Plantar Foot Research Articles

Clinical Efficacy of a Contralateral Shoe Lift in Patients with Diabetic Foot Ulcers and Induced Limb-Length Discrepancies: A Randomized Controlled Trial.

Objective: To evaluate the clinical efficacy of combining an offloading device with a contralateral shoe lift to compensate for induced limb-length discrepancies in participants with plantar diabetes-related foot ulcers. Approach: Between March 2021 and December 2023, 42 consecutive patients with active plantar diabetic foot ulcers (DFUs) were randomly assigned (1:1) to the treatment group (limb-length discrepancy compensation with a shoe lift in the therapeutic footwear of the contralateral limb) or a control group that did not receive limb-length discrepancy compensation. Primary outcomes included the 20-week wound-healing rate and wound area reduction. Secondary outcomes included minor amputation, new ulcers in the contralateral limb, perceived comfort, and hip pain. Results: On an intention-to-treat basis, 15 participants in the control and 19 in the treatment group showed ulcer healing (p = 0.0023). In those with >80% adherence to the offloading device, multivariate analysis showed that the shoe lifts improved ulcer healing time. The use of a shoe lift reduced the number of minor amputations and the occurrence of new ulcers in the contralateral limb (p = 0.035; p = 0.033 respectively). Hip pain and perceived comfort improved with the use of shoe lifts (p < 0.001). Innovation: It validates the use of shoe lifts for patients with DFUs, as it is the first largest study of its kind to establish a clear reference standard to guide clinician decision-making. Conclusion: The use of shoe lifts reduced healing time in participants with diabetes and active plantar foot ulcers. Shoe lifts reduce late complications, including new ulcers in the contralateral limb and minor amputations.

Effects of neural mobilization of sciatic nerve and its branches in plantar foot pressures and stabilometry

Benefits of neural mobilization (NM) have been described in musculoskeletal patients. The effects of NM on balance appear to be unclear in research, and no studies have tested the possible effects of NM on plantar pressures. Eighteen subjects were evaluated pre and post bilateral gliding of the sciatic nerve and its branches posterior tibial nerve, lateral dorsocutaneous, medial and intermediate dorsocutaneous nerves. Static variables of the plantar footprint and stabilometric variables were measured in a pre-post study. We found no differences in plantar pressure variables, Rearfoot maximum pressure (p = 0.376), Rearfoot medium pressure (p = 0.106), Rearfoot surface (p = 0.896), Midfoot maximum pressure (p = 0.975), Midfoot medium pressure (p = 0.950), Midfoot surface (p = 0.470) Forefoot maximum pressure (p = 0.559), Forefoot medium pressure(p = 0.481), Forefoot surface (p = 0.234), and stabilometric variables either, X-Displacement eyes-open (p = 0.086), Y-Displacement eyes-open (p = 0.544), Surface eyes-open (p = 0.411), Medium speed latero-lateral displacement eyes-open (p = 0.613), Medium speed anteroposterior displacement eyes-open (p = 0.442), X Displacement eyes-closed (p = 0.126), Y-Displacement eyes-closed (p = 0.077), Surface eyes-closed (p = 0.502), Medium speed latero-lateral displacement eyes-closed (p = 0.956), Medium speed anteroposterior displacement eyes-closed (p = 0.349). All variables don´t have significant differences however the measurements had a high reliability with at least an ICC of 0.769. NM doesn´t change plantar pressures or improve balance in healthy non-athletes subjects. NCT05190900.

Immediate effects of electronic stimulation to the plantar foot on foot function and postural stability during landing.

Sports injuries often occur during landing, necessitating postural stability for injury prevention. Electrical stimulation of the plantar foot induces activities of the intrinsic foot muscles and improves somatosensory and postural stability during landing. However, this effect remains unclear. Therefore, the aim of this study was to investigate the immediate effects of electrical stimulation on the activities of the intrinsic foot muscles, plantar somatosensory system, and postural stability during landing. Twenty-two college athletes were divided into an electrical stimulation group and a control group. Electrical stimulation was applied to the plantar foot using a commercial device. The toe function and plantar tactile sensations were evaluated. The activities of the intrinsic muscles and the parameters of the ground reaction force were measured and calculated. We compared pre- and postintervention outcomes. In the electrical stimulation group, two subjects showed improvement in toe function, and plantar tactile sensation improved significantly postintervention. The control group exhibited no significant change in plantar tactile sensation. A significant interaction was observed in anteroposterior postural stability during landing, notably improving in the electrical stimulation group. Electrical stimulation of the plantar foot immediately improved toe function, plantar tactile sensation, and postural stability during landing. Such stimulation would be beneficial in preventing sports injuries.

