Transient pain and discomfort when wearing high-heeled shoes

In the dynamic world of fashion, high-heeled footwear is revered as a symbol of style, luxury and sophistication. Yet, beneath the facade of elegance of classy footwear lies the harsh reality of discomfort and pain. Thus, this study aims to investigate the influence of wearing high-heeled shoes on the sensation of pain across different body regions over a period of 6 h. It involved fifty female participants, all habitual wearers of high-heeled shoes, aged between 20 and 30 years. Each participant kept a record of their perceptions of pain and discomfort every hour for a total of 6 h using a 0-10 pain scale with 0 indicating no pain and 10 indicating severe pain. The findings reveal a progressive rise in pain throughout wear, with the most intense pain reported in the back, calcaneus, and metatarsals. The analysis shows that after approximately 3.5 h, participants experience significant increases in pain levels. However, the relationship between heel height and pain is not linear. It appears that a heel height of 7.5 cm is the threshold where overall body pain becomes significant. The study suggests that a duration of 3.5 h of wear and a heel height of 7.5 cm serve as critical points to decrease overall body pain. Moreover, beyond this heel height, knee pain diminishes compared to other body areas possibly due to the shift towards a more neutral posture. The study findings, coupled with the recommendations, can assist footwear designers in crafting not only stylish but also comfortable shoes.

Physical performance and perception of foot discomfort during a soccer-specific match simulation. A comparison of football boots

Football boots are marketed with emphasis on a single key performance characteristic (e.g. speed). Little is known on how design parameters impact players' performance. This study investigated the impact of boot design on performance maintenance and perceived foot comfort during a 90-minute match simulation drill. Eleven male university football players tested two commercially available "sprint boots" known to generate significantly different plantar pressures (high=Boot H and low=Boot L) . Players completed a modified Soccer-specific Aerobic Field Test on a 3G pitch. Heart rate, rated perceived exertion and perceived foot discomfort were assessed for each 15-min interval. Power generation was assessed pre- and post-match simulation. A significantly higher mean heart rate was seen for Boot L in the 60th-75th and 75th-90th minute intervals (P = 0.017, P = 0.012 respectively). Perceived exertion did not differ between boots (P ≥ 0.302). Power generation significantly decreased in Boot H between pre- and post-match (P = 0.042). Both boots increased discomfort with significantly more plantar discomfort felt in the last 30 min in Boot H (75th min: P = 0.037; 90th min: P = 0.048). The results imply that a comfortable boot design may improve maintenance of performance during match-play.

Running barefoot leads to lower running stability compared to shod running - results from a randomized controlled study

Local dynamic running stability is the ability of a dynamic system to compensate for small perturbations during running. While the immediate effects of footwear on running biomechanics are frequently investigated, no research has studied the long-term effects of barefoot vs. shod running on local dynamic running stability. In this randomized single-blinded controlled trial, young adults novice to barefoot running were randomly allocated to a barefoot or a cushioned footwear running group. Over an 8-week-period, both groups performed a weekly 15-min treadmill running intervention in the allocated condition at 70% of their VO2 max velocity. During each session, an inertial measurement unit on the tibia recorded kinematic data (angular velocity) which was used to determine the short-time largest Lyapunov exponents as a measure of local dynamic running stability. One hundred running gait cycles at the beginning, middle, and end of each running session were analysed using one mixed linear multilevel random intercept model. Of the 41 included participants (48.8% females), 37 completed the study (drop-out = 9.7%). Participants in the barefoot running group exhibited lower running stability than in the shod running group (p = 0.037) with no changes during the intervention period (p = 0.997). Within a single session, running stability decreased over the course of the 15-min run (p = 0.012) without differences between both groups (p = 0.060). Changing from shod to barefoot running reduces running stability not only in the acute phase but also in the longer term. While running stability is a relatively new concept, it enables further insight into the biomechanical influence of footwear.

Impact of Footwear and Foot Deformities in patients with Parkinson's disease: A Case-Series Study

Background: Parkinson's disease (PD) is a common and complex neurological problem. Gait abnormalities are frequent in PD patients, and this increases the risk of falls. However, little is known about foot deformities and footwear in this vulnerable population. Here we investigate whether patients with PD use an appropriate shoe size and know if they have foot deformities or alterations. Methodology: A study of a series of observational descriptive cases in a convenience sample (n = 53 patients) diagnosed with Parkinson's disease. One trained investigator evaluated foot and ankle health. The footwear and foot measurements were obtained using a Brannock device. Results: The podiatric examination and footwear examination detected a high presence of podiatric pathologies and inappropriate footwear. This has a negative impact on the quality of life of these patients. Conclusions: This research detected an elevated number of people with foot deformities or alterations. Moreover, a high proportion of participants with PD wear inadequate footwear (in length, width, or both).

The effects of shoe type on lower limb venous status during gait or exercise: A systematic review

This systematic review evaluated the literature pertaining to the effect of shoes on lower limb venous status in asymptomatic populations during gait or exercise. The review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed-NCBI, EBSCO Host, Cochrane Library and Science Direct databases were searched (March 2019) for words around two concepts: shoes and venous parameters. The inclusion criteria were as follows: (1) the manuscript had to be published in an English-language peer-reviewed journal and the study had to be observational or experimental and (2) the study had to suggest the analysis of many types of shoes or orthotics on venous parameters before, during and/or after exercise. Out of 366 articles, 60 duplications were identified, 306 articles were analyzed, and 13 articles met the eligibility criteria after screening and were included. This review including approximately 211 participants. The methodological rigor of these studies was evaluated with the modified Downs and Black quality index. Nine studies investigated the effect of shoes on blood flow parameters, two on venous pressure and two on lower limb circumferences with exercise. Evidence was found that unstable shoes or shoes with similar technology, sandals, athletic or soft shoes, and customized foot orthotics elicited more improvement in venous variables than high-heeled shoes, firm shoes, ankle joint immobilization and barefoot condition. These venous changes are probably related to the efficiency of muscle pumps in the lower limbs, which in turn seem to be dependent on shoe features associated with changes in the kinetics, kinematics and muscle activity variables in lower limbs during gait and exercise.

