Medial Heel Research Articles

Treatment Options for Plantar Fasciitis: Surgical Release vs. Conservative Therapy

Introduction Plantar fasciitis is one of the most common reasons for visits to orthopedic clinics. This tendinopathy can cause medial heel pain, stiffness, and tenderness on the plantar surface of the foot. Both conservative and surgical methods are employed in its treatment. Aim The aim of this study is to evaluate selected conservative treatment methods, such as stretching, the use of orthotic insoles, splints, injections, extracorporeal shockwave therapy, and taping, as well as surgical treatment options. The study presents a comparison of these methods in terms of their effectiveness, advantages, and disadvantages. State of Knowledge The plantar fascia is a stiff, connective tissue structure extending along the plantar surface of the foot. Biomechanical load on the fascia, which supports the medial longitudinal arch, can lead to degenerative changes that underlie plantar fasciitis. Symptoms include pain, particularly in the mornings and late evenings, which intensifies with palpation of the heel area. Summary (Conclusions) Conservative treatments for plantar fasciitis are effective in 90% of patients. There are no studies that conclusively demonstrate the superiority of one treatment method over another. Thus, the choice of therapy should be tailored to the patient's lifestyle, activity level, and financial capability. Surgical intervention is necessary in cases of chronic plantar fasciitis which remains resistant to conservative treatments.

Could the anterior cruciate ligament reconstruction and pronated feet affect the plantar pressure variables and muscular activity during running? A comparative study

The unilateral anterior cruciate ligament reconstruction can create asymmetry in vertical ground reaction force and muscle activities, which could be amplified by pronated feet. The study compared plantar pressure variables, amplitude, and muscular frequency in individuals with pronated feet and anterior cruciate ligament reconstruction (PF/ACLR) versus control during running. As part of a cross-sectional study, 15 individuals with PF/ACLR (aged 23.2 ± 4.5 years) and 15 healthy control participants (aged 22.9 ± 4.1 years) ran barefoot at a speed of 3.3 m/s±5% on an 18-m runway. During running, a foot scan and electromyography systems were used to record the peak plantar pressure variables and electromyography activity of the main lower limb muscles, respectively. Results demonstrated lower peak plantar pressure values at the Toe 1 region (p < 0.001, d = 1.83) for the PF/ACLR group. The PF/ACLR group had larger peak plantar pressure values at toes second to fifth (p = 0.013, d = 1.15), fourth (p = 0.026, d = 0.97), fifth (p < 0.001, d = 1.74) metatarsal, and medial (p = 0.002, d = 1.41), and lateral (p = 0.001, d = 1.51) heel regions. The PF/ACLR group presented larger tibialis anterior (p = 0.003, d = 1.15), vastus lateralis (p = 0.001, d = 1.27), and gluteus medius (p = 0.009, d = 0.60) amplitude at the loading phase. At the mid-stance phase, larger tibialis anterior (p = 0.039, d = 0.99) and vastus lateralis (p = 0.00.024, d = 1.52) amplitudes were observed. For the push-off phase, the PF/ACLR group presented larger vastus medialis (p = 0.037, d = 0.82), biceps femoris (p = 0.004, d = 1.14), and semitendinosus (p = 0.001, d = 0.96) amplitudes. Our results demonstrated that pronated feet and anterior cruciate ligament reconstruction significantly impact plantar pressure variables and muscular amplitude in the lower limb during running.

Impact of foot progression angle on spatiotemporal and plantar loading pattern in intoeing children during gait

Intoeing in children is a common parental concern, but our understanding of the impact of foot progression angle (FPA) in these children leaves remains limited. This study examines the relationship between FPA and plantar loading pattern, as well as gait symmetry in children with intoeing. The sample included 30 children with intoeing caused by internal tibial torsion, uniformly divided into three groups: unilateral intoeing, bilateral mild intoeing, and bilateral mild-moderate intoeing. The relationship between FPA and plantar loading pattern, and gait symmetry within and among groups were assessed using dynamic pedobarographic and spatiotemporal data. Results indicated a significant correlation between FPA and peak pressure, maximum force, and plantar impulse in the medial and central forefoot, and also the medial and lateral heel zones for both bilateral intoeing groups. Significant differences were observed only in subdivided stance phase, including loading response, single support, and pre-swing phases, between the unilateral intoeing and bilateral mild intoeing groups. These findings suggest that FPA significantly affects the forefoot and heel zones, potentially increasing the load on the support structures and leading to transverse arch deformation. While children with intoeing demonstrate a dynamic self-adjustment capability to maintain gait symmetry, this ability begins to falter as intoeing becomes more pronounced.

