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Castro-Martins P, Marques A, Coelho L, Vaz M, Baptista JS. In-shoe plantar pressure measurement technologies for the diabetic foot: A systematic review. Heliyon 2024; 10:e29672. [PMID: 38699042 PMCID: PMC11064085 DOI: 10.1016/j.heliyon.2024.e29672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction Loss of cutaneous protective sensation and high plantar pressures increase the risk for diabetic foot patients. Trauma and ulceration are imminent threats, making assessment and monitoring essential. This systematic review aims to identify systems and technologies for measuring in-shoe plantar pressures, focusing on the at-risk diabetic foot population. Methods A systematic search was conducted across four electronic databases (Scopus, Web of Science, PubMed, Oxford Journals) using PRISMA methodology, covering articles published in English from 1979 to 2024. Only studies addressing systems or sensors exclusively measuring plantar pressures inside the shoe were included. Results A total of 87 studies using commercially available devices and 45 articles proposing new systems or sensors were reviewed. The prevailing market offerings consist mainly of instrumented insoles. Emerging technologies under development often feature configurations with four, six or eight resistive sensors strategically placed within removable insoles. Despite some variability due to the inherent heterogeneity of human gait, these devices assess plantar pressure, although they present significant differences between them in measurement results. Individuals with diabetic foot conditions appears exhibit elevated plantar pressures, with reported peak pressures reaching approximately 1000 kPa. The results also showed significant differences between the diabetic and non-diabetic groups. Conclusion Instrumented insoles, particularly those incorporating resistive sensor technology, dominate the field. Systems employing eight sensors at critical locations represent a pragmatic approach, although market options extend to systems with up to 960 sensors. Differences between devices can be a critical factor in measurement and highlights the importance of individualized patient assessment using consistent measurement devices.
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Affiliation(s)
- Pedro Castro-Martins
- CIETI, ISEP, Polytechnic of Porto, Portugal
- Faculty of Engineering, University of Porto, Portugal
| | - Arcelina Marques
- CIETI, ISEP, Polytechnic of Porto, Portugal
- Institute for Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Luís Coelho
- CIETI, ISEP, Polytechnic of Porto, Portugal
- INESC-TEC, Centre for Robotics in Industry and Intelligent Systems, Porto, Portugal
| | - Mário Vaz
- Faculty of Engineering, University of Porto, Portugal
- Institute for Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
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Malki A, van Kouwenhove L, Verkerke GJ, Dekker R, Hijmans JM. Effects of heel apex position, apex angle and rocker radius on plantar pressure in the heel region. Heliyon 2023; 9:e21036. [PMID: 37942153 PMCID: PMC10628656 DOI: 10.1016/j.heliyon.2023.e21036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction Rocker shoes and insoles are used to prevent diabetic foot ulcers in persons with diabetes mellitus and loss of protective sensation, by reducing the plantar pressure in regions with high pressure values (>200 kPa) (e.g., hallux, metatarsal heads and heel). However, forefoot rocker shoes that reduce pressure in the forefoot inadvertently increase pressure in the heel. No studies focused on mitigating the negative effects on heel pressure by optimizing the heel rocker midsole, yet. Therefore, we analyze the effect of different heel rocker parameters on the heel plantar pressure. Methods In-shoe pressure was measured, while 10 healthy participants walked with control shoe and 10 different heel rocker settings. Peak pressure was determined in 7 heel masks, for all shoes. Generalized estimating equations was performed to test the effect of the different shoes on the peak pressure in the different heel masks. Results In the proximal heel, a rocker shoe with distal apex position, small rocker radius and large apex angle (100°), shows the largest significant decrease in peak pressure compared to rocker shoes with more proximally located apex positions. In the midheel and distal heel, the same rocker shoes or any other rocker shoes, analyzed in this study, do not reduce the PP more than 2 % compared to the control shoe. For the midheel and distal heel region with high pressure values (>200 kPa), rocker shoes alone are not the correct option to reduce the pressure to below 200 kPa. Conclusion When using rocker shoes to reduce the pressure in the forefoot, a heel rocker midsole with a distal apex position, small rocker radius and apex angle of 100°, mitigates the negative effects on proximal heel pressure. For the midheel and distal heel, other footwear options as an addition or instead of rocker shoes are needed to reduce the pressure.
