous study, 1) we realized a method to measure directly the in-shoe plantar pressure and shear applied from footwear, 2) verified the validity and reliability of the method and 3) evaluated the ability of the system to assess the effect of footwear by measurements with multiple subjects and various footwear. The reliability and validity were demonstrated by comparison with our previous system. From the evaluation of the newly developed system, we found four suggestions as the following; a) Footwear does not always reduce the pressure and shear force. b) Fixing the instep with shoelace or straps is effective in the reduction of shear force on risk regions of plantar. c) People with callus show significantly higher peak shear force (3.31 ± 0.78 (kgf)) than people without callus (2.03 ± 0.42 (kgf)) when they walk with their usual wearing shoes (p < 0.01). But in barefoot walking, there is no significant difference (2.59 ± 1.08 (kgf) versus 2.67 ± 0.99 (kgf), (p = 0.66)). d) People with callus can reduce the shear force by changing footwear. The system employed in this study can be used for assessing the effect of the intervention such as footwear or instruction of a walk.

Correlation between maximum in-shoe plantar pressures and clubhead speed in amateur golfers

Disagreements exist in the literature regarding the manner in which weight should be dynamically shared during the golf swing, both within-feet and between the back- and target-foot, to generate maximal clubhead speed. The purpose of this study was to determine whether preferential foot-loading locations underlie weight sharing by examining the correlation between clubhead speed and maximum plantar pressure (PP) distributions. Thirty-two amateur golfers with handicap indexes ranging from 2.7 to 25 performed 10 driver swings on artificial turf following a warm-up. PP distributions were recorded at 100 Hz, and clubhead speed was recorded using a ball-tracking Doppler radar system. Maximum PPs were extracted from a 2-s window approximately centred on ball contact and were regressed against clubhead speed. Significance was assessed over the entire foot surface using statistical parametric mapping (SPM), a spatially continuous technique. SPM revealed, at relatively high anatomical resolution, significant positive correlations between clubhead speed and PPs in the lateral target-foot (P < 0.05). This suggests that not only weight transfer but also weight-transfer location may be an important determinant of clubhead speed in amateur golfers.

A comparison of two total contact cast constructs with variable body mass.

There is a growing body of evidence implicating obesity as having a negative effect on the development and treatment of diabetic foot disease. The aim of this study was to increase the body of knowledge on the effects of obesity on foot function, specifically as it relates to peak plantar pressures in the total contact cast (TCC). Our investigational objectives were to compare the effect of two different TCC designs on mean peak plantar pressures, and to evaluate the efficacy of two TCC constructs with increasing body mass. The primary outcome measure was mean peak plantar pressure in the heel, midfoot, forefoot and first metatarsal as measured with an in-shoe pressure measurement system. The variables were patient weight (from 'normal' body mass index (BMI) to 'overweight', 'obese' and 'morbidly obese') and the TCC construct (with both a standard and alternate cast design). The standard TCC is considered the gold standard for off-loading of the diabetic foot. The alternate TCC was designed to use the essential offloading component of the traditional TCC, namely the total contact leg section, with use of an open cell polyurethane foam to transfer load from the foot to the lower leg, thereby offloading the foot by suspending it within a padded fiberglass walking cast. We did not observe statistically significant differences in mean peak plantar pressures in any plantar foot anatomic area or with any body mass between the two TCC designs. Based on the results, we concluded that the alternate TCC design provides another viable TCC construct option for practitioners working with the neuropathic foot. This investigation also provides specific data on changes that occur in peak plantar pressures with use of the total contact cast and variable BMIs. none.

In-Shoe Loading in Rearfoot and Non-Rearfoot Strikers during Running Using Minimalist Footwear

Recent trends promote a "barefoot" running style to reduce injury. "Minimalist" shoes are designed to mimic the barefoot running with some foot protection. However, it is unknown how "minimalist" shoes alter plantar loading. Our purpose was to compare plantar loads between rearfoot strikers and non-rearfoot strikers after 4 weeks of running in minimalist footwear. 30 females were provided Vibram(®) Bikila shoes and instructed to gradually transition to running in these shoes. Plantar loading was measured using an in-shoe pressure sensor after the 4 weeks. Multivariate analysis was performed to detect differences in loading between rearfoot and non-rearfoot strikers in different plantar regions. Differences in plantar loading occurred between foot strike patterns running in minimalist footwear. Pressure and force variables were greater in the metatarsals and lower in the heel region in non-rearfoot strikers. Peak pressure for the whole foot was greater in non-rearfoot strikers while no difference was observed in maximum force or contact time for the whole foot between strike types. Allowing time for accommodation and adaptation to different stresses on the foot may be warranted when using minimalist footwear depending on foot strike pattern of the -runner.

