Maximum Plantar Pressure Research Articles

The Effect of Weight Distribution in the Foot on Balance and Plantar Pressure in Female Adolescent Athletes.

It is widely reported that the weight distribution in each foot is approximately 60% in the rearfoot and 40% in the forefoot. For balance training, it is recommended to transfer some weight to the forefoot. However, it is still unclear whether fore-rear foot weightbearing ratio affects balance and plantar pressure parameters. There is a relationship between the forefoot weightbearing ratio and balance and plantar pressure in female adolescent athletes. Cross-sectional study. Level 3. A total of 91 adolescent female athletes aged between 10 and 19 years were included in the study. Weightbearing ratios of the forefoot, balance, and plantar pressure were assessed using a plantar pressure platform (FootWork, AMCube IST). In the static and stabilometric evaluation, the weightbearing ratio (%), mean and maximum plantar pressure (kPa), center of pressure (CoP) total, antero-posterior and medio-lateral sway length (cm), CoP surface area (cm2), and length over area (cm-1) were recorded. In the dynamic evaluation, the maximum pressure (kPa) acting on each foot was recorded. Two groups with forefoot weightbearing ratio <40% and ≥40% were compared. Maximum pressure values in static conditions, CoP anteroposterior, and total sway length were significantly different between these groups. In addition, as the amount of load transferred to the forefoot increased, CoP total and anteroposterior sway length increased postural stability. Although postural control mechanisms are quite complex, plantar pressure and postural control parameters can be varied by optimizing rear-to-fore foot weight transfer. This study will contribute to the development of appropriate training and rehabilitation strategies to optimize athlete performance and reduce injury risk.

Immediate effects of ultrasound therapy on pain and plantar pressure in individuals with subacute ankle sprains: a randomized controlled trial

IntroductionDespite the fact that ultrasound (US) therapy is not advised for acute ankle sprains, its therapeutic effects may be beneficial for other stages of ankle sprains, such as a subacute ankle sprain. There is, however, a lack of evidence regarding the effects of US on pain relief and functional improvement in subacute ankle sprains. Therefore, this study aimed to determine the immediate effects of US on pain and plantar pressure in individuals with unilateral subacute ankle sprains.MethodsFifty-four participants with unilateral subacute ankle sprains (aged 16–55 years) were recruited and randomly allocated into a treatment group (&lt;i&gt;n&lt;/i&gt; = 27) and a control group (&lt;i&gt;n&lt;/i&gt; = 27). The treatment and control groups received a single intervention session of US and an ineffectual US, respectively. Pain intensity during weight-bearing and static and dynamic plantar pressures were assessed before and after receiving the intervention.ResultsIn both groups, pain intensity was statistically reduced (&lt;i&gt;p&lt;/i&gt; &lt; 0.05) and clinically relevant. Although the maximum plantar pressure in the hindfoot during static conditions was statistically higher in the control group (&lt;i&gt;p&lt;/i&gt; = 0.024), the values were still lower than MDC95.ConclusionsA single treatment of US could clinically reduce pain, but it had no effect on altering plantar pressure in individuals with unilateral subacute ankle sprains.

Effect of Novel Laser Shoe Photobiomodulation on Neuropathic Pain and Plantar Pressure Profile in Type 2 Diabetes Mellitus with Peripheral Neuropathy.

Photobiomodulation (PBM) or Low-level laser is used to treat diabetic foot complications. The existing method of laser application to the foot did not cover the foot's entire area to improve the foot's microcirculation. Therefore, we have developed a cost-effective Special LASER Shoe device, focusing exclusively on the entire foot region to manage neuropathic pain and other symptoms in individuals with type 2 diabetes mellitus. The main objective of the present study was to evaluate the effect of this newly developed special laser shoe PBM on neuropathic pain and plantar pressure profile in individuals with type 2 diabetes mellitus with neuropathy. We included 60 participants with diabetic peripheral neuropathy of both genders and age more than 20 years. Participants were treated with PBM by a specially designed novel Laser Shoe. Outcomes were clinical variables like Vibration Perception Threshold (VPT), Visual Analogue Scale (VAS), Michigan neuropathy screening instrument A&B, Ankle-Brachial Index (ABI), and Static dynamic gait parameters. Participants were with an average age of 62, and the average duration of diabetes was 11 years. Analysis showed a significant difference in VPT, VAS, Michigan neuropathic screening inventory, and ankle-brachial index. (P < 0.05). We conclude that Novel laser shoe photobiomodulation using 'Laser Shoe' effectively reduces peripheral neuropathic pain. It is also effective in reducing average and maximum plantar pressure. Reduction in neuropathic pain and improvement in plantar pressure distribution can reduce further complications.