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Affiliation(s)
- Athra Malki
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Laurens van Kouwenhove
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gijsbertus J. Verkerke
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Biomechanical Engineering, University of Twente, Enschede, Overijssel, the Netherlands
| | - Rienk Dekker
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Juha M. Hijmans
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Dragoi II, Popescu FG, Bowling FL, Bondor CI, Ionac M. Patients' Buying Behavior for Non-Reimbursed Off-Loading Devices Used in Diabetic Foot Ulcer Treatment-An Observational Study during COVID-19 Pandemic from a Romanian Physical Therapy Unit. J Clin Med 2023; 12:6516. [PMID: 37892654 PMCID: PMC10607790 DOI: 10.3390/jcm12206516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/29/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Diabetic foot ulcer non-reimbursed treatment depends on multiple factors, including the patient's buying behaviors. Factors affecting buying behaviors for the removable off-loading devices are not completely understood. The aim of this study was to investigate the patients' buying behaviors of the removable off-loading devices and their influence on the DFU treatment outcomes remotely monitored during the COVID-19 pandemic. In this prospective observational study, 45 patients affected by diabetic peripheral neuropathy, with/without peripheral arterial disease, with foot ulcers treated with removable devices were remotely monitored. Prefabricated removable cast walkers, insoles, and therapeutic footwear were the proposed off-loading methods. Patients affected by high blood pressure (p = 0.018), peripheral arterial disease (p = 0.029), past amputations (p = 0.018), and ulcer on the left foot (p = 0.007) bought removable cast walkers. Rural provenience (p = 0.011) and male (p = 0.034) did not buy a removable walker. The healing rate was 69.4%, while the median healing time was 20 weeks. High blood pressure negatively influenced healing time (p = 0.020). Patients who bought the most efficient treatment method for DFUs were females from urban provenience, with amputation in the past, with peripheral arterial disease, and with high blood pressure.
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Affiliation(s)
- Iulia Iovanca Dragoi
- Department of Vascular Surgery and Reconstructive Microsurgery, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (I.I.D.); (F.L.B.); (M.I.)
| | - Florina Georgeta Popescu
- Discipline of Occupational Health, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania
| | - Frank L. Bowling
- Department of Vascular Surgery and Reconstructive Microsurgery, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (I.I.D.); (F.L.B.); (M.I.)
- Department of Surgery & Translational Medicine, Faculty of Medical and Human Sciences, University of Manchester, Oxford Rd., Manchester M13 9PL, UK
| | - Cosmina Ioana Bondor
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy “Iuliu Hațieganu”, 8 Victor Babeș, 400000 Cluj-Napoca, Romania;
| | - Mihai Ionac
- Department of Vascular Surgery and Reconstructive Microsurgery, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania; (I.I.D.); (F.L.B.); (M.I.)
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Chatzistergos PE, Gatt A, Formosa C, Sinclair JK, Chockalingam N. Effective and clinically relevant optimisation of cushioning stiffness to maximise the offloading capacity of diabetic footwear. Diabetes Res Clin Pract 2023; 204:110914. [PMID: 37742803 DOI: 10.1016/j.diabres.2023.110914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/24/2023] [Accepted: 09/21/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Optimising the cushioning stiffness of diabetic footwear/orthoses can significantly enhance their offloading capacity. This study explores whether optimum cushioning stiffness can be predicted using simple demographic and anthropometric parameters. METHODS Sixty-nine adults with diabetes and loss of protective sensation in their feet were recruited for this cross-sectional observational study. In-shoe plantar pressure was measured using Pedar® for a neutral diabetic shoe (baseline) and after adding cushioning footbeds of varying stiffness. The cushioning stiffness that achieved maximum offloading was identified for each participant. The link between optimum cushioning stiffness and plantar loading or demographic/anthropometric parameters was assessed using multinomial regression. RESULTS People with higher baseline plantar loading required stiffer cushioning materials for maximum offloading. Using sex, age, weight, height, and shoe-size as covariates correctly predicted the cushioning stiffness that minimised peak pressure across the entire foot, or specifically in the metatarsal heads, midfoot and heel regions in 70%, 72%, 83% and 66% of participants respectively. CONCLUSIONS Increased plantar loading is associated with the need for stiffer cushioning materials for maximum offloading. Patient-specific optimum cushioning stiffness can be predicted using five simple demographic/anthropometric parameters. These results open the way for methods to optimise cushioning stiffness as part of clinical practice.
