Peak Plantar Pressure Research Articles

The effectiveness of shoe modifications and foot orthoses in conservative treatment of lesser toe deformities: a review of literature.

Forefoot disorders are prevalent in the general population, with an incidence between 2 and 20%. Among them, lesser toe deformities (hammer, claw, and mallet toes) are frequent disorders, and their conservative management is often not adequately considered but usually attempted before surgical indication. Among conservative treatments, shoe modifications and the application of orthoses may, in most cases, alleviate symptoms. From a careful analysis of the available literature, it emerged that treatment approaches should be individualized, and patient education has to be a central aspect of therapy. Proper footwear includes rocker and cushioned soles shoes, a wide toe box, proper length, and a lowered heel, eventually combined with the placement of a felt pad. Narrowed shoes must be avoided, limiting the impaction of the distal phalanx and toenail into the ground. A custom-made silicone orthosis applied at the second digit metatarsophalangeal (MTP) joint in a hammer or claw toe seems to reduce mean peak plantar pressure in the rigid stage of deformity but not the flexible one. A metatarsal pad placed 6.5mm proximal to the second metatarsal head was demonstrated to diminish peak pressures by 33%, and a 12.5-mm insole further reduced peak metatarsal head pressures by 23% compared with a 2.5-mm insole. The best comfort of orthoses seems to be given by treating metatarsalgia resulting from deformities such as MTP joint instability, mallet, and claw toe. Little orthotic relevance is given to deformities such as hammer toes. Although the most significant obstacle appears to be the psychological aspect of patients, who must accept the placement of compensatory orthoses, some studies show that all these management appear to be often beneficial for the treatment of these disorders. However, none of them are permanent solutions to the deformity and they can be treatment of choice just in advanced stages, in elderly and low functional demand patients.

Paradoxıcal effect of body mass index ranges on pedobarographic evaluatıon

Although there is evidence suggesting that obesity alters plantar pressure distribution, the specific effects of certain body mass index (BMI) ranges on pedobarographic measures in healty individuals has been poorly investigated. A cross-sectional study with 167 healthy participants was conducted to assess plantar pressure changes across 4 BMI ranges: Under/normal weight (NW), overweight (OW), obese (OB), severe obese (SO). Subjects walked on the Footscan® pressure plate at a self-selected speed, and peak plantar pressure (PPP), load rate, and contact area values were recorded. The foot was divided into 10 zones: hallux (T1), toes 2–5 (T2-5), metatarsals 1–5 (M1-M5), midfoot (MF), medial hindfoot (MH) and lateral hindfoot (LH). PPP underneath M2-M4 was lowest in the NW group (p = 0.011), and although PPP values for the SO group were lower than those for the OW and OB groups, these differences were not statistically significant. Load rate values of M2-M3 were lower in both the NW and SO groups (p = 0.008) compared to the OW and OB groups. In addition, the metatarsal load rate values for the SO group were generally lower than those for the NW group. The total metatarsal contact area of both the NW and SO groups was lower (p = 0.019) than that of the OW and OB groups in both feet. These findings suggest that as BMI increases, PPP, load rate, and contact area in the middle metatarsal region initially increase, stabilize early in obesity, and then decrease at advanced stages, indicating a shift of the load to the midfoot.

Optimum Insole Hardness for Attenuating Peak Plantar Pressure Under Simulated Loading Scenarios

To provide optimal cushioning capacity, an in-depth understanding of the biomechanical interactions between the foot and therapeutic insoles is mandatory. The goal of this study was to quantify the hardness of plantar soft tissues (PSTs) and investigate the potential association between the hardness of PSTs and the optimum hardness of insole materials. The authors tested the hardness of PSTs in eight plantar regions by using a durometer to examine 30 cadaveric feet. The effects of hardness and loading magnitude on peak plantar pressure at the heel–insole interface were investigated in simulated weight-bearing tests. Significant effects of insole hardness on the cushioning capacity were observed among different loading conditions (p<0.01). No significant association was found between the hardness of individual-specific PSTs and optimum cushioning materials (p<0.05). This study provides quantitative data on PST hardness, and this knowledge may be valuable for developing insole materials with similar hardness to the PST in order to achieve optimum pressure relief under the foot.