Plantar pressure distribution and altered postural control in multibacillary leprosy patients

BackgroundLeprosy is a chronic infectious disease caused by Mycobacterium leprae, predominantly affecting the peripheral nerves, resulting in sensory and motor deficits in the feet. Foot ulcers and imbalances are frequent manifestations in leprosy, often correlating with diminished sensitivity. While clinical scales and monofilament esthesiometers are conventionally utilized to evaluate foot sensitivity and balance in these patients, their discriminatory power is limited and their effectiveness is greatly dependent on the examiner’s proficiency. In contrast, baropodometry and posturography offer a more comprehensive evaluation, aiming to preempt potential damage events. This study aimed was to assess the correlation between baropodometry and force plate measurements in leprosy patients and control participants, to improve the prevention and treatment of foot ulcers and complications associated with leprosy.MethodologyThis cross-sectional study was conducted during 2022 and enrolled 39 participants (22 patients with multibacillary leprosy and 17 non-leprosy controls). Demographic data were collected, and a monofilament esthesiometer was used to assess sensory deficits. In addition, physical examinations and balance and plantar pressure tests were conducted.The Student’s t-test was used to compare mean and maximum plantar pressures between groups. For most COP variables, a Mann-Whitney Wilcoxon test was used, except for AP amplitude which was analyzed with the Student’s t-test due to its normal distribution. The relationship between foot pressure and balance control was assessed using Spearman’s correlation, focusing on areas with significant pressure differences between groups.Principal findingsLeprosy patients showed increased pressure in forefoot areas (T1, M1, T2-T5, and M2) and decreased pressure in hindfoot regions (MH and LH) compared to controls. These patients also displayed higher AP and ML amplitudes, suggesting poorer COP control. Correlation analyses between the two groups revealed that foot plantar pressures significantly impact balance control. Specifically, increased T1 region pressures correlated with greater sway in balance tasks, while decreased MH region pressures were linked to reduced COP control.Conclusions/significanceThe findings suggest a joint disturbance of plantar pressure distribution and static balance control in leprosy patients. These alterations may increase the risk of tissue injuries, including calluses and deformities, as well as falls.

The Impact of Tendon Lengthening Following Achilles Tendon Repair on Foot Kinetics, a Finite Element Analysis

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Triceps surae muscle force is transferred through the Achilles tendon to the calcaneus and from the calcaneus to the plantar fascia and then to the metatarsal heads and the toes which exert force on the ground. Achilles tendon ruptures occur in tendons that have reached a critical point of intrasubstance degeneration. The Achilles tendon almost always heals but frequently lengthens during the healing process, leading to an alteration in the triceps surae force production profile. We hypothesized that Achilles tendon overlengthening has implications not only for force generation but likely has many other impacts throughout the foot. The goal of this work was to evaluate the effect of a lengthened Achilles tendon following tendon repair on the kinetics of the foot. Methods: A validated finite element model of the foot was used to compare foot biomechanics between the foot with a functional and non-functional Achilles tendon. The model of the foot constructed from CT scan images of a female cadaveric foot weighing 60 kg included all 28 bones, 72 ligaments, cartilage, and an encapsulating soft tissue. The model was loaded with 0.5 body weight applied at the center of mass and 0.25 body weight applied to the Achilles tendon simulating quiet stance. The tendon forces were applied using force vectors in the direction of their lines of action. The foot with a non-functional Achilles tendon was created by unloading the Achilles tendon since triceps surae muscle shortening due to tendon lengthening significantly decreases force production. The force transmitted through the joints, force in the ligaments, and plantar pressure were determined for both the foot with a functional and non-functional Achilles tendon. Results: We found that the force transmitted through all the joints decreased when the Achilles tendon force was removed (Figure 1a). In addition, removing the Achilles tendon decreased the force within the plantar fascia, long and short plantar ligaments, and deep deltoid ligament, while it increased the force within the spring and superficial deltoid ligaments (Figure 1b). The plantar fascia experienced the greatest reduction in ligament force after unloading of the Achilles tendon (from 93 N to 26 N). Moreover, the maximum plantar pressure in the heel fat pad increased from 164 kPa to 231 kPa when the Achilles tendon was removed. Conclusion: The varying changes in the force in the ligaments and joints due to Achilles lengthening suggest that Achilles tendon rupture with sequent healing with overlengthening can alter the force distribution throughout the entire foot. A major implication of this work is that in treating Achilles ruptures, an extended period of protection with heel wedges beyond the customary six weeks may be needed to prevent over lengthening of the Achilles. Moreover, this study supports the efficiency of surgical lengthening of the Achilles in the treatment of diabetic forefoot foot ulcers by shifting the plantar pressure towards the calcaneus.