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Affiliation(s)
- Panagiotis E Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom.
| | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Cynthia Formosa
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Jonathan K Sinclair
- Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom; Faculty of Health Sciences, University of Malta, Msida, Malta
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de Haan A, Hijmans JM, van der Vegt AE, van der Laan HP, van Nes JGH, Werker PMN, Langendijk JA, Steenbakkers RJHM. Effect of painful Ledderhose disease on dynamic plantar foot pressure distribution during walking: a case-control study. Foot (Edinb) 2023; 56:101990. [PMID: 36905795 DOI: 10.1016/j.foot.2023.101990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Plantar pressure distribution during walking in patients with painful Ledderhose disease is unknown. RESEARCH QUESTION Do patients with painful Ledderhose disease have an altered plantar pressure distribution during walking compared to individuals without foot pathologies? It was hypothesized that plantar pressure is shifted away from the painful nodules. METHODS Pedobarography data of 41 patients with painful Ledderhose disease (cases, mean age: 54.2 ± 10.4 years) was collected and compared to pedobarography data from 41 individuals without foot pathologies (controls, mean age: 21.7 ± 2.0 years). Peak Pressure (PP), Maximum Mean Pressure (MMP) and Force-Time Integral (FTI) were calculated for eight regions (heel, medial midfoot, lateral midfoot, medial forefoot, central forefoot, lateral forefoot, hallux and other toes) under the soles of the feet. Differences between cases and controls were calculated and analysed by means of linear (mixed models) regression. RESULTS Proportional differences in PP, MMP and FTI showed increased values for the cases compared to the controls, especially in the heel, hallux and other toes regions, and decreased values in the medial- and lateral midfoot regions. In naïve regression analysis, being a patient was a predictor for increased- and decreased values for PP, MMP and FTI for several regions. When dependencies in the data were taken into account with linear mixed-model regression analysis, the increased- and decreased values for the patients were most prevalent for FTI at the heel, medial midfoot, hallux and other toes regions. SIGNIFICANCE In patients with painful Ledderhose disease, during walking, a shift of pressure was found towards the proximal and distal foot regions, while offloading the midfoot regions.
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Affiliation(s)
- Anneke de Haan
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands.
| | - Juha M Hijmans
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Anna E van der Vegt
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Hans Paul van der Laan
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | | | - Paul M N Werker
- University of Groningen, University Medical Center Groningen, Department of Plastic Surgery, Groningen, the Netherlands
| | - Johannes A Langendijk
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Roel J H M Steenbakkers
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, Groningen, the Netherlands
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Ribeiro AP, de Souza BL, João SMA. Effectiveness of mechanical treatment with customized insole and minimalist flexible footwear for women with calcaneal spur: randomized controlled trial. BMC Musculoskelet Disord 2022; 23:773. [PMID: 35964021 PMCID: PMC9375309 DOI: 10.1186/s12891-022-05729-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKROUND Calcaneal spurs are described as bony outgrowths arising on medial calcaneal, where inappropriate footwear can promote disease progression. OBJECTIVE Investigate the effectiveness of mechanical treatment with customized insole and minimalist flexible footwear during gait training program in women with calcaneal spur. METHODS Design: A single-blinded, randomized and controlled trial. SETTING Biomechanics laboratory. PARTICIPANTS Forty-three women, 29 with calcaneal spur and 14 control. INTERVENTION Gait training program with