A comparative study of foot dimension between adult male and female and evaluation of foot hazards due to using of footwear

Foot deformation analysis with different load-bearing conditions to enhance diabetic footwear designs

In-depth analyses of foot surface measurements upon weight bearing are crucial to understand how the dorsal and plantar surfaces of the foot deform during motion to enhance the fit of footwear, which is particularly important for diabetic patients with stringent fit requirements to redistribute the plantar weight forces. This study analyzes diabetic foot deformations under 3 different weight bearing conditions (no weight bearing, half weight bearing, and 80% weight bearing) by using a novel foot scanning method that enables efficient scanning of the dorsal and plantar surfaces of the foot simultaneously. The feet of 48 patients with diabetes mellitus (DM) are scanned. With increased load on the feet, the width of the forefoot increases by 9.7%-10.4%, height of the midfoot decreases by 15.1%-18.2%, forefoot and midfoot rotate to the medial side by 16.9%-23.9% while the rearfoot rotates to the lateral side by 15.2% simultaneously, and the plantar of the foot increases contact with the floor by 11.4%-23.0%. Gender differences in foot shape are also found between males and females, males have a broader foot than females for the same foot length. Precise anthropometric information of foot changes and deformation therefore enables adequate foot protection, fit and comfort when designing footwear. This research contributes to shoe design considerations that focus on the deformation of the foot under different loads.

Non-vehicle commuting in Italy: need for ergonomic action for women's lower limbs?

INTRODUCTION

The aim of this paper is to examine gender differences in the occurrence of accidents among workers while walking to or from their workplace (non-vehicle commuting accidents). We have previously found that the lower limb is more often injured at work among women, compared to men, so the paper concentrates on lower limb injuries.

METHODS

Using the records of the National Institute for Insurance against Injuries at Work (INAIL), we focused on the non-vehicle commuting accidents of women and men recognized as work-related for the period 2013-2017. In particular, we examined the gender difference by work sector and type of trauma suffered with particular attention to lower limb injuries.

RESULTS

The rate of non-vehicle commuting accidents (n. 60,936) among women was significantly higher than for men (1.29‰ vs 0.40‰ men, p < 0.001) for the period studied. Lower limb injuries (50.5% for women and 43.7% for men, p < 0.001) constituted the large majority of these injuries. In particular, dislocation of the ankle (78% for women vs 65.5% for men, p < 0.001), bruise of the knee (71.2% for women vs 54.9% for men, p < 0.001) and fracture of the foot (41% for women vs 33.6% for men, p < 0.001) were all significantly higher among women. The work sectors with higher injury rates were: Transport and Warehouse, Public Administration, Health and care services and Wholesale and retail trade. This result may be due to wear and tear from conditions at work. The women injured were on the average, a decade older than men (50-59 vs 40-49 years old).

CONCLUSIONS

Non-vehicle commuting represents an important, albeight neglected, preventable risk for women workers, causing lower limb trauma particularly at the ankle, the foot and the knee. These areas may be particularly injure-prone among women in specific sectors, due to the work environment. Effective prevention of these injuries requires gender-oriented ergonomic actions at work and in the commuting environment.

Wearing high-heeled shoes increases the foot arch angle inducing measurable changes in the musculoskeletal system

BACKGROUND AND OBJECTIVE

The study determined the effects of females wearing high-heeled shoes on the lower extremity musculoskeletal system and somatometry.

METHODS

The study was carried out with 136 females between 18 and 45 years old. The first group consisted of 66 females wearing 5 cm or higher high-heeled shoes, at least 5 hours a day, three days a week, and at least one year. The second group consisted of 70 females wearing shoes with heel height less than 5 cm for at least one year.

RESULTS

Differences in length parameters may result from the narrow and pointed toe of the high-heeled shoe. These shoes distribute the pressure on the caput ossis metatarsi I and compress the foot in this area. Differences in anthropometric measurements show that females wearing high-heeled shoes have more slender and smaller foot structure.

CONCLUSION

These findings show that regular wearing of high-heeled shoes causes changes via the increased foot arch structure. These alterations result from regional, racial, gender, heel height, shoe type (shape), and shoe habits.

How do we fit underground coal mining work boots?