Static and Dynamic Foot Pressure Changes Among Diabetic Patients With and Without Neuropathy: A Comparative Cross-Sectional Study.

Foot ulceration is a frequent diabetic complication with potentially fatal consequences. The pathophysiology of neuropathic ulcers in the diabetic foot is thought to be influenced by abnormal plantar pressures. This study aimed to compare the maximum peak pressures among diabetic patients with and without neuropathy. The secondary aim was to evaluate the effect of glycemic control on pressure changes in both feet. The study used 62 diabetic individuals as participants. BMI was calculated, as well as illness duration, hemoglobin A1c, and the existence of neuropathy. Plantar pressure was measured in static (standing) and dynamic (walking/taking a step on the mat) settings for all patients using the BTS P-Walk system. The plantar pressures (kPa) at the five metatarsal regions, the midfoot region, and the medial and lateral heel regions were measured. We found that the dynamic maximum pressures were significantly higher in patients with diabetic neuropathy (DN) compared to diabetics without neuropathy at the first metatarsal and mid-foot area in both feet (p<0.05). We also found significantly elevated plantar pressure in patients with poor glycemic control under the second metatarsal head in the right foot (p<0.05). Persons with DN have higher maximum plantar pressures compared to diabetics without neuropathy. Patients with poor glycemic control also have a higher maximum pressure.

The Effectiveness of Hard Insoles for Plantar Pressure in Cycling: A Crossover Study.

Hard insoles have been proposed to decrease plantar pressure and prevent foot pain and paresthesia due to repetitive loading. The aim of this research was to analyze the effect of three different hard insoles in cycling on healthy subjects. A crossover randomized trial was carried out. The mean age of the subjects was 35 ± 3.19 years, and all of them were men. While the subjects were cycling on a stationary bicycle, their plantar pressure was recorded with nine in-shoe sensors placed in nine specific foot areas to test a standard ethylene-vinyl-acetate 52° Shore A hardness insole, a polypropylene 58° Shore D insole, and a polypropylene 580 Shore D insole with selective aluminum 60 HB Brinell hardness in the metatarsal head and hallux. The maximum plantar pressure decreased significantly with the polypropylene insole containing selective aluminum in the metatarsal head and hallux areas. The maximum plantar data of the polypropylene aluminum insole in the M2 area (5.56 kgF/cm2), fifth metatarsal styloid process (6.48 kgF/cm2), M3-M4 area (4.97 kgF/cm2), and hallux (8.91 kgF/cm2) were of particular interest compared to the other insoles. The use of insoles made of polypropylene with aluminum in the metatarsal head and hallux areas decreases the maximum plantar pressure in cycling compared to standard EVA and polypropylene insoles.

Ergonomics Applied to the Development and Evaluation of Insoles for Protective Footwear

Knowledge of ergonomics/human factors plays an important role in the creation and design of safety shoes and insoles, contributing to worker protection, comfort, and stability. The purpose of this study is to compare previous insole designs and analyze the plantar pressure and gait pattern kinematics using the Oxford foot model protocol. The tests were performed comparing the environments on the three rockers of the gait, represented by the heel, midfoot, and forefoot, according to the classification of foot type. The analysis of plantar pressure, regarding its total and maximum distribution, showed that the innovative insole presents a better load distribution in terms of the maximum plantar pressure exerted in the hindfoot and forefoot regions. In the biomechanical analysis of gait, the five variables studied did not show variation in the normal mechanics of the foot in any of the three environments considered. The hallux joint was the one that presented the greatest divergences with the barefoot in terms of amplitude and variability, as expected.