use of the minimalist flexible footwear (MFG n = 15, age: 48.9 ± 9.4, height: 1.61 ± 0.1, BMI: 32.1 ± 7.0) and customized insole on footwear (COIG n = 14, age: 50.3 ± 5.8, height: 1.62 ± 0.1, BMI: 32.2 ± 4.3) and control (CG n = 14, age: 47.8 ± 8.6, height: 1.63 ± 0.1, BMI: 27.5 ± 4.5), followed of the evaluations: baseline (T0) and after three (T3) and six (T6) months. Duration of the intervention was of the six months consecutive for at least 42 h per week (six hours a day, seven days a week). Outcome primary were calcaneus pain (visual analogue scale), Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ-Br) and 6-min walk test (6MWT). Secondary was plantar pressure distribution by a pressure platform system during gait and static index foot posture (FPI). STATISTICAL ANALYSIS analysis of variance for repeated measure and between groups were used to detect treatment-time interactions (α = 5%). Effect size with D Cohen's also was used between T0 and after six (T6) months of intervention. RESULTS The MFG and COIG were effective at reducing pain after six months (MFG: 2.5-4.5 CI, p = 0.001; COIG: 1.5-3.5 CI, p = 0.011). The FFI and FHSQ-Br showed improvements with MFG and COIG after T6 (MFG: 13.7-15.4 CI, p = 0.010; COIG: 11.3-15.0 CI, p = 0.001). The 6MWT increased with MFG (589.3-622.7 CI) and COIG (401.3-644.7 CI) and foot pronation was decreased after T3 and T6 MFG (FPI Right: 4.2-5.4 CI; Left: 3.6-5.4 CI) COIG (FPI Right: 3.4-6.8 CI; Left: 3.3-5.7 CI). The contact area reduced on forefoot and rearfoot with MFG and GOIG and midfoot and rearfoot with MFG. Maximum force was reduced on foot with MFG after T3 and T6. The peak pressure was reduced on the forefoot with MFG and COIG and on midfoot and rearfoot with MFG. CONCLUSIONS The mechanical treatment with customized insole and minimalist flexible footwear during gait training program during six months in women with calcaneal spur reduced the calcaneus pain, increased function and health feet and reduced plantar load on the rearfoot, midfoot and forefoot. However, the footwear alone was more effective than when combined customized insole, given the greater efficacy on clinical and biomechanical aspects. TRIAL REGISTRATION ClinicalTrials.gov NCT03040557 (date of first registration: 02/02/2017).
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Affiliation(s)
- Ana Paula Ribeiro
- Physical Therapy Department, Post-Graduate Department, School of Medicine, University of São Paulo, R: Cipotânea, 51, Campus Universitário, São Paulo/SP, Brazil. .,School of Medicine, Post-Graduate in Health Science Department, Biomechanics and Musculoskeletal Rehabilitation Laboratory, University Santo Amaro, São Paulo, Brazil.
| | - Brenda Luciano de Souza
- School of Medicine, Post-Graduate in Health Science Department, Biomechanics and Musculoskeletal Rehabilitation Laboratory, University Santo Amaro, São Paulo, Brazil
| | - Silvia Maria Amado João
- Physical Therapy Department, Post-Graduate Department, School of Medicine, University of São Paulo, R: Cipotânea, 51, Campus Universitário, São Paulo/SP, Brazil
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Lin-Wei Chen T, Wai-Chi Wong D, Peng Y, Wang Y, Kwan-Kei Wong I, Lam TK, Lam WK, Zhang M. The interaction effects of rocker angle and apex location in rocker shoe design on foot biomechanics and Achilles tendon loading. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2022. [DOI: 10.1016/j.medntd.2021.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Effects of Longitudinal Bending Stiffness of forefoot rocker profile shoes on ankle kinematics and kinetics. Gait Posture 2021; 90:326-333. [PMID: 34564006 DOI: 10.1016/j.gaitpost.2021.09.