Acceptable footwear fit, particularly width, is subjective and vaguely quantified. Proper shoe fit is important because it affects both comfort and the potential to prevent injury. Although mismatches between the feet of underground coal miners and their internal boot dimensions are known, no research has been undertaken to determine the impact of these mismatches on worker perceptions of fit, comfort and pain. This study aimed to quantitatively assess mining work boot fit relative to underground coal miners' subjectively rated work boot fit and comfort, reported foot problems, lower limb pain and lower back pain in order to develop evidence-based work boot fit recommendations. Traditional footwear fitting methods based predominantly on foot length are insufficient for underground coal mining-specific footwear. Instead, fit at the heel, instep and forefoot must be considered when fitting underground coal mining work boots, in conjunction with the traditional length measurement.Practitioner summary: Underground coal miners report their work boots fit but are uncomfortable. This study assessed actual fit relative to perceived fit, comfort, foot problems, lower limb pain and lower back pain of 197 miners. Fit at the heel, instep and forefoot must be considered when fitting mining work boots.

A comparative study of standing fleshed foot and walking and jumping bare footprint measurements

Approximating true fleshed foot length and forefoot width from crime scene footprints is primarily based on anecdotal observations and fails to consider effects of different dynamic activities on footprint morphology. A literature search revealed numerous variables influencing footprint formation including whether the print was formed statically or dynamically. The aim of this study was to investigate if length and width measurements of the fleshed foot differ to the same measurements collected from walking and jumping footprints. Measurements of standing right foot length and forefoot width were collected from thirteen participants. Walking and jumping right footprints were then obtained using an Inkless Shoeprint Kit and digitally measured with GNU Image Manipulation Programme. Descriptive analysis compared standing fleshed foot length and forefoot width against the same measurements taken from walking and jumping footprints with and without ghosting. Results suggested walking footprint length with ghosting (x¯ = 268.61 mm) was greater than standing fleshed foot length (x¯ = 264.3 mm) and jumping footprint length with ghosting (x¯ = 261.57 mm). However, standing fleshed foot length was found to be greater than walking (x¯ = 254.85 mm) or jumping (x¯ = 255.63 mm) footprint lengths without ghosting. Forefoot widths showed standing fleshed foot width (x¯ = 105.66 mm) was greater than walking (x¯ = 95.63 mm) or jumping (x¯ = 98.03 mm) footprint widths. This study identifies variation in measurements of the standing fleshed foot and those of walking and jumping footprints, including variability between different dynamic states.

The inter- and intra-rater reliability of the Maestro and Barroco metatarsal length measurement techniques

Background

The relationship between metatarsal length and various forefoot pathologies is a topic of contention in Orthopaedics. The results of such investigations have been shown to depend on the method of metatarsal length measurement used. The aim of this study was to assess the inter- and intra-rater reliability of the Maestro and Barroco metatarsal length measurement techniques.

Methods

A retrospective and quantitative study was performed on 15 randomly selected radiographs to determine the reliability of the two measurement techniques across all five metatarsals (M1 to M5). This was done at one week apart for three weeks by three raters. The intraclass correlation coefficient (ICC), and the 95% lower confidence limit (95% LCL) were calculated.

Results

The Maestro and Barroco techniques produced high to very high ICC vlaues for length measurements across all metatarsals. The 95% lower confidence limit for inter-rater measurements ranged between 0.92–0.98 for Maestro’s and 0.86–0.99 for Barroco’s technique. For intra-rater measurements the 95% LCL ranged between 0.83–0.99 for Maestro’s and 0.75–0.99 for Barroco’s technique.

Conclusions

Our study found that both the Maestro and Barroco methods of measurements produced high to very high inter- and intra-rater reliability. Both methods may be suitable for the use of peri-operative planning and clinical research relating metatarsal length and forefoot pathology. Besides having a more simplistic method of application, the novel Barroco technique is comparable to the more established Maestro method in both repeatability and reproducibility.

Ergonomic footwear for Sri Lankan primary schoolchildren: A review of the literature

BACKGROUND

Foot ailments are common among schoolchildren, some of which may be attributed to wearing ill-fitting footwear. As schoolchildren often participate in athletic activity, they are doubly vulnerable to foot ailments, and are particularly vulnerable to conditions such as hallux valgus, Achilles tendonitis, athlete's foot, corns and calluses. Thus, there is an acute need for the design and manufacture of ergonomic footwear for this target group. While research on appropriate footwear for children has been carried out in relation to child populations in other societies, research on the circumstances of Sri Lankan schoolchildren is lacking. Neither the requisite design know-how nor the information for design is available to footwear manufacturers.

