Forefoot Pressure Research Articles

Baropodometric comparison of orthopedic footwear to assess the effectiveness of pairs of orthopedic shoes for reducing the forefoot pressure.

Objectives This study aimed to evaluate the distribution of foot pressure with the most frequently used orthopedic shoes and demonstrate the effect of offloading philosophy on the pressure distributions of rocker bottom or heel support shoes applied unilaterally or bilaterally.Materials and methods Three bilateral and four unilateral, a total of seven shoe designs with sensors included in the insole were tested by the same subject in a standard acquisition protocol. Two of the unilateral and one of the bilateral shoes had heel support, while others had a rocker bottom design. A descriptive analysis was performed for each shoe and compared to a reference value obtained from a standard shoe.Results Shoes with an offloading heel resulted in a greater reduction in pressure on the forefoot than other models. All other shoes increased pressure on the first metatarsophalangeal joint. Heel offloading models performed the best in forefoot offloading, and bilateral heel offloading shoes performed the best in first metatarsal offloading, with the highest scores of 83% and 82%, respectively.Conclusion This study showed that orthopedic shoes sold in pairs could reduce pressure on the forefoot at a comparable level to unilateral shoes. It supports their use to limit the disadvantages of single orthopedic shoes, such as limb length discrepancies.

세라밴드 운동이 고령여성의 신체조성, 관절가동범위(ROM) 및 하지 균형에 미치는 영향

In this study, the body composition and range of motion of shoulder, knee, and ankle joints and lower limbs balance were measured by performing thera-band exercise for 12 weeks targeting female elderly people. As a result of analyzing the effect by measuring and heel pressure ratio, the following conclusions were obtained.BR First, in the change of body composition, BMI increased significantly(p.05) in the control group. Second, in the change of shoulder joint, the thera-band exercise group significantly increased in flexion (p.001) and abduction(p.05), and in the knee joint, the thera-band exercise group significantly increased in flexion(p.01). The ankle joint significantly(p.05) increased in plantar flexion in the thera-band exercise group. Third, in the change of lower limbs balance, the sera band exercise group significantly increased the right foot average pressure(p.05) and the right forefoot pressure ratio(p.05), and the control group had the left forefoot pressure ratio(p.01) and the left There was a significant decrease in the heel pressure ratio(p.05).BR Summarizing the above conclusions, it is believed that 12 weeks of thera-band exercise for the elderly women will be helpful for healthy old life as it is an effective exercise for positive changes in body composition, increase and maintenance of joint range of motion, and improvement of left-right balance ability.

Characteristics of Plantar Pressure Distribution in Diabetes with or without Diabetic Peripheral Neuropathy and Peripheral Arterial Disease.

Background Excessive plantar pressure leads to increased risk of diabetic foot ulcers. Diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD) have been considered to be associated with alterations in gait and plantar pressure in diabetic patients. However, few studies have differentiated the effects with each of them. Objective To investigate the plantar pressure distribution in diabetic patients, with DPN and PAD as independent or combined factors. Methods 112 subjects were recruited: 24 diabetic patients with both DPN and PAD (DPN-PAD group), 12 diabetic patients with DPN without PAD (DPN group), 10 diabetic patients with PAD without DPN (PAD group), 23 diabetic patients without DPN or PAD, and 43 nondiabetic healthy controls (HC group). The in-shoe plantar pressure during natural walking was measured. Differences in peak pressure, contact area, proportion of high pressure area (%HP), and anterior/posterior position of centre of pressure (COP) were analysed. Results Compared with HC group, in DPN-PAD group and DPN group, the peak pressures in all three forefoot regions increased significantly; in PAD group, the peak pressure in lateral forefoot increased significantly. The contact area of midfoot in the DPN-PAD group decreased significantly. PAD group had larger HP% of lateral forefoot, DPN group had larger HP% of inner forefoot, and DPN-PAD group had larger HP% of total plantar area. There was a significant tendency of the anterior displacement of COP in the DPN-PAD group and DPN group. No significant differences were observed between the D group and HC group. Conclusion DPN or PAD could affect the plantar pressure distribution in diabetic patients independently or synergistically, resulting in increased forefoot pressure and the area at risk of ulcers. DPN has a more pronounced effect on peak pressure than PAD. The synergistic effect of them could significantly reduce the plantar contact area of midfoot.