Clinical and biomechanical characteristics of responders and non-responders to insoles in individuals with excessive foot pronation during walking

This study aimed to identify the clinical and biomechanical factors of subjects with excessive foot pronation who are not responsive (i.e., “non-responders”) to medially wedged insoles to increase knee adduction external moment. Ankle dorsiflexion range of motion, forefoot-shank alignment, passive hip stiffness, and midfoot passive resistance of 25 adults with excessive bilateral pronation were measured. Also, lower-limb angles and external moments were computed during walking with the participants using control (flat surface) and intervention insoles (arch support and 6° medial heel wedge). A comparison between “responders” (n = 34) and “non-responders” (n = 11) was conducted using discrete and continuous analyses. Compared with the responders, the non-responders had smaller forefoot varus (p = 0.014), larger midfoot passive internal torque peak (p = 0.005), and stiffness measured by the torsimeter (p = 0.022). During walking, non-responders had lower angle peaks for forefoot eversion (p = 0.001), external forefoot rotation (p = 0.037), rearfoot eversion (p = 0.022), knee adduction (p = 0.045), and external hip rotation (p = 0.022) and higher hip internal rotation angle peak (p = 0.026). Participants with small forefoot varus alignment, large midfoot passive internal torque, stiffness, small knee valgus, hip rotated internally, and foot-toed-in during walking did not modify the external knee adduction moment (“non-responders”). Clinicians are advised to interpret these findings with caution when considering the prescription of insoles. Further investigation is warranted to fully comprehend the response to insole interventions among individuals with specific pathologies, such as patellofemoral pain and knee osteoarthritis (OA).

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...

The effect of electromyographic feedback functional electrical stimulation on the plantar pressure in stroke patients with foot drop.

The purpose of this study was to observe, using Footscan analysis, the effect of electromyographic feedback functional electrical stimulation (FES) on the changes in the plantar pressure of drop foot patients. This case-control study enrolled 34 stroke patients with foot drop. There were 17 cases received FES for 20 min per day, 5 days per week for 4 weeks (the FES group) and the other 17 cases only received basic rehabilitations (the control group). Before and after 4 weeks, the walking speed, spatiotemporal parameters and plantar pressure were measured. After 4 weeks treatments, Both the FES and control groups had increased walking speed and single stance phase percentage, decreased step length symmetry index (SI), double stance phase percentage and start time of the heel after 4 weeks (p < 0.05). The increase in walking speed and decrease in step length SI in the FES group were more significant than the control group after 4 weeks (p < 0.05). The FES group had an increased initial contact phase, decreased SI of the maximal force (Max F) and impulse in the medial heel after 4 weeks (p < 0.05). The advantages of FES were: the improvement of gait speed, step length SI, and the enhancement of propulsion force were more significant. The initial contact phase was closer to the normal range, which implies that the control of ankle dorsiflexion was improved. The plantar dynamic parameters between the two sides of the foot were more balanced than the control group. FES is more effective than basic rehabilitations for stroke patients with foot drop based on current spatiotemporal parameters and plantar pressure results.

Pes Planuslu Hastalarda Kişiye Özel Tasarlamış 3D Baskılı Tabanlıkların Fiziksel Aktivite Düzeyi, Denge ve Fiziksel Performans Üzerine Etkisi: Randomize, Plasebo Kontrollü, Çift-Kör Bir Çalışma

Objective: The aim of this study was to investigate the effects of individually designed insoles on physical activity level, balance and functional performance in patients with pes planus.&#x0D; Methods: 38 participants were divided into 2 groups as 3D printed (n=20) and placebo(n=18). In the 3D printed group, medial longitudinal arch support, medial wedge of the foot, medial heel wedge and transverse arch support were given to the insoles according to the needs of the participants. The placebo group received placebo insoles. Range of motion, muscle strength, static and dynamic balance, physical and physical activity levels were measured at baseline, and eight weeks later (clinicaltrials.gov ID: NCT05306886).&#x0D; Results: Muscle strengths of the plantar flexion and eversion increased after the use of insoles in the 3D printed and placebo groups (p0.05), but there were significant improvements in dynamic balance in both groups (p