Minimally Invasive Distal Metatarsal Diaphyseal Osteotomy (MIS-DMDO) for the Prevention and Treatment of Chronic Plantar Diabetic Foot Ulcers.

Diabetic foot is one of the major complications of diabetes, affecting 15% of patients with diabetes. This study aims to evaluate and compare the clinical and radiographic outcomes of patients with diabetes affected by forefoot plantar preulcerative or ulcerative lesions who have undergone minimally invasive distal metatarsal diaphyseal osteotomy (MIS-DMDO) to assess its efficacy in the prevention and treatment of chronic plantar diabetic foot ulcers (CPDFUs). The study included 60 patients, 38 with preulcers and 22 with ulcers, with at least 2 years of clinical and radiologic follow-up. Clinical outcomes were assessed using the European Foot and Ankle Society (EFAS) score, the Foot Function Index (FFI), and the Manchester-Oxford Foot Questionnaire (MOXFQ). The radiographic evaluation was performed according to the Maestro criteria. Both groups improved in clinical and radiologic outcomes when comparing baseline measurements to those at the final follow-up. There were no statistical differences between preulcer and ulcer groups in terms of both clinical and radiologic outcomes, with the only exception being FFI, which was lower in the preulcerative group. In multivariate analysis, gender and glycated hemoglobin (HbA1c) were predictors of better outcomes. Specifically, FFI and MOXFQ (P < .05) exhibited larger improvements in females, while Maestro 1 and 2 were better in patients with lower HbA1c (P < .05). All patients were considered healed at the final follow-up. Carefully performed minimally invasive distal metatarsal diaphyseal osteotomy can be an effective approach to the care of impending or chronically present plantar diabetic foot ulcers.

Wearable device for detecting flat feet and high arches using pressure sensors based on graphite

The present study focuses on the design and construction of an innovative device aimed at identifying plantar foot conditions, such as normal, cavus, and flat feet, through the analysis of biosignals. The device was based on two identification methods: the plantar footprint test and the use of a template equipped with digital and analog sensors made of Velostat paper, a material derived from graphite that allows capturing biosignals with high precision. These biosignals were integrated into an Android application, facilitating the diagnosis and appropriate treatment of plantar conditions. The key component of the device was a sensor created with graphite, which functioned as a piezoelectric sensor to acquire and measure the pressure exerted by the foot. Thanks to the sensor’s ability to capture biosignals, it was possible to accurately detect and classify plantar conditions. The device stood out for its low cost and seamless integration with the mobile application, becoming a valuable and accessible tool for the healthcare sector, with the potential to significantly improve the quality of life for patients with foot problems through early detection and timely treatment.

A mouldable fibreglass backslab device as a novel approach to offload chronic plantar foot ulcers: A retrospective observational audit.

