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Liu M, Kang N, Zhang Y, Wen E, Mei D, Hu Y, Chen G, Wang D. Influence of motor capacity of the lower extremity and mobility performance on foot plantar pressures in community-dwelling older women. Heliyon 2024; 10:e28114. [PMID: 38560666 PMCID: PMC10979215 DOI: 10.1016/j.heliyon.2024.e28114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives To investigate the associations of motor capacity of the lower extremity and mobility performance in daily physical activities with peak foot plantar pressures during walking among older women. Methods Using the data collected among 58 community-dwelling older women (68.66 ± 3.85 years), Pearson correlation and multiple linear regression analyses were performed to analyze the associations of motor capacity of the lower extremity (the 30-s chair stand test, the timed one-leg stance with eyes closed, and the Fugl-Meyer assessment of lower extremity), mobility performance in daily physical activities (the average minutes of moderate to vigorous physical activity every day and the metabolic equivalents), and foot plantar pressures (peak force and peak pressure) with the age and body fat percentage as covariates. Results (1) The motor capacity of the lower extremity has higher explanatory power for peak foot plantar pressures compared with the mobility performance in daily physical activities. (2) Higher body fat percentage was positively associated with peak force and pressure, while a lower score on the Fugl-Meyer assessment of lower extremity was negatively associated with both of them. (3) The metabolic equivalents were positively associated with the peak force, while the 30-s chair stand test was negatively associated with it. Conclusions Mobility performance in daily physical activities can be significant predictors for peak foot plantar pressures among older women. The significant predictor variables include the Fugl-Meyer assessment of lower extremity, the 30-s chair stand test, and metabolic equivalents.
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Affiliation(s)
- Min Liu
- Institute of Population Research, Peking University, Beijing, 100871, China
| | - Ning Kang
- Institute of Population Research, Peking University, Beijing, 100871, China
| | - Yalu Zhang
- School of Social Welfare, Stony Brook University, New York, 11794, United States
| | - Erya Wen
- Department of Physical Education, Peking University, Beijing, 100871, China
| | - Donghui Mei
- Institute of Population Research, Peking University, Beijing, 100871, China
| | - Yizhe Hu
- Department of Physical Education, Peking University, Beijing, 100871, China
| | - Gong Chen
- Institute of Population Research, Peking University, Beijing, 100871, China
| | - Dongmin Wang
- Department of Physical Education, Peking University, Beijing, 100871, China
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Cho YJ, Lee DH, Kang HW, Kim DY, Lee DO, Lee DY. Pressure Properties of Three Different Types of Prefabricated Insoles Related to Plantar Pressure in Asymptomatic Men. Clin Orthop Surg 2022; 14:622-630. [PMID: 36518933 PMCID: PMC9715923 DOI: 10.4055/cios20280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND In clinical fields, many types of insoles are used to not only realign movement patterns, but also treat pressure-related foot diseases. However, the characteristics of and plantar pressure in each type of insole are still unclear. Therefore, the aim of this study was to validate the plantar pressure-relieving effect of three representative types of insoles (metatarsal padding insole [MPI], lateral heel wedge insole [LHI], and arch support insole [ASI]) in asymptomatic men. METHODS A total of 35 feet of 35 asymptomatic men with a mean age of 23.4 ± 2.0 years were included. Pedobarographic data were evaluated by dividing the foot into eight designated regions to compare the three types of insoles. Peak plantar pressure (PPP) and pressure time integral (PTI) were assessed using the Pedar-X system. A repeated measures analysis of variance was used for statistical analyses. RESULTS In the hallux region, there was no statistically significant difference. MPI showed highest pressure in the 2nd-5th toe and midfoot region, but lowest in the central and lateral forefoot regions. Meanwhile, ASI showed highest pressure in the medial forefoot region but lowest in the lateral heel region. Lastly, pressure in the lateral heel region was highest in LHI. Overall, results of PTI were similar to those of PPP. CONCLUSIONS This study demonstrated that the three types of insole each could reduce and redistribute pressure of specific part of the foot to help select an appropriate insole for each purpose.