OBJECTIVES

This review of the literature is aimed at confirming the need for ergonomic footwear from the point of view of the effects of wearing ill-fitting shoes and at identifying the requirements in terms of design information, especially for schoolchildren of the age group five to ten years, to empower footwear manufacturers.

METHODS

PubMed, Google scholar and Science Direct were used for the literature search.

RESULTS

208 publications were read in full, 94 of which are referenced in this review.

CONCLUSION

The review shows morphological measurements, behavior and activity patterns of schoolchildren and environmental conditions they are exposed to should be determined to formulate design information.

Evaluation of thermal formation and air ventilation inside footwear during gait: The role of gait and fitting

Comfort is an important concept in footwear design. The microclimate inside footwear contributes to the perception of thermal comfort. To investigate the effect of ventilation on microclimate formation inside footwear, experiments with subjects were conducted at four gait speeds with three different footwear sizes. Skin temperature, metabolism, and body mass were measured at approximately 25 °C and 50% relative humidity, with no solar radiation and a calm wind. The footwear occupancy and ventilation rate were also estimated, with the latter determined using the tracer gas method. The experimental results revealed that foot movement, metabolism, evaporation, radiation, convection, and ventilation were the main factors influencing the energy balance for temperature formation on the surface of the foot. The cooling effect of ventilation on the arch temperature was observed during gait. The significance of the amount of air space and ventilation on the improvement in the thermal comfort of footwear was clarified.

Contribution Levels of Intrinsic Risk Factors to the Management of Patients with Plantar Heel Pain A Pilot Study

BACKGROUND

Of all of the lower-extremity injuries with multifactorial causes, heel pain represents the most frequent reason for visits to health-care professionals. Managing patients with heel pain can be very difficult. The purpose of this research was to identify key variables that can influence foot health in patients with heel pain.

METHODS

A cross-sectional observational study was performed with 62 participants recruited from the Educational Welfare Unit of the University of Malaga, Malaga, Spain. Therapists, blinded for the study, acquired the anthropometric information and the Foot Posture Index, and participants completed the Foot Health Status Questionnaire.

RESULTS

The most significant results reveal that there is a moderate relationship between clinical variables such as footwear and Foot Health Status Questionnaire commands such as Shoe (r = 0.515; P < .001). The most significant model domain was General Health (P < .001), with the highest determination coefficient (beta not standard = 34.05). The most significant predictable variable was body mass index (-0.110).

CONCLUSIONS

The variables that can help us manage clinical patients with heel pain are age, body mass index, footwear, and Foot Posture Index (left foot).

Footwear suitability in Turkish preschool-aged children

BACKGROUND

Unsuitable footwear worn in childhood may cause some foot problems by interfering normal development of foot.

OBJECTIVES

To compare footwear suitability rate of indoor and outdoor footwear at all points in preschool children and investigate factors which could affect footwear suitability.

STUDY DESIGN

A cross-sectional survey study.

METHODS

A total of 1000 healthy preschool children (4-6 years old) participated in this study. Indoor and outdoor footwear of children were evaluated through Turkish version of Footwear Assessment Score. Effect of factors like age, sex, number of siblings, educational and occupational situation of parents, and behavior of school management about selecting footwear was investigated.

RESULTS

Children got better footwear score for outdoor than indoor ones (p < 0.001). Boys got statistically better footwear score for both indoor and outdoor ones than girls (p < 0.001). Also significant difference in footwear score was found in favor of children who were going to schools that gave guidance about selecting footwear for both indoor and outdoor in comparison to children going to other schools (p < 0.001).

CONCLUSIONS

For healthy foot development, parents need an education about suitable footwear for their children. Performing education programs and investigation of their effect with comprehensive follow-up studies in future is essential.

CLINICAL RELEVANCE

This study reflects footwear habits of Turkish preschool children and factors affecting this issue. Results may give way to education programs about suitable footwear worn in childhood for healthy foot development.