Compressive behavior of thermoplastic polyurethane with an active agent foaming for 3D-printed customized comfort insoles

The primary objective of this study was to investigate the compressive behavior of 3D-printed specimens made of a thermoplastic polyurethane filament, specifically colorFabb varioShore TPU, which incorporates a foaming agent. The foaming technology makes it possible to manipulate 3D prints' properties by adjusting process parameters that affect the level of expansion, such as printing temperature, printing speed or flow ratio. This capability opens new possibilities for 3D-printed personalized foot orthotics or for static comfort-oriented applications by tailoring the stiffness of the print based on the application requirements. Since infill density and infill pattern also affect the compressive characteristics of 3D prints, this research took these two parameters into account as independent variables, alongside the printing temperature. Thus, the specimens with printing temperatures set at 190 °C, 220 °C, and 240 °C, gyroid and honeycomb patterns, and infill variations from 10 % to 35 % in 5 % increments were experimentally investigated in compression testing. The evaluation was conducted to determine the influence of these factors on the stiffness of prints at 10 % and 20 % strains, in accordance with established standard. The findings had an important practical value as they provide data for adjusting the variable stiffness based on peak plantar pressure measurement data when developing tailored foot orthoses (insoles), which was the second objective of the research. The most influential factor affecting the compressive strength was the printing temperature, followed by infill density and pattern type. The difference in compression modulus between 10 % and 20 % strains did not exhibit statistical significance. Moreover, the main effects plots indicated minimal variations in compression modulus effects at 220 °C and 240 °C, whereas an important difference was observed at 190 °C printing temperature, which was confirmed by scanning electron microscopy investigations showing foamed layers at 220 °C and unfoamed layers at 190 °C. Furthermore, interaction plots revealed no significant interaction effect among the studied variables. Additionally, a comparison of samples’ sizes and densities before and two months after testing indicated no observable modifications When applied to custom orthotics (five pairs of insoles were customized and tested), the experimental findings documented variations in the reduction and distribution of peak plantar pressure based on the infill variability.

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.

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

BACKGROUND: High pressure in diabetic foot plantar areas causes ulcer formation, leading to disability and amputations. Around 25% of diabetics experience foot ulcers, with prevalence rates varying among Africans, Asians, and Europeans. Egypt has the highest rates, ranging from 6.1% to 29.3%. OBJECTIVE: To investigate the impact of functional ankle taping correction on plantar foot ulcer healing in diabetic patients. METHODS: A double-blinded randomized controlled trial design. A total of 70 patients with plantar foot ulcers PFUs were randomly divided into two groups: group A, which received ankle taping in addition to usual medical therapy and debridement, and group B, which received ankle taping without routine medical treatment and debridement. Over two months, all patients underwent evaluation using a Walkway pressure monitoring system, goniometer, wound workstation, and saline injection. This evaluation aimed to determine maximal peak plantar pressure, active ankle dorsiflexion, wound area, and volume sequentially. RESULTS: Initially, there was no meaningful difference between the two groups. However, after eight weeks of treatment, there was a substantial impact, as indicated by a p-value of 0.001 and an f-value of 87.49 for treatment effect at 95% CI.Furthermore, a statistically significant interaction was found between treatment and time in the ankle-taping group between pre-and post-treatment. However, no difference was identified in the control group. CONCLUSIONS: The correction of ankle taping has a significant impact on various factors, including peak plantar pressure, ankle dorsiflexion, wound area, and wound volume. This correction leads to a reduction in peak plantar pressure, wound area, and volume while also enhancing active ankle dorsiflexion.

Texture differences of microchambers and macrochambers in heel pads between the elderly with and without diabetes

ObjectiveThis study aims to use the texture analysis of ultrasound images to distinguish the features of microchambers (a superficial thinner layer) and macrochambers (a deep thicker layer) in heel pads between the elderly with and without diabetes, so as to preliminarily explore whether texture analysis can identify the potential injury characteristics of deep tissue under the influence of diabetes before the obvious injury signs can be detected in clinical management. MethodsUltrasound images were obtained from the right heel (dominant leg) of eleven elderly people with diabetes (DM group) and eleven elderly people without diabetes (Non-DM group). The TekScan system was used to measure the peak plantar pressure (PPP) of each participant. Six gray-level co-occurrence matrix (GLCM) features including contrast, correlation, dissimilarity, energy, entropy, homogeneity were used to quantify texture changes in microchambers and macrochambers of heel pads. ResultsSignificant differences in GLCM features (correlation, energy and entropy) of macrochambers were found between the two groups, while no significant differences in all GLCM features of microchambers were found between the two groups. No significant differences in PPP and tissue thickness in the heel region were observed between the two groups. ConclusionsIn the elderly with diabetes who showed no significant differences in PPP and plantar tissue thickness compared to those without diabetes, several texture features of ultrasound images were found to be significantly different. Our finding indicates that texture features (correlation, energy and entropy) of macrochambers could be used for early detection of soft tissue damage associated with diabetes.

