Shoe Group Research Articles

Flat flexible school shoes for adolescents with patellofemoral pain: a randomised, assessor-blinded, parallel-group feasibility trial

ObjectivesTo determine the feasibility of conducting a large-scale randomised controlled trial on the efficacy of flat, flexible school footwear versus traditional school footwear in adolescents (aged 12–18 years) with patellofemoral...

Comparison of lower extremity kinematics and ground reaction forces between adolescents who run in motion control shoes with adolescents who run in neutral shoes

Differences in running biomechanics have been reported in adult long-distance runners when running in motion control or neutral shoes. The influence of growth and coordination refinement during puberty limits the generalisability of adult research to adolescents and it is unknown if biomechanics differ between adolescent who run in different types of shoes. The purpose of our study was to compare lower extremity kinematics and ground reaction forces between adolescents running in motion control or neutral shoes. We matched 18 adolescent long-distance runners who ran in motion control shoes with 18 adolescent long-distance runners who ran in neutral shoes according to running speed, sex, and physical maturation. We collected three-dimensional kinematic and ground reaction force data during overground running and performed statistical parametric mapping to compare joint angle and ground reaction force waveforms between the motion control and neutral shoe groups. We found no significant differences for hip, knee, or ankle joint angles (average differences <2°) or ground reaction forces (average differences <0.05 N/kg) between runners who ran in motion control or neutral shoes. Lower extremity kinematics and ground reaction forces were similar between adolescents who ran in motion control or neutral shoes.

Determinants of healing of diabetic foot ulcer comparing two offloading modalities: A randomized prospective study

IntroductionHealing of Diabetic Foot ulcer is crucial to prevent amputation. Offloading is key treatment of diabetic foot ulcers, but choosing which offloading modality is still not clear. Besides, other factors that control ulcer healing, is a question that needs to be determined. Objective: to assess factors that affect ulcer healing, comparing two commonly used offloading devices, removable walker and cast-shoe. MethodsThis is a Randomized Clinical Trial which recruited 87 patients with active diabetic foot ulcers randomly assigned to either a removable walker (W-arm) or a cast-shoe (C-arm) at 3:2 ratio. Both groups received the routine ulcer care, and were followed-up for 24 weeks. Different possible factors related to healing were assessed, and a regression model was built for the most predictive factors. ResultsThe 24-week healing rate was 81% for the walker group and 62 % for the cast-shoe group. The mean adherence was 55 % ± 26 % and 46 % ± 29 for the walker and cast shoe groups respectively. Ulcer healing was significantly positively associated with: better adherence, device type (walker), less SINBAD score (2 or less), absence of ischemia, absence of infection, smaller ulcer area, superficial ulcer, better 4-week area reduction, and better blood glucose control. The most important predictors were adherence, total SINBAD score and 4-week area reduction. ConclusionSINBAD score at initial presentation and the degree of adherence to offloading device, are two major determinants of ulcer healing. Ulcer area reduction at 4 weeks represents an important clinical parameter to predict and guide the success of ulcer management.

Running shoes for preventing lower limb running injuries in adults.

Running shoes for preventing lower limb running injuries in adults.

Effect of shoe cushioning on landing impact forces and spatiotemporal parameters during running: results from a randomized trial including 800+ recreational runners

