Plantar Pressure Changes Research Articles

Plantar pressure is changed to increase post-impact ball speed during longline forehand and backhand groundstroke in elite female tennis players.

Achieving high ball speed during the execution of groundstrokes represents a performance-relevant factor in tennis. However, it is unclear how plantar pressure data undergo change during the execution of groundstrokes by tennis players to achieve high postimpact ball speed. Thus, the objective of the present study is to determine how tennis players change the plantar pressure in each foot when they execute longline forehand and backhand groundstrokes in order to increase postimpact ball speed. Seventeen healthy nationally ranked female tennis players (mean age: 21.7 ± 7.7 years) participated in this study. The players performed longline forehand and backhand groundstrokes (topspin) at four postimpact ball speed levels, i.e., at 80 km/h, 90 km/h, 100 km/h, and vmax. Plantar pressure was measured in each foot [i.e., dominant (equals the stroke arm) and non-dominant] using flexible instrumented insoles. Irrespective of the stroke technique, the repeated measures ANOVA procedure showed significant ball speed × foot dominance interactions. For the forehand stroke, post hoc analyses revealed significantly increased (dominant foot) and decreased (non-dominant foot) pressure values when the postimpact ball speed increased from 100 km/h to vmax. For the backhand stroke, the post hoc analyses yielded significantly decreased (dominant and non-dominant foot) plantar pressure values when the postimpact ball speed increased from 100 km/h to vmax. There were no further significant differences between the other ball speed levels. The significantly varying plantar pressure changes depending on the stroke technique and foot dominance to increase postimpact ball speed suggest that specific physical exercises related to the foot (dominant vs. non-dominant foot) and groundstroke (forehand vs. backhand) seem to be necessary for plantar pressure optimization.

Stiffness-tunable and self-sensing integrated soft machines based on 4D printed conductive shape memory composites

Through the synergy of nervous system and the self-regulation of muscle stiffness, living organisms are capable of quickly adjusting movements and actively adapting to dynamic environments. Likewise, the stiffness-changing and self-sensing functionalities are critical to empower soft robots with adjustable load capacity and agile movement. This work presents a paradigm for the design and fabrication of soft actuators with stiffness tunability and intrinsic self-sensing feedback through 4D printing method. The integration of 4D printed conductive composite into soft actuator body allows for stiffness adjustment within three orders of magnitude and ensures real-time stiffness-sensing, bending-sensing and pressure-sensing feedback. By constructing the theoretical deformation models and decoupling the resistance signals by machine learning methods, information on the stiffness, deformation and pressure of the material at different temperatures can be obtained. Cardiac-mimicking actuator and active therapeutic insoles are fabricated as proof-of-concept demonstrations, among which the active therapeutic insoles can perceive plantar pressure changes and conduct pressure-releasing actuation to ease the pain of patient at walk. It demonstrates the potential of this design approach for versatile applications such as medical assistive devices, artificial muscles, soft robotics, etc.

Analysis of Diabetic Foot Deformation and Plantar Pressure Distribution of Women at Different Walking Speeds.

Official guidelines state that suitable physical activity is recommended for patients with diabetes mellitus. However, since walking at a rapid pace could be associated with increased plantar pressure and potential foot pain, the footwear condition is particularly important for optimal foot protection in order to reduce the risk of tissue injury and ulceration of diabetic patients. This study aims to analyze foot deformation and plantar pressure distribution at three different walking speeds (slow, normal, and fast walking) in dynamic situations. The dynamic foot shape of 19 female diabetic patients at three walking speeds is obtained by using a novel 4D foot scanning system. Their plantar pressure distributions at the three walking speeds are also measured by using the Pedar in-shoe system. The pressure changes in the toes, metatarsal heads, medial and lateral midfoot, and heel areas are systematically investigated. Although a faster walking speed shows slightly larger foot measurements than the two other walking speeds, the difference is insignificant. The foot measurement changes at the forefoot and heel areas, such as the toe angles and heel width, are found to increase more readily than the measurements at the midfoot. The mean peak plantar pressure shows a significant increase at a faster walking speed with the exception of the midfoot, especially at the forefoot and heel areas. However, the pressure time integral decreases for all of the foot regions with an increase in walking speed. Suitable offloading devices are essential for diabetic patients, particularly during brisk walking. Design features such as medial arch support, wide toe box, and suitable insole material for specific area of the foot (such as polyurethane for forefoot area and ethylene-vinyl acetate for heel area) are essential for diabetic insole/footwear to provide optimal fit and offloading. The findings contribute to enhancing the understanding of foot shape deformation and plantar pressure changes during dynamic situations, thus facilitating the design of footwear/insoles with optimal fit, wear comfort, and foot protection for diabetic patients.