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Affiliation(s)
- Yun Jae Cho
- Department of Orthopedic Surgery, Han-il General Hospital, Seoul, Korea
| | - Dong Hyun Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ho Won Kang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Dae-Yoo Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Dong Oh Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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Neunteufel E, Krenn S, Chraim M, Amann P, Greiner F, Kranzl A, Bock P. Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy of the Lesser Toes: Clinical, Radiologic, and Pedobarographic Outcomes. Foot Ankle Int 2022; 43:153-163. [PMID: 34404241 DOI: 10.1177/10711007211034849] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) is a percutaneous operative technique with the aim to relieve the symptoms of metatarsalgia. To our knowledge, no previous research has analyzed both pre- and postoperative pedobarographic data including the changes in plantar pressure. METHODS Thirty patients (31 feet) were operated on with a DMMO and included in a prospective study. Clinical, radiologic, and pedobarographic outcomes were evaluated in comparison with the preoperative parameters. The American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score, the Foot Function Index (FFI), the Foot and Ankle Outcome Score (FAOS), and a visual analog scale (VAS) for pain were used in order to assess clinical parameters. Radiographs were taken to compare metatarsal lengths. The pedobarographic analysis served to determine plantar peak pressure (PPP) beneath the metatarsophalangeal (MTP) joints. RESULTS All scores indicated a significant mean pre- to postoperative improvement (AOFAS = 31.9 points, FAOS = 16.3%, FFI = 24.3%, VAS pain = 4.1 points, VAS general limitation = 3.3 points) (P < .05). PPP was substantially reduced in the relevant area (M6 [plantar area beneath the second and third MTP joint] had a mean pre to post PPP = 14.15 N/cm2) and concurrently higher in the lateral and medial MTP joint areas (M5 mean pre to post = +14.37, M7 pre to post = +7.11). Our mean metatarsal shortening was 6.6 mm. However, our findings do not demonstrate a significant correlation between metatarsal length relationships and the prevalence of metatarsalgia. CONCLUSION Our results demonstrate a significant improvement in clinical scores and PPP. A statistically significant relation between metatarsal length and the prevalence of metatarsalgia was not found in this prospective case series. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Sabine Krenn
- Orthopaedic Hospital Speising Vienna, Vienna, Austria
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Radiographic measurements have limited effect in dynamic plantar pressures in hallux valgus patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:19-26. [PMID: 33661373 DOI: 10.1007/s00590-021-02906-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Radiographic measurements are the gold standard in the management for preoperative surgical planning of hallux valgus deformity. Plantar pressure technology is a tool that is not commonly used to evaluate and manage hallux valgus patients, and few studies have reported the correlation of plantar pressure measurements and radiography. METHODS A prospective cohort study was designed to analyze plantar pressure measurements and radiographic variables. The inclusion criteria were age over 18 years old, and diagnosis of hallux valgus requesting surgical correction because of discomfort, pain or difficulty with shoe wear. Plantar pressure measurements were performed using a platform. Radiographic data were obtained according to the guidelines of the AOFAS Committee on Angular Measurements. RESULTS A total of 114 patients met the inclusion criteria. Mean age of the patients was 50 years, and 94 patients (82.5%) were women. We found significant correlations between dynamic plantar pressure measurements and HVA, DMAA, and MDA. Mean pressure under third metatarsal head was the most associated plantar pressure measurement with hallux valgus angle and metatarsal declination angle. However, this association showed signs of weakness. CONCLUSION Hallux valgus angle and metatarsal declination angle had a minimal influence on plantar-loading parameters. Pressure values did not discriminate the magnitude of HV deformity. Others factors responsible for the observed plantar pressures pattern should be addressed.