Extended finite element analysis for the 2nd and 3rd metatarsals stress fracture during push-off

Metatarsal stress fractures (MSF), particularly the 2nd and 3rd MSF, are common injuries among athletes. Although there are several practices to reduce foot and ankle injuries, there is no injury prevention program specifically designed to minimize MSF. This is mainly due to the lack of information about the loadings/postures that cause MSF. Therefore, this study aimed to investigate dangerous loadings/postures potentially causing MSF during push-off (PO). The analysis was conducted with Finite Element Modelling (FEM), calibrated with the three-point bending test, and validated with peak plantar pressure (PPP) and fracture force measurement. Extended Finite Element Method was used for MSF simulation such that ten different foot and ankle configurations were designed, with five for each of the 2nd and 3rd MSF under pure vertical loadings. A more complex loading, ankle eversion/inversion during PO, was also examined for the MSF. The average error percentage for the calibration of the model with the three-point bending test was 3.05%. The average error percentages for the validation of the model with PPP and fracture force measurements were 18% and 30%, respectively. The outcomes of pure vertical loadings indicated the higher potential for the 2nd and 3rd MSF at 30% PO and 70% PO, respectively. The results of ankle eversion/inversion loadings represented that the most dangerous posture for MSF was 30° ankle eversion for the 3rd metatarsal at 70% PO. These results provide a guide, including what postures to avoid for the 2nd and 3rd MSF among people who are at high risk of MSF.

A cross sectional pilot study utilising STrain Analysis and Mapping of the Plantar Surface (STAMPS) to measure plantar load characteristics within a healthy population

BackgroundNo in-shoe systems, measuring both components of plantar load (plantar pressure and shear stress) are available for use in patients with diabetes. The STAMPS (STrain Analysis and Mapping of the Plantar Surface) system utilises digital image correlation (DIC) to determine the strain sustained by a deformable insole, providing a more complete understanding of plantar shear load at the foot-surface interface. Research questionsWhat is the normal range and pattern of strain at the foot-surface interface within a healthy population as measured by the STAMPS system? Is STAMPS a valid tool to measure the effects of plantar load? MethodsA cross-sectional study of healthy participants was undertaken. Healthy adults without foot pathology or diabetes were included. Participants walked 20 steps with the STAMPS insole in a standardised shoe. Participants also walked 10 m with the Novel Pedar® plantar pressure measurement insole within the standardised shoe. Both measurements were repeated three times. Outcomes of interest were global and regional values for peak resultant strain (SMAG) and peak plantar pressure (PPP). ResultsIn 18 participants, median peak SMAG and PPP were 35.01 % and 410.6kPa respectively. The regions of the hallux and heel sustained the highest SMAG (29.31 % (IQR 24.56–31.39) and 20.50 % (IQR 15.59–24.12) respectively) and PPP (344.8kPa (IQR 268.3 – 452.5) and 279.3kPa (IQR 231.3–302.1) respectively). SMAG was moderately correlated with PPP (r= 0.65, p < 0.001). Peak SMAG was located at the hallux in 55.6 % of participants, at the 1st metatarsal head (MTH) in 16.7 %, the heel in 16.7 %, toes 3–5 in 11.1 % and the MTH2 in 5.6 %. SignificanceThe results demonstrate the STAMPS system is a valid tool to measure plantar strain. Further studies are required to investigate the effects of elevated strain and the relationship with diabetic foot ulcer formation.

Efficacy of auxetic lattice structured shoe sole in advancing footwear comfort-From the perspective of plantar pressure and contact area.