In a recent randomized trial including 800+ recreational runners, injury risk was lower in those who received the Soft shoe version compared to those using the Hard version (Hazard ratio = 1.52; 95% Confidence Interval = 1.07–2.16). Here, we investigated the effect of shoe cushioning on ground reaction forces (GRF) and spatiotemporal parameters in the same cohort, with a special focus on Vertical Impact Peak Force (VIPF) and Vertical Instantaneous Loading Rate (VILR). Healthy runners (n = 848) randomly received one of two shoe prototypes that differed only in their cushioning properties (Global stiffness: 61 ± 3 and 95 ± 6 N/mm in the Soft and Hard versions, respectively). Participants were tested on an instrumented treadmill at their preferred running speed. GRF data was recorded over 2 min. VIPF was higher in the Soft shoe group compared to the Hard shoe group (1.53 ± 0.21 vs. 1.44 ± 0.23 BW, respectively; p < 0.001). However, the proportion of steps with detectable VIPF was lower in the Soft shoe group (84 vs. 97%, respectively; p < 0.001) and Time to VIPF was longer (46.9 ± 8.5 vs. 43.4 ± 7.4 milliseconds, respectively; p < 0.001). No significant differences were observed for VILR (60.1 ± 13.8 vs. 58.9 ± 15.6 BW/s for Soft and Hard shoe group, respectively; p = 0.070) or any other kinetic variable. These results show that the beneficial effect of greater shoe cushioning on injury risk in the present cohort is not associated with attenuated VIPF and VILR. These GRF metrics may be inappropriate markers of the shoe cushioning-injury risk relationship, while delayed VIPF and the proportion of steps displaying a VIPF could be more relevant. Trial registration: ClinicalTrials.gov identifier: NCT03115437..

Alterations in Running Biomechanics after 12 Week Gait Retraining with Minimalist Shoes

Purpose: The intervention of 12 week gait retraining with minimalist shoes was established to examine its effect on impact forces, joint mechanics, and vertical stiffness during running. Methods: Thirty male recreational runners were randomly assigned to the gait retraining + minimalist shoe (n = 15, GR) and minimalist shoe (n = 15, MIN) groups. The ground reaction force and marker trajectories were collected before and after intervention at a speed of 3.33 ± 5% m/s. Results: A total of 17 participants (9 in the GR group and 8 in the MIN group) completed the training. After training, (1) the loading rate of both groups decreased significantly, and the loading rate of the GR group was lower than that of the MIN group. (2) The foot strike angle of the GR group decreased significantly after training, and the plantarflexion angle and hip joint angular extension velocity increased in both groups. (3) The moment of ankle joint increased in the GR group, and the stiffness of lower limbs was significantly improved in both groups. Conclusion: The 12 week gait retraining with minimalist shoes converted rearfoot strikers into forefoot strikers with a rate of 78% (7/9). More importantly, such a combined program, compared to the training with only minimalist shoes, can avoid the peak impact force and decrease the loading rate more effectively, thus providing a potential means of reducing risk of running injury caused by impact forces. Moreover, the increased vertical stiffness of lower extremity after gait retraining may improve running economy and corresponding energy utilization. However, these observations also suggest that the sole use of minimalist footwear may have limited effects on reducing running-related impacts.

The Impact of a Foot-Toe Orthosis on Dynamic Balance: An Exploratory Randomized Control Trial.

The influence of custom and over-the-counter foot orthoses on dynamic balance has been investigated in the past. However, there has not been an exploration of the use of a foot-toe orthosis for improving balance. The ability of clinicians to influence balance could have important implications for injury prevention and rehabilitation. To determine the impact of a foot-toe orthosis on dynamic balance in healthy, young adults. Randomized control trial. Athletic training laboratory. In total, 64 healthy, recreationally active participants aged 18-29 years were randomly allocated to one of the following groups: the foot-toe orthosis and laboratory-issued shoe group, the laboratory-issued shoe only (SO) group, or the control group. Subjects in the intervention group wore the foot-toe orthosis and laboratory-issued shoe with activities of daily living for 4 weeks. Subjects in the SO intervention group wore the laboratory-issued shoe with activities of daily living for 4 weeks. Participants in the control group did not receive any intervention. The instrumented version of the Star Excursion Balance Test, known as the Lower Quarter Y-Balance Test, was used to quantify the dynamic balance at baseline and follow-up. Reaches were normalized for leg length. There were statistically significant differences in postintervention scores on the Lower Quarter Y-Balance Test for both the dominant (P = .03, effect size = 0.84; 95% confidence interval, 0.25 to 1.43) and nondominant (P = .002, effect size = 0.74; 95% confidence interval, 0.15 to 1.32) legs when comparing dynamic balance scores of the foot-toe orthosis and laboratory-issued shoe group with the SO and control groups. No significant differences were observed when comparing dynamic balance between the SO and control groups. A 4-week intervention with a foot-toe orthosis and laboratory-issued shoe resulted in improved dynamic balance in a healthy young adult population. These findings suggest a novel intervention for increasing balance.