An observational ergonomic tool for assessing the worn condition of slip-resistant shoes

Worn shoes are known to contribute to slip-and-fall risk, a common cause of workplace injuries. However, guidelines for replacing shoes are not well developed. Recent experiments and lubrication theory suggest that the size of the worn region is an important contributor to the shoe tread's ability to drain fluid and therefore the under-shoe friction. This study evaluated a simple test for comparing the size of the worn region relative to a common object (AAA and AA battery) as a means of determining shoe replacement. This study consisted of three components involving slip-resistant shoes: Experiment #1: a longitudinal, mechanical, accelerated wear experiment; Experiment #2: a longitudinal experiment where the same shoes were tested after each month of worker use; and Experiment #3: a cross-sectional experiment that exposed participants to a slippery condition, while donning their own worn shoes. The COF (Experiments #1 and #2); under-shoe fluid pressure (all experiments); and slip severity (Experiment #3) were compared across outcomes (fail/pass) of the battery tests. Larger fluid pressures, lower coefficient of friction, and more severe slips were observed for shoes that failed the battery tests compared with those passing the tests. This method offers promise for assessing loss in friction and an increase in slip risk for slip-resistant shoes.

Influence of high-heeled shoe parameters on biomechanical performance of young female adults during stair ascent motion

BACKGROUND

High-heeled shoes are currently preferred by women due to contemporary aesthetics. However, high-heeled shoes may increase the effort required to ascend stairs and, hence, alter biomechanical performance.

RESEARCH QUESTION

How do high-heel shoe parameters affect the pelvis position, lower extremities kinematics, and ground reaction force in young women during stair ascent motion?

METHODS

Stair ascent experiments were performed with 20 healthy adult women. The participants were instructed to ascend a 3-step staircase, wearing heeled shoes of different heel heights and heel types and one pair of flat shoes as the control group. Changes in lower body biomechanics were analyzed with kinematics and ground reaction force variables collected from the dominant limb. A two-way repeated ANOVA was performed to determine which variables were affected by heel type and which were affected by heel height or a combination of both.

RESULTS

As the heel height increased, an increased range of ankle dorsiflexion-plantarflexion, as well as pelvic rotation, was observed(P = 0.039 and P = 0.003, respectively). A thinner heel type displayed a larger pelvic forward tilt movement(P = 0.026)and 1st peak vertical force(P = 0.025), as well as a smaller 2nd peak vertical force (P = 0.002). With high heels, increased external rotation of the knee, inversion and plantar flexion, and flexion values of the knee were observed. We also observed decreased external rotation of the pelvis, ankle eversion, varum, and dorsiflexion.

SIGNIFICANCE

To stabilize body posture during stair ascent motion with high-heeled shoes, compensatory response including increasd pelvic range of motion and changing the joint angles of the lower extremities.

The shape of the transverse arch in high heels while standing

Introduction

High heeled shoes have long been worn in society and they are known to cause biomechanical imbalances to not only the foot, but the whole musculoskeletal system. This study aims to show the detailed changes that happen to the shape of the transverse arch of the foot in high heels, using two different inclination degrees.

Methods

68 women participated in this study. Two custom-made high heels were made with inclinations of 15 degrees and 30 degrees (cm). A weight-bearing ultrasound was used to assess the coronal view of the transverse arch in standing. ANOVA and Tuckey tests were used to compare the results between 0 degrees, 15 degrees and 30 degrees inclinations.

Results

The transverse arch height was slightly increased as the heel height increased (0DI-15DI: p = 0.5852 / 15DI-30DI: p = 0.395 / 0DI-30DI: p = 0.0593). The transverse arch length (0DI-15DI: p = 0.0486 / 15DI-30DI: p = 0.0004 / 0DI-30DI: p = 0.1105) and the area under the metatarsal heads (0DI-15DI: p = 0.0422 / 15DI-30DI: p = 0.0180 / 0DI-30DI: p = 0.9463) significantly decreased as the heel height increased.

Discussion

The main changes were viewed in the 30 degrees inclinations compared to 0 degrees inclination. When the toes are dorsiflexed in high heels, it stimulates the Windlass mechanism which in turn stiffens the plantar fascia and adducts the metatarsal heads, while the soft tissues shrink in response to loads.

Conclusion

High heels affected the shape of the transverse arch even in short term standing, and these effects increased as the height of the heel increased.

Effect of Biomechanical Footwear on Knee Pain in People With Knee Osteoarthritis: The BIOTOK Randomized Clinical Trial

IMPORTANCE

Individually calibrated biomechanical footwear therapy may improve pain and physical function in people with symptomatic knee osteoarthritis, but the benefits of this therapy are unclear.

OBJECTIVE

To assess the effect of a biomechanical footwear therapy vs control footwear over 24 weeks of follow-up.

DESIGN, SETTING, AND PARTICIPANTS

Randomized clinical trial conducted at a Swiss university hospital. Participants (N = 220) with symptomatic, radiologically confirmed knee osteoarthritis were recruited between April 20, 2015, and January 10, 2017. The last participant visit occurred on August 15, 2017.

INTERVENTIONS

Participants were randomized to biomechanical footwear involving shoes with individually adjustable external convex pods attached to the outsole (n = 111) or to control footwear (n = 109) that had visible outsole pods that were not adjustable and did not create a convex walking surface.

MAIN OUTCOMES AND MEASURES

The primary outcome was knee pain at 24 weeks of follow-up assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscore standardized to range from 0 (no symptoms) to 10 (extreme symptoms). The secondary outcomes included WOMAC physical function and stiffness subscores and the WOMAC global score, all ranging from 0 (no symptoms) to 10 (extreme symptoms) at 24 weeks of follow-up, and serious adverse events.

RESULTS

Among the 220 randomized participants (mean age, 65.2 years [SD, 9.3 years]; 104 women [47.3%]), 219 received the allocated treatment and 213 (96.8%) completed follow-up. At 24 weeks of follow-up, the mean standardized WOMAC pain subscore improved from 4.3 to 1.3 in the biomechanical footwear group and from 4.0 to 2.6 in the control footwear group (between-group difference in scores at 24 weeks of follow-up, -1.3 [95% CI, -1.8 to -0.9]; P < .001). The results were consistent for WOMAC physical function subscore (between-group difference, -1.1 [95% CI, -1.5 to -0.7]), WOMAC stiffness subscore (between-group difference, -1.4 [95% CI, -1.9 to -0.9]), and WOMAC global score (between-group difference, -1.2 [95% CI, -1.6 to -0.8]) at 24 weeks of follow-up. Three serious adverse events occurred in the biomechanical footwear group compared with 9 in the control footwear group (2.7% vs 8.3%, respectively); none were related to treatment.