Foot morphology in Spanish school children according to sex and age

The aim of this study was to analyse the differences in foot dimensions in a sample of Spanish school-aged children. A total of 497 boys and 534 girls from Spain participated in the study. Measurements of both feet were obtained using a 3D foot digitiser, and shoe sizes were recorded and then estimated based on foot length measurements. The variations in foot measurements underwent a gradual increase with age in both boys and girls. Gender differences appeared at the age of 8-9 years, when the girls in the sample were found to wear smaller shoes than those they should have worn. Most foot dimensions begin to differ between boys and girls at the age of 8 years. The girls in the sample studied used footwear that was too small for their foot length, probably because they looked for a better width fit.

Gender differences in foot shape: a study of Chinese young adults

One important extrinsic factor that causes foot deformity and pain in women is footwear. Women's sports shoes are designed as smaller versions of men's shoes. Based on this, the current study aims to identify foot shape in 1,236 Chinese young adult men and 1,085 Chinese young adult women. Three-dimensional foot shape data were collected through video filming. Nineteen foot shape variables were measured, including girth (4 variables), length (4 variables), width (3 variables), height (7 variables), and angle (1 variable). A comparison of foot measures within the range of the common foot length (FL) categories indicates that women showed significantly smaller values of foot measures in width, height, and girth than men. Three foot types were classified, and distributions of different foot shapes within the same FL were found between women and men. Foot width, medial ball length, ball angle, and instep height showed significant differences among foot types in the same FL for both genders. There were differences in the foot shape between Chinese young women and men, which should be considered in the design of Chinese young adults' sports shoes.

Sex-related differences in foot shape of adult Caucasians--a follow-up study focusing on long and short feet

The study's purpose was to substantiate findings on sex-related differences in foot morphology focusing on fringe sizes. Altogether, 287 Caucasian adults with long or short feet were scanned. Data were analysed together with data from 847 subjects from a previous study with comparable inclusion criteria and anthropometric data by: (1)comparing absolute measures within 237-277 mm foot length (FL); (2) comparing averaged measures across sizes in % of foot length for 203-323 mm FL; (3) reclassifying the additional subjects into a previously defined foot type classification. Male feet were wider and higher for the same FL. Averaged across sizes, no relevant differences between sexes were found for widths and heights. Slender or flat-pointed foot types were more common in longer feet, shorter feet tended to be bigger. Definitions for 'long' and 'short' are sex-related with an offset of three shoe sizes (EU). Results of this follow-up study on long and short feet can substantiate previous findings mainly described for the most common sizes. STATEMENT OF RELEVANCE: Improper footwear can cause pain and injury and proper fit is a major criterion for shoe buyers. Knowledge about sex-related differences in foot shape is important for shoe design. This study supplements the field of knowledge for very small and large feet.

Differences in foot pressures between Caucasians and Indians

BACKGROUND

Indians are the largest single ethnic minority group in the United Kingdom and form more than one million of the current population. No studies have investigated foot pressure differences between Caucasians and Indians.

OBJECTIVE

The aim of our study was to investigate the in-shoe pressure differences in Caucasians and Indians using the Pedar(®)-m (Novel GmbH, Germany).

METHODS

The study included 12 Caucasians and 21 Indians. Peak pressure (PP), contact area (CA), contact time (CT), pressure-time integral (PTI), force-time integral (FTI), instant of peak pressure (IPP), maximum force (MaxF) and mean force (MeanF) were recorded.

RESULTS

Caucasians had higher significant PP compared to Indians under the heel (293 kPa vs. 251 kPa; P<0.001), 1st metatarsal head (294 kPa vs. 233 kPa; P=0.01), 2nd metatarsal head (266 kPa vs. 236 kPa; P=0.03), 3rd metatarsal head (254 kPa vs. 223 kPa; P=0.04), and the 5th metatarsal head (168 kPa vs. 133 kPa; P=0.04). There was no significant difference in the contact area between the two race groups. The PTI was statistically significantly higher in Caucasians in the region of the 1st metatarsal head (79 kPas vs. 62 kPas; P=0.03) and 5th metatarsal head (58 kPas vs. 44 kPas; P=0.03). There were no significant differences among CT, FTI, IPP, MaxF and MeanF among them.