The pressure time integral: An underused, clinically significant parameter as a determinant of neuropathic ulceration in diabetes

BackgroundThe purpose of this study was to evaluate plantar pressure dynamics in the occurrence of active diabetic neuropathic ulceration (DNU) and any changes in loadings occurring in individuals with a history of diabetic neuropathic ulceration (DHNU). Since current gold standard offloading strategies are not producing desirable healing outcomes and optimum ulcer prevention, this study aimed to better understand the effect of diabetic peripheral neuropathy (DPN) and ulceration on mean peak plantar pressure (MPPP) and pressure-time integral (PTI) changes. Research questionIs there a redistribution of plantar pressure during gait in the presence of active and history of diabetic neuropathic ulceration? MethodsA prospective, cross-sectional study was conducted, in which, eighty adult participants were divided into four groups, namely, the DM, DPN, DNU and DHNU groups. Participants were instructed to walk barefoot over a Tekscan HR Mat™ at self-selected speed. MPPP and PTI data were analysed under five forefoot anatomical landmarks and compared between individuals with and without active neuropathic ulceration. ResultsMinimal MPPP significant changes were observed between ulcerated and non-ulcerated groups, however, PTI values were significantly increased in the ulcerated groups under all plantar ulceration regions. No significant plantar pressure differences were observed between the DNU and DHNU groups. Logistic regression tests demonstrated that as PTIs under the hallux increase, the likelihood of an individual living with DPN developing ulceration increases. SignificanceA significant increase in PTI values in the presence of ulceration highlights the importance of evaluating the duration of loads under forefoot regions during gait rather than just focusing on the magnitude of pressures during ulcer management and prevention. Moreover, results show that PTI values remain high in the presence of a history of neuropathic ulceration, possibly demonstrating the value of PTI as a clinical tool over MPPP in the assessment of the high-risk diabetic foot.

The Foot and Ankle Kinematics of a Simulated Progressive Collapsing Foot Deformity During Stance Phase: A Cadaveric Study.

Progressive collapsing foot deformity (PCFD) is a complex pathology associated with tendon insufficiency, ligamentous failure, joint malalignment, and aberrant plantar force distribution. Existing knowledge of PCFD consists of static measurements, which provide information about structure but little about foot and ankle kinematics during gait. A model of PCFD was simulated in cadavers (sPCFD) to quantify the difference in joint kinematics and plantar pressure between the intact and sPCFD conditions during simulated stance phase of gait. In 12 cadaveric foot and ankle specimens, the sPCFD condition was created via sectioning of the spring ligament and the medial talonavicular joint capsule followed by cyclic axial compression. Specimens were then analyzed in intact and sPCFD conditions via a robotic gait simulator, using actuators to control the extrinsic tendons and a rotating force plate underneath the specimen to mimic the stance phase of walking. Force plate position and muscle forces were optimized using a fuzzy logic iterative process to converge and simulate in vivo ground reaction forces. An 8-camera motion capture system recorded the positions of markers fixed to bones, which were then used to calculate joint kinematics, and a plantar pressure mat collected pressure distribution data. Joint kinematics and plantar pressures were compared between intact and sPCFD conditions. The sPCFD condition increased subtalar eversion in early, mid-, and late stance (P < .05), increased talonavicular abduction in mid- and late stance (P < .05), and increased ankle plantarflexion (P < .05), adduction (P < .05), and inversion (P < .05). The center of plantar pressure was significantly (P < .01) medialized in this model of sPCFD and simulated stance phase of gait. Subtalar and talonavicular joint kinematics and plantar pressure distribution significantly changed with the sPCFD and in the directions expected from a PCFD foot. We also found that ankle joint kinematics changed with medial and plantar drift of the talar head, indicating abnormal talar rotation. Although comparison to an in vivo PCFD foot was not performed, this sPCFD model produced changes in foot kinematics and indicates that concomitant abnormal changes may occur at the ankle joint with PCFD. This study describes the dynamic kinematic and plantar pressure changes in a cadaveric model of simulated progressive collapsing foot deformity during simulated stance phase.