Proprioceptive Exercises in Hemiplegia Improve Balance and Spatiotemporal Parameters

Abstract Objective It was planned to investigate the effects of proprioceptive exercises applied to patients with hemiplegia on muscle tone, balance, perception, posture, mobility, and spatiotemporal parameters. Materials and Methods 70 participants with hemiplegia were randomized to an experimental group (conventional stroke rehabilitation program+proprioceptive exercise, 30 sessions) and a control group (conventional stroke rehabilitation program, 30 sessions). Timed Up and Go (TUG) Test, Modified Ashworth Scale (MAS), Posture Assessment Scale for Stroke Patients (PASS), Mini-Mental State Examination (MMSE), Rivermead Mobility Index (RMI), Spatiotemporal parameters (cadence, maximum plantar pressure, total weight transfer, step cycle duration, swing phase, step length and foot angle), and Berg Balance Scale (BERG) were applied on all participants before and after treatment. Results When the intra-group values were compared before and after the treatment, TUG, PASS, MMSE, RMI and BERG values increased significantly. MAS upper extremity and MAS lower extremity values decreased significantly. (p&lt;0.01). In the comparison between the groups, one of the spatiotemporal parameters, cadence, total weight transfer, and maximum plantar pressure values, increased significantly after the treatment. Step cycle duration, swing phase, step length and foot angle values decreased significantly after the treatment. (p&lt;0.01) Conclusion Unlike the literature, proprioceptive exercises that we add to the conventional rehabilitation program can be used to improve muscle tone, balance, perception, postural control, mobility, and spatiotemporal parameters.

Effect of novel Matrix Rhythm Therapy (MaRhyThe®) on neuropathic pain and maximum plantar pressure distribution among type 2 diabetes mellitus patients with peripheral neuropathy

BackgroundThere is a need for a non-pharmacological approach to reduce pain and plantar pressure in diabetic peripheral neuropathy (DPN). Matrix Rhythm Therapy (MaRhyThe®) is a therapeutic modality that works on the principle of physiologic rhythmic oscillations of the body cells. This study aimed to evaluate the effect of MaRhyThe® on neuropathic pain and maximum plantar pressure distribution among type 2 diabetes mellitus patients with peripheral neuropathy.Materials and methodsA total of 33 participants with DPN were recruited for the study based on inclusion criteria. Maximum plantar pressure was recorded using Win-Track 11K005, and the pain score was obtained using a visual analogue scale. Ten sessions of MaRhyThe® were given to all the participants. Outcome measures were evaluated at the baseline and after 10th session. Paired t-test was performed to analyze the changes in outcome measures.ResultsParticipants of DPN were recruited with the average age of 64 ± 9 years, and an average duration of diabetes was 14 ± 9 years were included. Results of the present study found significant improvement in neuropathic pain and plantar pressure in post intervention assessment. (p < 0.05)ConclusionIn the present study, we found that MaRhyThe® is effective in reducing neuropathic pain and maximum plantar pressure in type 2 diabetes mellitus with peripheral neuropathy.

Does Kinesiophobia Affect Spatiotemporal Parameters in Patients with Ankylosing Spondylitis?

Abstract Aim We aimed to examine the effect of kinesiophobia on functional capacity, disease activity, quality of life and spatiotemporal parameters of patients with AS by comparing AS patients with healthy controls. Material and method Our study included 46 patients with ankylosing spondylitis (AS) and 45 healthy controls (HC). Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Tampa Kinesiophobia Scale (TKS) scores, Timed Up and Go (TUG) test, maximum plantar pressure and spatiotemporal parameters (total weight transfer, step cycle duration, double-support phase, swing phase, step length, foot angle and cadence) were evaluated. Results Ninety-one individuals (46 AS, 45 HC) (age/sex/BMI) were included in our study. Statistically significant differences were seen between AS and HC groups in TUG, cadence, TKS, maximum pressure, step cycle duration, swing phase, step length, double-support phase, and foot angle measurements (p&lt;0.05). Significant positive correlations existed between TKS and BASMI, BASDAI, BASFI, ASoQ, TUG and foot angle (p&lt;0.05) in AS. Substantial negative correlations were found between TKS and maximum pressure, cadence and swing phase values (p&lt;0.05) in AS. Conclusion Our study is the first in the literature to measure spatiotemporal parameters between patients with AS and HC and evaluate their relationship with kinesiophobia, which was done to the best of our knowledge. We found that patients with AS changed their gait phases by developing a unique pattern and created a more cautious and safe gait model to provide balance and stability. Our study revealed a statistically significant relationship between kinesiophobia and disease activity, functional status, quality of life, cadence, maximum plantar pressure, swing phase, and foot angle. The detailed data we obtained in our study will shed light on gait analysis and research on kinesiophobia in patients with AS. Kinesiophobia should be evaluated in routine gait rehabilitation protocols applied to individuals with AS, and treatment protocols for kinesiophobia should be added if necessary.

