Peak Plantar Pressure Research Articles

A Method for Diabetic Wound-Specific Insole Design, Manufacturing, and Biomechanical Validation for Better Recovery.

Muscle disorders may cause a change in plantar pressures by the misalignment on the foot during gait phases. Therefore, corns or calluses develop at the plantar regions, and diabetic foot ulcers follow for severe cases, although it can be prevented and even treated by podiatric approaches with patient-specific therapeutic insoles and footwear. Although the importance of a threshold value of 200 kPa in peak plantar pressure reduction has been highlighted as a standard to prevent reulceration in the diabetic foot, it may not be possible to ensure this pressure reduction for each patient. In this study, three types of ethylene-vinyl acetate have been used to optimize the off-loading performance for predetermined early-stage diabetic foot ulcer scenarios by means of baropodometric plantar pressure analyses and finite element method for each gait phase. The total cost of the manufacturing for this study was reduced to $10.26 and it was performed in 24.6 minutes. In addition, the off-loaded pressure was increased by 2.3 times and the volume of the off-loading geometry was increased 8.12 times based on the foam polymer used. Consequently, improved off-loading was obtained and a standard was proposed for the first time to calculate the off-loading performance before manufacturing of the therapeutic insole model to ensure a better recovery period.

Experimental and Theoretical Predictions of Static Plantar Pressure of Socks with Different Stitch Lengths.

Socks are mainly used to give the foot more comfort while wearing shoes. Stitch density of the knitted fabric used in socks can significantly affect the sock properties because it is one of the most important fabric structural factors influencing the mechanical properties. Continuous plantar pressures can cause serious damage, particularly under the metatarsal heads, and it is deduced that using socks redistributes and reduces peak plantar pressures. If peak pressure under the metatarsal heads is predicted, then it will be possible to produce socks with the best mechanical properties to reduce the pressure in these critical areas. Plain knitted socks with three different stitch lengths (high, medium, and low) were produced. Static plantar pressure measurements by the Gaitview system were accomplished on ten women and then compared with the barefoot situation. Also, the peak plantar pressure of three types of socks under the metatarsal heads are theoretically predicted using the Hertz contact theory. Experimental results indicate that all socks redistribute the plantar pressure from high to low plantar pressure regions compared with barefoot. In particular, socks with high stitch length have the best performance. By increasing the stitch length, we can significantly reduce the peak plantar pressure of the socks. Correspondingly, the Hertz contact theory resulted in a trend of mean peak pressure reductions in the forefoot region similar to the socks with different stitch densities. The theoretical results show that by using the Hertz contact theory, static plantar pressure in the forefoot region can be well predicted at a mean error of approximately 9% compared with the other experimental findings.

Residual effects of combined vibratory and plantar stimulation while seated influences plantar pressure and spatiotemporal gait measures in individuals with Parkinson's disease exhibiting freezing of gait.

Combined plantar pressure and vibratory stimulation has been shown to decrease freezing of gait (FOG) episodes and improve spatiotemporal gait parameters compared to single stimulation in Parkinson's disease (PD) patients with FOG. However, the effect of combined plantar stimulations on plantar pressure analysis has never been explored. Forty PD patients with frequent FOG were allocated to either FOG shoes embedded with a 100 Hz vibratory stimulation at the Achilles tendons and a soft thickened silicone pad at the hallux and sole, or sham shoes with a non-working vibratory motor and a flat non-pressure silicone pad (20 patients per arm) while seated for 96 s. The objective gait and plantar pressure analysis were measured immediately after the stimulation. Outcomes included the normalized percentage of changes in percent FOG (%FOG) and plantar pressure in the heel-strike and push-off phase that were compared between pre- and post-stimulations. The FOG shoes group showed significantly decreased %FOG (81.5 ± 28.9% vs. 6.8 ± 22.1%, p < 0.001), plantar pressure in the heel-strike (47.8 ± 43.7% vs. 4.3 ± 9.8%, p < 0.001), plantar pressure in the push-off (57.7 ± 59.6% vs. 6.2 ± 11.6%, p < 0.001), force time integral (FTI) (40.9 ± 32.5% vs. 6.6 ± 17.3%, p < 0.001), and decreased heel contact time (19.3 ± 12.3% vs. 22.7 ± 32.5%, p < 0.001) when compared to the sham group. There was a strong negative correlation between %FOG and peak plantar pressure (r = -0.440, p = 0.005), plantar pressure in the heel-strike (r = -0.847, p < 0.001). Our study demonstrated that the FOG shoe could decrease FOG episodes by improving the heel-strike pressure, toe push-off and normalized heel-to-toe plantar pressure, suggesting that modification inputs from the peripheral sensory systems might significant improvement in FOG in PD.