CONCLUSION

The PP under the heel, 1st, 2nd, 3rd and 5th metatarsal heads and the PTI under the 1st and 5th metatarsal heads in Caucasians is higher than in Indians. There is no difference in the CA.

Foot pain: is current or past shoewear a factor?

OBJECTIVE

Foot pain is common, yet few studies have examined the condition in relationship to shoewear. In this cross-sectional study of men and women from the population-based Framingham Study, the association between foot pain and type of shoewear was examined.

METHODS

Data were collected on 3,378 members of the Framingham Study who completed the foot examination in 2002-2008. Foot pain (both generalized and at specific locations) was measured by the response to the question "On most days, do you have pain, aching or stiffness in either foot?" Shoewear was recorded for the present time and 5 past age categories, by the subject's choice of the appropriate shoe from a list. The responses were categorized into 3 groups (good, average, or poor shoes). Sex-specific multivariate logistic regression models were used to examine the effect of shoewear (average shoes were the referent group) on generalized and location-specific foot pain, adjusting for age and weight.

RESULTS

In women, compared with average shoes, those who wore good shoes in the past were 67% less likely to report hindfoot pain (P = 0.02), after adjusting for age and weight. In men, there was no association between foot pain, at any location, and shoewear, possibly due to the fact that <2% wore bad shoe types, making it difficult to see any relationship.

CONCLUSION

Even after taking age and weight into account, past shoewear use in women remained associated with hindfoot pain. Future studies should address specific support and structural features of shoewear.

Development of a finite element model of female foot for high-heeled shoe design

BACKGROUND

Wearing high-heeled shoes may produce deleterious effects on the musculoskeletal system while elevation of the shoe heel with arch insole insert is used as a treatment strategy for plantar fasciitis. Due to limitations of the experimental approaches, direct measurements of internal stress/strain of the foot are impossible or invasive. This study aims at developing a finite element model for evaluating the biomechanical effects of high-heeled support on the ankle-foot complex.

METHODS

A 3D anatomically detailed FE model of the female foot and ankle together with a high-heeled support was developed and used to investigate the plantar contact pressure and internal loading responses of the bony and soft tissue structures of the foot with varying heel heights during simulated balanced standing.

FINDINGS

In the balanced standing position with high-heeled support, a pronounced increase in von Mises stress at the first metatarsophalangeal (MTP) joint was predicted. The strain on plantar fascia decreased compared to the flat horizontal support and valgus deformity of the hallux was not significant.

INTERPRETATION

The increased stress in forefoot especially at the first MTP segment during prolonged high-heeled standing may contribute to progressive hallux valgus (HV) deformity. However, the reduced tensile strain in the plantar fascia with heel elevation may help relieve plantar fasciitis related pain and inflammation.

Sex-related differences in foot shape

The purpose of the study was to investigate sex-related differences in foot morphology. In total, 847 subjects were scanned using a 3-D-footscanner. Three different analysis methods were used: (1) comparisons were made for absolute foot measures within 250-270 mm foot length (FL); (2) and for averaged measures (% FL) across all sizes; (3) the feet were then classified using a cluster analysis. Within 250-270 mm FL, male feet were wider and higher (mean differences (MD) 1.3-5.9 mm). No relevant sex-related differences could be found in the comparison of averaged measures (MD 0.3-0.6% FL). Foot types were categorised into voluminous, flat-pointed and slender. Shorter feet were more often voluminous, longer feet were more likely to be narrow and flat. However, the definition of 'short' and 'long' was sex-related; thus, allometry of foot measures was different. For shoe design, measures should be derived for each size and sex separately. Different foot types should be considered to account for the variety in foot shape. Improper footwear can cause foot pain and deformity. Therefore, knowledge of sex-related differences in foot measures is important to assist proper shoe fit in both men and women. The present study supplements the field of knowledge within this context with recommendations for the manufacturing of shoes.