CONCLUSIONS AND RELEVANCE

Among participants with knee pain from osteoarthritis, use of biomechanical footwear compared with control footwear resulted in an improvement in pain at 24 weeks of follow-up that was statistically significant but of uncertain clinical importance. Further research would be needed to assess long-term efficacy and safety, as well as replication, before reaching conclusions about the clinical value of this device.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02363712.

Important features of retail shoes for women with rheumatoid arthritis: A Delphi consensus survey

Objectives

Footwear management aims to preserve foot function, reduce the burden of foot pain and maintain joint mobility in women with rheumatoid arthritis (RA). Whilst retail footwear is commonly recommended by health professionals, there is no current consensus on recommended features of retail footwear for women with RA. This study aimed to determine consensus from health professionals about the important features of retail footwear for women with RA.

Methods

An international Delphi exercise using online survey software was conducted with 39 participants from health care backgrounds. Three iterative rounds were conducted. In the first round, participants listed features of retail footwear that would be important for women with RA. Responses of the first round, combined with results of a scoping review of patient-reported outcome measures used in assessing footwear in arthritis and a qualitative analysis of female patients’ perspectives of retail footwear in RA were used to create items for the second round. Items were scored by a 9-point rating scale with consensus defined by the RAND/UCLA disagreement index. The third round consisted of items which did not reach consensus or scored >1 on the RAND/UCLA disagreement index from round two.

Results

Fifty-eight items (n = 58) were generated for rating and at the end of three iterative rounds, there was agreement that thirty-eight items were important, that two were not important, and there was no agreement for a further eighteen items. Item themes reaching consensus included footwear characteristics and acceptability and psychosocial aspects of footwear. Footwear characteristics related to heel height, shape, cushioning, toe box size, adjustable fastening, removable insoles, mid-foot support and soft accommodative uppers. Acceptability and psychosocial aspects included affordability, comfort, aesthetic, style, colour and impact on femininity.

Conclusion

This consensus exercise has identified the important features of retail footwear for women with RA.

Internal environment of footwear is a risk factor for tinea pedis

The relation between tinea pedis and the internal environment of footwear has not been scientifically proven. This study aimed to determine whether the internal environment of footwear affects the incidence of tinea pedis and tinea unguium. This cross-sectional, observatory study involved 420 outpatients who were categorized into non-tinea, tinea pedis or tinea unguium groups based on mycological analysis. External climatic conditions, and temperature, humidity and dew points inside the patients' footwear were recorded. Univariate and multivariate analyses were used to determine independent risk factors for tinea pedis and tinea unguium. A significant correlation was found between high temperature/high humidity and dew point of the internal environment of the footwear and the season. Furthermore, those who wore footwear with internal environments characterized by high temperature, high humidity, high-temperature/high-humidity and high dew point values had a significantly higher incidence of tinea pedis. The internal dew point correlated with the incidence of tinea pedis, whereas the external temperature correlated with the incidence of tinea unguium. The internal humidity and dew point of footwear as well as the frequency with which footwear with a high-temperature/high-humidity internal environment were worn was significantly higher in men than in women. In conclusion, the internal environment of footwear is a risk factor for tinea pedis, and this environment is affected by the season. Moreover, the frequency of tinea pedis among men is related to the internal environment of footwear. The dew point is an appropriate index for evaluating temperature and humidity in relation to tinea pedis.

Changes in under-shoe traction and fluid drainage for progressively worn shoe tread

Shoe wear is known to increase slipping risk, but few studies have systematically studied this relationship. This study investigated the impact of progressive shoe wear on the available coefficient of friction (ACOF) and under-shoe fluid dynamics. Five different slip-resistant shoes were progressively worn using an accelerated, abrasive, wear protocol. The ACOF and fluid forces (the load supported by the fluid) were measured as shoes were slipped across a surface contaminated with a diluted glycerol solution. As the shoes became worn, an initial increase in ACOF was followed by a steady decrease. Low fluid forces were observed prior to wear followed by increased fluid forces as the worn region became larger. Results suggest that traction performance decreases particularly when the heel region without tread exceeds a size of 800 mm2. This study supports the concept of developing shoe replacement guidelines based upon the size of the worn region to reduce occupational slips.

Factors associated with wearing inadequate outdoor footwear in populations at risk of foot ulceration: A cross-sectional study

BACKGROUND

Few studies have investigated if people at risk of foot ulceration actually wear the footwear recommended by best practice guidelines to prevent foot ulceration. This study aimed to investigate the prevalence of, and factors associated with, wearing inadequate outdoor footwear in those with diabetes or peripheral neuropathy in an inpatient population.

METHODS

This was a secondary analysis of a multi-site cross-sectional study investigating foot conditions in a large representative inpatient population admitted into hospital for any medical reason on one day. A range of explanatory variables were collected from all participants including sociodemographic, medical and foot condition factors. The outcome variable for this study was the self-reported outdoor footwear type worn most by participants outside the house in the year prior to hospitalisation. The self-reported footwear type was then categorised into adequate and inadequate according to footwear features recommended in guidelines for populations at risk of foot ulceration. Logistic regression identified factors independently associated with inadequate footwear in all inpatient participants, and diabetes and neuropathy subgroups.

RESULTS

Overall, 47% of a total of 726 inpatients wore inadequate outdoor footwear; 49% of the 171 in the diabetes subgroup and 43% of 159 in the neuropathy subgroup. Wearing inadequate outdoor footwear was independently associated (Odds Ratio (95% Confidence Interval)) with being female in the diabetes (2.7 (1.4-5.2)) and neuropathy subgroups (3.7 (1.8-7.9)) and being female (5.1 (3.7-7.1)), having critical peripheral arterial disease (2.5 (1.1-5.9)) and an amputation (0.3 (0.1-0.7)) in all inpatients (all, p<0.05).