Risk Factors for Plantar Foot Ulcer Recurrence in Neuropathic Diabetic Patients

Recurrence of plantar foot ulcers is a common and major problem in diabetes but not well understood. Foot biomechanics and patient behavior may be important. The aim was to identify risk factors for ulcer recurrence and to establish targets for ulcer prevention. As part of a footwear trial, 171 neuropathic diabetic patients with a recently healed plantar foot ulcer and custom-made footwear were followed for 18 months or until ulceration. Demographic data, disease-related parameters, presence of minor lesions, barefoot and in-shoe plantar peak pressures, footwear adherence, and daily stride count were entered in a multivariate multilevel logistic regression model of plantar foot ulcer recurrence. A total of 71 patients had a recurrent ulcer. Significant independent predictors were presence of minor lesions (odds ratio 9.06 [95% CI 2.98-27.57]), day-to-day variation in stride count (0.93 [0.89-0.99]), and cumulative duration of past foot ulcers (1.03 [1.00-1.06]). Significant independent predictors for those 41 recurrences suggested to be the result of unrecognized repetitive trauma were presence of minor lesions (10.95 [5.01-23.96]), in-shoe peak pressure <200 kPa with footwear adherence >80% (0.43 [0.20-0.94]), barefoot peak pressure (1.11 [1.00-1.22]), and day-to-day variation in stride count (0.91 [0.86-0.96]). The presence of a minor lesion was clearly the strongest predictor, while recommended use of adequately offloading footwear was a strong protector against ulcer recurrence from unrecognized repetitive trauma. These outcomes define clear targets for diabetic foot screening and ulcer prevention.

A knowledge-based modeling for plantar pressure image reconstruction.

It is known that prolonged pressure on the plantar area is one of the main factors in developing foot ulcers. With current technology, electronic pressure monitoring systems can be placed as an insole into regular shoes to continuously monitor the plantar area and provide evidence on ulcer formation process as well as insight for proper orthotic footwear design. The reliability of these systems heavily depends on the spatial resolution of their sensor platforms. However, due to the cost and energy constraints, practical wireless in-shoe pressure monitoring systems have a limited number of sensors, i.e., typically K < 10. In this paper, we present a knowledge-based regression model (SCPM) to reconstruct a spatially continuous plantar pressure image from a small number of pressure sensors. This model makes use of high-resolution pressure data collected clinically to train a per-subject regression function. SCPM is shown to outperform all other tested interpolation methods for K < 60 sensors, with less than one-third of the error for K = 10 sensors. SCPM bridges the gap between the technological capability and medical need and can play an important role in the adoption of sensing insole for a wide range of medical applications.

An evaluation of classification algorithms for manual material handling tasks based on data obtained using wearable technologies

With recent progress in wearable measurement systems, physical exposures can be feasibly assessed at high precision in the workplace. Such systems, however, generally lack contextual information for a given job (e.g. task type, duration). To extract such information, we explored three classification algorithms to classify manual material handling (MMH) tasks during a simulated job in a laboratory, using several combinations of outputs from commercially available inertial motion capture and in-shoe pressure measurement systems. A total of 10 participants completed three replications of four cycles of a simulated job. Precision and recall values of ≥ ∼90% and 80%, respectively, and errors in estimated task duration of < ∼14%, could be achieved across the MMH task examined. Classification performance, however, varied between classification algorithms, input data sets and task types. Overall, combining wearable technology with task classification could be an effective approach for field-based exposure assessment, though field-testing is needed to demonstrate the applicability of this method.Practitioner Summary: Combining wearable technologies with task classification was explored to extract exposure context, specifically task type and duration. Results supported that task classification can facilitate the use of wearable technologies in field-based exposure assessment, specifically by aiding in task identification from within the rather large data sets obtained from these technologies.