The effect of complex decongestive therapy on spatio-temporal parameters and balance in women with breast cancer-related upper extremity unilateral lymphedema

BackgroundThe aim of this study was to investigate the effect of complex decongestive therapy on spatio-temporal parameters and balance in individuals with breast cancer-related upper extremity unilateral lymphedema. MethodsThe study was designed as a prospective, cross-sectional study. Thirty sessions of complex decongestive therapy were applied. Participants' pre-and post-treatment spatio-temporal parameters and balance parameters were evaluated with the Win Track platform. In addition, the Timed Up and Go test was used to evaluate the dynamic balance. Plethysmography, a water displacement method, was used to measure upper extremity volume. FindingsSignificant improvement was observed in limb volume asymmetry after complex decongestive therapy. While the stride length of the affected side was 409.93 mm before the treatment, it increased to 500.93 mm after the treatment, and a significant increase was observed (p = 001). Significant improvements were found in the other spatio-temporal parameters of the participants. Compared to the pre-treatment, a significant decrease was detected in the average cadence value, Timed Up and Go value, double stance time, and maximum plantar pressure point of the participants. Significant improvements were found in the participants' balance. InterpretationComplex decongestive therapy applied to individuals with unilateral upper extremity lymphedema provides significant improvement in both spatio-temporal and balance parameters. However, we recommend complex decongestive therapy as an effective and safe treatment to reduce the volume of lymphedema. Patients with unilateral lymphedema that may cause postural asymmetry should be informed about balance and gait disturbance and should be encouraged to receive lymphedema treatment as soon as possible.

Effect of Shoes With Toe Rocker Angles of 10 and 15 Degrees Compared to Control Shoes on Plantar Pressure, Force and Contact Surface in Healthy Older Adults: A Clinical Trial

Objectives: The present study aims to investigate the effect of shoes with toe rocker angles of 10 and 15 degrees, compared to control shoes, on the plantar pressure distribution, force, and contact surface in healthy older adults to help maintain the independence and function of the elderly and prevent possible injuries. Methods &amp; Materials: In this clinical trial, 35 healthy older adults (15 males and 20 females) with mean age of 65.2±4.37 years, who were selected using a convenience sampling method from those with no lower limb deformity, no orthopedic and neurological diseases, and with ability to walk without assistance devices. Three types of shoes were used including traditional shoes as controls, shoes with a toe rocker angle of 10 degrees, and shoes with a toe rocker angle of 15 degrees. The maximum plantar pressure in eight anatomical areas were measured using the Pedar system. Repeated measures ANOVA was used for data analysis. Results: There was no significant difference in pressure distribution (P&gt;‌0.05), force (P&gt;‌0.05) and contact surface (P&gt;‌0.05) in eight anatomical areas of the sole of the feet between the three study groups. Conclusion: It seems that the use of shoes with toe rockers do not affect the plantar pressure distribution, force and contact surface in older adults. These shoes can be used without the fear of changing the plantar pressure distribution and causing pain and injury in the elderly.

Plantar pressure distribution profile of type 2 diabetes mellitus with diabetic foot syndrome: A hospital-based observational study

INTRODUCTION: The prevalence of diabetic foot syndrome is increasing in the Indian population. It is a triad of neurological, vascular, and biomechanical changes due to long term diabetes mellitus (DM). Altered plantar pressure distribution is a risk factor for developing diabetic foot ulcers. The purpose of this study is to evaluate the altered plantar pressure distribution in diabetic peripheral neuropathy individuals with peripheral vascular disease in comparison with diabetic peripheral neuropathy and non-diabetic neuropathy. Therefore, the objective of the study is to evaluate the plantar pressure distribution and parameters in type 2 DM (T2DM) with diabetic foot syndrome.METHODS: In this study, 60 participants with T2DM were recruited in either one of the three groups: 20 Diabetic non-neuropathy (DNN), 20 Diabetic peripheral neuropathy (DPN), and 20 Diabetic peripheral neuropathy with the peripheral arterial disease (DNPAD). Then we compared the plantar pressure parameters like maximum plantar pressure, pressure-time integral, fore foot-hind foot ratio, and total contact area were measured using a WinTrack plantar pressure system.RESULTS: The diabetic peripheral neuropathy with peripheral vascular disease group shown a significant difference in all the plantar pressure parameters measured in comparison with the diabetic peripheral neuropathy group. There was increased Maximum plantar pressure, pressure-time integral and forefoot hindfoot ratio, and reduced total contact area of the foot (p &lt; 0.05).CONCLUSION: For patients, with combined peripheral neuropathy and peripheral vascular disease have increased plantar pressure distribution, are at higher risks of developing neuro-ischemic foot, which further leads to diabetic foot ulcers.