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/27/2021] [Accepted: 09/16/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Rocker profile shoes with a proximally placed apex are currently one of the most prescribed shoe modifications for treatment and prevention of lower leg deficits. Three geometrical rocker design parameters apex position (AP), apex angle (AA) and rocker radius (RR) influence both plantar pressure redistribution and kinetic and kinematic alterations of the lower leg. In addition, longitudinal bending stiffness (LBS) of the outsole influences these parameters as well. This study aims to investigate the effects of the LBS in combination with different forefoot radii of rocker shoes on kinematics and kinetics of the lower limb. METHODS 10 participants walked in standard shoes and six experimental shoe conditions with high and low LBS and three different forefoot rocker radii with the same (proximal) AP and AA. Lower extremity kinematics and kinetics were collected while walking on an instrumented treadmill at preferred walking speed and analysed with a repeated measures ANOVA and Statistical Parametric Mapping (SPM) (α = .05; post hoc α = .05/6). RESULTS SPM analyses revealed no significant differences for LBS and interaction LBS*RR for most research variables in terminal stance (ankle angle, ankle moment, ankle power, foot-to-horizontal angle, shank-to-vertical angle, external ankle moment, ground reaction force angle). A significant LBS effect was found for anterior-posterior position of the centre of pressure during pre-swing and peak ankle dorsiflexion angle. No relevant significant differences were found in spatio-temporal parameters and total work at the ankle between low and high LBS. CONCLUSION This study showed that longitudinal bending stiffness does not affect the biomechanical working mechanism of rocker profile shoes as long as toe plantarflexion is restricted. Providing that the forefoot rocker radius supports at least a normal foot-to-horizontal angle at toe-off, there is no reason to increase sole stiffness to change ankle kinematics and kinetics.
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Ten Wolde IY, van Kouwenhove L, Dekker R, Hijmans JM, Greve C. Effects of rocker radii with two longitudinal bending stiffnesses on plantar pressure distribution in the forefoot. Gait Posture 2021; 90:457-463. [PMID: 34601308 DOI: 10.1016/j.gaitpost.2021.09.186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Outsole parameters of the shoe can be adapted to offload regions of pain or region of high pressures. Previous studies already showed reduced plantar pressures in the forefoot due to a proximally placed apex position and higher longitudinal bending stiffness (LBS). The aim of this study was to determine the effect of changes in rocker radii and high LBS on the plantar pressure profile during gait. METHOD 10 participants walked in seven shoe conditions of which one control shoe and six rocker shoes with small, medium and large rocker radii and low and high longitudinal bending stiffness. Pedar in-shoe plantar pressure measuring system was used to quantify plantar pressures while walking on a treadmill at self-selected walking speed. Peak plantar pressure, maximum mean pressure and force-time integral were analyzed with Generalized Estimated Equation (GEE) and Tukey post hoc correction (α = .05). RESULTS Significantly lower plantar pressures were found in the first toe, toes 2-5, distal and proximal forefoot in all rocker shoe conditions as compared to the control shoe. Plantar pressures in the first toe and toes 2-5 were significantly lower in the small radius compared to medium and large radii. For the distal forefoot both small and medium radii significantly reduced plantar pressure compared to large radii. Low LBS reduced plantar pressure at the first toe significantly compared to high LBS independent of the rocker radius. Plantar pressures in the distal forefoot and toes 2-5 were lower in high LBS compared to low LBS. CONCLUSION Manipulation of the rocker radius and LBS can effectively reduce peak plantar pressures in the forefoot region during gait. In line with previous studies, we showed that depending on the exact target location for offloading, different combinations of rocker radius and LBS need to be adopted to maximize treatment effects.
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Affiliation(s)
- I Y Ten Wolde
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - L van Kouwenhove
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - R Dekker
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - J M Hijmans
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - C Greve
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands.