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Ohlendorf D, Kerth K, Osiander W, Holzgreve F, Fraeulin L, Ackermann H, Groneberg DA. Standard reference values of weight and maximum pressure distribution in healthy adults aged 18-65 years in Germany. J Physiol Anthropol 2020; 39:39. [PMID: 33256834 PMCID: PMC7706280 DOI: 10.1186/s40101-020-00246-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022] Open
Abstract
Background The aim of this study was to collect standard reference values of the weight and the maximum pressure distribution in healthy adults aged 18–65 years and to investigate the influence of constitutional parameters on it. Methods A total of 416 healthy subjects (208 male / 208 female) aged between 18 and 65 years (Ø 38.3 ± 14.1 years) participated in this study, conducted 2015–2019 in Heidelberg. The age-specific evaluation is based on 4 age groups (G1, 18–30 years; G2, 31–40 years; G3, 41–50 years; G4, 51–65 years). A pressure measuring plate FDM-S (Zebris/Isny/Germany) was used to collect body weight distribution and maximum pressure distribution of the right and left foot and left and right forefoot/rearfoot, respectively. Results Body weight distribution of the left (50.07%) and right (50.12%) foot was balanced. There was higher load on the rearfoot (left 54.14%; right 55.09%) than on the forefoot (left 45.49%; right 44.26%). The pressure in the rearfoot was higher than in the forefoot (rearfoot left 9.60 N/cm2, rearfoot right 9.51 N/cm2/forefoot left 8.23 N/cm2, forefoot right 8.59 N/cm2). With increasing age, the load in the left foot shifted from the rearfoot to the forefoot as well as the maximum pressure (p ≤ 0.02 and 0.03; poor effect size). With increasing BMI, the body weight shifted to the left and right rearfoot (p ≤ 0.001, poor effect size). As BMI increased, so did the maximum pressure in all areas (p ≤ 0.001 and 0.03, weak to moderate effect size). There were significant differences in weight and maximum pressure distribution in the forefoot and rearfoot in the different age groups, especially between younger (18–40 years) and older (41–65 years) subjects. Discussion Healthy individuals aged from 18 to 65 years were found to have a balanced weight distribution in an aspect ratio, with a 20% greater load of the rearfoot. Age and BMI were found to be influencing factors of the weight and maximum pressure distribution, especially between younger and elder subjects. The collected standard reference values allow comparisons with other studies and can serve as a guideline in clinical practice and scientific studies.
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Affiliation(s)
- D Ohlendorf
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - K Kerth
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - W Osiander
- School of Dentistry, Department of Orthodontics, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - F Holzgreve
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt, Frankfurt am Main, Germany.
| | - L Fraeulin
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - H Ackermann
- Institute of Biostatistics and Mathematical Modeling, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - D A Groneberg
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt, Frankfurt am Main, Germany
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Neville C, Nguyen H, Ross K, Wingood M, Peterson EW, Dewitt JE, Moore J, King MJ, Atanelov L, White J, Najafi B. Lower-Limb Factors Associated with Balance and Falls in Older Adults: A Systematic Review and Clinical Synthesis. J Am Podiatr Med Assoc 2020; 110:436245. [PMID: 31743051 DOI: 10.7547/19-143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite sufficient evidence to suggest that lower-limb-related factors may contribute to fall risk in older adults, lower-limb and footwear influences on fall risk have not been systematically summarized for readers and clinicians. The purpose of this study was to systematically review and synethesize the literature related to lower-limb, foot, and footwear factors that may increase the risk of falling among community-dwelling older adults. METHODS We searched PubMed, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Library, and AgeLine. To describe the trajectory toward increasing risk of falls, we examined those articles that linked age-related changes in the lower limb or footwear to prospective falls or linked them to evidenced-based fall risk factors, such as gait and balance impairment. RESULTS This systematic review consisted of 81 articles that met the review criteria, and the results reflect a narrative review of the appraised literature for eight pathways of lower-limb-related influences on fall risk in older adults. Six of the eight pathways support a direct link to fall risk. Two other pathways link to the intermediate factors but lack studies that provide evidence of a direct link. CONCLUSIONS This review provides strong guidance to advance understanding and assist with managing the link between lower-limb factors and falls in older adults. Due to the lack of literature in specific areas, some recommendations were based on observational studies and should be applied with caution until further research can be completed.