Shoe-surface friction in tennis: influence on plantar pressure and implications for injury

Purpose. The different strategies employed by tennis players as a result of changes in friction properties of the playing surface are likely to influence injury incidence. Lower risk of injuries on surfaces that allow sliding has been reported. The aim of the present study was to characterise in-shoe pressure during tennis specific movements performed on a hard court and artificial clay in two surface-specific shoes.Methods. Two tennis surfaces were compared: artificial clay and cushioned acrylic hard court. Participants wore two different pairs of court-specific shoes on each surface. Seven (five males, two females) competitive tennis players performed three movements - open stance forehand, forehand plant (incorporated into a drill) and side jump. In-shoe plantar pressure distribution was recorded using the Pedar (Novel, Munich) insole system.Results. Significantly lower mean and peak pressure were measured during the side jump and running forehand plant on clay compared to hard court. Running forehand plant on artificial clay was characterised by a longer step duration and larger number of unloading episodes than on acrylic. Footwear did not influence peak pressures.Conclusions. A change in surface has a greater effect on plantar pressures than a change in shoe. The higher pressures on a hard court support an association for increased levels of overuse injuries. On clay, limiting areas of high pressure and a longer braking step could facilitate sliding by preventing sticking. Unloading episodes could also be part of the strategy aiming at sliding on clay. These differences are relevant to understand surface-specific mechanisms of injuries.

In-Shoe Plantar Pressures and Ground Reaction Forces During Overweight Adults' Overground Walking

Purpose: Because walking is highly recommended for prevention and treatment of obesity and some of its biomechanical aspects are not clearly understood for overweight people, we compared the absolute and normalized ground reaction forces (GRF), plantar pressures, and temporal parameters of normal-weight and overweight participants during overground walking. Method: A force plate and an in-shoe pressure system were used to record GRF, plantar pressures (foot divided in 10 regions), and temporal parameters of 17 overweight adults and 17 gender-matched normal-weight adults while walking. Results: With high effect sizes, the overweight participants showed higher absolute medial-lateral and vertical GRF and pressure peaks in the central rearfoot, lateral midfoot, and lateral and central forefoot. However, analyzing normalized (scaled to body weight) data, the overweight participants showed lower vertical and anterior-posterior GRF and lower pressure peaks in the medial rearfoot and hallux, but the lateral forefoot peaks continued to be greater compared with normal-weight participants. Time of occurrence of medial-lateral GRF and pressure peaks in the midfoot occurred later in overweight individuals. Conclusions: The overweight participants adapted their gait pattern to minimize the consequences of the higher vertical and propulsive GRF in their musculoskeletal system. However, they were not able to improve their balance as indicated by medial-lateral GRF. The overweight participants showed higher absolute pressure peaks in 4 out of 10 foot regions. Furthermore, the normalized data suggest that the lateral forefoot in overweight adults was loaded more than the proportion of their extra weight, while the hallux and medial rearfoot were seemingly protected.

Biomechanical and functional indicators in male semiprofessional soccer players with increased hip alpha angles vs. amateur soccer players

BackgroundFemoroacetabular impingement (FAI) is predominant in young male athletes, but not much is known about gait differences in cases of increased hip alpha angles. In our study, the hip alpha angle of Nötzli of soccer players was quantified on the basis of magnetic resonance imaging (MRI) with axial oblique sequences. The aim of the current study was to compare the rearfoot motion and plantar pressure in male semiprofessional soccer players with increased alpha angles to age-matched amateur soccer players.MethodsIn a prospective analysis, male semiprofessional and amateur soccer players had an MRI of the right hip to measure the alpha angle of Nötzli. In a biomechanical laboratory setting, 14 of these participants in each group ran in two shoe conditions. Simultaneously in-shoe pressure distribution, tibial acceleration, and rearfoot motion measurements of the right foot were performed.ResultsIn the semiprofessional soccer group, the mean value of the alpha angle of group was 55.1 ± 6.58° (range 43.2-76.6°) and 51.6 ± 4.43° (range 41.9-58.8°) in the amateur group. In both shoe conditions, we found a significant difference between the two groups concerning the ground reaction forces, tibial acceleration, rearfoot motion and plantar pressure parameters (P < 0.01, P < 0.05, P = 0.04). Maximum rearfoot motion is about 22% lower in the semiprofessional group compared to the amateur group in both shoe conditions.ConclusionsThis study confirmed that semiprofessional soccer players with increased alpha angles showed differences in gait kinematics compared to the amateur group. These findings support the need for a screening program for competitive soccer players. In cases of a conspicuous gait analysis and symptomatic hip pain, FAI must be ruled out by further diagnostic tests.