Pressure offloading is a critical component of plantar foot ulcer management, including diabetes-related foot ulcers (DFU). Conventional offloading options such as total contact casting and removable knee-high walkers may be unsuitable or unsuccessful in patients with morbid obesity, intermittent lower limb oedema, high exudative wounds or poor mobility. A mouldable fibreglass backslab device (BSD) may be a practical alternative to be considered in these situations. Data were retrospectively collected on 28 patients (29 foot ulcers) with non-healing ulcers who received a BSD to offload their foot ulcer as an extension to standard offloading care. Baseline data included: patient demographics, type of offloading prior to BSD application, date of ulcer onset, days ulcer present prior to BSD application and ulcer size at BSD initiation. Measures of success included ulcer size reduction 12weeks post-BSD application, time to complete ulcer healing in BSD, time to 50% reduction in ulcer size post-BSD application and total number of days ulcer present. The median (IQR) ulcer area and ulcer duration at baseline for 19 patients (20 ulcers) who used the BSD was 1.65 (0.4-3.8) cm2 and 531 (101-635) days. At 12weeks, the median (IQR) ulcer area was 0.3 (0-0.55) cm2 with a median (IQR) reduction of 97 (80-100) %. Nine (45%) ulcers achieved complete wound healing (100% reduction in wound size) at 12weeks post-BSD application, and the remaining 11 (55%) ulcers achieved at least 50% reduction in wound size. The median (IQR) time to complete wound healing and 50% reduction in wound size was 71 (35-134) days and 24 (15-44) days, respectively. Nine patients ceased use of the BSD and reverted to conventional offloading before their wounds had healed. Of these, four patients achieved a 50% reduction in wound size at the 12-week mark with conventional offloading. Our preliminary data suggests that a mouldable fibreglass BSD may be a practical offloading option in the management of DFUs, especially when conventional offloading methods are unsuccessful, unsuitable or unacceptable to patients. Higher level evidence is required to demonstrate suitability or efficacy of the BSD compared to current evidence-based recommended offloading methods.

Differences in the Size of Individual Plantar Intrinsic Foot Muscles Between Ballet Dancers and Non-Dancers.

In classic ballet, choreography often involves tiptoe standing. Tiptoe standing requires a high and stable foot arch structure, which is achieved by contraction of the plantar intrinsic foot muscles (PIFMs). Long-term repetitive loading with a specific movement can induce hypertrophic adaptation of the associated muscles. For dancers, however, limited information on the size of individual PIFMs is available from previous studies. The purpose of this study was to determine the differences in the sizes of 10 individual PIFMs between dancers and non-dancers. Muscle volumes (MVs) of 10 individual PIFMs were measured using magnetic resonance imaging in 15 female dancers and 15 female non-dancers. Muscles analyzed included abductor hallucis, flexor digitorum brevis, abductor digiti minimi, quadratus plantae, lumbricals, flexor hallucis brevis, adductor hallucis oblique head, adductor hallucis transverse head, flexor digiti minimi, plantar/dorsal interossei. In addition to absolute MVs, relative MVs normalized to body mass (rMVBM) and the percentage of individual MVs relative to the sum of 10 individual PIFM MVs (%MVWHOLE) were calculated. The absolute MVs of 6 individual PIFMs, including the flexor digitorum brevis and lumbricals, were +16% to 59% larger in dancers than in non-dancers (P ≤ .048). The rMVBM of all individual PIFMs were +35% to 95% larger in dancers than in non-dancers (P ≤ .019). The %MVWHOLE of the flexor digitorum brevis and lumbricals were +10% to 36% higher (P ≤ .014) and those of the abductor digiti minimi and adductor hallucis oblique head were +8% to 11% lower (P ≤ .037) in dancers than in non-dancers. For all 3 MV measures, only the flexor digitorum brevis and lumbricals, which are functionally specialized for flexion of the second to fifth metatarsophalangeal joints, were consistently larger in dancers than in non-dancers. This may be due to long-term repetitive loading on these PIFMs during ballet training involving tiptoe standing.

Automatic Detection of Fatigued Gait Patterns in Older Adults: An Intelligent Portable Device Integrating Force and Inertial Measurements with Machine Learning.

This study aimed to assess the feasibility of early detection of fatigued gait patterns for older adults through the development of a smart portable device. The smart device incorporated seven force sensors and a single inertial measurement unit (IMU) to measure regional plantar forces and foot kinematics. Data were collected from 18 older adults walking briskly on a treadmill for 60min. The optimal feature set for each recognition model was determined using forward sequential feature selection in a wrapper fashion through fivefold cross-validation. The recognition model was selected from four machine learning models through leave-one-subject-out cross-validation. Five selected characteristics that best represented the state of fatigue included impulse at the medial and lateral arches (increased, p = 0.002 and p < 0.001), contact angle and rotation range of angle in the sagittal plane (increased, p < 0.001), and the variability of the resultant swing angular acceleration (decreased, p < 0.001). The detection accuracy based on the dual signal source of IMU and plantar force was 99%, higher than the 95% accuracy based on the single source. The intelligent portable device demonstrated excellent generalization (ranging from 93 to 100%), real-time performance (2.79ms), and portability (32g). The proposed smart device can detect fatigue patterns with high precision and in real time. The application of this device possesses the potential to reduce the injury risk for older adults related to fatigue during gait.