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Landorf KB, Ackland CA, Bonanno DR, Menz HB, Forghany S. Effects of metatarsal domes on plantar pressures in older people with a history of forefoot pain. J Foot Ankle Res 2020; 13:18. [PMID: 32375847 PMCID: PMC7201604 DOI: 10.1186/s13047-020-00388-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background Forefoot pads such as metatarsal domes are commonly used in clinical practice for the treatment of pressure-related forefoot pain, however evidence for their effects is inconsistent. This study aimed to evaluate the effects on plantar pressures of metatarsal domes in different positions relative to the metatarsal heads. Methods Participants in this study included 36 community-dwelling adults aged 65 or older with a history of forefoot pain. Standardised footwear was used and plantar pressures were measured using the pedar®-X in-shoe plantar pressure measurement system. Peak pressure, maximum force and contact area were analysed using an anatomically-based masking protocol that included three forefoot mask sub-areas (proximal to, beneath, and distal to the metatarsal heads). Data were collected for two different types of prefabricated metatarsal domes of different densities (Emsold metatarsal dome and Langer PPT metatarsal pad) in three different positions relative to the metatarsal heads. Seven conditions were tested in this study: (i) control (no pad) condition, (ii) Emsold metatarsal dome positioned 5 mm proximal to the metatarsal heads, (iii) Emsold metatarsal dome positioned in-line with the metatarsal heads, (iv), Emsold metatarsal dome positioned 5 mm distal to the metatarsal heads, (v) Langer PPT metatarsal pad positioned 5 mm proximal to the metatarsal heads, (vi) Langer PPT metatarsal pad positioned in-line with the metatarsal heads, and (vii) Langer PPT metatarsal pad positioned 5 mm distal to the metatarsal heads. Results When analysed with the mask that was distal to the metatarsal heads, where the plantar pressure readings were at their highest, all metatarsal dome conditions led to significant reductions in plantar pressure at the forefoot compared to the control (no pad) condition (F3.9, 135.6 = 8.125, p < 0.001). The reductions in plantar pressure were in the order of 45–60 kPa. Both the Emsold metatarsal dome and the Langer PPT metatarsal pad, when positioned proximal to the metatarsal heads, managed to achieve this without adversely increasing plantar pressure proximally where the pad was positioned, however the Emsold metatarsal dome was most effective. Conclusions Metatarsal domes reduce plantar pressure in the forefoot in older people with a history of forefoot pain. All metatarsal dome conditions significantly reduced peak pressure in the forefoot, however metatarsal domes that were positioned 5 mm proximal to the metatarsal heads provided the best balance of reducing plantar pressure distal to the metatarsal heads, where the pressure is at its greatest, but not adversely increasing plantar pressure proximally, where the bulk of the pad is positioned. In this proximal position, the Emsold metatarsal dome was more effective than the Langer PPT metatarsal pad and we cautiously recommend this forefoot pad for alleviating forefoot pressure in older people with forefoot pain.