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.

Comparative Analysis of Three Types of Therapeutic Offloading Diabetic Shoes With Custom Made Insole on Plantar Pressure Distribution in Severe Diabetic Charcot Foot.

Charcot foot deformity, a severe complication of diabetes, involves neuropathy and abnormal peak plantar pressure in the midfoot and forefoot. However, orthotic interventions and shoe modifications are used to address the sequelae of Charcot neuroarthropathy, offering different approaches to managing abnormal peak plantar pressure. To compare the effects of three types of therapeutic offloading diabetic shoes; prefabricated, relasting, and double rocker-modified shoes on peak plantar pressure in the midfoot and forefoot of nonulcerated chronic Charcot foot during walking. A repeated measure design involved 15 participants (40% males and 60% females) with a mean age of 60.73 years (SD=10.50), with Charcot neuropathy. Participants were provided with three types of shoes; prefabricated, relasting, and double rocker-modified shoes, each equipped with the same custom-made insole (CMI). Plantar pressure was recorded while walking on level ground, focusing on the forefoot, midfoot, and hindfoot. The study also investigated additional variables affecting plantar pressure distribution, including the pressure-time integral and contact area. The type of shoe had distinct effects on the distribution of plantar pressure. The double rocker-modified shoe particularly impacted forefoot pressure during the terminal stance phase of the gait cycle. Peak plantar pressure at the forefoot increased by 5.37% with double rocker-modified shoes compared to relasting shoes. Both double rocker-modified and prefabricated shoes reduced midfoot peak plantar pressure by 8.73% and 11.97%, respectively. Similar trends were observed at the hindfoot, with reductions in peak plantar pressure. However, there were no significant differences in regional peak plantar pressure between the types of shoes except for the central forefoot (F (1.61, 22.5) = 5.69, p = 0.014). There were no significant differences in the effectiveness of prefabricated, relasting, and double rocker-modified shoes in reducing and redistributing peak plantar pressure in high-risk areas of chronic Charcot foot.

Clinical Effect of Screw Internal Fixation on Fracture Healing and Ankle Alignment in Patients with Posterior Malleolar Fracture.