Plantar pressure profile during walking is associated with talar cartilage characteristics in individuals with chronic ankle instability

BackgroundIndividuals with chronic ankle instability typically present with abnormal gait patterns favoring the lateral foot. This gait pattern may alter cartilage stress potentially increasing the risk of osteoarthritis development, thus exploring this relationship may provide insights for early interventions. The purpose of this study was to examine the relationship gait biomechanics and talar articular cartilage characteristics. MethodsTalar articular cartilage was assessed with ultrasound at rest and after walking for 30-min in twenty-five adults (14 females, 22.6 ± 3.12 years, 168.12 ± 9.83 cm, 76.00 ± 15.47 kg) with chronic ankle instability. Cartilage was segmented into Total, Medial, and Lateral regions. During the 30-min walking period, plantar pressure of the entire foot was recorded every 5-min and condensed to create a biomechanical loading pattern and center of pressure gait line. Relationships between resting cartilage thickness and echo intensity, changes in thickness and echo intensity, and plantar pressure profiles were assessed with correlation coefficients. FindingsThere was a significant relationship between plantar pressure in the lateral forefoot and medial talar cartilage deformation (r = 0.408, p < .05). Early stance center of pressure was correlated with deformation in the total (r = 0.439–0.524) and lateral (r = 0.443–0.550) regions (p < .05). There were no significant correlations between echo intensity and biomechanics. InterpretationThis study contributes to the growing evidence that talar cartilage strain patterns are associated with biomechanics during walking. Further validation is needed to determine a causal relationship between biomechanics and ultrasound cartilage characteristics after ankle sprains. In addition, research should continue determining the utility of ultrasound to monitor joint health after musculoskeletal injuries.

Peak pressure during gait in patients with severe haemophilia: A controlled cross-sectional study

Patients with severe haemophilia suffer from bleeding-related joint changes in which the ankle joint is most frequently affected. In the resulting gait changes, the forefoot is involved by reducing the foot pressure. However, it is unclear which changes in foot pressure are present in the individual's foot zones. The aim of the study was to determine whether compensation mechanisms are present in the foot zones regarding the peak pressure under dynamic conditions and to identify possible underlying mechanisms for gait changes. In a controlled cross-sectional study, a pedobarography was performed during gait with a standardized speed (3km/h) in patients with haemophilia (PwH;n=40) and healthy controls (Con;n=40). Pressure pain thresholds (PPT) were detected, and Haemophilia Joint Health Score (HJHS) was performed to determine the current joint status. PwH showed a decreased peak pressure in metatarsals II-IV and heel compared to Con. Patients with major-affected ankle joints (determined with the HJHS) showed a decreased single-step length, stride-length and stride-time. Accordingly, the cadence was increased by 10±11 steps/min in PwH compared to Con. Furthermore, PwH showed decreased ankle range of motion (ROM) in HJHS and an altered pain perception due to reduced PPT. PwH showed a changed gait pattern in peak pressure compared to Con. A restricted rolling behavior, which might be caused by movement restrictions and pain sensation, leads to reduced pressure in the center forefoot, resulting in a shorter stride-length. Future therapies should focus on maintaining joint mobility for better rolling behavior and improving ankle joints' stability to achieve a balanced load between the midfoot, heel, and forefoot. The use of insoles adapted to our data, based on group differences between PwH and Con, could be supportive in this case.

The interaction effects of rocker angle and apex location in rocker shoe design on foot biomechanics and Achilles tendon loading

The influences of rocker shoes on foot biomechanics were controversial because the interaction between two design factors—rocker angle and apex location, was usually omitted. This study investigated the interaction effects of rocker angle and apex location on plantar foot pressure, metatarsophalangeal/ankle angle, and Achilles tendon force during walking. Ten participants performed walking trials under six rocker shoe conditions: 2 rocker angles (mild and severe) ​× ​3 apex locations (distal, standard, and proximal), wherein the plantar foot pressure was measured and the movement data were processed by musculoskeletal modeling to report joint angle and Achilles tendon force. A two-way ANOVA repeated measures was used for statistics. Significant interaction effects were reported in examinations of forefoot pressure, midfoot pressure, and metatarsophalangeal dorsiflexion. The standard apex significantly reduced peak forefoot and midfoot pressures (p ​= ​0.008–0.034, Hedges'g ​= ​0.75–0.84), which was further decreased by a severe rocker angle (p ​= ​0.006, Hedges'g ​= ​0.51–0.81). Moving the apex proximally reduced Achilles tendon forces (p ​< ​0.001, Hedges' g ​= ​0.80) and facilitated both metatarsophalangeal dorsiflexion and ankle plantarflexion during push-off (p ​= ​0.003–0.006, Hedges' g ​= ​0.03–0.82). Rocker angle seemed to have fewer effects on ankle joint angle and Achilles tendon force. We concluded that apex location was likely the dominant design factor of the rocker sole in influencing foot biomechanics, yet its interactions with rocker angle should be considered. The configuration of the two features could be varied to possess different therapeutic merits and adapt to specific application purposes.