Effects of a 12-week intrinsic foot muscle strengthening training (STIFF) on gait in older adults: a parallel randomized controlled trial protocol

BackgroundFalling is highly prevalent among older adults and has serious impact. Age-induced mobility impairments, such as gait modifications, are strongly associated with increased fall risk. Among fall prevention interventions, those including exercises are most effective. However, there is an urgent need to further improve these kinds of interventions. Strengthening the plantar intrinsic foot muscles might benefit mobility in older adults, which may contribute to the reduction of fall risk. The aim of this paper is to provide a protocol to investigate the effect of a plantar intrinsic foot muscle strengthening training versus no training on gait and intrinsic foot muscle function in older adults who are involved in a functional exercise program.MethodsFor this assessor-blinded RCT, older adults (> 65 years) are recruited who are involved in a group-based functional exercise program. Eligibility criteria include: being able to ambulate 10 m barefoot without using a walking aid and reporting to have either fear of falling or experienced a fall in the previous 12 months or have difficulties with mobility, gait, or balance in daily life. Participants are randomly assigned to an intervention and a control group. The intervention group follows a 12-week plantar intrinsic foot muscle strengthening training. The training consists of isolated and functional foot exercises to be performed 5 times a week, each session lasting approximately 20 min. The training is supervised once a week and the intensity gradually increases based on the participant’s progression. Both groups keep a diary to report physical activities, fall incidents and movement related discomfort. The control condition is limited to keeping this diary. Data are collected at baseline and post-intervention. The trial outcomes are the between group differences in the mean change from baseline in maximum gait speed (primary outcome measure), capacity and strength of the plantar intrinsic foot muscles, foot and ankle biomechanics during gait, and various other fall risk-related variables. ANCOVA’s are used to analyze the trial outcomes.DiscussionThe results of this RCT will offer recommendations, related to plantar intrinsic foot muscle strengthening, to existing fall preventive exercise programs.Trial registrationThe trial is registered in the United States National Library of Medicine through ClinicalTrials.gov (NCT05531136, 07/26/2022).

EVALUATION OF PLANTAR FASCIA THICKNESS ACCORDING TO THE MORPHOMETRIC OF THE FOOT

OBJECTIVE: In our study, it was aimed to examine the relationship among plantar fascia thickness, foot morphometric values, and Achilles tendon thickness. MATERIAL AND METHODS: The study was carried out on young volunteers who did not engage in any active regular sports. In total, morphometric measurements were performed on 64 feet (17 men, 15 women). The thickness of the plantar fascia on the ultrasound image was measured. Foot length, foot width, heel width, and ankle circumference were used as foot morphometric variables. RESULTS: It was determined that the plantar fascia thickness was greater than 4 mm in 14.7% of young healthy male individuals. The plantar fascia thickness was found to be less than 3.6 mm in all young female individuals. In men, plantar fascia thickness was found to be moderately positively correlated with foot length and ankle circumference (p&amp;lt;0.05). However, it was interesting that there was no correlation between plantar fascia thickness and foot width. When all the participants were evaluated together, a moderate positive correlation was found between plantar fascia thickness and foot length, ankle circumference, and Achilles tendon thickness, while a weak correlation was found with foot width and heel diameter (p&amp;lt;0.001). CONCLUSIONS: The addition of foot morphometry and plantar fascia data to the literature, depending on different racial and geographical conditions, allows anatomists and anthropologists to make necessary comparisons. To support the diagnosis of plantar fasciitis, the accepted “plantar fascia thickness greater than 4 mm” should be reviewed and discussed separately for both men and women.