CONCLUSIONS

Almost half of all inpatients at risk of foot ulceration reported wearing outdoor footwear most of the time that did not meet recommendations for prevention. We found women were much more likely to wear inadequate footwear. More work needs to be done to increase the uptake of footwear recommendations in these populations to prevent foot ulceration.

Impact of military type footwear and load carrying workload on postural stability

Postural stability has been shown to be impacted by footwear and task performed. This study analysed the impact of two military footwear, standard boot (STB) and minimalist boot (MTB) on postural stability, before (PRE) and after (POST) a load carriage task. Sixteen participants were tested for postural stability using sensory organisation and motor control tests on Neurocom Equitest™. Postural sway, equilibrium scores and postural latencies were analysed using a two-factor repeated measures ANOVA: boot type (STB-MTB) × time (PRE-POST) load carriage task. Significantly greater postural sway variables, lower balance scores and slower postural latencies were seen in STB and POST load carriage conditions (p < .05). The results suggest that MTB exhibited greater balance compared to STB in balance conditions that rely on somatosensory feedback and that balance is lowered after a load carriage task. Decrements in postural stability could be attributed to boot design characteristics and muscular exertion due to the load carriage task. Practitioner Summary: Maintaining optimal postural stability is crucial in military. Impact of military footwear types and load carriage task on postural stability are addressed. Findings provide footwear design and physical exertion implications on postural stability leading to potential interventions that reduce postural stability decrements; thereby, reducing potential falls and fall related injuries.

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.

Effects of barefoot and footwear conditions on learning of a dynamic balance task: a randomized controlled study

PURPOSE

Although barefoot balancing has shown to be more challenging compared to shod balancing, it is still unclear whether this may also influence the balance learning effects. The purpose of this study was to explore the impact of barefoot and shod exercising on learning of a dynamic balance task.

METHODS

Sixty healthy and physically active adults (mean age 25.3 ± 3.4 years) were randomly allocated into one of three groups (barefoot, shod and controls). The barefoot and shod intervention groups exercised once weekly over 7 weeks on a stability platform with an unstable surface. Each training session included 15 trials over 30 s. Before and after the intervention period, all participants completed two balance tests (stability platform and Balance Error Scoring System = BESS) under barefoot and shod conditions. Group effects in stability gains (pre to post-test differences) were analysed using ANOVA. Development of balance learning curves during the intervention period was analysed using a mixed effects model.

RESULTS

Balance times improved in both intervention groups (p < 0.001, 95% CI barefoot 5.82-9.22 s, shod 7.51-10.92 s) compared to controls. The barefoot intervention group showed a significantly less sloped balance learning curve compared to the shod intervention group (p = 0.033). No changes over time or differences between groups were found for the BESS test.

CONCLUSIONS

Improvements in the dynamic balance task did not differ between individuals exercising barefoot or with footwear although the progression was slower in the barefoot group. The lack of changes in the BESS supports the task-specificity of balance learning effects.

Allergic contact dermatitis to shoes: contribution of a specific series to the diagnosis

BACKGROUND

In our country, the Brazilian Standard Series is the most used for the etiological diagnosis of allergic contact dermatitis to shoes. However, there is no assessment of the usefulness of specific allergens for shoes.

OBJECTIVES

To measure the improvement in diagnostic accuracy of allergic contact dermatitis to shoes with the use of a specific complementary series in patch testing and describe the characteristics of the affected population, such as gender, location of lesions, time of evolution, and the most common allergens.

METHODS

This retrospective study evaluated the results of 52 patients with suspected shoe dermatitis subjected to patch tests with the standard and specific series to quantify the gain in diagnostic accuracy.

RESULTS

Among the 52 suspected cases, 29 cases (56%) were confirmed. In 13 (45%) cases the diagnosis was determined through the specific series, which results in an 81% increase in the number of diagnoses.

STUDY LIMITATION

Small sample size.

CONCLUSIONS

Women were more commonly affected, with a mean time for the final diagnosis of 45 months, and the most common localization was the dorsum of the feet. There was an increase in diagnostic accuracy with the introduction of new haptens in the patch test of patients with suspected shoes dermatitis.

Footwear choices for painful feet - an observational study exploring footwear and foot problems in women

BACKGROUND

A high percentage of the population report footwear related foot pain, yet there is limited research on the effect footwear has on the development of this pain. The aim of this study was to establish whether footwear purchased by patients have an association with foot pain and what choices determined a purchase decision.

METHODS

Shape and size measurements of the dominant foot and footwear (length and width) were taken from 67 female participants who routinely received podiatric treatment. Participants were also asked to complete a short questionnaire to rate the shoe characteristics, emotions whilst wearing and reasons for the purchase.

RESULTS

Results highlighted a high prevalence of structural foot pathology for those over 61 who preferred slip on shoes. This group also wore shoes that were significantly narrower than their feet with width difference correlating to the presence of Hallux Abductovarus (HAV). In addition, results indicate that individual footwear advice is more important than previously thought, as it is clear that choice of footwear worn to podiatry appointments are not always worn on a daily basis.

CONCLUSIONS

This study emphasises that the width of the shoe is an important part of fit, highlighting the need for patient specific footwear assessment and education for behaviour changes.

Footwear Contact Dermatitis: A Prospective Cross-Sectional Study of 108 Outpatients from Delhi, India

Footwear contact dermatitis is a common problem with multifactorial exogenous, as well as endogenous, etiologies. Patch testing is the gold standard for detection of the possible contactants. A cross-sectional study was conducted in 108 outpatients over a period of 18 months. Demographic data comprising age, sex, and occupation were collected. Details of clinical and laboratory investigations were used to define the incriminating ingredient(s), subsequently confirmed by patch test using Indian standard and footwear series approved by the Contact and Occupational Dermatitis Forum of India. Reading and interpretation were carried out according to the International Contact Dermatitis Research Group (ICDRG) guidelines. Of the 108 patients, 64 were girls or women and 44 boys or men. Although footwear contact dermatitis affected all age groups, most individuals were 21 to 40 years old. The morphology and distribution of the lesions were very specific. Patch testing was helpful, the primary sensitizing agent being mercapto mix, followed by mercaptobenzothiazole, potassium dichromate, and paraphenylenediamine. Footwear contact dermatitis is an extraordinary entity, requiring a high level of expertise (or knowledge) to determine its etiology through history, clinical examination, and patch testing.