Plantar loads characteristics of male non-rearfoot strikers running on different overground surfaces at preferred speed

Background: This study aimed to investigate the plantar loads of male non-rearfoot strike runners running on different overground surfaces at their preferred speeds. Methods: A total of 32 male runners with non-rearfoot strike were required to run for 15 m on concrete, synthetic rubber and grass surfaces at their preferred speeds. An insole sensor system was used to determine the runners’ foot strike pattern and measure peak pressure, pressure-time integral, maximum force, force-time integral and contact area of the total foot and nine selected foot regions. Results: No significant differences on their preferred speeds were observed running on concrete, synthetic rubber and grass surfaces. No significant differences on plantar loads parameters of the total foot were found when running on the three overground surfaces. Running on concrete showed higher peak pressure in the lateral forefoot compared with grass and synthetic rubber (283.49 kPa vs. 264.31 kPa, P &lt; 0.023; 283.49 kPa vs. 263.18 kPa, P &lt; 0.019, respectively). Maximum force in the medial forefoot was lower when running on concrete compared with grass and synthetic rubber (40.16 %BW vs. 42.52 %BW, P &lt; 0.042; 40.16 %BW vs. 43.21 %BW, P &lt; 0.022, respectively). Conclusions: Repetitive and excessive plantar loads during long-distance running may result in loads-related injury in lower extremity skeletal tissues for non-rearfoot runners at preferred speeds. Therefore, male non-rearfoot strikers should choose the appropriate overground surface to reduce the risk of lower extremity musculoskeletal injuries.

The effects of selected lower limb muscle activities on a level of imbalance in reaction on anterior-posterior ground perturbation

Purpose We investigated whether an increase in muscular tone induced by the information about imminent posture destabilisation brings a positive result and prevents such destabilisation. Methods We measured forward and backwards movements of 38 participates (27 females and 11 males, aged 23 (SD 2.6)) on the treadmill (forward and backward movements). All participants were subject to three test condition trials (Tr): 1) subject did not know the nature and time of perturbation (Tr1); 2) subject knew the nature of perturbation but did not know time (Tr2); 3) both the time and nature of perturbation were known precisely (Tr3). The tests resulted in the determination of muscular activity connected with a postural adjustment as well as values of pressure exerted by the forefoot on the ground, and the angle of flexion in the knee joint. Results In terms of postural adjustments it was possible to observe statistically significant differences in muscular activity between Tr1 and Tr2 refer to Tr3. No statistically significant differences were identified in all phases as regards values of forefoot pressure and those concerning the angle of flexion in the knee joint. An increase in the muscle tone before perturbation was correlated with the displacement and the velocity of the COP after perturbation. Conclusions These data indicate that knowledge of the expected time of perturbation is responsible for postural adjustment. Furthermore, muscle tone resulting from an adjustment of perturbation and responsible for the stiffening of lower limbs triggered greater displacement of the COP after perturbation.

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.

Impact of Asthma on Plantar Pressures in a Sample of Adult Patients: A Case-Control Study.

Based on the high prevalence of asthma in the population, and its relationship with various musculoskeletal and postural disorders, the aim of this study was to evaluate the plantar pressures in asthmatic patients compared to a control group. A case-control study involving 90 participants was conducted, consisting of 45 asthma patients and 45 healthy paired controls. Static plantar pressure data were recorded using a portable pressure sensor platform. Statistically significant differences were shown in the body weight on the left heel (p = 0.031), and the right forefoot maximum peak pressure was lower in the case group (p = 0.042). The findings of this study show alterations in static plantar pressures in asthmatic patients compared to healthy individuals. Specifically, the subjects with asthma showed less maximum pressure in the right forefoot and less weight on the left heel, which appear to be associated with the asthma disease.

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.