The influence of foot muscles exercises and minimalist shoes on lactate threshold velocity in long-distance amateur runners: a randomized controlled trial

The exercises of plantar foot muscles may have beneficial effects on the performance of the lower extremity muscles. The aim of this study was to compare two methods of foot muscle strengthening: direct short foot muscle exercises and indirect activation through training in minimalist footwear in regard to influence on lactate threshold velocity in long-distance runners. 55 recreational runners aged 21–45 years took part in that study. They were randomly divided into 2 groups: Group 1 (n = 25) with short foot muscle exercises, and Group 2 (n = 30) with training in minimalist shoes. The progressive running test was performed to determine heart rate (HR) and running velocity corresponding to lactate threshold (VLT). Two-way ANOVA was used to determine the significance of the differences regarding the evaluated variables. After the 8-week training program, higher values of VLT were observed in both groups. This change was significant only in Group 1 (p < 0.05). In Group 2, the higher value was noted but the changes were non-significant. Strengthening of the short foot muscles may improve lactate threshold velocity which is connected with running performance. Considering the obtained results, it is worth contemplating the implementation of these methods in the training of long-distance runners.

Associations between static foot posture, dynamic in-shoe plantar foot forces and knee pain in people with medial knee osteoarthritis: A cross-sectional exploratory study

ObjectiveTo investigate relationships between static foot posture, dynamic plantar foot forces and knee pain in people with medial knee osteoarthritis (OA). DesignData from 164 participants with symptomatic, moderate to severe radiographic medial knee OA were analysed. Knee pain was self-reported using a numerical rating scale (NRS; scores 0-10; higher scores worse) and the Knee Injury and Osteoarthritis Outcome Score pain subscale (KOOS; scores 0-100; lower scores worse). Static foot posture was assessed using clinical tests (foot posture index, foot mobility magnitude, navicular drop). Dynamic plantar foot forces (lateral, medial, whole foot, medial-lateral ratio, arch index) were measured using an in-shoe plantar pressure system while walking. Relationships between foot posture and plantar forces (independent variables) and pain (dependent variables) were evaluated using linear regression models, unadjusted and adjusted for sex, walking speed, KL grade, shoe category, and body mass (for dynamic plantar foot forces). ResultsNo measure of static foot posture was associated with any knee pain measure. Higher medial-lateral foot force ratio at midstance, and a higher arch index during overall stance, were weakly associated with higher knee pain on the NRS (regression coefficient=0.69, 95% confidence interval (CI) 0.09 to 1.28) and KOOS (coefficient=3.03, 95% CI 0.71 to 5.35) pain scales, respectively. ConclusionDynamic plantar foot forces, but not static foot posture, were associated with knee pain in people with medial knee OA. However, the amount of pain explained by increases in plantar foot force was small, thus these associations are unlikely to be clinically meaningful.

Functional ankle taping correction on plantar foot ulcer healing in diabetic patients: Randomized controlled trial

Functional ankle taping correction on plantar foot ulcer healing in diabetic patients: Randomized controlled trial

Surgical Offloading versus Medical Conservative Methods in Management of Diabetic Foot Plantar Ulcers (Interventional study)

Abstract Background As a result, peripheral neuropathy is frequently caused by diabetes (DM). Diabetic plantar foot pressure ulcers develop from the lack of protective pain sensibility as a result of recurrent shear and tear pressures. Relieving pressure on the foot's sole is necessary for the ulcers to heal. The purpose of the study is to compare the effectiveness of surgical and nonsurgical unloading procedures in the healing of plantar ulcers. Subjects and Methods 50 diabetic foot ulcer patients who visited Ain Shams University, the national institute of DM, and the endocrinology outpatient clinic participated in this interventional trial (NIDE). We employed mechanical and surgical unloading methods in this trial, and patients were monitored for 6 months to see how long it took for their injuries to recover. Results At the conclusion of the follow-up period, 88% of the surgical group's pressure ulcers were fully healed, compared to 86.7% of the non-surgical patients (6 months). Infection, recurrence, and non-healing were complications we encountered throughout the follow-up period. Regarding the treatment of plantar diabetic foot ulcers, offloading is crucial (DFUs). Compared to using only non-surgical methods, surgical offloading may hasten the recovery time. A well- trained team is necessary to prevent the issues with improperly fitting footwear and to teach the patient how to use them on a regular basis with the non-surgical offloading technique.