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Affiliation(s)
- Karl B Landorf
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia. .,La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, 3086, Australia.
| | - Claire A Ackland
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - Daniel R Bonanno
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia.,La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - Hylton B Menz
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - Saeed Forghany
- Musculoskeletal Research Center, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.,Centre for Health Sciences Research, University of Salford, Salford, M5 4WT, England
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The Effectiveness of Personalized Custom Insoles on Foot Loading Redistribution during Walking and Running. JOURNAL OF BIOMIMETICS BIOMATERIALS AND BIOMEDICAL ENGINEERING 2020. [DOI: 10.4028/www.scientific.net/jbbbe.44.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The objective of this study was to investigate the effectiveness of different hardness of personalized custom insoles on plantar pressure redistribution in healthy young males during walking and running. Six males participated in the walking and running test (age: 24±1.6 years, weight: 67.9±3.6 kg, height: 175.5±4.7 cm). All subjects were instructed to walk and run along a 10m pathway wearing two different hardness insoles (i.e., hard custom insoles (CHI) and soft custom insole (CSI)) and control insole (CI) at their preferred speed. Peak pressure, mean pressure, maximum force, pressure-time integral were collected to analyze using SPSS. The plantar pressure of forefoot and medial midfoot were significantly increased and of lateral forefoot and lateral midfoot were decreased by both kinds of custom insoles in running tests. While the CHI significantly increased plantar pressure of the medial forefoot compared with the CSI and CI both in walking and running tests. The custom insoles showed significantly higher plantar pressure on medial midfoot. But CSI seems better than CHI because of redistributing the plantar pressure by increasing the plantar pressure of whole forefoot. Moreover, CSI showed significantly lower plantar pressure than CI and CHI at lateral midfoot during running test. The CHI causes significant high pressure at medial forefoot (MF), which may raise the risk of forefoot pain.
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Akambase JA, Kokoreva TV, Gurova OA, Akambase JA. The effect of body positions on foot types: Considering body weight. TRANSLATIONAL RESEARCH IN ANATOMY 2019. [DOI: 10.1016/j.tria.2019.100048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Park J, Kim T. Acute effect of taping on plantar pressure characteristics in athletes with exercise-induced leg pain: a description and comparison of groups. PHYSICIAN SPORTSMED 2019; 47:212-219. [PMID: 30462925 DOI: 10.1080/00913847.2018.1547085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Foot pronation is considered as a potential risk factor of lower leg overuse injury. This study aimed to identify plantar pressure characteristics of elite athletes with exercise-induced leg pain in throwing athletic disciplines, and to verify the acute effect of taping for restricting foot pronation by analyzing the plantar pressure characteristics. METHODS This study was designed as a description and comparison of throwing athletic athletes. Participants were divided into exercise-induced leg pain (ELP group, n = 17) and control groups (CON group, n = 14). Plantar pressure variables (contact area, maximum force, and peak pressure) at eight-foot regions in athletes' supporting leg were recorded during standing on one leg and a natural walk before and after applying anti-pronation or sham taping techniques. RESULTS There are significant difference of contact area, maximal force, and peak pressure in some regions of their foot between the ELP and CON groups. But the anti-pronation taping decreased only the peak pressure in lateral midfoot of CON group during a natural walk (p = 0.002). CONCLUSION The anti-pronation taping technique may not be effective preventive strategy from the exercise-induced leg pain, such as shin splints.