Evaluation of the efficacy of trigger points combined with extracorporeal shock waves in the treatment of plantar fasciitis: heel temperature and plantar pressure

BackgroundPlantar fasciitis (PF) is the most common cause of heel pain. Among conservative treatments, extracorporeal shock wave therapy (ESWT) is considered effective for refractory PF. Studies have shown that applying ESWT to the trigger points (TrPs) in the triceps surae may play an important role in pain treatment in patients with PF. Therefore, the purpose of this study was to combine the concept of trigger points and ESWT to explore the effect of this combination on plantar temperature and pressure in patients with PF.MethodsAfter applying inclusion and exclusion criteria, 86 patients with PF were recruited from the pain clinic of Huadong Hospital, Fudan University and randomly divided into experimental (n = 43) and control groups (n = 43). The experimental group was treated with extracorporeal shock waves to treat the medial heel pain point and the gastrocnemius and soleus TrPs. The control group was only treated with extracorporeal shock waves at the medial heel pain point. The two groups were treated twice with an interval of 1 week. Primary measurements included a numerical rating scale (NRS) score (overall, first step, heel pain during daily activities), and secondary measurements included heel temperature, Roles–Maudsley score (RMS), and plantar pressure. All assessments were performed before treatment (i.e., baseline) and 6 and 12 weeks after treatment.ResultsDuring the trial, 3 patients in the experimental group withdrew from the study, 2 due to interruption of the course of treatment by the COVID-19 epidemic and 1 due to personal reasons. In the control group, 3 patients fell and were removed due to swelling of the heel. Therefore, only 80 patients with PF were finally included. After treatment, the two groups showed good results in NRS score (overall, first step, heel pain during daily activities), RMS, and plantar temperature, especially in the experimental group, who showed a significantly better effect than the control group.ConclusionESWT of the heel combined with the triceps trigger point of the calf can more effectively improve the pain, function and quality of life of refractory PF than ESWT of the heel alone. In addition, ESWT of the heel combined with the triceps trigger point of the calf can effectively reduce the skin temperature of the heel on the symptomatic side, indicating that the heel temperature as measured by infrared thermal imaging may be used as an independent tool to evaluate the therapeutic effect for patients with chronic PF. Although extracorporeal shock waves combined with TrPs treatment can cause changes in the patients’ gait structure, plantar pressure is still difficult to use as an independent tool to evaluate the therapeutic effect for PF.Trial registrationRegistered in the Chinese Clinical Trial Registry (www.chictr.org.cn) on 12/17/2021 with the following code: ChiCTR-INR-2,100,054,439.

Comparing Frequency Spectrum of Ground Reaction Forces in Blind and Healthy Participants With Open and Closed Eyes During Walking

Background and Aims This study aimed to compare the frequency spectrum of ground reaction forces in blind and healthy participants with open and closed eyes during walking. Methods This study was quasi-experimental. The statistic samples comprised 15 blind men with a mean age of 25.22±6.33 years and 15 healthy men with a mean age of 27.22±5.31 years. They were selected by available sampling. A foot scan (RS Scan International, Belgium) device was used to measure the foot pressure values while walking. Variables of foot pressure were recorded at a sampling frequency of 300 Hz. For data analysis, we used the paired t test to compare the within-group means and the independent t test to compare the between-group means in SPSS software, version 24. Results The results showed that the frequency content with 99.5% power was greater in the blind group than in the healthy group with open eyes in the vertical direction, first metatarsal, and lateral and medial heel parts (P&lt;0.05). Also, the frequency content with 99.5% power was greater in the healthy group with closed eyes than those healthy ones with open eyes (P&lt;0.05). The frequency content with 99.5% power (P=0.004) and numbers of essential harmonics (P=0.003) in the vertical direction in the blind group were respectively 9.84% and 13.51% less than the healthy group with closed eyes. The number of essential harmonics (P=0.002) in the vertical direction in the healthy group with closed eyes was 20.61% greater than those healthy ones with open eyes. The frequency content with 99.5% power in the vertical direction in the blind group was less than that of the healthy group with closed eyes (P=0.023). Conclusion Considering the increase in frequency with 99.5% power and the number of essential harmonics in different areas of the soles of the foot in the blind group and healthy group with closed eye, it is recommended that physiotherapists, motion analysts, and rehabilitation specialists design a special rehabilitation protocol for blind people and those who lost their vision due to an accident.