Unstable shoes for the treatment of lower back pain: a meta-analysis of randomized controlled trials

Objective: We aimed to perform a systematic review and meta-analysis to compare the treatment effects of unstable shoes and flat shoes on lower back pain patients. Data sources: Literature databases, including PubMed, Web of Science, and EMBASE (up to June 2019), were searched systematically. Review methods: Two authors independently screened the retrieved records and identified the randomized controlled trials where patients with lower back pain who wore unstable shoes as intervention and wore flat shoes as a control. Relevant data were extracted for meta-analysis using Review Manager 5.3 software. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the pooled outcome evidence levels. Results: Five randomized controlled trials and 251 patients were included in the analysis. The meta-analysis results showed that there was a tendency toward a reduction in the Roland–Morris disability questionnaire score (mean difference (MD) –2.16, 95% confidence interval (CI) –4.28 to −0.03, I2 = 53%) and pain score (MD −0.84, 95% CI −1.66 to −0.02, I2 = 84%) in patients wearing unstable shoes compared to those wearing flat shoes. There was no significant difference in the life quality scores between the unstable shoe and flat shoe groups (MD −0.59, 95% CI −6.18 to 5.01, I2 = 0%). Functional disability and pain scores were determined to have very low-quality evidence, and life quality scores were determined to have low-quality evidence according to the Grading of Recommendations Assessment, Development and Evaluation analysis. Conclusion: Unstable shoes may be effective in treating lower back pain in the clinic, but the conclusion was limited by the current low-quality studies.

Clinical and Radiological Outcomes of Forefoot Offloading Versus Rigid Flat Shoes in Patients Undergoing Surgery of the First Ray.

It is common clinical practice to use either flat or reverse camber shoes to protect the foot for up to 6 weeks after surgery for hallux valgus or hallux rigidus. To date there is a paucity of evidence as to whether there is any difference between these 2 postoperative shoes, in either patient satisfaction or clinical outcomes. One hundred consecutive patients undergoing scarf/Akin osteotomies or first metatarsophalangeal joint (MTPJ) arthrodesis were recruited. Patients were randomized 50:50 to either flat or reverse camber postoperative shoes. Patients undergoing ancillary lesser toe procedures were not excluded. Patient satisfaction was assessed by visual analog scale (VAS) pain score and Likert satisfaction survey. Radiographic outcomes were reviewed at 1 year observing differences in fusion rates or deformity recurrence. There were 47 patients in the reverse cam and 43 in the flat shoe group. No difference in primary forefoot operation, additional operation, age at surgery, or preop VAS pain score was seen. At 6 weeks, there was no significant difference in postop VAS pain score. The flat shoe group was significantly more likely to be satisfied with their general mobility (86.0% vs 61.7%; P = .01) and with their stability in the shoe (90.7% vs 69.6%; P = .03). No significant difference was seen between groups for nonunion or hallux valgus recurrence rates. Both forms of postoperative footwear were effective in enabling patients to mobilize and in preventing adverse outcomes. Patients were more likely to be satisfied with a flat postoperative shoe due to improved stability and ease of mobilizing. The results of this study aid surgeon decision making for postoperative footwear in forefoot surgery. Level II, prospective randomized controlled trial.