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Affiliation(s)
- JaeMyoung Park
- a Research Institute of Physical Education and Sport Science , Korea National Sport University , Seoul , Republic of Korea
| | - Taegyu Kim
- b Department of Marine Sports , Pukyoung National University , Busan , Republic of Korea
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Telfer S, Bigham JJ. The influence of population characteristics and measurement system on barefoot plantar pressures: A systematic review and meta-regression analysis. Gait Posture 2019; 67:269-276. [PMID: 30391749 DOI: 10.1016/j.gaitpost.2018.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/17/2018] [Accepted: 10/25/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The measurement of plantar pressure distributions during gait can provide insights into the effects of musculoskeletal disease on foot function. A range of hardware, software, and protocols are available for the collection of this type of data, with sometimes disparate and conflicting results reported between individual studies. In this systematic review and meta-regression analysis of dynamic regional peak pressures, we aimed to test if 1) the system used to obtain the pressure measurements and 2) the characteristics of the study populations had a significant effect on the results. METHODS A systematic review of the literature was undertaken to identify articles reporting regional peak plantar pressures during barefoot walking. A mixed-effects modeling approach was used to analyze the extracted data. Initially, the effect of the system used to collect the data was tested. Following this, the effect of participant characteristics on the results were analyzed, using moderators of cohort type (defined as the primary health characteristic of the participants), age, sex, and BMI. RESULTS 115 participant groups were included in the analysis. Sufficient cohorts were available to test those that consisted of healthy individuals, and those with diabetes and diabetic neuropathy. Significant differences were found between results reported by studies using different pressure measurement systems in 8 of the 16 regions analyzed. The analysis of participant characteristics revealed a number of significant relationships between regional peak pressures and participant characteristics, including: BMI and midfoot plantar pressures; elevated forefoot pressures as a result of diabetic neuropathy; and sex-differences in regional loading patterns. CONCLUSIONS At the level of the literature, we confirmed significant effects of disease status, age, BMI, and sex on regional peak plantar pressures. Researchers and clinicians should be aware that measurements of peak plantar pressure variables obtained from different collection equipment are not directly comparable.
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Affiliation(s)
- S Telfer
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, United States.
| | - J J Bigham
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, United States
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Ali Z, Karim H, Wali N, Naraghi R. The inter- and intra-rater reliability of the Maestro and Barroco metatarsal length measurement techniques. J Foot Ankle Res 2018; 11:47. [PMID: 30127858 PMCID: PMC6097434 DOI: 10.1186/s13047-018-0289-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 07/31/2018] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Zainab Ali
- University of Western Australia, School of Surgery, Podiatric Medicine, Crawley, Western Australia 6009 Australia
| | - Hassan Karim
- University of Western Australia, School of Surgery, Podiatric Medicine, Crawley, Western Australia 6009 Australia
| | - Navid Wali
- University of Western Australia, School of Surgery, Podiatric Medicine, Crawley, Western Australia 6009 Australia
| | - Reza Naraghi
- University of Western Australia, School of Surgery, Podiatric Medicine, Crawley, Western Australia 6009 Australia
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13
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Naraghi R, Slack-Smith L, Bryant A. Plantar Pressure Measurements and Geometric Analysis of Patients With and Without Morton's Neuroma. Foot Ankle Int 2018; 39:829-835. [PMID: 29641258 DOI: 10.1177/1071100718766553] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this research was to see if there were any differences in peak pressure, contact time, pressure-time integrals, and geometric variables such as forefoot width, foot length, coefficient of spreading, and arch index between subjects with Morton's neuroma (MN) and control subjects. METHODS Dynamic peak plantar pressure, contact time, pressure-time integral, and geometric data were extracted using the EMED-X platform in 52 subjects with MN and 31 control subjects. Differences in peak pressure, contact time, pressure-time integral, and geometric data between participants with and those without MN were determined using independent-samples t tests. There were no significant differences in age, weight, height, and body mass index between patients with MN and control subjects. RESULTS There were no significant differences in the peak pressures of all masked areas and pressure-time integrals under metatarsal 2 to 4 heads between patients with MN and control subjects. In addition, no significant differences were observed between patients with MN and control subjects in geometric measurements of forefoot length, width, coefficient of spreading, foot progression angle, and arch index. CONCLUSION No relationship was found in this study between peak pressure, contact time, and pressure-time integral under the metatarsal heads, forefoot width, foot length, coefficient of spreading, and foot progression angle in a symptomatic MN group compared with a control group. The need to perform osteotomies to treat MN not associated with other lesser metatarsal phalangeal joint pathologies is questionable. LEVEL OF EVIDENCE Level III, Case-Control Study.