Static and Dynamic Plantar Pressure and Normalized Plantar Pressure Characteristics among Children, Adults, and the Elderly

Background: A better understanding of plantar pressure while standing and walking would help in improving balance and gait performance across different age ranges. Objective: To clarify the differences of plantar pressure while standing and walking among children, adults, and the elderly. Materials and Methods: Fifty-three participants including eleven aged 3 to 8 years, thirty aged 20 to 40 years, and twelve aged 60 to 90 years were included in the present study. Plantar pressure and related parameters while quiet standing and walking with self-selected speed were assessed. Results: In static plantar pressure, no significant differences were observed of mean different pressure and mean different contact area between dominant and non-dominant limbs among the three groups, while center of pressure (COP) displacement was shown as significantly greater between children and adults (p&lt;0.05). For dynamic plantar pressure, no significant differences in COP velocity were found among the three groups. The elderly showed significant lower normalized maximum plantar pressure in areas of the second and third metatarsal, and internal heel compared with the young adults (p&lt;0.05). Additionally, normalized maximum plantar pressures among children seemed to differ from adults. Conclusion: Plantar pressure characteristics could indicate that children develop gait ability in braking and propulsion phases with greater heel and toe function, while the ability of braking and propulsion declined with aging. These could reflect balance ability while standing or walking. Keywords: Foot pressure; Children; Elderly; Normalization

Plantar sensation, plantar pressure, and postural stability alterations and effects of visual status in older adults

Purpose Ageing leads to plantar sensation and pressure alterations and poor postural control. The aim of this study was to compare the plantar sensation and static plantar pressure distribution between young and older adults. A secondary aim was to investigate the effect of ageing and visual status on postural stability. Materials and methods Forty older subjects and 43 young adult individuals participated in the study. Plantar light touch sensation was evaluated using Semmes–Weinstein monofilaments. Static plantar pressure and postural stability were assessed with the WinTrack® Pedobarography device. Results Plantar sensation thresholds of the older individuals were higher compared to the young in all plantar regions (p < 0.001). The plantar contact area was greater in older individuals (p < 0.001). Maximum plantar pressure of midfoot was higher and maximum plantar pressure of the rearfoot and whole foot was less in older individuals during quiet stance (p < 0.05). The main effects of group and visual condition were significant for mean latero-lateral and antero-posterior sway speed with large effect sizes (p < 0.05). Conclusions The sensation of all plantar regions reduced, the rearfoot plantar pressure decreased, and the midfoot plantar pressure increased in older individuals compared to young. Postural stability was reduced in the older individuals, and their postural control was more affected by the eliminated visual information compared to the young. Increased plantar contact area and midfoot plantar pressure may be related to decreased MLA height in older individuals. Older individuals may need visual information more to maintain postural control because of reduced plantar sensation.

Spatiotemporal parameters of the operated and non-operated knees before and after unilateral total knee arthroplasty

BackgroundKnee osteoarthritis is a common condition in various orthopedic clinics and hospitals. The aim of this study was to investigate the effects of unilateral total knee arthroplasty (TKA) application on short and long-term spatiotemporal gait parameters, maximum plantar pressure (MPP), and functional status in patients with knee osteoarthritis. Research questionWhat is the change process in spatiotemporal parameters without any intervention before and after TKA surgery? MethodsThis study is a prospective and cross-sectional study. Participants were assessed preoperatively at the 1st week (Pre1W), postoperative 1st month (Post1M) and 6th month (Post6M). Spatiotemporal parameters and MMP were assessed using the Win Track platform (Medicapteurs Technology, France) and functional states were assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Lequesne Index. ResultsSignificant improvements were found in the WOMAC and Lequesne Index values in the Post1M and Post6M periods compared to the preoperative period. However, the improvement in WOMAC and Lequesne Index scores in the Post6M period was significant compared to the scores in the Post1M period (p < 0.01). Spatiotemporal parameters deteriorated in the Post1M period, while improvements were observed in the Post6M period. We observed that patients had worse gait parameters in the near postoperative period than before surgery. It was the period with the greatest improvements in long-term outcomes. SignificanceIn the light of our study results, we think that early gait disturbances in patients who underwent direct TKA may be caused by physiological processes. Therefore, we believe that there is no need for any intervention for gait disorders that occur in the early postoperative period.