Pressure-Reducing Design of 3D-Printed Diabetic Shoe Midsole Utilizing Auxetic Lattice Structure

With the global rise in the prevalence of diabetes, diabetic patients need innovative footwear designs to reduce the risk of foot ulcers. This study examined the mechanical properties of diabetic shoe midsoles featuring auxetic lattice structures. Through the construction of finite element models and simulation, this research compared the biomechanical parameter differences in the plantar regions of the metatarsal head, midfoot, and hindfoot when wearing two types of auxetic midsoles with internal angles of 60° and 75° and a non-auxetic midsole with an internal angle of 90° under both walking and running conditions. Compared to the non-auxetic midsole, the auxetic midsoles significantly reduced the peak plantar pressure and optimized the pressure distribution across various plantar regions. Notably, the auxetic 60° midsole reduced the peak plantar pressure by 19.68–55.25% and 16.19–54.39% compared to the non-auxetic 90° midsole during walking and running, respectively. This study also verified that the auxetic midsoles exhibited greater adaptability and compliance to the plantar foot shape, contributing to reductions in plantar pressure in comparisons of deformation values and plantar contact areas across the different midsoles. Auxetic midsoles manufactured using 3D printing technology have significant potential to prevent diabetic foot ulcers and maintain human foot health. This research integrates insights and techniques from materials science and ergonomics, offering a new direction for footwear design.

Differences in muscle activity of extrinsic and intrinsic foot muscles in toe grip and push-down movements of the great toe

Toe flexor strength is generated primarily by the flexor hallucis longus (FHL) of the extrinsic foot muscles (EFMs) and the plantar intrinsic foot muscles (PIFMs) of the great toe. Toe flexion methods can be broadly classified into toe grip (TG) and toe push-down (TP). Additionally, TP's interphalangeal joint (IPJ) position may influence the FHL and PIFMs activity ratios. This study aimed to elucidate the differences in the muscle activity and muscle activity ratios of the FHL and AbdH during TG, TP with IPJ flexion (TPIF), and TP with IPJ extension (TPIE).Surface electromyography and a custom-made instrument were used to measure the FHL and AbdH muscle activity during TG, TPIF, and TPIE of the great toe in 28 healthy men. The muscle activity and AbdH/FHL muscle activity ratio in the three conditions were statistically compared.The FHL activity was significantly higher during TG and TPIF than during TPIE. The AbdH muscle activity was significantly higher during TPIF and TPIE than that during TG. The AbdH/FHL muscle activity ratio was significantly higher for TPIE, TPIF, and TG in that order.This study showed that the FHL and AbdH muscle activity differed depending on the TG and TP of the great toe, and that the AbdH/FHL muscle activity ratio was different in the IPJ position. These results suggest that selecting a toe flexion method according to the target muscle when measuring and training the great toe flexor strength is important.

Preventing Diabetic Foot Re-Ulceration Through an Innovative Pressure and Temperature Monitoring Clinical Device.

This study compared the outcome of an innovative in-shoe pressure and temperature measuring device as an adjunct to standard clinical care for diabetic foot versus standard clinical care alone. It included 88 participants with Type 2 diabetes mellitus with a history of one or more plantar foot ulceration who were already using prescription orthoses. These were randomly divided into the control group (n = 44, standard care only) and the experimental group (n = 44, standard care plus the innovative device). Both groups were monitored for re-ulceration for one year. Overall, the control group exhibited a higher number of re-ulcerations (n = 14) with 2 amputations in comparison with the experimental group (only 2 ulcerations and no amputations) at the end of the study. In conclusion, this innovative in-shoe pressure and temperature measuring device appears to reduce re-ulcerations by offering objective data for clinical decision making in the management of the diabetic high-risk foot.