Shoes with elastic upper vs. shoes with a round toe box for perceived comfort and interdigital forefoot pressure in patients with hallux valgus deformity

Although shoes act as a protective covering for the feet, they can be an important source of pain and foot disorder if not properly fitted. The purpose of this study was to investigate the effect of a shoe with highly compliant upper on the dorsal digital and interdigital pressure in comparison with shoes with a rounded toe box and participant’s own shoes in patients with Hallux Abducto Valgus (HAV) deformity. Eighteen participants with moderate to severe HAV were recruited. The patients’ perceived comfort and interdigital forefoot pressure were measured using force sensitive resistance sensors while wearing shoes with a round toe box and shoes with stretchable fabric upper and were compared to when the participants were wearing their own preferred shoes. Shoes with stretchable fabric upper significantly reduced the dorsal digital and interdigital pressure and increased perceived comfort. The results of the present study showed the superiority of shoes with stretchable fabric upper in reducing the pressure on the forefoot and the overall comfort compared to shoes with a round toe box and participant’s own shoes in people with HAV. It, therefore, seems that shoes with stretchable fabric upper can be recommended to ameliorate the treatment outcome in people with HAV.

Effects of Head Direction on Electromyographic Activity of Quadriceps, Center of Pressure and Foot Pressure during Squat Exercise

PURPOSE: This study examined the effects of changes in the head direction (forward, upward 10° and downward 10°) on the quadriceps, center of pressure (COP), and foot pressure during squat exercises. The aim was to determine if the head direction could better activate the quadriceps muscle and provide a safer and stable squat posture during squat exercise. METHODS: Fifteen healthy college students were asked to stand on a Zebris, and three electrodes for sEMG were attached to their vastus medialis oblique (VMO), vastus lateralis (VL), and rectus femoris (RF) muscles. The participants then performed squatting exercises under three head directions (forward, upward 10°, and downward 10°). Surface electrodes were then used to record the EMG data during exercise. The Zebris FDM-SX was used to measure the foot pressure and COP of the participants. RESULTS: In squat exercise, the upward head direction group showed significantly higher VL activation than the downward head direction group (p < .05). The upward head direction group showed a significant backward change in the deviation of the COP than the downward and forward groups (p < .05). The upward head direction group showed a significant decrease in forefoot pressure than the downward and forward groups (p < .05) and an increase in the hindfoot pressure compared to the downward and forward groups (p < .05). CONCLUSION: The head direction upward in squat exercise has a positive effect on the quadriceps.

In Pursuit of the Perfect Dancer's Ballet Foot. The Footprint, Stabilometric, Pedobarographic Parameters of Professional Ballet Dancers.

Simple SummaryThe purpose of this research was to assess footprint parameters in a group of ballet dancers and the correlation between these parameters with lateralisation, stabilometric parameters, pedo-barographic parameters and work environment. The research was carried out on a group of 44 elite professional ballet dancers—the reference group was 44 students. The results of the test of body balance, thrust under feet and footprint parameters (e.g., Clarke angle and Weissflog index) were analyzed. Statistically significant differences between the groups were observed in relation to the stabilometric parameters, the percentage pressure of the left forefoot and the right heel and the value of the Clarke angle. The obtained results imply that the high arch of the foot is, most probably, inborn and can be increased only slightly through exercise. The occurrence of pes cavus and flatfoot in ballet dancers is not connected to the total and professional career duration and weekly training volume. Practical conclusions drawn from the tests suggest that, during recruitment to ballet schools, it is necessary to pay attention to whether the applicant’s feet are properly arched. It is not recommended for children with pes cavus to practice en pointe.This work aims to assess footprint parameters in a group of professional ballet dancers and to determine the correlation between the aforementioned parameters and lateralization, stabilometric parameters, pedobarographic parameters and work environment conditions. A group subjected to tests consisted of 44 elite professional ballet dancers and the reference group was composed of 44 students. The test of balance and thrust under feet involved 30 s-long free standing with open eyes on a podographic platform. The research-related analysis was concerned with footprint parameters (foot length and width, Clarke angle, and Weissflog index), stabilometric parameters (path length and ellipse field, mean value of the velocity and deflection of the displacement of the center of the foot pressure on the ground) and pedobarographic parameters (percentage thrust on the right, left foot as well as the front and rear part the foot). Statistically significant differences between the groups were observed in relation to the stabilometric parameters, the percentage pressure of the left forefoot and the right heel, as well as the value of the Clarke angle (p ≤ 0.05). The longitudinal arch of the foot and the width of the foot in ballet dancers are not dependent on the total and professional career duration and weekly training volume

Structural and functional foot and ankle characteristics associated with falls in older people