Designing footwear for comfort is vital for preventing foot injuries and promoting foot health. This study explores the impact of auxetic structured shoe soles on plantar biomechanics and comfort, motivated by the integration of 3D printing in footwear production and the superior mechanical properties of auxetic designs. The shoe sole designs proposed in this study are based on a three-dimensional re-entrant auxetic lattice structure, orthogonally composed of re-entrant hexagonal honeycombs with internal angles less than 90 degrees. Materials fabricated using this lattice structure exhibit the characteristic of a negative Poisson's ratio, displaying lateral expansion under tension and densification under compression. The study conducted a comparative experiment among three different lattice structured (auxetic 60°, auxetic 75° and non-auxetic 90°) thermoplastic polyurethane (TPU) shoe soles and conventional polyurethane (PU) shoe sole through pedobarographic measurements and comfort rating under walking and running conditions. The study obtained peak plantar pressures (PPPs) and contact area across seven plantar regions of each shoe sole and analyzed the correlation between these biomechanical parameters and subjective comfort. Compared to non-auxetic shoe soles, auxetic structured shoe soles reduced PPPs across various foot regions and increased contact area. The Auxetic 60°, which had the highest comfort ratings, significantly lowered peak pressures and increased contact area compared to PU shoe sole. Correlation analysis showed that peak pressures in specific foot regions (hallux, second metatarsal head, and hindfoot when walking; second metatarsal head, third to fifth metatarsal head, midfoot, and hindfoot when running) were related to comfort. Furthermore, the contact area in all foot regions was significantly associated with comfort, regardless of the motion states. The pressure-relief performance and conformability of the auxetic lattice structure in the shoe sole contribute to enhancing footwear comfort. The insights provided guide designers in developing footwear focused on foot health and comfort using auxetic structures.

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.

Updates in the Management of Leg Length Discrepancy: A Systematic Review.

The aim of this study is to comprehensively investigate the recent literature on the management of leg length discrepancy (LLD). A thorough search of pertinent databases was done in order to find studies that satisfied the requirements for inclusion. A thorough search of PubMed, Web of Science, Scopus, and Science Direct was conducted to find pertinent literature. Rayyan Qatar Computing Research Institute (QRCI,Ar Rayyan, Qatar) was utilized during the whole operation.Eight studies, including a total of 345 patients, were included in our data, and 206 (59.7%) of them were males. Percutaneous epiphysiodesis was the surgical intervention of choice in four studies. LLD can be effectively corrected by temporary and permanent epiphysiodesis. One study reported the incidence of angular deformities following temporary epiphysiodesis. Circumferential periosteal and dual tension-band plating significantly reduced LLD, but reported the incidence of an "over-shoot" in some patients. Bilateral motion control shoes and orthotic insole both were found to improve the patient's gait and trunk symmetry, evidenced by longer and faster steps, reduced ground impact at heel strike, and lower peak plantar pressure in both limbs.Our findings confirm that no inferences about the superiority of a particular management approach for the treatment of LLD can be made. The poor quality of the studies shows that more randomized control trials and prospective studies on the subject are required.

Does plantar pressure in short-term standing differ between modular insoles selected based upon preference or matched to self-reported foot shape?

Prolonged workplace standing is commonplace and associated with a range of lower limb issues. Evaluating footwear interventions aiming to modify plantar pressure during standing is essential as the body is static, creating a different requirement for footwear. Previous research associates medial midfoot pressure with greater perceived comfort and identifies arch height as the most variable element of foot shape. Targeting footwear mass customization within this area may better address differences within the target wearers. This study aims to evaluate a modular insole system for its ability to modify plantar pressure during standing. Twenty-five participants completed a static and dynamic standing protocol for 60 seconds whilst measuring in-shoe peak and mean plantar pressure (KPa) and contact area (%). Individuals wore three insole options targeted towards different medial arch shapes (A– low arch, B– medium arch, C– high arch) and rated them for comfort. Participants received guidance to self-identify foot shape (low, medium, or high arch). Comparisons were drawn across the three insole profiles and between the insole rated as most comfortable (preferred), and the insole that matched the self-identified foot shape (matched). As insole arch height increased, medial midfoot pressure and contact area significantly increased, alongside significant reductions in first metatarsal pressure and contact. Preference was spread across insoles A, B, and C (56%, 32%, 12% of participants, respectively). Sixteen participants had different matched and preferred insoles, with significantly greater medial midfoot pressure and contact in the matched insole. The modular insole enabled different wear experiences, however, results suggest that individuals selected insoles lower than their foot shape. Providing adequate medial arch support enables redistribution of pressure which may enable greater comfort during the workday.