Factors associated with changes in plantar pressure of people with peripheral diabetic neuropathy.

Diabetic neuropathy is one of the main complications of Diabetes Mellitus, which can lead to loss of protective sensation, motor, and plantar pressure alteration, generating deformities, abnormal gait and mechanical trauma to the feet. to evaluate the distribution of plantar pressure, sensorimotor changes, balance and associated factors to plantar pressure changes in people with peripheral diabetic neuropathy. Cross-sectional study conducted with individuals registered in the primary public health service of a city in the east of São Paulo - Brazil. The sample was composed by people with Diabetes Mellitus and Peripheral Neuropathy identified by the Michigan Screening Instrument. It were investigated variables such as sensory-motor changes, static and dynamic plantar pressure using baropodometry and balance using the Berg scale. A significance level of 5% was adopted for all tests used. Of the 200 individuals evaluated, 52.55% had no plantar protective sensitivity, the static evaluation did not demonstrated changes in the peak of plantar pressure, however in the dynamics the mean in the right foot was 6.0 (±2) kgf/cm2 and 6,7 (±1.62) kgf/cm2 on the left foot, the center of static pressure on the right foot was lower (10.55 ± 3.82) than on the left foot (11.97 ± 3.90), pointing hyper plantar pressure. The risk of falling was high, ranging from 8 to 56 points, with an average of 40.9 (±10.77). The absence of protective plantar sensitivity, increased pressure, biomechanical changes lead to loss of balance and are predictive of complications in the feet due to diabetic neuropathy.

3-10 YAŞINDAKİ ÇOCUKLARDA MEDİAL LONGİTUDUNAL ARKIN GELİŞİMİ

Purpose: It is very important to follow the development of the medial arch in children and to detect it in the early period in case of developmental deficiency. The aim of this study is to determine the development of medial arch in children by investigating the change in plantar contact area ratio and pressure with age. Materials and Methods: 51 (16 girls, 35 boys) healthy children (3-10 years old) whose consent was obtained by their families with the randomization method evaluated on the foot sole pressure measuring device were included in our study. For evaluation, medial and lateral of the anterior part of the foot, medial and lateral of the middle part, and medial and lateral of the posterior part of the foot were divided into six. In our study, the ratio of the contact surfaces of the determined areas of the foot to the entire foot sole area and the sole pressure per unit surface were statistically evaluated according to age. The obtained data were analyzed with descriptive statistics and percentage analyzes in the SPSS 11 package program. Results: As a result of the statistical analysis, no statistically significant difference was found between the plantar pressure and contact area ratio values of the right and left foot regions (p&amp;gt;0.05). In the analysis of the plantar pressure value according to age, there was no significant difference between the 9th and 10th ages of 3,4 and 5 years of age only in the medial of the midfoot (p&amp;gt;0.05). In plantar contact area ratios; While there was a significant increase in the medial part of the anterior part of the foot and the lateral part of the posterior part of the foot above the age of 8, there was a significant decrease in the medial part of the middle part of the foot (p&amp;lt;0.05). Conclusion: According to the results we obtained, it was determined that 8 years of age is important in the development of MLA and with the development of the arch, foot contact is transferred from the medial of the anterior part of the foot to the lateral part of the posterior part of the foot.

Effectiveness of the Fixtoe Device® in plantar pressure reduction: a preliminary study

BackgroundMetatarsalgia is a common foot condition. The metatarsophalangeal stabilizing taping technique described by Yu et al. has shown good clinical results as a provisional treatment in propulsive metatarsalgia. 35 The Fixtoe Device®, a novel orthopedic device, intends to simulate stabilizing tape. However, to date, there is no evidence of its effectiveness. The aim of this study was to assess plantar pressure changes using the Fixtoe Device®, in comparison with the traditional method (stabilizing tape) in a young, healthy sample thorough a cross-sectional study.MethodsMaximal pressure (Kpa) and pressure–time integral (Kpa/s) in the second metatarsal head were measured in twenty-four healthy volunteers. Registers were taken in four different conditions: barefoot, traditional stabilizing tape, Fixtoe Device® without metatarsal pad, and Fixtoe Device® with metatarsal pad.ResultsMean second metatarsal head maximal pressure and mean pressure–time integral showed statistical difference among the four analyzed conditions (p < 0.0001 in both cases). The improvement in maximal pressure and pressure–time integral obtained in each intervention also showed significance (p < 0.0001 in both cases). Comparing the improvement of the Fixtoe Device® with and without metatarsal pad with that of tape condition showed a moderate to high and moderate effect size for both peak pressure and pressure–time integral reduction.ConclusionsThe Fixtoe Device® reduces median maximal pressure and median pressure–time integral under the second metatarsal head in healthy young individuals. The Fixtoe Device® shows higher effectiveness than the traditional second metatarsophalangeal joint stabilizing taping technique. To our knowledge, this is the first investigation proving the effectiveness of the recently developed Fixtoe Device® in terms of plantar pressure modification, which leads the way to its use in clinics.