Clinical Aspects of Foot Health in Individuals with Alzheimer's Disease

Alzheimer's disease (AD) shows a marked presence of physiologic changes and the start or aggravation of underlying diseases such as physical frailty in diverse anatomical regions. It is believed to have a particularly harmful effect on the health of the foot. We examined the foot health status in older persons with AD, with a specific focus on the extent to which people with AD may be using inadequate footwear in old age. Seventy-three community-dwelling people with probable, mild to moderate AD aged 65-95 years were recruited from a center of excellence for AD. A single trained physician evaluated health status and foot conditions. Current shoe and foot length and width measurements were taken using a calibrated Brannock device. The results indicate that sixty-five participants (89.04%) suffered from feet problems. Also, only twenty-two subjects (30.14%) used the correct shoes in width and size related with the morphology of their feet. Fifty-one participants (69.86%) were using incorrect shoes in length or width. The present study revealed that peoples with AD had a high presence of foot health problems. Also, the use of inappropriate shoes revealed measurable differences of association between shoe size and the morphology of the foot.

Work boot design affects the way workers walk: A systematic review of the literature

Safety boots are compulsory in many occupations to protect the feet of workers from undesirable external stimuli, particularly in harsh work environments. The unique environmental conditions and varying tasks performed in different occupations necessitate a variety of boot designs to match each worker's occupational safety and functional requirements. Unfortunately, safety boots are often designed more for occupational safety at the expense of functionality and comfort. In fact, there is a paucity of published research investigating the influence that specific variations in work boot design have on fundamental tasks common to many occupations, such as walking. This literature review aimed to collate and examine what is currently known about the influence of boot design on walking in order to identify gaps in the literature and develop evidence-based recommendations upon which to design future research studies investigating work boot design.

Footwear used by older people and a history of hyperkeratotic lesions on the foot: A prospective observational study

Inadequate footwear, painful and hyperkeratotic lesions (HL) are an extremely common problems amongst older people. Such problems increase the risk of falls, hamper mobility, reduction of quality of life, dignity, and ability to remain independent. The etiology of painful and feet conditions is poorly understood.To discover footwear preferences of older people, pain tolerance may favor presence of HL for the use of inadequate footwear in old age.A sample of 100 participants with a mean age of 74.90 ± 7.01 years attended an outpatient clinic where self-reported demographic data, frequency with which they checked their feet were recorded and measurements were taken of foot sensitivity. Additionally, all participants' shoes were allocated into optimal, adequate, and dangerous categories based on design, structural and safety features, and materials.Only 12% of the sample population checked their feet every day, 37% revealed symptoms of neuropathy, 14% used optimal shoes, and 61% presented HL. In a bivariate analysis, no significant differences were observed.HL are associated with inadequate footwear, loss of sensitivity, and low frequency of foot health checks.

[Skin lesions and other foot problems associated with safety footwear]

OBJECTIVES

The principal purpose of this epidemiological cross-sectional study was to evaluate the frequency of foot problems associated with the wearing of safety footwear (SFW).

METHODS

We examined 509 workers from 12 separate metal-working factories, representing all workers employed in these factories. All subjects wore SFW on a daily basis. The study was based on an interviewer-administered questionnaire and a clinical examination of the feet, with particular attention to skin lesions.

RESULTS

81% of the workers had at least one foot problem. The most frequently reported shoe concern was the hot/wet conditions inside the SFW (42%), followed by weight (27.5%), fit (22.9%) with narrowness (19%) and poor sole flexibility (16.3%).

CONCLUSIONS

Preventive measures should be implemented to reduce the risk associated with SFW. To achieve this goal, it is necessary on one hand to improve the comfort of SFW from a physiological and ergonomic point of view and, on the other hand, to make an appropriate choice of this personal protective device from the various brands and models available on the market.

Footwear Dermatitis: Diagnosis and Management-Part III

Footwear dermatitis is an entity with clear clinical features, and the confirmation of its diagnosis is vital. The authors review several tools used for its diagnosis to facilitate appropriate and timely management.

Injuries and Footwear (Part 1): Athletic Shoe History and Injuries in Relation to Foot Arch Height and Training in Boots

This article traces the history of the athletic shoe, examines whether selecting running shoes based on foot arch height influences injuries, and examines historical data on injury rates when physical training (PT) is performed in boots versus running shoes. In the 1980s and into the 2000s, running shoe companies were advertising specialized shoes with "motion control," "stability," and "cushioning," designed for individuals with low, normal, and high arches, respectively. Despite marketing claims that these shoes would reduce injury rates, coordinated studies in Army, Air Force, and Marine Corps basic training showed that assigning or selecting shoes on this basis had no effect on injury rates. Consistent with this finding, biomechanical studies have shown that the relationships between arch height, foot joint mobility, and rear-foot motion are complex, variable, and frequently not as strong as often assumed. In 1982, the US Army switched from PT in boots to PT in running shoes because of the belief that boots were causing injuries and that running shoes would reduce injury rates. However, a historical comparison of injury rates before and after the switch to running shoes showed virtually no difference in injury risk between the two periods. It is not clear at this point if the type of footwear effects injury incidence.

High-heeled shoes and musculoskeletal injuries: a narrative systematic review

OBJECTIVES

To conduct the first systematic review from an epidemiological perspective regarding the association between high-heeled shoe wear and hallux valgus, musculoskeletal pain, osteoarthritis (OA) and both first-party and second-party injury in human participants without prior musculoskeletal conditions.

SETTING

A systematic review of international peer-reviewed scientific literature across seven major languages.

DATA SOURCES

Searches were conducted on seven major bibliographic databases in July 2015 to initially identify all scholarly articles on high-heeled shoes. Supplementary manual searches were conducted. Titles, abstracts and full-text articles were sequentially screened to identify all articles assessing epidemiological evidence regarding the association between high-heeled shoe wear and hallux valgus, musculoskeletal pain, OA and both first-party and second-party injury in human participants without prior musculoskeletal conditions. Standardised data extraction and quality assessment (Threats to Validity tool) were conducted.