Design optimization procedure for an orthopedic insole having a continuously variable stiffness/shape to reduce the plantar pressure in the foot of a diabetic patient

Foot ulcers and lower-limb amputations are among the major problems in diabetic patients. Orthopedic insoles can reduce the risk of diabetic foot ulcers in patients through pressure redistribution on the bottom of the foot. The purpose of this study was to propose an optimization method to design the dedicated insoles for diabetic patients in order to decrease the maximum plantar pressure. At first, a three-dimensional finite element model of bones, ligaments and soft tissue of a diabetic patient's foot was created using CT scan images. Then, the foot plantar pressure was calculated by means of a finite element software. Next, the stiffness and shape of a simple flat insole were separately modified to reduce the maximum foot plantar pressure. The optimization method resulted in a dedicated insole design with a continuously variable stiffness/shape within its area that creates a smooth pressure distribution for the patient comfort. The results showed a 40% reduction in the maximum foot pressure, which we attribute to the modification of insole stiffness. In addition, the optimal shape of the proposed insole decreased the maximum plantar pressure by 25% compared to the flat insole.

Plantar Pressure Distribution during Standing in Female Patients with Hip Osteoarthritis Who Underwent Total Hip Arthroplasty

Introduction: Assessment of plantar pressure indicates the manner in which the plantar region contacts the ground as the first point in a leg-linked kinetic chain, and receives force from the ground. However, few studies have examined the changes in plantar pressure distribution in patients who underwent Total Hip Arthroplasty (THA) before and after THA, or compared plantar pressure distribution between THA patients and healthy adults. Objective: Plantar pressure distribution in patients with end-stage hip osteoarthritis who undergo THA may be adjusted to that in healthy adults by correcting leg length discrepancy. Herein, our objective was to find out if the plantar pressure distribution during standing differs before and after THA, and between healthy adults and THA patients. Design: Case control study. Setting: Single orthopedic clinic in Japan. Participants: THA patients (n=58; THA group) and healthy adults (n=53; control group). Interventions: Not applicable. Main outcome measure(s): The maximum plantar pressure under each foot measured during standing for 20 s was assessed for location, symmetry, and leg length discrepancy. Results: The distribution plantar pressure in the THA group differed preand postoperatively. The maximum plantar pressure region was the heel in approximately 80% of the patients three months after THA; it was not different in THA patients three months postoperatively and in healthy adults. Patients with asymmetrical maximum plantar pressure regions were those whose postoperative maximum plantar pressure region in the affected leg was the forefoot and those whose maximum plantar pressure region in the affected leg shifted to the heel. The leg length discrepancies decreased significantly after THA. Conclusions: The plantar pressure distribution during standing in female patients adjusted to that in healthy adults after THA. Patients with asymmetrical distribution of maximum plantar pressure may benefit from balance assessment and physical therapy.

Photobiomodulation With Customized Insoles on Maximum Plantar Pressure in Diabetic Foot Syndrome by the Biomechanical Model: A Case Report

A 49-year-old male patient with type 2 diabetes mellitus and Diabetic Foot Syndrome (DFS) was evaluated by comprehensive diabetic foot assessment. A 10-session photobiomodulation therapy (low-level laser therapy) was prescribed for neuropathic pain and symptoms applying the scanning and probe method. Customized insoles were recommended for redistributing the plantar pressures and reducing stress on the diabetic foot’s plantar surface for 4 weeks. Dynamic plantar pressure distribution, lower limb kinematics, and postural sway were evaluated using WinTrack dynamic pressure platform. Photobiomodulation therapy with customized insoles is useful in the redistribution and treatment of plantar pressure and gait kinematics. This approach should be extensively used in DFS as preventive and treatment measures.