Clinical Acceptance, Reasons for Rejection, and Reduction of In-Shoe Peak Pressure with Interdigital Silicone Orthoses

For several years, confectioned or customized interdigital silicone orthoses have been used to treat toe malformations; however, long-term clinical and biomechanical studies are missing. The aim of this study was to evaluate the biomechanical effects of these orthoses and their clinical acceptance. In 2008, 46 patients (30 women and 16 men; average age, 56.8 years) received interdigital silicone orthoses. All of the patients were included in the biomechanical and clinical study. Compliance and acceptance were measured by the Muenster shoe and foot questionnaire, which includes 13 items on pain, activities of daily living, satisfaction, and activity. Mean follow-up was 18 months. Ten feet (eight patients) were chosen by random and underwent pedobarography. One forefoot sensor and two single sensors were attached between the skin and the orthosis. Measurements were performed in-shoe three times with and without the orthosis without removal of the sensors. Forty-four of the 46 patients (95.7%) were included. At the 18-month investigation, 19 patients no longer used their orthoses, most commonly because of pain and failure of the material. Twenty-two patients regularly used their orthoses (8 h/d on average). In-shoe peak pressure lowered significantly with orthosis use (P < .04). Patients who used the orthoses were mostly satisfied. Interdigital silicone orthoses reduce in-shoe peak pressure. Patient satisfaction was good. The durability of the material has to be optimized, and manufacturing remains difficult. The effect on ulcer reduction must be evaluated in a large prospective study.

3P2-J05 歩行中に靴内でフットウェアが足底に与える圧力およびせん断力の評価(看護とメカトロニクス)

3P2-J05 歩行中に靴内でフットウェアが足底に与える圧力およびせん断力の評価(看護とメカトロニクス)

Is it possible to predict optimal rocker shoe design using barefoot gait parameters?

Curved rocker shoes are routinely prescribed for people with diabetes in order reduce in-shoe plantar pressures. However, previous research has shown that different individuals may require different rocker outsole geometries in order to optimise pressure reduction [1, 2]. This has led some researchers to suggest that every individual should try a range of possible outsole designs to identify the design which maximises pressure reduction [1]. However, this process may not be feasible in a clinical setting. Given that plantar pressure has been shown to depend on specific gait variables [3], it may be possible to develop an algorithm which could predict an individual’s pressure response to a specific rocker outsole design using an input of gait data. Such an algorithm would remove the need to try on a large number of pairs of rocker shoes.

A Longitudinal Investigation into the Functional and Physical Durability of Insoles Used for the Preventive Management of Neuropathic Diabetic Feet

Insoles are commonly used to assist in the prevention of diabetic neuropathic foot ulceration. Insole replacement is often triggered only when foot lesions deteriorate, an indicator that functional performance is comprised and patients are exposed to unnecessary ulcer risk. We investigated the durability of insoles used for ulcer prevention in neuropathic diabetic feet over 12 months. Sixty neuropathic individuals with diabetes were provided with insoles and footwear. Insole durability over 12 months was evaluated using an in-shoe pressure measurement device and through repeated measurement of material depth at the first metatarsal head and the heel seat. Analysis of variance was performed to assess change across time (at issue, 6 months, and 12 months). Analyses were conducted using all available data (n = 43) and compliant data (n = 18). No significant difference was found in the reduction of mean peak pressure tested across time (P < .05). For both sites, significant differences in insole depth were identified between issue and 6 months and between issue and 12 months but not between 6 and 12 months (P < .05). Most insole compression occurred during the initial 6 months. Visual material compression does not seem to be a reliable indicator of insole usefulness. Frequency of insole replacement is best informed by a functional review of effect determined using an in-shoe pressure measurement system. These results suggest that insoles for diabetic neuropathic patients can be effective in maintaining peak pressure reduction for 12 months regardless of wear frequency.