PMS100 - COMPARISON OF LOW AND HIGH TOP BASKETBALL SHOES WITH RESERVE PLAYERS

The aim of the study was to compare high-top and low-top basketball shoes in respect of injury and stability of joint. Throughout our study an edited questionnaire was applied to analyse the injuries. The prevalence of the injuries was calculated from the completed questionnaires of 51 players. Furthermore, instrumental examination of the proprioception in the ankle joints was also managed on the stabilometric device of Bretz. Romberg’s test was also done. 20 basketball players participated in the study, 10 wore low-top, while the other 10 players wore high-top shoes during the matches. The medio-lateral and the antero-posterior movements and deviations of the balance of the ankle joints were measured. The results of the study revealed no significant differences in matter of all the examined factors. Significant deviation (p=0.038) was found as a result of the examination of the medio-lateral movment of the ankle joint which was fulfilled by having the eyes of subjects closed. The averages of the examinations with closed eyes were 1.077m and 1.204m. During the antero-posterior shift the result of the low-top shoes was 1.004m while the high-top shoes was 1.008m (p=0.957). Unfortunately, the remaining measurements coping with movements showed no significant differences. Regarding the injuries, a significant difference emerged between the wearers of shoes with low- and high-top. Altogether 78 injuries were documented (36 knees, 46 ankles). In the aspect of ankle injuries we found no significance. At the low-top shoe group there were 27 injuries while the high-top shoe group there were 9 injuries in the knee joint (p=0.024). It can be concluded that the height of the leg of the basketball shoes is not a significant risk factor regarding the injuries therefore they do not affect proprioception.

Custom foot orthoses improve first-step pain in individuals with unilateral plantar fasciopathy: a pragmatic randomised controlled trial

BackgroundFoot orthoses are routinely used to treat plantar fasciopathy in clinical practice. However, minimal evidence exists as to the effect of both truly custom designed foot orthoses, as well as that of the shoe the foot orthoses are placed into. This study investigated the effect of wearing custom foot orthoses and new athletic footwear on first-step pain, average 24-h pain and plantar fascia thickness in people with unilateral plantar fasciopathy over 12 weeks.MethodsA parallel, three-arm randomised controlled trial with blinding of participants and assessors. 60 participants diagnosed with unilateral plantar fasciopathy were randomised to either custom foot orthoses and new shoes (orthoses group), a sham insole with a new shoes (shoe group) or a sham insole placed in the participant’s regular shoes (control group). Primary outcome was first-step pain. Secondary outcomes were average 24-h pain and plantar fascia thickness measured on ultrasound. Outcomes were assessed at baseline, 4 week and 12 week trial time-points.ResultsAt 4 weeks, the orthoses group reported less first-step pain (p = 0.002) compared to the control group. At 12 weeks, the orthoses group reported less first-step pain compared to both the shoe (p = < 0.001) and sham (p = 0.01) groups. Both the orthoses (p = < 0.001) and shoe (p = 0.006) groups reported less average 24-h pain compared to the control group at 4 and 12 weeks. The orthoses group demonstrated reduced plantar fascia thickness on ultrasound compared to both the shoe (p = 0.032) and control groups (p = 0.011).ConclusionsCustom foot orthoses in new shoes improve first-step pain and reduce plantar fascia thickness over a period of 12 weeks compared to new shoes alone or a sham intervention.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN 12613000446763). Submitted on the 10th of April 2013 and registered on the 18th of April 2013.

The morphology of foot soft tissues is associated with running shoe type in healthy recreational runners