Falls affect approximately one in three older people, and foot problems are amongst the modifiable potential risk factors. what are the associations between foot and ankle functional and structural characteristics with falls in community-dwelling older adults? One hundred eighty-seven community-dwelling older adults (106 females) aged 62-90 years (mean 70.5 ± 5.2) from Isfahan, Iran were recruited. Foot and ankle structure and function (including foot posture, range of motion, muscle strength, deformity, pain and plantar loading patterns during walking) were measured. Fall history was documented in the preceding year. Univariate analyses compared fallers and non-fallers on all variables to determine significant differences and logistic regression analysis identified variables independently associated with falls. Seventy-four participants (39.9 %) had experienced a fall in the previous year. Logistic regression analysis revealed that less first metatarsophalangeal joint extension (odds ratio 0.82, 95 % CI 0.73-0.91), less plantarflexor muscle strength (odds ratio 0.29, 95 % CI 0.15-0.55), greater pressure-time integral in the medial forefoot (odds ratio 2.65, 95 %CI 1.10-6.38), greater center of pressure velocity in the forefoot (odds ratio 1.27, 95 % CI 1.07-1.49) and greater foot pain (odds ratio 1.09, 95 % CI 1.02-1.16) were significantly and independently associated with falls after accounting for physiological falls risk factors. We have identified several structural and functional foot and ankle characteristics associated with falling in older people. Future development of interventions to help prevent or treat these potentially modifiable risk factors may help decrease the risk of falling in this population.

An exploration of changes in plantar pressure distributions during walking with standalone and supported lateral wedge insole designs

BackgroundLateral wedge insoles (LWI), standalone or with medial arch support (supported-LWI), have been thoroughly investigated for their effects on modifying gait biomechanics for people with knee osteoarthritis. However, plantar pressure distribution between these insole types has not been investigated and could provide insight towards insole prescription with concomitant foot symptoms taken into consideration.MethodsIn a sample of healthy individuals (n = 40), in-shoe plantar pressure was measured during walking with LWI, with or without medial arch support (variable- and uniform-stiffness designs), and a flat control insole condition. Pressure data from the plantar surface of the foot were divided into seven regions: medial/lateral rearfoot, midfoot, medial/central/lateral forefoot, hallux. Plantar pressure outcomes assessed were the medial-lateral pressure index (MLPI) for the whole foot, and the peak pressure, pressure-time integral (PTI), and contact area in each plantar region. Comfort in each insole condition was rated as a change relative to the flat control insole condition. Repeated-measures analyses of variance were calculated to compare the plantar pressure outcomes between insole conditions.ResultsRegionally, medial rearfoot and forefoot pressure were reduced by all wedged insoles, with the variable-stiffness supported-wedge showing greater reductions than the standalone wedge. Lateral rearfoot and forefoot pressure were reduced by both supported-LWI, but unchanged by the standalone wedge. In the midfoot, the standalone wedge maintained pressure but reduced regional contact area, while both supported-LWI increased midfoot pressure and contact area. All LWI increased the MLPI, indicating a lateral shift in plantar pressure distribution throughout the weightbearing phase of gait. Comfort ratings were not significantly different between insole conditions.ConclusionsRegional differences in plantar pressure may help determine an appropriate lateral wedge insole variation to avoid exacerbation of concomitant foot symptoms by minimizing pressure in symptomatic regions. Lateral shifts in plantar pressure distribution were observed in all laterally wedged conditions, including one supported-LWI that was previously shown to be biomechanically ineffective for modifying knee joint load distribution. Thus, shifts in foot centre of pressure may not be a primary mechanism by which LWI can modify knee joint load distribution for people with knee osteoarthritis.

The comparison of pedobarographic parameters after calcaneal fractures.

This study aims to reveal surgical treatment's effect on plantar load restoration and clinical outcomes compared to conservative treatment in intra-articular calcaneal fractures. Thirty-two patients (Group 1) who underwent surgery for unilateral intra-articular calcaneal fractures and 28 patients who received conservative treatment (Group 2) were included in the study. Detailed static pedobarography examinations were performed on all patients. Plantar load distribution was evaluated based on the forefoot maximum and mean pressure, hindfoot maximum and mean pressure, and distribution of pressure in the heel area in the mediolateral direction. Clinical results were evaluated with the American orthopedic foot and ankle association (AOFAS) score and visual analog scale (VAS) scores. While the mean contact area between injured and non-injured sides did not differ in Group 1, there was a significant difference between the two sides in Group 2 (p=0.009). Furthermore, on the injured side, the mean contact area (p=0.023) and forefoot pressures (p<0.001) were significantly higher in Group 2 compared to Group 1. Hindfoot pressure on the injured side was significantly lower in Group 2 compared to the uninjured side (p<0.001) and the injured side in Group 1 (p<0.001). A significant anterolateral shift in plantar load was detected in Group 2 (p<0.001). There was a significant difference between the two groups in terms of mean VAS and AOFAS scores in favor of Group 1 (p<0.001). Surgical treatment of calcaneus intra-articular fractures should be preferred primarily as it provides better clinical results and better plantar load distribution in midterm follow-up.