To examine the clinical impact of screw internal fixation on the process of fracture healing and ankle alignment in individuals diagnosed with posterior malleolar (PM) fracture, specifically those with a fracture involving less than 25% of the articular surface (ASR) area. A total of 120 patients diagnosed and treated for PM fracture, encompassing less than 25% of the distal tibial ASR area, were selected from our hospital's records spanning from September 2021 to June 2023. These people were subsequently divided into two groups, namely the control group (group A) and the observation group (group B), based on the distinct treatment methods employed, with each group consisting of 60 patients. The people in the group A were treated with posterior malleolus non internal fixation, while the patients in the group B were treated with posterior malleolus screw internal fixation. The visual analog scores, peak plantar pressure and AOFAS scores of the two groups were subjected to comparison. The visual analog scores in the observation group at 6 months and 12 months after operation were reduced than the group A. Three months after operation, the peak plantar pressure of the affected foot (full foot, hind foot) in the group B was reduced than that of the healthy foot; There was a lack of statistically significant variation observed in the peak plantar pressure (full foot, hind foot) between the affected foot and the healthy foot 12 months after operation in the group B, and the plantar pressure tended to be balanced. Three months after operation, the peak plantar pressure of the affected foot (full foot, hind foot) in the group A was reduced than that of the healthy foot; After a period of 12 months following the surgical procedure, no notable disparity in the maximum pressure exerted on the sole of the foot was observed between the foot that underwent the operation and the unaffected foot in the group A, but the peak plantar pressure of the whole foot was reduced than that of the healthy foot, and the plantar pressure did not tend to be balanced. At the intervals of 6 months and 12 months following the surgical procedure, AOFAS ankle hind foot score in the group B was increased than the group A. The utilization of screw internal fixation demonstrates favorable clinical outcomes in patients presenting with PM fracture encompassing less than 25% of the articular surface area, which is conducive to promoting fracture healing, maintaining good ankle alignment, and promoting patient rehabilitation. screw internal fixation, posterior ankle fracture, articular surface of distal tibia, fracture healing, ankle joint alignment.

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

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

Plantar pressures in people with midfoot osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot

BackgroundMidfoot osteoarthritis (OA) is a common condition, however its aetiology is not well understood. Understanding how plantar pressures differ between people with and without midfoot OA may provide insight into the aetiology and how best to manage this condition. Research questionTo compare plantar pressures between people with and without symptomatic radiographic midfoot OA. MethodsThis was a cross-sectional study of adults aged ≥ 50 years registered with four UK general practices who reported foot pain in the past year. Symptomatic radiographic midfoot OA was defined as midfoot pain in the last four weeks, combined with radiographic OA in one or more midfoot joints. Cases were matched 1:1 for sex and age ( ± 5 years) to controls. Peak plantar pressure and maximum force in 10 regions of the foot were determined using a pressure platform (RSscan International, Olen, Belgium) and compared between the groups using independent samples t-tests and effect sizes (Cohen’s d). ResultsWe included 61 midfoot OA cases (mean age 67.0, SD 8.1, 31 males, 30 females) and matched these to 61 controls (mean age 66.0, SD 7.9). Midfoot OA cases displayed greater force (d=0.79, medium effect size, p = <0.001) and pressure at the midfoot (d=0.70, medium effect size, p = <0.001), greater force at the fourth metatarsophalangeal (MTP) joint (d=0.28, small effect size, p = 0.13), and fifth MTP joint (d=0.37, small effect size, p = 0.10) and greater pressure at the fifth MTP joint (d=0.34, small effect size, p = 0.13). They also displayed lower force (d=0.40, small effect size, p = 0.02) and pressure at the hallux (d=0.50, medium effect size, p = <0.001) and lower force (d=0.54, medium effect size, p = <0.001) and pressure at the lesser toes (d=0.48, small effect size, p = <0.001) compared with controls. SignificanceMidfoot OA appears to be associated with lowering of the medial longitudinal arch, greater lateral push off and less propulsion at toe off. Longitudinal studies are needed to establish causal relationships.

The Detection of Compensatory Movements in Gait by Evaluating Plantar Pressure in Transfemoral Amputees