IDF21-0225 Research on influencing factors of dynamic plantar pressure in diabetic patients based on intelligent shoe system

Background: The abnormal size and distribution of plantar pressure in diabetic patients is an important factor affecting the formation of foot ulcers, which can predict the occurrence of foot ulcers in patients early. The intelligent shoe testing system makes up for the shortage of force measuring plate and force measuring table, continuously and dynamically monitoring the patient’s plantar pressure parameters for a long time. When there is a disease condition in the foot of a diabetic patient, the foot function appears abnormal, causing abnormal changes in plantar pressure.

Changes in Plantar Pressures and Ground Reaction Force in Healthy Adults When Walking a Dog On-Lead: A Pilot Study

Changes in Plantar Pressures and Ground Reaction Force in Healthy Adults When Walking a Dog On-Lead: A Pilot Study

The effectiveness and sustainability of supervised balance training in chronic ankle instability with grade III ligament injury: a one-year prospective study

BackgroundTo determine the effectiveness and sustainability of supervised balance training in people with chronic ankle instability (CAI) with grade III ligament injury.MethodsTwenty young adults (12 males and 8 females) diagnosed with CAI with grade III ligament injury underwent 3 months of supervised balance training. The self-reported functional questionnaire, plantar pressure (walking and single leg standing), and isokinetic ankle strength were consecutively evaluated at pre-training, 3 months, 6 months and one year. Paired T tests were used to explore changes in muscle strength and plantar pressures following the supervised balance training. According to whether the patient had sprain recurrence, the patients were divided into sprain recurrence group and control group. The risk factors of sprain recurrence were explored with univariate analysis and multivariable logistic regression.ResultsThe self-reported functional scores, the plantar pressure distribution and the muscle strength showed significant immediate improvements after 3 months of supervised balance training. At 6 months post-training, peak force under 2nd metatarsal, time to peak force under the medial hindfoot, time to boundary measurements and dorsiflexion, and eversion strength were partly declined to the pre-training level. 16 patients (80%) resumed the daily life and sports without sprain recurrence during the follow-up. Four patients (20%) reported ankle sprain during the follow-up, and the sprain recurrence group showed significantly higher Beighton scores (p = 0.012) and weaker initial inversion strength (p = 0.022) than the control group.ConclusionsThree months’ of supervised balance training could effectively improve postural control and muscle strength of CAI cases with grade III ligament injury, although these improvements would partially deceased over time. Additional strength exercises for dorsiflexion and eversion should be supplemented from 6 months. Higher Beighton score and initial inversion muscle strength weakness might increase the risk of sprain recurrence.Trial registrationChiCTR, ChiCTR1900023999, Registered 21 June 2019, https://www.chictr.org.cn/edit.aspx?pid=39984&htm=4

Changes in Plantar Forces and Pressures During Functional Movement with an Intrepid Dynamic Exoskeletal Orthosis Brace