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Affiliation(s)
- Reza Naraghi
- 1 School of Allied Health, Podiatric Medicine and Surgery Division, The University of Western Australia, Crawley, Australia
| | - Linda Slack-Smith
- 2 UWA Dental School, The University of Western Australia, Crawley, Australia
| | - Alan Bryant
- 1 School of Allied Health, Podiatric Medicine and Surgery Division, The University of Western Australia, Crawley, Australia
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14
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Abstract
There are several forefoot conditions that can result in metatarsal head pain. Various points of the gait cycle can predispose the metatarsal heads to pain based on intrinsic and extrinsic imbalances. Metatarsalgia can further be classified according to primary, secondary, or iatrogenic etiologies. Within these groups, conservative management is the first line of treatment and can often obviate surgical intervention. Depending on the cause of pain, proper shoewear, orthoses, and inserts coupled with targeted physical therapy can alleviate most symptoms of metatarsalgia and lesser toe deformities.
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Affiliation(s)
- Andrew E Federer
- Foot and Ankle Division, Department of Orthopedic Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3000, Durham, NC 27710, USA
| | - David M Tainter
- Foot and Ankle Division, Department of Orthopedic Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3000, Durham, NC 27710, USA
| | - Samuel B Adams
- Foot and Ankle Division, Department of Orthopedic Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3000, Durham, NC 27710, USA
| | - Karl M Schweitzer
- Foot and Ankle Division, Department of Orthopedic Surgery, Duke University Medical Center, 2301 Erwin Road, Box 3000, Durham, NC 27710, USA.
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15
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Abstract
Knowledge and command of anatomy is paramount to effectively treating disorders of the lesser metatarsophalangeal (MTP) joints. The osseous structures consist of the proximal phalanx of the toe and the metatarsal head. The soft tissues on the dorsum of the MTP joint include the joint capsule and the tendons of extensor digitorum longus and extensor digitorum brevis. The proper and accessory collateral ligaments form the medial and lateral walls and contribute to stability in the coronal and sagittal planes. The plantar plate forms the plantar border of the MTP joint and stabilizes the MTP joint against hyperextension and dorsal translation.
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Affiliation(s)
- Fred T Finney
- Department of Orthopaedic Surgery, University of Michigan, 2098 South Main Street, Ann Arbor, MI 48103, USA
| | - Ezequiel Cata
- Department of Orthopaedic Surgery, Sanatorio Allende, Independencia 757, Cordoba Capital, Córdoba, Argentina
| | - James R Holmes
- Department of Orthopaedic Surgery, University of Michigan, 2098 South Main Street, Ann Arbor, MI 48103, USA
| | - Paul G Talusan
- Department of Orthopaedic Surgery, University of Michigan, 2098 South Main Street, Ann Arbor, MI 48103, USA.
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16
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Walsh TP, Butterworth PA, Urquhart DM, Cicuttini FM, Landorf KB, Wluka AE, Michael Shanahan E, Menz HB. Increase in body weight over a two-year period is associated with an increase in midfoot pressure and foot pain. J Foot Ankle Res 2017; 10:31. [PMID: 28770005 PMCID: PMC5526261 DOI: 10.1186/s13047-017-0214-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/11/2017] [Indexed: 02/07/2023] Open
Abstract
Background There is a well-recognised relationship between body weight, plantar pressures and foot pain, but the temporal association between these factors is unknown. The aim of this study was to investigate the relationships between increasing weight, plantar pressures and foot pain over a two-year period. Methods Fifty-one participants (33 women and 18 men) completed the two-year longitudinal cohort study. The sample had a mean (standard deviation (SD)) age of 52.6 (8.5) years. At baseline and follow-up, participants completed the Manchester Foot Pain and Disability Index questionnaire, and underwent anthropometric measures, including body weight, body mass index, and dynamic plantar pressures. Within-group analyses examined differences in body weight, foot pain and plantar pressures between baseline and follow up, and multivariate regression analysis examined associations between change in body weight, foot pain and plantar pressure. Path analysis assessed the total impact of both the direct and indirect effects of change in body weight on plantar pressure and pain variables. Results Mean (SD) body weight increased from 80.3 (19.3), to 82.3 (20.6) kg, p = 0.016 from baseline to follow up. The change in body weight ranged from −16.1 to 12.7 kg. The heel was the only site to exhibit increased peak plantar pressures between baseline and follow up. After adjustment for age, gender and change in contact time (where appropriate), there were significant associations between: (i) change in body weight and changes in midfoot plantar pressure (B = 4.648, p = 0.038) and functional limitation (B = 0.409, p = 0.010), (ii) plantar pressure change in the heel and both functional limitation (B = 4.054, p = 0.013) and pain intensity (B = 1.831, p = 0.006), (iii) plantar pressure change in the midfoot and both functional limitation (B = 4.505, p = 0.018) and pain intensity (B = 1.913, p = 0.015). Path analysis indicated that the effect of increasing body weight on foot-related functional limitation and foot pain intensity may be mediated by increased plantar pressure in the midfoot. Conclusions These findings suggest that as body weight and plantar pressure increase, foot pain increases, and that the midfoot may be the most vulnerable site for pressure-related pain.