Microprocessor-controlled prosthetic knees (MPKs) improve the safety and functional capabilities of transfemoral amputees, but there is a lack of information on plantar pressure distribution and effects among individuals who have undergone transfemoral amputation of the sound limb. (1) Background: The aim of this study was to determine possible compensatory mechanisms in gait by evaluating intact extremity foot plantar pressure distribution in young MPK prosthesis users. Twenty-one patients with unilateral transfemoral amputation (TFA) and twenty-four healthy individuals were selected for the study. (2) Methods: The WalkinSense system was used to assess different foot plantar pressure distribution parameters as the participants walked at their chosen walking speed. Plantar pressure peaks and activation percentages in the eight foot regions were measured during the gait cycle. (3) Results: The pressure peaks and activation percentages in the sound limb with TFA patients and healthy subjects were measured, and statistically significant differences between the two groups were identified. The 1-, 2-, 3-, 4-, and 6-point sensor activation percentages significantly increased, whereas the 7- and 8-point sensor activation percentages decreased in the sound limb TFA participants compared with the healthy subjects. Peak plantar pressure sensor points 1, 3, 4, and 6 increased in the TFA sound limb foot in relation to healthy individuals, while they decreased in point 8. (4) Conclusion: In this study, with the use of a microprocessor knee joint TF prosthesis, in the evaluation of the underfoot pressure of intact legs, the maximum pressure point shifted to the forefoot, and it was observed that the forefoot and midfoot were more active during walking compared with the control group. This may indicate that gait compensation and plantar flexion in the sound limb are used more forcefully in the gait cycle.

The effects of different inner pressures of air insoles and walking durations on peak plantar pressure.

Exercise reduces chronic complications in individuals with diabetes and peripheral vascular diseases. In clinical practice, the use of air insole may reduce peak plantar pressure (PPP), and risk for diabetic foot ulcers (DFUs). However, there is no guideline on selecting air insole pressure for effectively reducing PPP. Therefore, this study aimed to investigate the effects of different air insole pressure on PPP at different walking durations. We tested 13 participants using repeated measures study design, including 3 air insole pressures (80, 160, and 240 mm Hg) and 2 walking durations (10 and 20 minutes) for 6 walking conditions. PPP values at the first toe, first metatarsal head, and second metatarsal head were calculated. The one-way ANOVA showed significant pairwise differences of PPP at 20 minutes duration in the first metatarsal head between 80 and 240 mm Hg (P = .007) and between 160 and 240 mm Hg (P = .038); in the second metatarsal head between 80 and 240 mm Hg (P = .043). The paired t test confirmed that walking duration significantly has lower PPP at 10 minutes than 20 minutes with 240 mm Hg air insole in the first metatarsal head (P = .012) and the second metatarsal head (P = .027). People at risk of foot ulcers are suggested to wear shoes with 80 mm Hg of air insole for reducing PPP in the first metatarsal head and the second metatarsal head. Moreover, people may avoid wearing the stiffer insole (240 mm Hg) for more than 20 minutes.

Sub-calcaneal plantar fat pad assessment using dual-energy computed tomography: First experience in the diabetic foot

BackgroundThis study assessed the use of dual-energy computed tomography (CT) to evaluate sub-calcaneal plantar fat pad changes in people with diabetic neuropathy. MethodsDual-energy CT scans of people with diabetic neuropathy and non-diabetic controls were retrospectively included. Average CT values (in Hounsfield Units) and thickness (in centimeters) of the sub-calcaneal plantar fat pad were measured in mono-energetic images at two energy levels (40 keV and 70 keV). The CT values measured in patients with diabetic neuropathy were correlated to barefoot plantar pressure measurements performed during walking in a clinical setting. FindingsForty-five dual-energy CT scans of people with diabetic neuropathy and eleven DECT scans of non-diabetic controls were included. Mean sub-calcaneal plantar fat pad thickness did not significantly differ between groups (diabetes group 1.20 ± 0.34 cm vs. control group 1.21 ± 0.28 cm, P = 0.585). CT values at both 40 keV (−34.7 ± 48.7 HU vs. −76.0 ± 42.8 HU, P = 0.013) and 70 keV (−11.2 ± 30.8 HU vs. -36.3 ± 27.2 HU, P = 0.017) were significantly higher in the diabetes group compared to controls, thus contained less fatty tissue. This elevation was most apparent in patients with Type 1 diabetes. CT values positively correlated with the mean peak plantar pressure. InterpretationDual-energy CT was able to detect changes in the plantar fat pad of people with diabetic neuropathy.