Category:Ankle; Ankle Arthritis; Midfoot/Forefoot; TraumaIntroduction/Purpose:Non-surgical interventions such as bracing using ankle foot orthoses (AFO) aim to assist, restore and redirect weightbearing forces with immobility in mind. We identified a custom carbon fiber specific energy storing AFO that was created to improve functional performance in veterans after limb salvage procedures. While being evaluated exclusively in a veteran population, the Intrepid Dynamic Exoskeletal Orthosis (IDEO) has also been indicated to be a conservative treatment option for veterans with posttraumatic osteoarthritis of the tibiotalar and subtalar joints. To evaluate the off-loading properties of the IDEO brace in a civilian population with osteoarthritis of the ankle.Methods:Eight civilian patients 18-years or older who were prescribed an IDEO brace by a single surgeon participated in the study. Foot pressure data were recorded using Tekscan F-Scan system, an ultra-thin, in-shoe sensor that provides force and pressure information. Participants were instructed to walk at a self-selected pace along a 20 meter walkway under three conditions. Using F-Scan Research software, the stances were identified and averaged. Then, the forefoot and heel areas were identified. Next, the maximal force, force*time integral (FTI), maximal contact area, maximal contact pressure, pressure*time integral (PTI), and center of force (COF) excursion were calculated. One-way ANOVA with repeated measures was performed to detect effects of the condition (three levels: Without, Under and Over). Pairwise comparison with least significant difference (equivalent to no adjustments) was performed to detect difference among the conditions.Results:Compared to the Without condition, the Under condition showed higher pressure in both the heel and the forefoot areas (especially in the forefoot) in most subjects; COF excursion was increased in some subjects. Compare to the Without condition, the Over condition showed reduced pressure in both the heel and the forefoot areas (especially in the forefoot) in most subjects. The statistical results below only included the involved side of the six subjects who were tested in all three conditions. Table 1 showed the results of one-way ANOVA with repeated measures of the six subjects.Conclusion:The results of this study showed that the IDEO is effective in improving gait function and relieving forefoot pressure in the civilian population. IDEO generated force (and thus power), especially in the forefoot area in late stance, to provide more push-off power and propel the body moving forward. While acting as a functional foot, the IDEO reduced force by 66% and reduced pressure by 49% in the forefoot area, which helped to relieve pain. IDEO creates functional foot by storing power in the early stance and release power in late stance.

Plantar pressure distribution and perceived comfort in hiking boots with different heel-to-toe drops before and after 45 minutes of walking

The purpose of this study was to investigate the influence of heel-to-toe drop (heel drop) modifications of a hiking shoe on plantar pressure distribution and perceived comfort before and after walking. Data of three shoe conditions with a low (11 mm), medium (16 mm) and high (21 mm) heel drop were obtained of twelve healthy male participants (mean age: 23.8 ± 2.8 yrs.) before (pre-test) and after a 45-minute walk in a park (post-test). Two-way repeated-measures analysis of variance (ANOVA) was applied to investigate differences between the three shoe types at the two time points and over time. Post-hoc analyses showed few significant differences in pressure and comfort parameters between shoe conditions at the two time points. Over time, however, several significant changes in comfort measures and pressure distribution were observed depending on the shoe condition. Most of the plantar pressure changes were seen in the hiking shoe with the medium heel drop showing significantly increased pressures values in the toe and forefoot area after the walk. Comfort measures deteriorated from the pre-to the post-test, in particular for the hiking shoe with the high heel drop. The results of the study showed that comfort and pressure parameters altered from walking for 45 minutes depending on the shoe condition and that the modification of the heel drop affected pressure parameters and comfort parameters in different ways. These findings may have implications for future considerations of values for the heel drop in hiking shoes.

The effect of induced joint restriction on plantar pressure during gait - a pilot study.

The aim of this study was to analyse the effect of induced lower limb joint restriction on plantar pressures during gait. Focusing on restricting a single joint, without the effect of other co-morbidities, would provide better understanding as to the resultant plantar loadings during gait, which would be especially beneficial in patients requiring offloading procedures. Does induced lower limb joint restriction affect plantar pressure distribution during gait? A prospective, quasi-experimental study was conducted, recruiting ten healthy, adult participants who were instructed to walk barefoot over a Tekscan HR Mat™. This procedure was repeated after separately inducing restriction of the hip, knee and ankle joints. Mean peak plantar pressure (MPP) and pressure-time integral (PTI) data were analysed to compare between unrestricted and restricted data. Significant plantar pressure changes were observed in the heel and first metatarsal regions. Rearfoot PTIs were increased with restriction of the contralateral hip (left p <0.001) (right p =0.02) and knee joints (left p =0.01) (right p =0.04). Both MPPs (left p =0.01; right p =0.01) and PTIs (left p =0.004; right p =0.03) were increased in the first metatarsal when restricting the hip joint of the same limb. MPP was decreased in the left first metatarsal with induced knee (left p =0.01; right p =0.04) and ankle (left and right p <0.001) joint restriction. Finally, MPP was decreased in the right first metatarsal with knee (left and right p =0.01) and ankle (left p =0.04; right p =0.01) joint restriction. Limited joint mobility may have a direct effect on plantar pressure, particularly with restriction in the hip and knee joints, hence careful attention should be given especially in patients with conditions involving plantar loadings. Results in this study also show that PTI changes during gait should be equally evaluated clinically along with peak plantar pressure analysis.