Estimation of stature from foot length and foot breadth among the Rajbanshi: an indigenous population of North Bengal

In forensic anthropology, estimation of stature from feet dimensions plays a significant role in establishing personal identity. There is a scarcity of literature on the estimation of stature from foot length and foot breadth among various Indian populations, including the indigenous populations found in the northern part of the state of West Bengal, India. The Rajbanshis and the Meches are two such indigenous populations. The present study is an attempt to understand the relationship between stature and feet dimensions among Rajbanshi male and female individuals of North Bengal, India. Measurements of stature, foot length and foot breadth were recorded from 350 adult Rajbanshi and 100 adult Meche individuals (age range: 18-50 years) residing in different villages located in the Darjeeling District of West Bengal. The Technical Error of Measurements was within the accepted limits. The results of the present study indicate that female Rajbanshi individuals exhibit shorter stature and smaller feet than their male counterparts. Using ANOVA, it is determined that there was significant differences (p<0.05) in stature, foot length and foot breadth between sexes. Using paired t-test, it is further observed that bilateral variation was significant (p<0.05) within sexes with respect to foot length, but not with foot breadth (p>0.05). Stature, foot length and foot breadth are positively and significantly correlated with each other (p<0.01). The higher correlation coefficient between stature and foot length over that of stature and foot breadth points to the fact that foot length, rather than foot breadth, is more accurate in estimating stature. Sexual dimorphism is more pronounced than bilateral differences among Rajbanshi individuals. Using linear regression, it is observed that stature was strongly dependent on foot length and foot breadth. Foot breadth is strongly dependent on foot length. Prediction of stature is more accurate by using step-wise multiple regression. Age does not have a significant effect on stature estimation. The equations obtained for the Rajbanshis were fitted on the Meches to check whether the same equations could be utilized for both these indigenous communities. The equations obtained for another Indian population from the literature were also fitted and tested on the Rajbanshi. It may be concluded that the present study has provided equations to estimate stature from the feet dimensions among the Rajbanshis. It would be unwise to use the same equations for stature estimation for different Indian populations.

What is the best method for child longitudinal plantar arch assessment and when does arch maturation occur?

BACKGROUND

The medial longitudinal arch modifies significantly during growth. Nevertheless, authors differ on the age at which the foot acquires the adult-like shape. The best method to assess this arch in children is also controversial.

OBJECTIVES

Characterize the longitudinal arch of children between 3 and 10 years and compare the applicability of five evaluation methods.

METHODS

Plantar prints were acquired from 391 healthy preschools children from the University of Sao Paulo, Brazil. We calculated the arch indexes of: Cavanagh and Rodgers, Chipaux-Smirak, Staheli and the Alfa Angle, and compared them with the feet posture assessment. Non-parametric tests were used to compare among methods and ages. Spearman correlation was used to establish relationships among indexes.

RESULTS

3 and 4 years old showed a high prevalence of low arches (36-86%). Between 4 and 5 years old, significant difference was observed for all indexes. The indexes presented good correlation among them, although the proportions of the different arch types were different for each age group (p<0.001).

CONCLUSIONS

The longitudinal arch acquires an adult-like shape progressively, being statistically notorious the moment of medial longitudinal arch's formation between 4 and 5 years old. The Chipaux-Smirak Index is the best index to assess children's feet; it provides a better classification for lower arches and is easily calculated.

Do patients with diabetes wear shoes of the correct size?

BACKGROUND

Fifteen per cent of patients with diabetes will develop a foot ulcer at some point in their life. Ill-fitting footwear frequently contributes to foot ulceration. A good fitting shoe is an essential component in the management of the diabetic foot. The objective of this study was to assess the feet and footwear of patients with diabetes to determine whether they are wearing the correct-sized shoes.

METHODS

One-hundred patients with diabetes who were attending the general diabetic clinic had their foot length measured using a 'Clarks' shoe shop device and foot width using a pair of callipers. Measurements were taken whilst seated and standing. Shoe dimensions were also assessed by recording the manufactured shoe length and using callipers to assess shoe width. A calibrated measuring stick standardised shoe lengths. Neurovascular status and the presence of deformities in the foot were also recorded.

RESULTS

One-third of diabetic patients were wearing the correct shoes on either foot whilst seated or whilst standing. However, only 24% of patients were wearing shoes that were of the correct length and width for both feet whilst seated and 20% upon standing. Seventeen per cent of patients appeared in both groups. No significance was found between any other variables, such as sensory neuropathy.

CONCLUSIONS

Many patients with diabetes wear shoes that do not fit, particularly, shoes that are too narrow for their foot width. Assessing the appropriateness of footwear maybe an important part of foot examination.