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Matthias EC, Banwell HA, Arnold JB. Methods for assessing footwear comfort: a systematic review. FOOTWEAR SCIENCE 2021. [DOI: 10.1080/19424280.2021.1961879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Elsa C. Matthias
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - Helen A. Banwell
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - John B. Arnold
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
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Zwaferink JBJ, Custers W, Paardekooper I, Berendsen HA, Bus SA. Effect of a carbon reinforcement for maximizing shoe outsole bending stiffness on plantar pressure and walking comfort in people with diabetes at high risk of foot ulceration. Gait Posture 2021; 86:341-345. [PMID: 33857799 DOI: 10.1016/j.gaitpost.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 03/15/2021] [Accepted: 04/07/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Different shoe design features can reduce peak plantar pressure to help prevent foot ulcers in people with diabetes. A carbon reinforcement of the shoe outsole to maximize bending stiffness is commonly applied in footwear practice, but its effect has not been studied to date. RESEARCH QUESTION What is the effect of a carbon shoe-outsole reinforcement on peak plantar pressure and walking comfort in people with diabetes at high risk of foot ulceration? METHODS In 24 high-risk people with diabetes, in-shoe regional peak pressures were measured during walking at a comfortable speed in two different shoe conditions: an extra-depth diabetes-specific shoe with a non-reinforced outsole and the same type of shoe with a 3-mm-thick full-length carbon reinforcement of the outsole. The same custom-made insole was worn in both shoe conditions. Walking comfort was assessed using a Visual Analogue Scale (0-10, 10 being highest possible comfort). RESULTS Significantly lower metatarsal head peak pressures (by a median 10-22 kPa) were found with the reinforced shoe compared to the non-reinforced shoe (p < .001). In >83% of cases with the reinforced shoe and >71% with the non-reinforced shoe metatarsal head peak pressures were <200 kPa. At the hindfoot, peak pressures were significantly higher (by a median 24 kPa) with the reinforced shoe (p = .001). No significant shoe effects were found for the toes. No significant shoe effects were found for walking comfort: median 6.1 for the reinforced shoe versus 5.6 for the non-reinforced shoe. SIGNIFICANCE Adding a full-length carbon reinforcement to the outsole of a diabetes-specific shoe significantly reduces peak pressures at the metatarsal heads, where ulcers often occur, in high-risk people with diabetes, and this does not occur at the expense of patient-perceived walking comfort.
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Affiliation(s)
- Jennefer B J Zwaferink
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Wim Custers
- Penders Voetzorg, Reinier De Graafweg 1, 2625 AD, Delft, the Netherlands
| | - Irma Paardekooper
- Penders Voetzorg, Reinier De Graafweg 1, 2625 AD, Delft, the Netherlands
| | - Heleen A Berendsen
- Department of Rehabilitation Medicine, Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, the Netherlands
| | - Sicco A Bus
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands.
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van Kouwenhove L, Verkerke GJ, Postema K, Dekker R, Hijmans JM. Effect of different forefoot rocker radii on lower-limb joint biomechanics in healthy individuals. Gait Posture 2021; 86:150-156. [PMID: 33725583 DOI: 10.1016/j.gaitpost.2021.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/22/2021] [Accepted: 03/03/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Previous studies showed that rocker shoes with a stiff forefoot rocker profile significantly reduce peak plantar flexion moment at the ankle (PFM) and peak ankle dorsiflexion (DF). Both parameters are related to Achilles tendon and Plantar Fascia unloading. The shape of an outsole with a forefoot rocker is described with multiple rocker design parameters. The aim of this research is, to determine the relation between different forefoot rocker radii on peak DF and peak PFM at a self-selected walking speed. METHODS 10 participants walked in standard shoes and three experimental pairs of shoes with different forefoot rocker radii. Lower extremity kinematics and kinetics were collected while walking on an instrumented treadmill at preferred walking speed and analysed with Statistical Parametric Mapping (SPM) (α = .05; post-hoc α = .05/6). RESULTS Peak value analyses showed significant decreases in peak DF, peak PFM, and peak ankle power generation for the rocker conditions. No relevant significant differences were found in spatio-temporal parameters and total work at the ankle joint. SPM showed a significant decrease (% gait cycle) in DF (40-69 %), PFM (7-15 %; 41-68 %; 69-81 %), ankle power (10-15 %; 32-51 %; 55-64 %; 64-67 %; 72-80 %) and foot-to-horizontal angle (FHA) (0-4 %; 40-62 %; 92-100 %) and an increased shank-to-vertical angle (SVA) (44-84 %) for the rocker conditions. CONCLUSION The results of this study suggest that rocker shoes with a proximally placed apex significantly reduce DF and PFM during the third rocker compared with control shoes. This effect is mainly explained by a change in the FHA. Smaller radii cause the largest reductions in DF and PFM, so therefore, a uniform standardisation of the forefoot rocker radius is essential.