Pedobarographic Statistical Parametric Mapping of plantar pressure data in new and confident walking infants: A preliminary analysis

In infancy, plantar pressure data during walking has been investigated through regional approaches, whilst the use pedobarographic Statistical Parametric Mapping (pSPM) has not been reported. Analysis of pressure data using pSPM is higher in resolution and can enhance understanding of foot function development, providing novel insights into plantar pressure changes. This work aims to detail the implementation of the pSPM data processing framework on infants' pressure data, comparing plantar pressure patterns between new and confident walking steps. Twelve infants walked across an EMED- xl platform. Steps were extracted and imported into MATLAB for analysis. Maximum pressure pictures were transformed to point clouds and registered within and between participants with iterative closest point and coherent point drift algorithms, respectively. Root mean square error (RMSE) was calculated within both registrations as a quality measure. Pressure patterns were compared between new and confident walking using nonparametric-paired sample SPM1D t-test. RMSEs were under 1 mm for both registration algorithms. In the transition to confident walking, significantly increasing pressure was detected in the left central forefoot. Implementing pSPM to infants' pressure data was non-trivial, as several phases of data processing were required to ensure a robust approach. Our analysis highlighted the presence of significant changes in pressure in central left forefoot after 2.2 months of walking, which have not been reported before. This can be explained as previous regional approaches in infancy considered the forefoot as whole, preventing detection of changes in discrete anatomical regions.

Changes in plantar pressure, contact area and contact time symmetry during the gait 4 weeks before and 12 and 24 weeks after unilateral total hip arthroplasty

BackgroundFoot to ground pressure changes in total hip arthroplasty patients' gait are not widely described, although they are sensitive to gait abnormalities and the distribution of plantar pressures may differ before and after the surgery. This study aimed to analyse longitudinally differences in plantar pressure during gait in total hip arthroplasty patients compared to healthy controls. MethodsEighteen males participated in this study. Eight males, who underwent unilateral total hip arthroplasty, participated at the data collection three times: 4 weeks before the surgery, 12 and 24 weeks after, and ten healthy controls. All participants were asked to walk over Emed platform. To compare differences between the affected and unaffected limbs, Kolmogorov-Smirnov test was used. Kruskal-Wallis test was used to compare the difference between total hip arthroplasty patients and healthy controls. FindingsStatistically significant differences between the affected and unaffected limb were observed only during the preoperative measurement in peak pressure at MH4 area and in the contact area at MH4 and big toe. When comparing total hip arthroplasty patients and controls, a difference in the contact time at MH2, MH3 and MH4 areas 12 weeks after surgery and at MH2 and MH4 24 weeks after the surgery were observed. InterpretationThe shorter contact time at forefoot areas may indicate an alteration in the propulsive phase of the gait of both the affected limb and unaffected limb in total hip arthroplasty patients as a result of decreased terminal hip extension during the stance phase described in previous studies.

Dynamic Characteristics of Foot Development: A Narrative Synthesis of Plantar Pressure Data During Infancy and Childhood.

Quantifying plantar pressure throughout childhood enables clinicians to enhance knowledge of typical changes in foot function. This narrative review aims to describe existing research reporting plantar pressure analysis in infants and children developing typically, to advance understanding of foot development. A narrative approach was used; 263 articles were identified and 13 met inclusion criteria. Plantar pressures during walking rapidly change in infancy and childhood. With development, pressures increasingly resemble those in adults with the development of initial heel contact, shift in pressure distribution from medial to lateral foot side, decreasing midfoot pressure magnitude. The literature has a variety of study designs, data collection protocols, and analysis. This review describes plantar pressure changes occurring as walking develops, emphasizing the typical trajectory of foot function development in infancy and childhood. The present finding describes the complex biomechanical development of foot function in typically developing infancy and childhood.

Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy of the Lesser Toes: Clinical, Radiologic, and Pedobarographic Outcomes.

The minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) is a percutaneous operative technique with the aim to relieve the symptoms of metatarsalgia. To our knowledge, no previous research has analyzed both pre- and postoperative pedobarographic data including the changes in plantar pressure. Thirty patients (31 feet) were operated on with a DMMO and included in a prospective study. Clinical, radiologic, and pedobarographic outcomes were evaluated in comparison with the preoperative parameters. The American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score, the Foot Function Index (FFI), the Foot and Ankle Outcome Score (FAOS), and a visual analog scale (VAS) for pain were used in order to assess clinical parameters. Radiographs were taken to compare metatarsal lengths. The pedobarographic analysis served to determine plantar peak pressure (PPP) beneath the metatarsophalangeal (MTP) joints. All scores indicated a significant mean pre- to postoperative improvement (AOFAS = 31.9 points, FAOS = 16.3%, FFI = 24.3%, VAS pain = 4.1 points, VAS general limitation = 3.3 points) (P < .05). PPP was substantially reduced in the relevant area (M6 [plantar area beneath the second and third MTP joint] had a mean pre to post PPP = 14.15 N/cm2) and concurrently higher in the lateral and medial MTP joint areas (M5 mean pre to post = +14.37, M7 pre to post = +7.11). Our mean metatarsal shortening was 6.6 mm. However, our findings do not demonstrate a significant correlation between metatarsal length relationships and the prevalence of metatarsalgia. Our results demonstrate a significant improvement in clinical scores and PPP. A statistically significant relation between metatarsal length and the prevalence of metatarsalgia was not found in this prospective case series. Level IV, case series.

Plantar Pressure Variations Induced by Experimental Malocclusion-A Pilot Case Series Study.

Background: All body systems involved in ensuring a healthy posture (musculoskeletal system, oculomotor, oto-vestibular and occluso-cranial-mandibular) are essential in maintaining postural balance. Research Question: Does experimental malocclusion in subjects in static position determine variations in plantar pressure? Methods: Overall, 31 subjects were included in the study. The plantar pressure was evaluated in five different points: lateral and medial heel, midfoot, 1st and 5th metatarsal area. Using a specially designed splint, an artificial malocclusion was induced on the right hemimandibular arch. The pressure was measured at 0 (T0), 15 (T1) and 30 min (T2) after splint application. Results: The right external plantar sensors recorded statistically significant differences in pressure values after 15 min of splint wear (5th metatarsal area, p = 0.05; midfoot, p = 0.04). Important pressure values were also recorded by the left internal plantar sensors (1st metatarsal, p = 0.01; medial heel, p = 0.006), after 30 min of splint wear. Conclusions: Asymmetrical experimental malocclusion produces early changes in plantar pressure, a proof of compensatory mechanisms induced by secondary postural imbalance.

Effect of Proximal Dome and Distal Chevron Osteotomies on Plantar Pressures and Radiographic and Functional Outcomes in Hallux Valgus Surgery: A Retrospective Analysis.

No detailed comparative studies have been performed regarding plantar pressure changes between proximal dome and distal chevron osteotomies. This study aimed to compare radiographic and plantar pressure changes after distal chevron and proximal dome osteotomies and to investigate the effect of radiographic and plantar pressure changes on clinical outcomes. This study included 26 and 22 patients who underwent distal chevron and proximal dome osteotomies, respectively. Visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) forefoot scores were used to evaluate pain and functional outcomes. Hallux valgus angle, intermetatarsal angle, talar-first metatarsal angle, and calcaneal inclination angle were measured in the evaluation of radiographic outcomes. Preoperative and postoperative plantar pressure changes were evaluated. There were no statistically significant differences between the two groups in age, body mass index, or AOFAS forefoot and VAS scores. In the proximal dome group, the pressure measurement showed significant lateralization of the maximal anterior pressure point in the forefoot (P < .001). In addition, the postoperative calcaneal inclination angle was significantly lower (P = .004) and the talar-first metatarsal angle was significantly higher (P < .001) in the proximal dome group. Postoperative transfer metatarsalgia was observed in one patient (3.8%) in the distal chevron group and five (22.7%) in the proximal dome group (P < .05). Proximal dome osteotomy led to more lateralization of the maximum anterior pressure point, decreased calcaneal inclination angle and first metatarsal elevation, and related higher transfer metatarsalgia.