Effects of a range of 6 prefabricated orthotic insole designs on plantar pressure in a healthy population: A randomized, open-label crossover investigation.

Prefabricated orthotic insoles are widely commercially available for self-selection to treat foot and lower-body musculoskeletal pain, without requiring advice from health care professionals. Although they are generally designed to mimic traditional design features of custom-made orthotics used in clinical practice, the effects of prefabricated insoles on plantar pressure distribution are poorly understood. This investigation aimed to evaluate and directly compare the effects of a range of 6 different commercially available prefabricated orthotic insole designs on plantar pressure in healthy individuals. This was a single-center, randomized, open-label, crossover investigation. In-shoe dynamic pressure (F-scan) was investigated in 24 healthy subjects with normal foot posture, wearing standard shoes alone and in combination with 6 different orthotic insoles, consecutively, measured on a single day. The biomechanical impact of each insole was determined by the statistical significance of changes from baseline measurements (standard shoe alone). Insoles with heel cups and medial arch geometries consistently increased contact area at medial arch and whole-foot regions and reduced both plantar peak pressure (PP) and pressure time integral at medial arch and heel regions. This investigation has aided in further understanding the mode of action of prefabricated insoles in a healthy population. The insoles in this study redistributed plantar pressure at key regions of the foot, based on design features common to prefabricated insoles. Prefabricated orthotic insoles represent an easily accessible means of reducing lower-body musculoskeletal stress for those who spend prolonged periods of time on their feet.

Theoretical Evaluation of Ankle Foot Orthosis Made of Carbon Fiber, Polyethylene and Structural Steel

Due to substantial developments in prosthetic foot research and development over the past 20 years, many people living in industrialized countries who had their lower limbs amputated today enjoy improved function and a higher quality of life. The great majority of end users in underdeveloped countries are unable to exploit this new R&D due to the components' high cost, low durability, high maintenance needs, and restricted accessibility. A prosthetic foot that is exceedingly useful, complies with monetary, environmental, and physical regulations, and can resist challenging working conditions and weather requires more study. A good prosthesis often depends on the elasticity of its component materials to generate a “spring,” which matches a physiological foot's stride, in order to optimize performance while minimizing manufacture costs. This study studied the mechanical properties of AFOs, especially structural stiffness, rotational motion, and strut deflection, to uncover design variables impacting superior functional results. AFO and footwear are routinely prescribed for diabetic patients to assist prevent the onset of foot ulcers. In regions of interest, plantar peak pressure (PPP) is reduced utilizing AFO and supportive footwear (ROI). This paper has main concentration on find out best suitable material available for manufacturing of AFO by comparing three standard materials to each other and check their performance by theoretical calculations method.

Customized Design for Ergonomic Products via Additive Manufacturing Considering Joint Biomechanics

This paper presents a customized design method for ergonomic products via additive manufacturing (AM) considering joint biomechanics. An ergonomic customized design model can be built based on kinesiology involving human joint biomechanics. Manifolds of the human bone can be reconstructed from X-rays, computed tomography (CT), magnetic resonance imaging (MRI), and direct 3D scanning. The conceptual and detailed design of customized products were implemented on ergonomic shoes and insoles. A lightweight lattice structure with variable porosity was generated via structural topology optimization for an ergonomic customized design. Notably, the upper surface of the custom-made insole may adhere perfectly to the plantar surface of the patient, resulting in a lower peak plantar pressure. Finite element analysis (FEA) can be employed to simulate the static or dynamic biomechanical characteristics. The conceptual ergonomic products were forwarded to the machine and fabricated via AM, driven by visual digital twin techniques. The experiments proved that a customized design suitability method for wearable ergonomic products via 3D printing is specifically tailored to the rehabilitation needs of individual customers, while consuming the least cost, time, and materials.