Validity and repeatability of three commercially available in‐shoe pressure measurement systems

In-shoe pressure measurement devices are commonly used in research and clinical settings to quantify pressure on the plantar foot. Various in-shoe pressure measurement devices are currently available and they differ in their size, number of sensors, sensor type and therefore their loading response and accuracy. Previous comparisons focus on pressure plates [1]. An in-shoe study highlighted that the F-Scan system became erroneous at pressures over 200kPa and the repeatability of the Novel device was high [2]. However the long loading durations (11 minutes) studied has limited application to a real-life setting. The validity and repeatability of each system effects their appropriateness for applications within clinical and research test settings. This abstract, therefore aims to establish the suitability of each device to test protocols with differing loading magnitudes and durations.

Evaluating the effect of apex position and rocker in curved rocker shoes

Curved rocker shoes are designed with a contoured outsole which can be characteristics by three principle design features: rocker angle, apex angle and apex position. Although these shoes are routinely prescribed to reduce in-shoe pressure in patients with diabetes, there is only minimal scientific evidence to inform the choice of value for each of the three design features. Results from a previous study [1], suggested that a 95° apex angle may be the best compromise for offloading the different regions of the forefoot. The results of this study also suggested that higher rocker angle may lead to decrease pressure, however, this study did not quantify the precise effect of rocker angle and apex position in shoes with a 95° apex angle.

Plantar Pressure Distribution During Robotic-Assisted Gait in Post-stroke Hemiplegic Patients.

ObjectiveTo assess the plantar pressure distribution during the robotic-assisted walking, guided through normal symmetrical hip and knee physiological kinematic trajectories, with unassisted walking in post-stroke hemiplegic patients.MethodsFifteen hemiplegic stroke patients, who were able to walk a minimum of ten meters independently but with asymmetric gait patterns, were enrolled in this study. All the patients performed both the robotic-assisted walking (Lokomat) and the unassisted walking on the treadmill with the same body support in random order. The contact area, contact pressure, trajectory length of center of pressure (COP), temporal data on both limbs and asymmetric index of both limbs were obtained during both walking conditions, using the F-Scan in-shoe pressure measurement system.ResultsThe contact area of midfoot and total foot on the affected side were significantly increased in robotic-assisted walking as compared to unassisted walking (p<0.01). The contact pressure of midfoot and total foot on affected limbs were also significantly increased in robotic-assisted walking (p<0.05). The anteroposterior and mediolateral trajectory length of COP were not significantly different between the two walking conditions, but their trajectory variability of COP was significantly improved (p<0.05). The asymmetric index of area, stance time, and swing time during robotic-assisted walking were statistically improved as compared with unassisted walking (p<0.05).ConclusionThe robotic-assisted walking may be helpful in improving the gait stability and symmetry, but not the physiologic ankle rocker function.

Variation in the location of the shoe sole flexion point influences plantar loading patterns during gait

BackgroundSeveral footwear design characteristics are known to have detrimental effects on the foot. However, one characteristic that has received relatively little attention is the point where the sole flexes in the sagittal plane. Several footwear assessment forms assume that this should ideally be located directly under the metarsophalangeal joints (MTPJs), but this has not been directly evaluated. The aim of this study was therefore to assess the influence on plantar loading of different locations of the shoe sole flexion point.MethodTwenty-one asymptomatic females with normal foot posture participated. Standardised shoes were incised directly underneath the metatarsophalangeal joints, proximal to the MTPJs or underneath the midfoot. The participants walked in a randomised sequence of the three shoes whilst plantar loading patterns were obtained using the Pedar® in-shoe pressure measurement system. The foot was divided into nine anatomically important masks, and peak pressure (PP), contact time (CT) and pressure time integral (PTI) were determined. A ratio of PP and PTI between MTPJ2-3/MTPJ1 was also calculated.ResultsWearing the shoe with the sole flexion point located proximal to the MTPJs resulted in increased PP under MTPJ 4–5 (6.2%) and decreased PP under the medial midfoot compared to the sub-MTPJ flexion point (−8.4%). Wearing the shoe with the sole flexion point located under the midfoot resulted in decreased PP, CT and PTI in the medial and lateral hindfoot (PP: −4.2% and −5.1%, CT: −3.4% and −6.6%, PTI: −6.9% and −5.7%) and medial midfoot (PP: −5.9% CT: −2.9% PTI: −12.2%) compared to the other two shoes.ConclusionThe findings of this study indicate that the location of the sole flexion point of the shoe influences plantar loading patterns during gait. Specifically, shoes with a sole flexion point located under the midfoot significantly decrease the magnitude and duration of loading under the midfoot and hindfoot, which may be indicative of an earlier heel lift.