Asymmetry of peak plantar pressure in transfemoral amputees during indoor and outdoor walking

This study investigates the differences in peak plantar pressure between the amputated and intact limbs of transfemoral amputees when walking outdoors. Ten non-amputees (aged 24.4 ± 2.0 years, 176.9 ± 2.5 cm, 72.3 ± 7.9 kg) and six transfemoral amputees (48.5 ± 6.3 years, 173.8 ± 4.2 cm, 82.0 ± 11.9 kg) participated in the study. Over approximately 1.6 km, the participants encountered various obstacles, including stairs, uneven surfaces, hills, and level ground, both indoors and outdoors. Throughout the walking session, the peak plantar pressure in both feet was monitored using wearable insole sensors. For all terrains, the percentage asymmetry was determined. Significant changes in peak plantar pressure asymmetry were found between the intact and amputated limbs, particularly when walking on level ground indoors, uneven terrains, descending stairs, and on steep slopes outdoors (all p < 0.05). These findings highlight the greater peak plantar pressure asymmetry in transfemoral amputees when walking outside. In addition, this study revealed that not all terrains contribute uniformly to this asymmetry.

Numerical Analysis of the Plantar Pressure Points during the Stance Phases for the Design of a 3D-Printable Patient-Specific Insole

The study of the phenomena occurring in the plantar region is remarkably intriguing, especially when performing a normal gait cycle where the foot is under loading conditions. The effects presented in the foot while walking provide relevant indicators regarding clinical means for enhancing regular performance or rehabilitation therapies. Nevertheless, more than traditional methods are needed to biomechanically evaluate foot structural conditions, leading to an incomplete database for determining the patient’s needs so that advanced methodologies provide detailed medical assessment. Therefore, it is necessary to employ technological engineering tools to optimize biomechanical plantar pressure evaluations to reach suitable personalized treatments. This research initially evaluated numerically the pressure points in the foot sole region in each one of the five stance phases in a normal gait cycle. Medical imaging techniques were utilized to construct an anatomically accurate biomodel of the soft tissues of the right foot. The Finite Element Method was employed to predict peak plantar pressure in barefoot conditions for all stance phases; results from this case study presented a close alignment with gait experimental testing implemented to analyze the feasibility and validation of all mechanical considerations for the numerical analyses. Hence, having a solid foundation in the biomechanical behavior from the first case study close estimates, a 3D-printable patient-specific insole was designed and numerically analyzed to observe the mechanical response in the plantar critical zones utilizing a personalized orthotic device. Results from the second case study notably demonstrated a crucial decrement in excessive pressure values. Employing morphological customization orthopedics modeling combined with 3D-printable materials is revolutionizing assistive device design and fabrication techniques. The fundamental contribution of this research relies on deepening the knowledge of foot biomechanics from an interdisciplinary approach by numerically analyzing pressure distribution in critical regions for all five stances phases; thus, based on the methods employed, the results obtained contribute to the advances of patient-specific foot orthopedics.

Plantar pressure analysis of different orthoses in patients after first metatarsophalangeal joint arthrodesis.

There is no gold standard for a walking orthosis after first metatarsophalangeal joint (MTPJ) arthrodesis surgery. Evaluation of plantar pressure measures and patient perceptions for different orthoses may assist surgeons to choose a postsurgery orthotic. The purpose of this study was to measure plantar pressure under the distal first ray during walking and patient perceptions of comfort, stability, and preference with 4 different orthoses in patients with a history of first MTPJ arthrodesis. Crossover study in a university laboratory. Eleven patients volunteered (8 female, 3 male, age = 59.4 ± 9.1 years, 21.9 ± 17.5 months since surgery) who had a unilateral first MTPJ arthrodesis procedure more than 6 months before study participation. Four orthosis conditions were evaluated in all participants: patient's shoe, carbon fiber insert, OrthoWedge, and Post-Op Shoe. We analyzed peak plantar pressure and pressure-time integral under the whole foot and the distal first ray as well as recorded subjective rating for comfort and stability. Rank ordered for preferred orthosis. OrthoWedge had significantly lower whole-foot and distal first ray peak pressure than the other conditions. The pressure-time integral for the OrthoWedge was significantly less than the Carbon Fiber Insert and Post-Op Shoe. For stability, comfort, and condition preference, the OrthoWedge was ranked lowest among the 4 conditions. The OrthoWedge generated the lowest peak plantar pressure but was subjectively ranked as the least preferred orthosis. This discrepancy between objective biomechanical and subjective comfort measures must be weighed as surgeons prescribe an orthosis to patients after first MTPJ arthrodesis.