Efficacy of extracorporeal shockwave therapy, compared to corticosteroid injections, on pain, plantar fascia thickness and foot function in patients with plantar fasciitis: A systematic review and meta-analysis

Objective To compare the efficacy of extracorporeal shock waves versus corticosteroids injections on pain, thickness of plantar fascia and foot function in patients with plantar fasciitis. Secondarily, to assess the efficacy of radial and focused extracorporeal shock waves and the most appropriated intensity (high, medium or low). Data sources PubMed, SCOPUS, CINAHL and PEDro, until April 2024, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Review methods Randomized controlled trials comparing the efficacy of extracorporeal shock waves versus corticosteroids injections on pain intensity and sensitivity, thickness of plantar fascia and foot function in patients with plantar fasciitis. Methodological quality and risk of bias were assessed using PEDro Scale and Cochrane Risk of Bias Tool. Pooled effect was calculated using the standardized mean difference (SMD) and its 95% confidence interval (95%CI). Results Sixteen studies involving 1121 patients, showing a mean of 6 points in PEDro scale, were included. At three months, extracorporeal shock waves were better than corticosteroids injections in reducing pain (SMD −0.6; 95%CI −1.1 to −0.11) and thickness of the plantar fascia (SMD −0.4; 95%CI −0.8 to −0.01) and increasing foot function (SMD 0.27; 95%CI 0.12–0.44). At six months, extracorporeal shock waves are more effective in reducing pain (SMD −0.81; 95%CI −1.6 to −0.06) and increasing foot function (SMD 0.67; 95%CI 0.45–0.89). Local pain and slight erythema were the most frequent adverse events. Conclusions Extracorporeal shock waves are a safe therapy, presenting more efficacy than corticosteroids injections in improving pain, thickness of plantar fascia and foot function at mid-term.

Exposure of Undergraduate Nursing Students to Standing Environments: A Longitudinal Study on Plantar Force and Pressure Distribution.

Understanding the link between plantar force, pressure, and foot discomfort is important for nursing students' well-being, given the prevalence of foot and ankle musculoskeletal disorders among nurses. Assessing these factors can inform tailored self-care interventions, supporting holistic nursing education. To assess the plantar force and pressure distribution of third-year nursing students at baseline and after 5months of exposure to a clinical setting. A prospective cohort study in a Portuguese nursing school measured changes in podiatric profile at 5months, including peak pressure, maximum force, and contact area. Elevated mean peak pressure in the heel correlated positively with maximum force and contact area. Negative correlations were found between the contact area and edema. Peak pressure correlated positively with thigh pain, indicating pressure transfer to metatarsal heads. The findings underscore the importance of integrating ergonomic education into nursing curricula and raising awareness of self-care interventions.

Effects of integrated intrinsic foot muscle exercise with foot core training device on balance and body composition among community-dwelling adults aged 60 and above

BackgroundEvidence on the effects of plantar intrinsic foot muscle exercise in older adults remains limited. This study aimed to evaluate the effect of an integrated intrinsic foot muscle exercise program with a novel three-dimensional printing foot core training device on balance and body composition in community-dwelling adults aged 60 and above.MethodsA total of 40 participants aged ≥ 60 years were enrolled in this quasi-experimental, single-group, pretest-posttest design; participants were categorized into two groups, those with balance impairment and those without balance impairment. The participants performed a 4-week integrated intrinsic foot muscle exercise program with a three-dimensional printing foot core training device. The short physical performance battery (SPPB) and timed up and go test were employed to evaluate mobility and balance. A foot pressure distribution analysis was conducted to assess static postural control. The appendicular skeletal muscle mass index and fat mass were measured by a segmental body composition monitor with bioelectrical impedance analysis. The Wilcoxon signed rank test was used to determine the difference before and after the exercise program.ResultsAmong the 40 enrolled participants (median age, 78.0 years; female, 80.0%; balance-impaired group, 27.5%), the 95% confidence ellipse area of the center of pressure under the eyes-closed condition was significantly decreased (median pretest: 217.3, interquartile range: 238.4; median posttest: 131.7, interquartile range: 199.5; P = 0.001) after the exercise. Female participants without balance impairment demonstrated a significant increase in appendicular skeletal muscle mass index and a decrease in fat mass. Participants in the balance-impaired group exhibited a significant increase in SPPB.ConclusionsIntegrated intrinsic foot muscle exercise with a three-dimensional printing foot core training device may improve balance and body composition in adults aged 60 and above.Trial registrationClinicalTrials.gov ID: NCT05750888 (retrospectively registered 02/03/2023).