Fatigue Effects on Peak Plantar Pressure and Bilateral Symmetry during Gait at Various Speeds

Fatigue-related changes in gait biomechanics, specifically plantar pressures, are well documented in the general population. However, research is generally confined to unilateral measures across a limited range of speeds, while changes in more well-trained populations remain largely unknown. Therefore, we sought to assess the impact of fatigue on bilateral peak plantar pressure (PP) and plantar pressure symmetry angle (SA) in well-trained runners across a range of speeds. Data from 16 (females, n = 9) well-trained runners were collected using in-sole pressure sensors pre- and post-fatigue at the following speeds: walking (1.3 m/s), jogging (2.7 m/s), running (3.3 m/s), and sprinting (4.5 m/s). Pre-fatigue PP significantly increased from walking to jogging (p &lt; 0.001) and from jogging to running (p &lt; 0.005) with no difference between running and sprinting (p &gt; 0.05). Post-fatigue PP for walking was less than jogging (p &lt; 0.002), running (p &lt; 0.001), and sprinting (p &lt; 0.001), with no other significant differences (p &gt; 0.05). Post-fatigue PP was significantly greater when compared to pre-fatigue PP at all speeds (p &lt; 0.001 for all). Though SA was not significantly different pre- to post-fatigue across speeds (p’s &gt; 0.05) at the cohort level, noteworthy changes were observed at the individual level. Overall, fatigue effects are present at all running speeds but isolating these effects to a single side (left or right) may be inadequate.

Evaluating wrapping alpine ski boots during on-snow carving.

Alpine ski boots enable rapid and precise force transfer between skier and ski while carving. These boots are made of rigid plastic and fit tightly commonly through four buckles. Such a fit can improve speed and control but also pain and discomfort. In athletic footwear, alterations to the upper designed to wrap the foot improve performance during rapid changes of direction and during trail running. The purpose of this study was to systematically evaluate the performance and fit of two different ski boot shell closure mechanisms: a BOA closure and a Buckle closure. This was a two-part study with 22 subjects performing on-mountain skiing and 10 of those subjects completing an in-laboratory pressure evaluation. Subjects skied in both boots three times each while data from inertial measurement units (IMUs) and plantar pressures were collected along with subjective data. In lab, static dorsal and plantar pressures were collected while the subjects flexed into the boots. The BOA boots improved subjective and objective ski performance; qualitative carving scores were greater, likely through increasing the amount of normal force applied to the ski while turning. There were no differences in edge angles between the boots, as computed from IMUs. The BOA boot also reduced static peak plantar pressures in the rearfoot along with reducing overall static pressure on the dorsum as compared with the Buckle boot. This is the first study to systematically evaluate differences in ski boot closures. The improvements in carving performance in the BOA boot are supported by distinct differences in pressure distribution within each boot, which we speculate contributed to improved performance by reducing discomfort or pain while still facilitating effective force transfer.

Systematic review and meta-analysis of the effects of foot and ankle physical therapy, including mobilisations and exercises, in people with diabetic peripheral neuropathy on range of motion, peak plantar pressures and balance.

To evaluate the effects of foot and ankle physical therapy on ankle and first metatarsophalangeal joint range of motion (ROM), peak plantar pressures (PPPs) and balance in people with diabetes. MEDLINE, EBSCO, Cochrane Database of Systematic Reviews, Joanna Briggs Institute Database of Systematic Reviews, PROSPERO, EThOS, Web of Science and Google Scholar were searched in April 2022. Randomised Controlled Trials (RCT), quasi-experimental, pre-post experimental design and prospective cohort studies were included. Participants were people with diabetes, neuropathy and joint stiffness. Interventions included physical therapy such as mobilisations, ROM exercises and stretches. Outcome measures focused on ROM, PPPs and balance. Methodological quality was assessed with Critical Appraisal Skills Programme RCT and Risk-of-Bias 2 tool. Meta-analyses used random-effects models and data was analysed using the inverse variance method. In total, 9 studies were included. Across all studies, participant characteristics were similar; however, type and exercise dosage varied greatly. Meta-analysis was performed with four studies. Meta-analysis showed significant effects of combined exercise interventions in increasing total ankle ROM (3 studies: MD, 1.76; 95% CI, 0.78-2.74; p=0; I2 =0%); and reducing PPPs in the forefoot area (3 studies; MD, -23.34; 95% CI, -59.80 to 13.13; p=0.21, I2 =51%). Combined exercise interventions can increase ROM in the ankle and reduce PPPs in the forefoot. Standardisation of exercise programmes with or without the addition of mobilisations in the foot and ankle joints needs further research.