349 Addressing the Gaps in Diabetic Foot Ulcer Management: Prediction and Prevention

OBJECTIVES/GOALS: Globally, diabetes affects 537 million people and 15-25% will develop a foot ulcer in their lifetime. Diabetic foot ulcers (DFU) tend to be chronic and non-healing due to the poor wound healing environment, leading to infection or amputation. Our study aims to develop a method to predict and prevent DFU formation. METHODS/STUDY POPULATION: Our preliminary plan is to develop a method to detect high plantar pressures, coupled with the ability to automatically adjust an orthotic device to offload excess pressure. Our current aim is to create a “smart orthotic” which will link with foot mapping technology to automatically offload high pressure areas, reducing the need for a separate clinic visit for orthotic adjustment. We aim to prove that our device will normalize plantar pressure distribution, which will prevent callus and subsequent DFU formation. The current target population includes those with diagnosed diabetes and are ambulatory. RESULTS/ANTICIPATED RESULTS: With our technology, we anticipate normalization of plantar pressure distribution in a more frequent fashion than is currently done. Because annual orthotic fittings, which is current standard of care, do not provide regular enough adjustments to match the rate of diabetic foot structural changes and peak plantar pressure redistribution, our device will address two gaps in management. One, patients will receive near-instantaneous changes in plantar pressure offloading, allowing for near continuous orthotic customization. Secondly, our device would reduce the clinical appointment burden, which would be especially important for patients with multiple medical comorbidities or experience other barriers to accessing healthcare. DISCUSSION/SIGNIFICANCE: While DFUs are commonplace and their complications are well recognized, there still exists a gap in ulcer prevention. Our proposed solution will redistribute pathologic plantar pressures, allow for more frequent monitoring, automatic therapy, and aid in the management of high ulcer risk patients.

Sonification of plantar pressure in runners with and without pain after running practice

PurposeHumans interact with the environment using sensory channels. Although vision is the main sensory channel, the auditory channel is excellent for learning when trained. Movement learning via auditory inputs requires sound analysis, such as sonification.MethodsData on peak plantar pressure from 43 recreational runners were collected using Flexinfit resistive insoles. Participants wore Run Falcon 1.0 (Adidas) running shoes and were categorised into four groups: without pain; spine or hip pain; thigh or knee pain; and leg, ankle, or foot pain. Participants responded to whether they presented pain and whether it was related to running (training or races). Sonification data were collected using the TwoTone software. We used the C note in the first octave to transform numerical data into sounds according to the pressure magnitude. The sound file was decomposed using the Audacity software into a spectrogram illustrating the main frequency components and their amplitudes.ResultsThe spectrogram made it possible to identify qualitative differences between the runners with and without pain after running. The frequency spectrum showed that some frequencies had greater sound intensity in runners without pain.ConclusionsOur results indicated differences between runners with and without pain after running using sonification. The frequency spectrum also indicated a difference in the sound intensity produced between the groups at specific frequencies.

Plantar pressure gradient and pressure gradient angle are affected by inner pressure of air insole.

Clinically, air insoles may be applied to shoes to decrease plantar pressure gradient (PPG) and increase plantar gradient angle (PGA) to reduce foot ulcers. PPG and PGA may cause skin breakdown. The effects of different inner pressures of inflatable air insoles on dynamic PPG and PGA distributions are largely unknown in non-diabetics and people with diabetes. This study aimed to explore the impact of varying inner air insole pressures on PPG and PGA to establish early mitigation strategies for people at risk of foot ulcers. A repeated measures study design, including three air insoles (80mmHg, 160mmHg, and 240mmHg) and two walking durations (10 and 20min) for a total of six walking protocols, was tested on 13 healthy participants (height, 165.8 ± 8.4cm; age, 27.0 ± 7.3years; and weight, 56.0 ± 7.9kg, BMI: 20.3 ± 1.7kg/m^2) over three consecutive weeks. PPG, a measurement of the spatial variation in plantar pressure around the peak plantar pressure (PPP) and PGA, a variation in the gradient direction values at the three plantar regions, big toe (T1), first metatarsal head (M1), and second metatarsal head (M2), were calculated. This study indicated that PPG was lower at 80mmHg air insoles after 20min of walking in the M1 region (p = 0.010). The PGA in the M2 increased at an air insole of 80mmHg compared to 240mmHg (p = 0.015). Compared to 20min, the 10min walking duration at 240mmHg of air insole had the lowest PPG in the M1 (p = 0.015) and M2 (p = 0.034) regions. The 80mmHg air insole significantly lowered the PPG compared to a 160mmHg and 240mmHg air insole. Moreover, the 80mmHg air insole significantly decreased PPP and increased PGA compared to the 160mmHg and 240mmHg air insole. A shorter walking period (10min) significantly lowered PPG. The findings of this study suggest that people with a higher risk of foot ulcers should wear softer air insoles to have a lower PPG, as well as an increased PGA.

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.