The effect of personalized orthopedic insoles on plantar pressure during running in subtle cavus foot.

Objective: This study aims to investigate the patterns of plantar pressure distribution during running for patients with subtle cavus foot (SCF) and determine the impact of personalized orthopedic insoles with forefoot wedge on plantar pressure distribution in patients with SCF. Methods: Sixteen undergraduate participants (8 with SCF and 8 with normal arches) were recruited based on arch height index measurements. Two full-length insoles were personalized for each SCF based on plantar pressures during running, an arch support insole (ASI) and an arch support with forefoot wedge insole (AFI). Foot pressure data collected during different insole conditions in running, analyzing ten regions of footprints for peak pressure and pressure-time integral. Results: Higher peak pressures were observed in patients with SCF at the medial forefoot (p = 0.021), medial heel (p = 0.013), and lateral heel (p = 0.025), with a higher pressure-time integral also noted at the medial forefoot (p = 0.025), medial heel (p = 0.015), and lateral heel (p = 0.047) when compared to normal arches. Compared with without-insole, both the AFI and the ASI reduced peak pressure at the medial (AFI p = 0.011; ASI p = 0.024) and lateral heel (AFI p = 0.028; ASI p = 0.032). The AFI reduced peak pressure at the medial heel (p = 0.013) compared with the ASI. Both the AFI and the ASI reduced pressure-time integral at the medial forefoot (AFI p = 0.003; ASI p = 0.026), central forefoot (AFI p = 0.005; ASI p = 0.011), medial heel (AFI p = 0.017; ASI p = 0.005), and lateral heel (AFI p = 0.017; ASI p = 0.019). Additionally, the ASI reduced pressure-time integral at the big toe (p = 0.015) compared with the without-insole. Conclusion: These findings demonstrate that during running in patients with SCF, plantar pressures are concentrated in the forefoot and heel compared to the normal arch. The personalized orthotic insoles can be used to effectively redistribute plantar pressure in patients with SCF running. Incorporating a forefoot wedge to specifically address the biomechanical abnormalities associated with SCF may enhance the effectiveness of orthopedic insoles.

Dynamic Foot Pressure During Walking: A Potential Indicator of Bone Mineral Density.

Physical skeletal loading can affect the bone mineral density (BMD). This study investigated the association between BMD and dynamic foot pressure during gait. A total of 104 patients (mean age, 62.6 ± 12.4 years; 23 male and 81 female) who underwent dual x-ray absorptiometry and pedobarography were included. BMD values of the lumbar spine, femoral neck, and total femur were assessed. The mean and maximum pressures were measured at the hallux, lesser toes, 1st metatarsal head, 2nd and 3rd metatarsal heads, 4th and 5th metatarsal heads, midfoot, medial heel, and lateral heel. Multivariable regression analysis was performed to identify factors significantly associated with BMD. The lumbar spine BMD was significantly associated with the mean pressure at the 4th and 5th metatarsal heads (p = 0.041, adjusted R 2 of model = 0.081). The femoral neck BMD was significantly associated with the maximum pressure at the 2nd and 3rd metatarsal heads (p = 0.002, adjusted R 2 = 0.213). The total femoral BMD also showed a significant association with the maximum pressure at the 2nd and 3rd metatarsal heads (p = 0.003, adjusted R 2 = 0.360). Foot plantar pressure during gait was significantly associated with BMD, and could potentially be used to predict the presence of osteoporosis. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Center of mass motion and plantar pressure distribution during walking in overweight individuals