ObjectivesTo determine the differences in the morphology of foot soft tissues between runners using different types of running shoes. DesignCross-sectional study. MethodsThirty-eight recreational runners were divided into four groups based on running shoe type, namely, neutral shoes, motion control shoes, minimalistic shoes and neutral shoes with custom-made insoles. An arch height index and a relative arch deformation index were calculated for each participant. An ultrasound device was used to measure the cross-sectional area and/or the thickness of selected intrinsic foot muscles (abductor hallucis, flexor hallucis brevis and flexor digitorum brevis) and extrinsic foot muscles (flexor digitorum longus, tibialis anterior and the peroneus muscles), and the thickness of the plantar fascia, Achilles tendon and heel pad. ResultsRecreational runners using minimalistic shoes demonstrated stiffer foot arches than those using neutral shoes. Among the selected foot muscles, only abductor hallucis showed a significant morphological difference between shoe groups. Runners using minimalistic shoes had the thickest abductor hallucis. The minimalistic shoe runners also showed a thinner proximal plantar fascia and a thicker Achilles tendon than other runners. Insole runners had a thinner heel pad than neutral shoe runners. ConclusionsThis study suggests that the morphology of foot soft tissues is associated with running shoe type in recreational runners. A sudden change in running shoe type without adjusting training volume should be undertaken with caution, since it may take time for foot soft tissues to adapt to a new shoe condition.

Six-week transition to minimalist shoes improves running economy and time-trial performance.

This study investigated if gradually introducing runners to minimalist shoes during training improved running economy and time-trial performance compared to training in conventional shoes. Changes in stride rate, stride length, footfall pattern and ankle plantar-flexor strength were also investigated. Randomised parallel intervention trial. 61 trained runners gradually increased the amount of running performed in either minimalist (n=31) or conventional (n=30) shoes during a six-week standardised training program. 5-km time-trial performance, running economy, ankle plantar-flexor strength, footfall pattern, stride rate and length were assessed in the allocated shoes at baseline and after training. Footfall pattern was determined from the time differential between rearfoot and forefoot (TDR-F) pressure sensors. The minimalist shoe group improved time-trial performance (effect size (ES): 0.24; 95% confidence interval (CI): 0.01, 0.48; p=0.046) and running economy (ES 0.48; 95%CI: 0.22, 0.74; p<0.001) more than the conventional shoe group. There were no minimalist shoe training effects on ankle plantar-flexor concentric (ES: 0.11; 95%CI: -0.18, 0.41; p=0.45), isometric (ES: 0.23; 95%CI: -0.17, 0.64; p=0.25), or eccentric strength (ES: 0.24; 95%CI: -0.17, 0.65; p=0.24). Minimalist shoes caused large reductions in TDR-F (ES: 1.03; 95%CI: 0.65, 1.40; p<0.001) but only two runners changed to a forefoot footfall. Minimalist shoes had no effect on stride rate (ES: 0.04; 95%CI: -0.08, 0.16; p=0.53) or length (ES: 0.06; 95%CI: -0.06, 0.18; p=0.35). Gradually introducing minimalist shoes over a six-week training block is an effective method for improving running economy and performance in trained runners.

Electromyographic changes in muscles around the ankle and the knee joints in women accustomed to wearing high-heeled or low-heeled shoes

ObjectivesThis study aimed to investigate muscle activities in the muscles around the ankle and knee joints in women accustomed to wearing high-heeled or low-heeled shoes. MethodologyForty young women (age: 18–40 years) participated in this comparative clinical study. Twenty of the recruited subjects were accustomed to high-heeled shoes and the other half to low-heeled shoes. Electrical activities of the ankle and knee muscles in both groups with and without wearing their accustomed shoes were studied during walking. ResultsTibialis anterior and the medial gastrocnemius muscles started contraction earlier in the high-heeled shoe group. The duration of medial gastrocnemius activity and the intensity of proneus longus activity were significantly more in the high-heeled shoe group. ConclusionWearing high-heeled shoe for a long time could result in over work of muscles such as medial gastrocnemius and proneus longus by increasing the duration or the intensity of their contractions during walking.

Nuclear Anomalies in Exfoliated Buccal Epithelial Cells of Shoe Workers in Khartoum State

Shoe polishes product consists of a complex mixture of chemical compounds. Some of these chemical are known to be absorbed into the body. In this study 50 shoe workers in Khartoum state and 50 controls were tested for cellular abnormalities in buccal mucosa. The age group of the tested individuals ranged between 14 to 49 years. For this a questionnaire based survey was conducted. Simultaneously, buccal smears were collected from oral cavity of the selected individuals and tested for nuclear anomalies. The results of the study showed high frequency of Micronuclei, Karyolysis and Binucleated cells among shoe workers group. These findings indicate the possible role of shoe cleaner products as a source of abnormal changes in buccal mucosa.