PRIMARY AND SECONDARY OUTCOME MEASURES

Musculoskeletal pain or OA as assessed by clinical diagnosis or clinical assessment tool. First-party or second-party injury.

RESULTS

644 unique records were identified, 56 full-text articles were screened and 18 studies included in the review. Four studies assessed the relationship with hallux valgus and three found a significant association. Two studies assessed the association with OA and neither found a significant association. Five studies assessed the association with musculoskeletal pain and three found a significant association. Eight studies assessed first-party injury and seven found evidence of a significant injury toll associated with high-heeled shoes. One study provided data on second-party injury and the injury toll was low.

CONCLUSIONS

High-heeled shoes were shown to be associated with hallux valgus, musculoskeletal pain and first-party injury. No conclusive evidence regarding OA and second-party injury was found. Societal and clinical relevance of these findings is discussed. Concern is expressed about the expectation to wear high-heeled shoes in some work and social situations and access by children.

A shift in priority in diabetic foot care and research: 75% of foot ulcers are preventable

Diabetic foot ulceration poses a heavy burden on the patient and the healthcare system, but prevention thereof receives little attention. For every euro spent on ulcer prevention, ten are spent on ulcer healing, and for every randomized controlled trial conducted on prevention, ten are conducted on healing. In this article, we argue that a shift in priorities is needed. For the prevention of a first foot ulcer, we need more insight into the effect of interventions and practices already applied globally in many settings. This requires systematic recording of interventions and outcomes, and well-designed randomized controlled trials that include analysis of cost-effectiveness. After healing of a foot ulcer, the risk of recurrence is high. For the prevention of a recurrent foot ulcer, home monitoring of foot temperature, pressure-relieving therapeutic footwear, and certain surgical interventions prove to be effective. The median effect size found in a total of 23 studies on these interventions is large, over 60%, and further increases when patients are adherent to treatment. These interventions should be investigated for efficacy as a state-of-the-art integrated foot care approach, where attempts are made to assure treatment adherence. Effect sizes of 75-80% may be expected. If such state-of-the-art integrated foot care is implemented, the majority of problems with foot ulcer recurrence in diabetes can be resolved. It is therefore time to act and to set a new target in diabetic foot care. This target is to reduce foot ulcer incidence with at least 75%.

When and how to audit a diabetic foot service

Quality improvement depends on data collection and audit of clinical services to inform clinical improvements. Various steps in the care of the diabetic foot can be used to audit a service but need defined audit standards. A diabetes foot service should have risk stratification system in place that should compare to the population-based figures of 76% having low-risk feet, 17% moderate risk and 7% being at high risk of ulceration. Resources can then be directed towards those with high-risk feet. Prevalence of foot ulceration needs to be audited. Community-based studies give an audit standard of around 2%, with 2 to 9% having had an ulcer at some stage in the past. Amputation rates should be easier to measure, and the best results are reported to be around 1.5-3 per 1000 people with diabetes. This is a useful benchmark figure, and the rate has been shown to decrease by approximately a third over the last 15 years in some centres. Ulceration rates and ulcer healing rates are the ultimate outcome audit measure as they are always undesirable, whilst occasionally for defined individuals, an amputation can be a good outcome. In addition to clinical outcomes, processes of care can be audited such as provision of clinical services, time from new ulcer to be seen by health care professional, inpatient foot care or use of antibiotics. Measurement of clinical services can be a challenge in the diabetic foot, but it is essential if clinical services and patient outcomes are to be improved.

Prevention and management of foot problems in diabetes: a Summary Guidance for Daily Practice 2015, based on the IWGDF Guidance Documents

In this 'Summary Guidance for Daily Practice', we describe the basic principles of prevention and management of foot problems in persons with diabetes. This summary is based on the International Working Group on the Diabetic Foot (IWGDF) Guidance 2015. There are five key elements that underpin prevention of foot problems: (1) identification of the at-risk foot; (2) regular inspection and examination of the at-risk foot; (3) education of patient, family and healthcare providers; (4) routine wearing of appropriate footwear; and (5) treatment of pre-ulcerative signs. Healthcare providers should follow a standardized and consistent strategy for evaluating a foot wound, as this will guide further evaluation and therapy. The following items must be addressed: type, cause, site and depth, and signs of infection. There are seven key elements that underpin ulcer treatment: (1) relief of pressure and protection of the ulcer; (2) restoration of skin perfusion; (3) treatment of infection; (4) metabolic control and treatment of co-morbidity; (5) local wound care; (6) education for patient and relatives; and (7) prevention of recurrence. Finally, successful efforts to prevent and manage foot problems in diabetes depend upon a well-organized team, using a holistic approach in which the ulcer is seen as a sign of multi-organ disease, and integrating the various disciplines involved.

Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review

BACKGROUND

Footwear and offloading techniques are commonly used in clinical practice for preventing and healing of foot ulcers in persons with diabetes. The goal of this systematic review is to assess the medical scientific literature on this topic to better inform clinical practice about effective treatment.

METHODS

We searched the medical scientific literature indexed in PubMed, EMBASE, CINAHL, and the Cochrane database for original research studies published since 1 May 2006 related to four groups of interventions: (1) casting; (2) footwear; (3) surgical offloading; and (4) other offloading interventions. Primary outcomes were ulcer prevention, ulcer healing, and pressure reduction. We reviewed both controlled and non-controlled studies. Controlled studies were assessed for methodological quality, and extracted key data was presented in evidence and risk of bias tables. Uncontrolled studies were assessed and summarized on a narrative basis. Outcomes are presented and discussed in conjunction with data from our previous systematic review covering the literature from before 1 May 2006.

RESULTS

We included two systematic reviews and meta-analyses, 32 randomized controlled trials, 15 other controlled studies, and another 127 non-controlled studies. Several randomized controlled trials with low risk of bias show the efficacy of therapeutic footwear that demonstrates to relief plantar pressure and is worn by the patient, in the prevention of plantar foot ulcer recurrence. Two meta-analyses show non-removable offloading to be more effective than removable offloading for healing plantar neuropathic forefoot ulcers. Due to the limited number of controlled studies, clear evidence on the efficacy of surgical offloading and felted foam is not yet available. Interestingly, surgical offloading seems more effective in preventing than in healing ulcers. A number of controlled and uncontrolled studies show that plantar pressure can be reduced by several conservative and surgical approaches.