BackgroundGait imbalance has been reported in overweight individuals and could further impair their mobility and quality of life. As the feet are the most distal part of the body and sensitively interface with external surroundings, evaluating the plantar pressure distribution can provide critical insights into their roles in regulating gait balance control. Therefore, the purpose of this study was to evaluate the effect of body weight and different gait speeds on the plantar pressure distribution and whole-body center of mass (COM) motion during walking. MethodsEleven overweight individuals (OB) and 13 non-overweight individuals (NB) walked on a 10-meter walkway at three speed conditions (preferred, 80% and 120% of preferred speed). Gait balance was quantified by the mediolateral COM sway. Plantar pressure data were obtained using wireless pressure-sensing insoles that were inserted into a pair of running shoes. Analysis of variance models were used to examine the effect of body size, gait speeds, or their interactions on peak mediolateral COM and peak plantar pressure during walking. ResultsSignificant group effects of peak plantar pressure under the lateral forefoot (P = 0.03), lateral midfoot (P = 0.02), and medial heel (P = 0.02) were observed. However, the mediolateral COM motion and spatiotemporal gait parameters only revealed significant speed effects. SignificanceFindings from this study indicated that overweight individuals exhibited increased plantar pressure under the lateral aspect of the foot, particularly during the late stance phase of walking, in an effort to maintain a comparable mediolateral COM motion to that of non-overweight individuals. Such elevated pressure in overweight individuals may potentially increase the risk of musculoskeletal pathology in the long term. The identified patterns are noteworthy as they have practical implications for designing targeted interventions and improving the overall health of individuals with a high BMI.

Effects of individually optimized rocker midsoles and self-adjusting insoles on plantar pressure in persons with diabetes mellitus and loss of protective sensation

IntroductionRocker shoes and insoles reduce peak pressure (PP) in persons with diabetes (DM) and loss of protective sensation (LOPS). However, they are handmade, leading to inconsistent effectiveness. If foot structure changes over time, high PP-locations also change. To address this, individualized algorithm based 3D-printed rockers and self-adjusting pressure-reducing insoles are applied. MethodsPP across seven foot regions was analyzed in 21 persons with DM and LOPS. Regions with PP < 200 kPa were considered not at risk (RnoR); regions with PP ≥ 200 kPa at risk (RaR). The aim was to offload RaR, while remaining PP < 200 kPa in RnoR. ResultsIndividualized rockers and self-adjusting insoles combined successfully reduce PP < 200 kPa (on average 24 % - 48 %) in all feet with toes, central and lateral forefoot identified as RaR. Same intervention reduces PP in 68 % of the feet with medial forefoot identified as RaR. With the heel as RaR, no intervention reduces PP successfully in all feet. ConclusionsIndividualized 3D-printed rockers combined with self-adjusting insoles reduce PP (< 200 kPa) in toes, central and lateral forefoot, but not in heels. Alternative insoles with medial arch support, heel cup and compliant midsole materials might enhance success rate across entire foot.

Evaluation of therapeutic benefits of botulinum toxin for foot dystonia associated with Parkinson's disease

BackgroundFoot dystonia occurs in patients with Parkinson's disease (PD) and leads to pain, malformation, and difficulty with walking. Botulinum toxin injections may be effective for foot dystonia, but the extent of improvement and effects on motor function are unclear. MethodsIn this study, we performed botulinum toxin injections for foot dystonia in 25 patients with PD. At 3 weeks and 3 months post-infection, we assessed changes in plantar pressure distribution utilizing the Pressure Plate system; dystonia using the Modified Ashworth Spasm score; pain using the visual analog scale (VAS) score; and lower extremity function using the Calf-raise Senior (CRS) test, Timed Up and Go (TUG) test, and gait parameters (eg, stride length, step length). ResultsWe found improved Modified Ashworth Spasm score (p < 0.01) and VAS score (p < 0.01) post-injection. CRS test score (3 weeks, p = 0.006; 3 months, p = 0.068), stride length (3 weeks, p = 0.012; 3 months, p = 0.715), and step length (3 weeks, p = 0.011; 3 months, p = 0.803) also improved. Plantar pressure distribution improved after botulinum toxin injection (metatarsal 1, 3 weeks, p = 0.031; 3 months, p = 0.144; metatarsal 2, 3 weeks, p = 0.049; 3 months, p = 0.065; metatarsal 3, 3 weeks, p = 0.002; 3 months, p = 0.017; metatarsal 4, 3 weeks, p = 0.017; 3 months, p = 0.144; medial heel, 3 weeks, p = 0.01; 3 months, p = 0.395; lateral heel, 3 weeks, p = 0.035; 3 months, p = 0.109). ConclusionBotulinum toxin injection for foot dystonia in patients with PD can reduce spasms and pain and normalize plantar pressure distribution, which improves balance and lower extremity function.