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Affiliation(s)
- L van Kouwenhove
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands.
| | - G J Verkerke
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands; University of Twente, Department of Biomechanical Engineering, Enschede, the Netherlands
| | - K Postema
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - R Dekker
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - J M Hijmans
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
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Drăgulinescu A, Drăgulinescu AM, Zincă G, Bucur D, Feieș V, Neagu DM. Smart Socks and In-Shoe Systems: State-of-the-Art for Two Popular Technologies for Foot Motion Analysis, Sports, and Medical Applications. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4316. [PMID: 32748872 PMCID: PMC7435916 DOI: 10.3390/s20154316] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 12/25/2022]
Abstract
The present paper reviews, for the first time, to the best of our knowledge, the most recent advances in research concerning two popular devices used for foot motion analysis and health monitoring: smart socks and in-shoe systems. The first one is representative of textile-based systems, whereas the second one is one of the most used pressure sensitive insole (PSI) systems that is used as an alternative to smart socks. The proposed methods are reviewed for smart sock use in special medical applications, for gait and foot pressure analysis. The Pedar system is also shown, together with studies of validation and repeatability for Pedar and other in-shoe systems. Then, the applications of Pedar are presented, mainly in medicine and sports. Our purpose was to offer the researchers in this field a useful means to overview and select relevant information. Moreover, our review can be a starting point for new, relevant research towards improving the design and functionality of the systems, as well as extending the research towards other areas of applications using sensors in smart textiles and in-shoe systems.
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Affiliation(s)
- Andrei Drăgulinescu
- Electronics Technology and Reliability Department, Faculty of Electronics, Telecommunications and Information Technology, University Politehnica of Bucharest, 061071 Bucharest, Romania;
| | - Ana-Maria Drăgulinescu
- Telecommunications Department, Faculty of Electronics, Telecommunications and Information Technology, University Politehnica of Bucharest, 061071 Bucharest, Romania;
| | - Gabriela Zincă
- Automation and Industrial Informatics Department, Faculty of Automatic Control and Computer Science, University Politehnica of Bucharest, 061071 Bucharest, Romania;
| | - Doina Bucur
- Mechatronics Department, Faculty of Mechanical Engineering and Mechatronics, Biomedical Engineering and Biotechnology Department, Faculty of Medical Engineering, University Politehnica of Bucharest, 061071 Bucharest, Romania;
| | - Valentin Feieș
- Electronics Technology and Reliability Department, Faculty of Electronics, Telecommunications and Information Technology, University Politehnica of Bucharest, 061071 Bucharest, Romania;
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López-Moral M, Molines-Barroso RJ, Álvaro-Afonso FJ, Uccioli L, Senneville E, Lázaro-Martínez JL. Importance of Footwear Outsole Rigidity in Improving Spatiotemporal Parameters in Patients with Diabetes and Previous Forefoot Ulcerations. J Clin Med 2020; 9:jcm9040907. [PMID: 32218232 PMCID: PMC7230652 DOI: 10.3390/jcm9040907] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/07/2020] [Accepted: 03/24/2020] [Indexed: 02/06/2023] Open
Abstract
We aimed to identify if any differences existed in spatiotemporal parameters during gait among different densities of rocker soles in patients with a history of neuropathic ulcerations and the differences in comfort between shoe conditions. This study was a cross-sectional study of 24 patients with diabetes and a history of neuropathic diabetic foot ulcers (DFUs). Spatiotemporal parameters (duration of stance phase (ms), stride length (cm), and step velocity (m/s)) were analyzed in barefoot, semirigid outsole, and rigid outsole footwear conditions. A dynamic pressure measurement system (Footscan® system, RSscan International, Olen, Belgium) was used to assess shoe conditions. We also analyzed differences in comfort between the shoe conditions using a visual analog scale. A Wilcoxon test for paired samples was used to assess gait differences. Result showed that a rigid outsole causes changes in the subphases of the stance phase (p < 0.001; Cohen d = 0.6) compared to a semirigid outsole. Stride length (p < 0.001; Cohen d = 0.66) and step velocity were significantly longer (p < 0.001; Cohen d = 2.03) with the use of rigid outsole footwear. A rigid rocker sole reduces the time of the stance phase, in addition to increasing the stride length and velocity of step in patients with a previous history of DFUs.