CONCLUSIONS

Sufficient evidence of good quality supports the use of non-removable offloading to heal plantar neuropathic forefoot ulcers and therapeutic footwear with demonstrated pressure relief that is worn by the patient to prevent plantar foot ulcer recurrence. The evidence base to support the use of other offloading interventions is still limited and of variable quality. The evidence for the use of interventions to prevent a first foot ulcer or heal ischemic, infected, non-plantar, or proximal foot ulcers is practically non-existent. High-quality controlled studies are needed in these areas.

Effects of high heeled shoes wearing experience and heel height on human standing balance and functional mobility

This study aimed to examine the effects of high heeled shoes (HHS) wearing experience and heel height on human standing balance and functional mobility. Thirty young and healthy females (ten experienced and twenty inexperienced HHS wearers) participated in a series of balance tests when they wore shoes of four different heel heights: 1 cm (flat), 4 cm (low), 7 cm (medium) and 10 cm (high). Experimental results show that regardless of the wearing experience, the heel elevation induces more effort from lower limb muscles (particularly calf muscles) and results in worse functional mobility starting at 7 cm heel height. While the heel height increased to 10 cm, the standing balance also becomes worse. Experienced HHS wearers do not show significantly better overall performance on standing balance and functional mobility than inexperienced controls, even though they have better directional control (76.8% vs. 74.4%) and larger maximum excursion (93.3% vs. 89.7%). To maintain standing balance, experienced wearers exert less effort on tibialis anterior, vastus lateralis and erector spinae muscles at the cost of more intensive effort from gastrocnemius medialis muscle.

PRACTITIONER SUMMARY

Many women wear high heeled shoes (HHS) to increase female attractiveness. This study shows that HHS induce more muscular effort and worse human standing balance and functional mobility, especially when heel height reaches 10 cm. HHS wearing experience only provides certain advantages to wearers on limits of stability in terms of larger maximum excursion and better directional control.

Innovations in plantar pressure and foot temperature measurements in diabetes

Plantar pressure and temperature measurements in the diabetic foot primarily contribute to identifying abnormal values that increase risk for foot ulceration, and they are becoming increasingly more integrated in clinical practice and daily life of the patient. While plantar pressure measurements have long been present, only recently evidence shows their importance in ulcer prevention, as a data-driven approach to therapeutic footwear provision. The long-term monitoring of plantar pressures with the option to provide feedback, when alarming pressure levels occur, is a promising development in this area, although more technical and clinical validation is required. Shear is considered important in ulcer aetiology but is technically difficult to measure. Innovative research is underway to assess if foot temperature can act as a useful surrogate for shear. Because the skin heats up before it breaks down, frequent monitoring of foot temperature can identify these warning signals. This approach has shown to be effective in preventing foot ulcers. Innovation in diagnostic methods for foot temperature monitoring and evidence on cost effectiveness will likely facilitate implementation. Finally, monitoring of adherence to offloading treatment using temperature-based sensors has proven to be a feasible and relevant method with a wide range of possible research and patient care applications. These innovations in plantar pressure and temperature measurements illustrate an important transfer in diabetic foot care from subjective to objective evaluation of the high-risk patient. They demonstrate clinical value and a large potential in helping to reduce the patient and economic burden of diabetic foot disease.

Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review

BACKGROUND

Prevention of foot ulcers in patients with diabetes is extremely important to help reduce the enormous burden of foot ulceration on both patient and health resources. A comprehensive analysis of reported interventions is not currently available, but is needed to better inform caregivers about effective prevention. The aim of this systematic review is to investigate the effectiveness of interventions to prevent first and recurrent foot ulcers in persons with diabetes who are at risk for ulceration.

METHODS

The available medical scientific literature in PubMed, EMBASE, CINAHL and the Cochrane database was searched for original research studies on preventative interventions. Both controlled and non-controlled studies were selected. Data from controlled studies were assessed for methodological quality by two independent reviewers.

RESULTS

From the identified records, a total of 30 controlled studies (of which 19 RCTs) and another 44 non-controlled studies were assessed and described. Few controlled studies, of generally low to moderate quality, were identified on the prevention of a first foot ulcer. For the prevention of recurrent plantar foot ulcers, multiple RCTs with low risk of bias show the benefit for the use of daily foot skin temperature measurements and consequent preventative actions, as well as for therapeutic footwear that demonstrates to relieve plantar pressure and that is worn by the patient. To prevent recurrence, some evidence exists for integrated foot care when it includes a combination of professional foot treatment, therapeutic footwear and patient education; for just a single session of patient education, no evidence exists. Surgical interventions can be effective in selected patients, but the evidence base is small.

CONCLUSION

The evidence base to support the use of specific self-management and footwear interventions for the prevention of recurrent plantar foot ulcers is quite strong, but is small for the use of other, sometimes widely applied, interventions and is practically nonexistent for the prevention of a first foot ulcer and non-plantar foot ulcer.

Dance between biology, mechanics, and structure: A systems-based approach to developing osteoarthritis prevention strategies

Osteoarthritis (OA) is a leading cause of human suffering and disability for which disease-modifying treatments are lacking. OA occurs through complex and dynamic interplays between diverse factors over long periods of time. The traditional research and clinical focus on OA, the end stage disease, obscured understanding pathogenesis prior to reaching a common pathway defined by pain and functional deficits, joint deformity, and radiographic changes. To emphasize disease modification and prevention, we describe a multi-disciplinary systems-based approach encompassing biology, mechanics, and structure to define pre-osteoarthritic disease processes. Central to application of this model is the concept of "pre-osteoarthritis," conditions where clinical OA has not yet developed. Rather, joint homeostasis has been compromised and there are potentially reversible markers for heightened OA risk. Key messages from this perspective are (i) to focus research onto defining pre-OA through identifying and validating biological, mechanical, and imaging markers of OA risk, (ii) to emphasize multi-disciplinary approaches, and (iii) to propose that developing personalized interventions to address reversible markers of OA risk in healthy joints may be the key to prevention. Ultimately, a systems-based analysis of OA pathogenesis shows potential to transform clinical practice by facilitating development and testing of new strategies to prevent or delay the onset of osteoarthritis.