The long-term effect of minimalist shoes on running performance and injury: design of a randomised controlled trial.

IntroductionThe outcome of the effects of transitioning to minimalist running shoes is a topic of interest for runners and scientists. However, few studies have investigated the longer term effects of running in minimalist shoes. The purpose of this randomised controlled trial (RCT) is to investigate the effects of a 26 week transition to minimalist shoes on running performance and injury risk in trained runners unaccustomed to minimalist footwear.Methods and analysisA randomised parallel intervention design will be used. Seventy-six trained male runners will be recruited. To be eligible, runners must be aged 18–40 years, run with a habitual rearfoot footfall pattern, train with conventional shoes and have no prior experience with minimalist shoes. Runners will complete a standardised transition to either minimalist or control shoes and undergo assessments at baseline, 6 and 26 weeks. 5 km time-trial performance (5TT), running economy, running biomechanics, triceps surae muscle strength and lower limb bone mineral density will be assessed at each time point. Pain and injury will be recorded weekly. Training will be standardised during the first 6 weeks. Primary statistical analysis will compare 5TT between shoe groups at the 6-week time point and injury incidence across the entire 26-week study period.Ethics and disseminationThis RCT has been approved by the Human Research Ethics Committee of the University of South Australia. Participants will be required to provide their written informed consent prior to participation in the study. Study findings will be disseminated in the form of journal publications and conference presentations after completion of planned data analysis.Trial registration numberThis RCT has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN12613000642785).

Pedobarographic and kinematic analysis in the functional evaluation of two post-operative forefoot offloading shoes.

BackgroundForefoot offloading shoes are special orthopaedic footwear designed to protect and unload the injured part of the foot after surgery and for conservative treatments.The offloading action is often achieved by transferring plantar load to the rearfoot via rocker shoes with reduced contact area between shoe and ground. While these shoes are intended to be worn only for short periods, a compromise must be found between functionality and the risk of alterations in gait patterns at the lower limb joints. In this study, the pedobarographic, kinematic and kinetic effects of a traditional half-shoe and a double-rocker full-outsole shoe were compared to those of a comfortable shoe (control).MethodsTen healthy female participants (28.2 ± 10.0 years) were asked to walk in three different footwear conditions for the left/right foot: control/half-shoe, control/full-outsole, and control/control. Full gait analysis was obtained in three walking trials for each participant in each condition. Simultaneously a sensor insole system recorded plantar pressure in different foot regions. Normalized root-mean-square error, coefficient of determination, and frame-by-frame statistical analysis were used to assess differences in time-histories of kinematic and kinetic parameters between shoes.ResultsThe half -shoe group showed the slowest walking speed and the shortest stride length. Forefoot plantar load was significantly reduced in the half-shoe (maximum force as % of Body Weight: half-shoe = 62.1; full-outsole = 86.9; control = 93.5; p < 0.001). At the rearfoot, mean pressure was the highest in the full-outsole shoe. At the ankle, sagittal-plane kinematics in the full-outsole shoe had a pattern more similar to control.ConclusionsThe half-shoe appears significantly more effective in reducing plantar load at the forefoot than a double-rocker full-outsole shoe, which is designed to reduce forefoot loading by using an insole with a thicker profile anteriorly as to maintain the foot in slight dorsiflexion. However, the half-shoe is also associated with altered gait spatio-temporal parameters, more kinematic modifications at the proximal lower limb joints and reduced propulsion in late stance.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-015-0116-3) contains supplementary material, which is available to authorized users.