An exploration into the orthopedic effect and patterns of the correction based on the three-point force system in patients with strephenopodia

According to the orthopedic principle based on the three-point force system, this study aimed to reveal the orthopedic effect and patterns of the orthopedic based on this system in 3 patients with strephenopodia through the weight-bearing stance phase experiment and numerical simulation analysis of ankle-foot orthoses (AFOs). After the correction with AFOs, Under the pressure tolerance of human skin, different three correction forces were applied to the medial heel, above the medial ankle, below the lateral ankle and the first metatarsal bone,the weight-bearing region of the affected foot gradually shifted to the normal region of the first metatarsal bone, the fifth metatarsal bone, and the heel. The weight-bearing capacity of the affected foot increased by 11.4 %. After the three-point force was adjusted for the AFO, the distribution of the plantar weight-bearing region became more uniform, and the supporting force of the affected foot increased significantly, the weight-bearing capacity of the affected foot increased to 15.19 %, which approached the theoretical value. When the three-point force of was over-adjusted to exceed the pain threshold, the weight-bearing capacity of the affected foot decreased by 2.79 % compared with the theoretical value. It was confirmed that the foot varus angle was attenuated significantly 8 weeks after the orthopedic with three-point force system. Further, the strephenopodia with 10° was corrected with the finite element method based on the three-point force principle, and orthopedic angle and the plantar weight-bearing region before and after the correction were also obtained, The visualization of orthopedic effects and the orthotic principle is clear contributes to clinicians provide important scientific reference for the formulation of scientific and accurate orthopedic regimens.

Combined effect of myofascial release and passive stretching on plantar pressure in individual with hamstring tightness- an experimental study

IntroductionThe lower kinetic chain is known to be affected by hamstring tightness which causes biomechanical alterations. As per the literature, short hamstring might cause prolonged forefoot loading, which can cause higher repeated stress on the plantar fascia. There is evidence supporting the use of various stretching and myofascial release techniques for hamstring tightness, further research is needed to investigate their impact on plantar pressure. Hence the study aims to determine combined effect of myofascial release and passive stretching on plantar pressure in individual with hamstring tightness. MethodsThis was an experimental pre-post study design with 67 randomised screenings from asymptomatic health care science students aged 18 to 25. From this scientific survey, a sample size of 47 students having HMS tightness based on the popliteal angle were recruited using a universal goniometer. An intervention was proposed that included MFR and passive stretching in 3 sessions on alternate days. Plantar pressure of these individuals was noted by using the “Harris and Beath foot printing mat” before and after the intervention. ResultSignificant pressure changes were observed after intervention: great toe of right side (p = 0.001), toes 2 to 5 of right side (p = 0.010) and left side (p = 0.008), first metatarsal of left side (p = 0.010), lateral forefoot of right side (p = 0.019) and left (p = 0.018), medial heel (p = 0.044), and lateral heel of right side (p = 0.025). These values substantiate the enhancement in plantar pressure. ConclusionThe combined effect of Myofascial release and passive stretching in an individual with hamstring tightness resulted in a significant increase in popliteal angle and plantar pressure.

Effects of biofeedback on biomechanical factors associated with chronic ankle instability: a systematic review with meta-analysis

BackgroundBiofeedback may alter the biomechanics of lower extremities in patients with chronic ankle instability (CAI). We aimed to systematically review the literature on the effect of gait-training and biofeedback on biomechanical parameters in individuals with CAI and conduct a meta-analysis.MethodsWe searched four databases including PubMed, Web of Science, Scopus and Embase from their inception through 30th June 2022. The Downs and Black appraisal scale was applied to assess quality of included studies. Two reviewers screened studies to identify those reporting the effect of biofeedback on biomechanical factors associated with CAI. Outcomes of interest were kinetics and kinematics. Two authors separately extracted data from included studies. Data of interest were study design, number of sessions, intervention, tools, outcomes, number, sex, age, height, and body mass of participants.ResultsThirteen studies with a total of 226 participants were included. Biofeedback was capable of shifting center of pressure (COP) and lateral plantar pressure medially and reducing foot inversion, adduction, propulsive vertical ground reaction force (vGRF), ankle joint contact force, peak pressure and pressure time integral in the lateral mid-foot and forefoot. Auditory biofeedback had agreater impact on modifying plantar pressure in individuals with CAI. The meta-analyses revealed that visual biofeedback reduces peak pressure in lateral mid-foot and pressure time integral at lateral and medial heel and pressure increases under the hallux.ConclusionBiofeedback can alter pressure, vGRF, and foot inversion associated with CAI. Auditory biofeedback had greater impact on modifying plantar pressure in individuals with CAI. Further studies are required to assess the prolonged effect and clinical consequences of biofeedback or a combination of feedback on CAI in different age groups. Moreover, developing a low-cost and user-friendly device that can be evaluated in high quality RCTs is important prior to implementing the intervention in the clinical setting to reduce symptoms of CAI.