Effect of firefighters' personal protective equipment on gait

The biomechanical experiment with eight male and four female firefighters demonstrates that the effect of adding essential equipment: turnout ensemble, self-contained breathing apparatus, and boots (leather and rubber boots), significantly restricts foot pronation. This finding is supported by a decrease in anterior-posterior and medial-lateral excursion of center of plantar pressure (COP) trajectory during walking. The accumulation of this equipment decreases COP velocity and increases foot-ground contact time and stride time, indicating increased gait instability. An increase in the flexing resistance of the boots is the major contributor to restricted foot pronation and gait instability as evidenced by the greater decrease in excursion of COP in leather boots (greater flexing resistance) than in rubber boots (lower resistance). The leather boots also shows the greatest increase in foot contact time and stride time. These negative impacts can increase musculoskeletal injuries in unfavorable fire ground environments.

[Stress fracture after changing to barefoot running]

Barefoot running is increasing in popularity but little is known about the implications in respect to injuries. It has been proposed that barefoot running is associated with a decrease in running injuries as it represents a more natural way of running. A 50-year-old runner with a weekly running distance of 50 km presented suffering from a stress fracture of the second metatarsal after six weeks of intensive barefoot running.

Microclimate in ski boots--temperature, relative humidity, and water absorption

Ski boot quality is determined by mechanical properties and comfort. Comfort is strongly affected by cold feet. The purpose of this study was to determine the microclimate in ski boots. Climate chamber tests with five male subjects and field tests with two male subjects were conducted. Temperature and relative humidity were measured using four sensors placed on the foot and one on the liner. Absorbed water in liners and socks was measured with a precision balance. The subjects gave subjective ratings for comfort. The toe sensor temperature dropped below 20 °C at an ambient temperature of 0 °C, -10 °C, and -20 °C. Relative humidity values at the foot were as high as 78% in the climate chamber and 93% in the field. Water absorption in socks and liners ranged from 4 to 10 g in the climate chamber and 19 to 45.5 g in the field. The results reveal the importance of keeping the feet and in particular the toes warm during skiing. One possible improvement may be to construct the liner so that sweat and melted snow are kept as far away as possible from the foot. Liner material with high water absorption capacity and hydrophobic socks were suggested to prevent wet feet.

Component contribution of personal protective equipment to the alleviation of physiological strain in firefighters during work and recovery

The purpose of this study was to investigate the components contributions of personal protective equipment on physiological strain in firefighters during exercise and recovery. Eight firefighters participated in trials in which various combinations of personal protective equipment components weighing from 1.3 to 15.1 kg were worn. The results showed that rectal temperature, changes in rectal temperature, mean skin temperature, heart rate, oxygen consumption and blood lactate concentration were smaller in conditions without boots (no-boots) than in other conditions with no helmet, gloves or self-contained breathing apparatus (P < 0.05). Increases in rectal temperature per unit mass of personal protective equipment were approximately twice as small in no-boots condition as the other conditions. These results suggest that the reduction of the boots' mass might be more efficient to alleviate heat strain of firefighters wearing personal protective equipment, rather than the reduction of the mass of self-contained breathing apparatus, helmet or gloves.

PRACTITIONER SUMMARY

As firefighters’ protective boots induce greater physiological burden when compared with a helmet, gloves or self-contained breathing apparatus, personal protective equipment designers need to consider the improvement of boots in terms of mass reduction, improvement of thermal comfort and ease of doffing during recovery to alleviate physiological strain on firefighters.

Hallux valgus

Hallux valgus is a common foot problem whose cause and progression is multifactorial, complex, and poorly known. Hallux valgus shows a predilection toward women. It is a progressive disorder with no treatment known to slow or stop progression. Surgery is indicated in healthy individuals when nonoperative measures fail. Adverse effects of surgery include infection and recurrence. Many procedures have been described, including soft tissue and bony reconstruction of the first ray. The procedure that is indicated depends on the severity of the deformity.

Macerated foot dermatitis related to occlusive footwear

Gram-negative bacterial toe-web infections (GNBTWI's) are relatively under-recognized among physicians. Even though skin infections are usually thought to involve gram-positive bacteria, gram-negative organisms have a particular affinity for the toe-web. We present two patients with GNBTWI's who presented with maceration of the toe-webs, vesiculopustules and a hyperkeratotic rim. Treatment includes using both oral and topical antibiotics along with antifungals to treat co-existing dermatophyte infections. Awareness of this condition is particularly important for primary care physicians in West Virginia, as a few of the potential risk factors include wearing occlusive footwear, such as work boots, and type II diabetes mellitus.

The effect of unstable sandals on instability in gait in healthy female subjects

Unstable footwear generally lacks thorough peer-review published research to support concepts and marketing claims. The purpose of this study was to investigate the instability induced by four (FitFlop, Masai Barefoot Technology, Reebok Easy-Tone and Skechers Tone-Ups) commercially available unstable sandals and one stable control sandal (Earth) in walking in 15 females (mean±SD age was 29±6.7 years, mass 62.6±6.9kg and height 167.1±4.2cm). Three-dimensional motion with synchronised electromyography and kinetic data were collected. Walking speed and step length remained consistent between conditions, however double support time decreased in Masai Barefoot Technology. Centre of pressure data identified no consistent difference between the stable control and the unstable sandals, however Masai Barefoot Technology reduced the anterior-posterior range of centre of pressure. Muscle activity differed significantly at the ankle in the unstable footwear. FitFlop, Reebok and Skechers increased peroneal activity during pre-swing, whereas Masai Barefoot Technology increased medial gastrocnemius and decreased tibialis anterior activity in loading response and mid-stance. The larger rocker sole of the Masai Barefoot Technology altered gait and muscle activation with regard to braking and progression in the sagittal plane. Reebok, Skechers and FitFlop, with softer, less stable foreparts increased evertor action at toe-off, having their effect in the coronal plane. The study highlighted that any instability induced by the shoes is design-specific.