Post-marathon wearing of Masai Barefoot Technology shoes facilitates recovery from race-induced fatigue: an evaluation utilizing a visual analog scale.

PurposeTo investigate the potential benefit of post-race wearing of unstable shoes (Masai Barefoot Technology [MBT]) on recovery from marathon race–induced fatigue.Patients and methodsForty-five runners who participated in a full marathon race were divided into three groups: 1) MBT shoes, 2) trail running shoes, and 3) control (CON). Participants ran a full marathon with their own running shoes, and then put on the assigned shoes immediately after the race. They continued to wear the assigned shoes for the ensuing 3 days. The CON group wore their usual shoes. Estimates of post-race fatigue were made by the participants on questionnaires that utilized a visual analog scale. Estimates were made just after the race, as well as for the next 3 days.ResultsThe subjective fatigue of the MBT group was lower than that of the CON (P<0.05) or trail running shoe groups (P<0.05) on day 3.ConclusionMBT shoe intervention can promote recovery from the fatigue induced by running a full marathon.

The effect of good and poor walking shoe characteristics on plantar pressure and gait in people with gout

BackgroundPrevious research has shown that good footwear characteristics may reduce foot pain and foot-related disability in people with gout. The aim of this study was to determine the effect of good and poor footwear characteristics on plantar pressure and spatiotemporal parameters of gait in people with gout. MethodsThirty-six people with gout participated in a cross-sectional repeated measures study. Plantar pressure and spatiotemporal parameters were recorded in two shoe conditions: (1) the participants own footwear, and (2) either a new pair of walking shoes with good footwear characteristics (n=21) or poor characteristics (n=15). Differences between good and poor shoe groups compared to participants own shoes were also determined. FindingsCompared to participant’s own shoes, footwear with good characteristics significantly reduced peak pressure at metatarsal 3 and 5, reduced pressure time integrals beneath the heel and metatarsals 3 and 5 and increased pressure time integrals beneath the midfoot. The footwear with poor characteristics significantly increased peak pressure beneath the heel and lesser toes, reduced peak pressure at metatarsal 3 and reduced pressure time integrals in the midfoot compared to participants own shoes. Both good and poor footwear significantly increased walking velocity, step length, and stride length compared to participants own shoes. InterpretationWalking shoes with good footwear characteristics can influence plantar pressure values and encourage a more efficient heel to toe gait pattern in people with gout. These changes may contribute to the reduction in foot pain and foot-related problems in this population.

Total Ossiculoplasty

Review experience using a titanium TORP with a footplate shoe; compare early and long-term hearing results and complications with those obtained using a TORP alone. Retrospective chart review. Tertiary referral neurotologic private practice. Patients undergoing total ossicular replacement with a titanium prosthesis (total ossicular reconstruction prosthesis [TORP]); 74 with a TORP + footplate shoe and 62 with TORP alone. Ossicular chain reconstruction with a titanium TORP. Short- and long-term air-bone gap (ABG), change in ABG from preoperative to postoperative and from postoperative to last recorded follow-up, sensorineural hearing loss. The shoe group had a smaller mean postoperative ABG (17.7 dB versus 21.6 dB, p ≤ 0.048) and a greater average amount of closure in ABG (21.9 dB versus 13.2 dB, p ≤ 0.004), but there was no significant difference in percentage of patients achieving a postoperative ABG of 20 dB or lesser (57.4% versus 61.6%). There were no differences between groups at long-term follow-up or in amount of change in ABG from postoperative to last audiogram or in amount of change in sensorineural hearing from preoperative to postoperative. Although surgical factors (number of previous surgeries, and presence of a cavity) impacted outcomes, there were no interactions with prosthesis group and no differences in complications between groups. Ossicular reconstruction still presents challenges. A titanium prosthesis with a "shoe" for stabilization may offer advantages. Results in this study consistently favored the TORP + shoe group,although not all differences achieved statistical significance. A larger study might better define possible advantages of the shoe prosthesis for specific subgroups of patients.