The effects of hydration on the topographical and mechanical properties of corneocytes

It is well established that the biomechanical properties of the Stratum Corneum (SC) are influenced by both moisture-induced plasticization and the lipid content. This study employs Atomic Force Microscopy to investigate how hydration affects the surface topographical and elasto-viscoplastic characteristics of corneocytes from two anatomical sites. Volar forearm cells underwent swelling when immersed in water with a 50% increase in thickness and volume. Similarly, medial heel cells demonstrated significant swelling in volume, accompanied by increased cell area and reduced cell roughness. Furthermore, as the water activity was increased, they exhibited enhanced compliance, leading to a decreased Young's modulus, hardness, and relaxation times. Moreover, the swollen cells also displayed a greater tolerance to strain before experiencing permanent deformation. Despite the greater predominance of immature cornified envelopes in plantar skin, the comparable Young's modulus of medial heel and forearm corneocytes suggests that cell stiffness primarily relies on the keratin matrix rather than on the cornified envelope. The Young's moduli of the cells in distilled water are similar to those reported for the SC, which suggests that the corneodesmosomes and intercellular lamellae lipids junctions that connect the corneocytes are able to accommodate the mechanical deformations of the SC.

“Antero-medial load shift” in unilateral plantar heel pain – A cross-sectional exploratory study

Background and purposePlantar foot pressure provides an insightful data in the ankle and foot complex which may aid in the detection of underlying pathology. Since individuals with unilateral plantar heel pain (PHP) tend to develop compensatory loading strategies, this study aimed to observe the foot loading pattern compared to the asymptomatic side and its relationship with the morphological variations in individuals with unilateral PHP. MethodsIt was a prospective cross-sectional study done on 17 participants with unilateral PHP. The calcaneal inclination and calcaneal first metatarsal angles were measured using lateral weight-bearing radiographs for both symptomatic and asymptomatic feet. Static and dynamic plantar foot pressures for both sides were obtained using a “Portable baropodometry platform 0, 5 m Entry Level footscan®. ResultsOn the symptomatic side, the pressure in the lateral heel was reduced by 65% in static and 67% in dynamic measurements, while in the medial heel, it was reduced by 16 % in static and 47 % in dynamic measurements compared to that of the asymptomatic side. There was a transfer of pressure from the hind foot to the forefoot by 44 % in static and 46 % in dynamic measurements resulting in anterior load shift. It was also observed that the prevalence of PHP was higher in the normal arched foot (59%). ConclusionBased on the observations, compared to the asymptomatic side, patients with unilateral plantar heel pain exhibited an anteromedial load shift (AMLS) in their plantar pressures. PHP was reported higher in the foot with normal morphology. Level of evidenceLevel 4.

The effect of a contralateral foot touch on stability of one-leg stance in young adults: an exploratory study

Purpose Previous studies demonstrated that providing light finger touch to a stationary object leads to reduced body sway. The focus of the current exploratory study was on the investigation of postural sway during one-leg stance when light touch is provided by the contralateral foot. Methods Eleven healthy young adults participated in the study. They stood on the top of the force platform with eyes open and on their dominant leg with no touch and with a touch from the contralateral foot applied to the stance leg. Medial arch, heel, and big toe of the contralateral foot were used to touch the medial malleolus or mid shank of the stance leg. The excursion, velocity, and sway area of the centre of pressure were obtained and analysed. Results Standing with light touch from the contralateral foot to the medial malleolus resulted in significantly smaller postural sway as compared to standing with no touch (p < 0.05). There was no difference in the study outcomes between conditions of standing with a touch applied by the medial arch, heel, or big toe to the stance leg. Conclusions The results of the study suggest that the application of light touch provided by a contralateral foot could be an effective strategy for enhancing body stability when no external support is available. The study outcome provides a foundation for future studies exploring ways to enhance balance control during one-leg stance.