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Affiliation(s)
- Mateo López-Moral
- Diabetic Foot Unit, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (M.L.-M.); (F.J.Á.-A.); (J.L.L.-M.)
| | - Raúl Juan Molines-Barroso
- Diabetic Foot Unit, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (M.L.-M.); (F.J.Á.-A.); (J.L.L.-M.)
- Correspondence: ; Tel.: +34-913-942-203; Fax: +34-913-942-203
| | - Francisco Javier Álvaro-Afonso
- Diabetic Foot Unit, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (M.L.-M.); (F.J.Á.-A.); (J.L.L.-M.)
| | - Luigi Uccioli
- Diabetic Foot Unit, Department Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Eric Senneville
- Infectious Diseases Department, Gustave Dron Hospital, 59200 Tourcoing, France;
| | - José Luis Lázaro-Martínez
- Diabetic Foot Unit, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (M.L.-M.); (F.J.Á.-A.); (J.L.L.-M.)
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López-Moral M, Lázaro-Martínez JL, García-Morales E, García-Álvarez Y, Álvaro-Afonso FJ, Molines-Barroso RJ. Clinical efficacy of therapeutic footwear with a rigid rocker sole in the prevention of recurrence in patients with diabetes mellitus and diabetic polineuropathy: A randomized clinical trial. PLoS One 2019; 14:e0219537. [PMID: 31295292 PMCID: PMC6623964 DOI: 10.1371/journal.pone.0219537] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 06/25/2019] [Indexed: 01/09/2023] Open
Abstract
Background Therapeutic footwear becomes the first treatment line in the prevention of diabetic foot ulcer and future complications of diabetes. Previous studies and the International Working Group on the Diabetic Foot have described therapeutic footwear as a protective factor to reduce the risk of re-ulceration. In this study, we aimed to analyze the efficacy of a rigid rocker sole to reduce the recurrence rate of plantar ulcers in patients with diabetic foot. Methods Between June 2016 and December 2017, we conducted a randomized controlled trial in a specialized diabetic foot unit. Participants and intervention Fifty-one patients with diabetic neuropathy who had a recently healed plantar ulcer were randomized consecutively into the following two groups: therapeutic footwear with semi-rigid sole (control) or therapeutic footwear with a rigid rocker sole (experimental). All patients included in the study were followed up for 6 months (one visit each 30 ± 2 days) or until the development of a recurrence event. Main outcome and measure Primary outcome measure was recurrence of ulcers in the plantar aspect of the foot. Findings A total of 51 patients were randomized to the control and experimental groups. The median follow-up time was 26 [IQR—4.4—26.1] weeks for both groups. On an intention-to-treat basis, 16 (64%) and 6 (23%) patients in the control and experimental groups had ulcer recurrence, respectively. Among the group with >60% adherence to therapeutic footwear, multivariate analysis showed that the rigid rocker sole improved ulcer recurrence-free survival time in diabetes patients with polyneuropathy and DFU history (P = 0.019; 95% confidence interval, 0.086–0.807; hazard ratio, 0.263). Conclusions We recommend the use of therapeutic footwear with a rigid rocker sole in patients with diabetes with polyneuropathy and history of diabetic foot ulcer to reduce the risk of plantar ulcer recurrence. Trial registration ClinicalTrials.gov NCT02995863.
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Affiliation(s)
- Mateo López-Moral
- Diabetic Foot Unit, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José Luis Lázaro-Martínez
- Diabetic Foot Unit, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- * E-mail:
| | - Esther García-Morales
- Diabetic Foot Unit, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Yolanda García-Álvarez
- Diabetic Foot Unit, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Francisco Javier Álvaro-Afonso
- Diabetic Foot Unit, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Raúl J. Molines-Barroso
- Diabetic Foot Unit, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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