A prospective study of the muscle strength and reaction time of the quadriceps, hamstring, and gastrocnemius muscles in patients with plantar fasciitis

BackgroundMuscle weakness is an important etiological factor in plantar fasciitis (PF), but available data on the role of the quadriceps, hamstring, and gastrocnemius (GCM) muscles are limited. The aim of this study was to compare the strength and reaction time of the quadriceps, hamstring, and GCM muscles and foot pressure between patients with PF and normal controls.MethodsA total of 21 PF patients and 21 normal controls were enrolled. Muscle strength was measured by the peak torque per body weight (Nmkg− 1 × 100). Muscle reaction time was evaluated by the acceleration time (AT, milliseconds). Foot pressure and posture were assessed by pedobarography [valgus/varus index (VV index), %].ResultsThe strength of the quadriceps was significantly lower in the affected ankles of the PF group than in the control group (p = 0.005). The AT of the quadriceps and hamstring muscles was significantly increased in the affected ankles of the PF group than in the control group (quadriceps: p = 0.012, hamstring: p = 0.001), while the AT of the GCM muscle was significantly decreased (p = 0.009) and significantly correlated negatively with quadriceps muscle strength (r = −.598, p = 0.004) and AT (r = −.472, p = 0.031). Forefoot (p = 0.001) and hindfoot (p = 0.000) pressure were significantly greater, with the VV index showing hindfoot valgus, in the affected ankles in the PF group compared to the control group (p = 0.039).ConclusionsThis study demonstrated weakness and delayed reaction time of the quadriceps and hamstring muscles, with a rapid reaction time of the GCM muscle, in patients with PF.Clinical relevanceClinicians and therapists should assess the function of the quadriceps and hamstring muscles when planning the management of PF patients without muscle tightness.

Insoles of uniform softer material reduced plantar pressure compared to dual-material insoles during regular and loaded gait

There is limited evidence on the efficacy of insole materials to reduce plantar pressure during regular walking and loaded walking. In-shoe plantar pressures and subjective footwear comfort were recorded in twenty healthy participants at a self-selected treadmill walking speed in six conditions: two commercial insoles or no insole, and with or without carrying a load in a backpack. A single-material insole, comprised of polyurethane, had reduced density and compressive stiffness compared to a dual-material insole with added viscoelastic material in rearfoot and forefoot regions. Load carriage increased peak pressure across the foot. Both insoles reduced plantar pressure in the rearfoot. Yet, the softer single-material insole also attenuated forefoot pressure and loaded walking did not appear to cause bottoming-out of the polyurethane. Plantar pressure changes did not affect perceived footwear comfort. The softer single-material insole was more effective in reducing plantar pressure, further research would confirm if this influences injury prevalence.

Gait Training Strategy Focusing on Perceptual Learning for Improved Gait Capacity in Stroke Survivors

Objective: The purpose of this study was to determine the force of lower extremities, the change in walking ability on the ground by ap plying a walking training program based on perceptual learning to improve gait capacity of chronic stroke patients. Method: This study included Twenty-four patients with chronic stroke. Using a perceptual-based gait training, the experimental group trained twice a day for 30 minutes each time, 5 times a week, for a total of 8 weeks. The control group underwent ground gait training that excluded the element of a perceptual training for 30 minutes, 5 times a week for 8 weeks. Results: In the two groups, the maximum forefoot pressure after intervention was significantly different in both the LEPGT and GGT (p<0.05). The maximum midfoot pressure was significantly different in LEPGT (p<0.05). There was a significant difference in the maxi mum heel pressure after intervention between the two groups (p<0.05). As a result of comparing the change in step length and stride length after intervention in the two groups, there was a significant difference between the two groups (p<0.05). Conclusion: Both gait training programs was found that gait training based on perceptual learning and ground gait training were the training for improving the functional gait of stroke patient. Perceptual learning gait training utilizing intensive perceptual awareness was the training for improving gait capacity within the period than ground gait training.