Innovative single-sensor, in-shoe pressure and temperature monitoring device: A static laboratory validation study

BackgroundTo perform laboratory static validation of pressures from an innovative, single-sensor pressure and temperature monitoring device for the early detection of complications in the high-risk foot. Research questionCan an innovative, newly developed, in-shoe pressure and temperature measuring device, detect and measure the in-shoe peak plantar pressures and skin temperature as accurately as the reference standard? MethodsA pressure generating rig, the Tekscan™ Equilibration ‘bladder calibrator’, was used to produce a known force, against the gold standard, FScan™ in-shoe pressure mapping system by Tekscan™ and a newly developed prototype. The F-scan® system was used to record the pressure readings and establish a baseline for the readings recorded utilising the prototype. A total of 20 pressure values were recorded with 100 samples each. ResultsExploratory data analysis was conducted to gain insights and analyse the prototype's behaviour at different pressure points. Pre-processing and data cleaning were also performed to remove any anomalies. Support Vector Regressor with a polynomial kernel and Grid-Search algorithm was used to fit the recorded data curve. The best combination of parameters had a Mean Squared Error of 2.59 and a Root Mean Squared Error of 1.61. A simple linear equation was used to convert raw readings to pressure values. SignificanceThe results of this study conclude that the pressure measurements taken with the prototype are congruent to the gold standard, F-scan® in-shoe system. This confirms that the prototype is a valid device that can be used safely as a low-cost alternative to current costly commercial in-shoe pressure mapping devices.

Impaired foot vibration sensitivity is related to altered plantar pressures during walking in people with multiple sclerosis

Balance and mobility impairment are two of the most common and debilitating symptoms among people with multiple sclerosis (MS). Somatosensory symptoms, including reduced plantar cutaneous sensation, have been identified in this cohort. Given the importance of the somatosensory system in gait, it is likely that impaired plantar sensation may play a role in the walking adaptations commonly observed in people with MS, including decreased stride length and increased stride width and dual support time, often described as a cautious gait strategy. Understanding the contributions of plantar sensation to these alterations may provide targets for interventions that seek to improve sensory feedback and normalize gait patterns. This cross-sectional study determined whether individuals with MS who demonstrate reduced sensitivity of the plantar surfaces also demonstrate altered plantar pressure distributions during walking compared to a control cohort.Twenty individuals with MS and twenty age- and sex-matched control participants walked barefoot at preferred and three matched speeds. Participants walked across a walkway with an embedded pressure plate used to quantify pressures within ten plantar zones. In addition, vibration perception thresholds were assessed at four sites on the plantar surface.Individuals with MS demonstrated increased peak total plantar pressures compared to control participants, that increased with walking speed. For the MS group, plantar pressures were higher on the less sensitive foot, although pressures on both feet exceeded those of the control cohort. Positive correlations between vibration perception threshold and peak total pressure were evident, although generally stronger in the MS cohort.A relationship between plantar vibration sensitivity and pressure could indicate that individuals with MS seek to increase plantar sensory feedback during walking. However, because proprioception may also be impaired, increased plantar pressure could result from inaccurate foot placement. Interventions targeting improved somatosensation may have the potential to normalize gait patterns and should be investigated.

The effect of transverse arch support on peak plantar pressure and foot pronation before and after prolonged running

The effect of transverse arch support on peak plantar pressure and foot pronation before and after prolonged running