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Affiliation(s)
- Tom P Walsh
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia.,Department of Orthopaedics and Trauma, The Queen Elizabeth Hospital, Woodville South, South Australia Australia
| | - Paul A Butterworth
- Discipline of Podiatry and La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria Australia.,School of Health and Human Sciences, Southern Cross University, Bilinga, Queensland Australia
| | - Donna M Urquhart
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - Karl B Landorf
- Discipline of Podiatry and La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria Australia
| | - Anita E Wluka
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria Australia
| | - E Michael Shanahan
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia Australia.,Department of Rheumatology, Southern Adelaide Local Health Network, Bedford Park, South Australia Australia
| | - Hylton B Menz
- Discipline of Podiatry and La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria Australia
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17
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MacMahon A, Hillstrom HJ, Do HT, Chan JY, Deland JT, Ellis SJ. In Vivo Plantar Pressures in Adult-Acquired Flatfoot Compared to Control Using an Intraoperative Pedobarographic Device. HSS J 2017; 13:136-145. [PMID: 28690463 PMCID: PMC5481264 DOI: 10.1007/s11420-017-9542-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/10/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intraoperative pedobarography has the potential to aid surgical decisions, but no parameters exist to guide its use. QUESTIONS/PURPOSES This study compared supine plantar pressures between flatfoot patients and controls using a previously validated intraoperative pedobarographic device and examined associations between supine, walking, and standing plantar pressures. METHODS Ten preoperative patients with stage II adult-acquired flatfoot deformity (AAFD) were compared to ten healthy controls. Supine plantar pressures were assessed using the pedobarographic device. Standing and walking plantar pressures were assessed with an EMED-XT sensor array (Novel). Maximum force (MF) and peak pressure (PP) were calculated for nine anatomical foot regions adjusting for age and BMI. RESULTS No differences in plantar pressures were found between flatfoot patients and controls in the supine or standing positions. During walking, flatfoot patients had greater MF of the first, second, and third metatarsals (p ≤ 0.018) and greater PP of the first and second metatarsals than controls (p ≤ 0.010). Supine MF and PP were both strongly positively correlated with their respective pressure measurements for both standing and walking in multiple foot regions (p ≤ 0.05, all analyses). Correlations in the first metatarsal region were generally weak and not statistically significant. CONCLUSION This device did not show differences in supine plantar pressures of flatfoot patients and healthy subjects, highlighting the limitations of intraoperative devices in guiding flatfoot correction. The differences between flatfoot and controls during walking and the correlations between supine and walking conditions suggest that dynamic plantar pressures are a more useful parameter in guiding flatfoot reconstruction.
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Affiliation(s)
- Aoife MacMahon
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Howard J. Hillstrom
- Leon Root Motion Analysis Laboratory, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Huong T. Do
- Department of Epidemiology and Biostatistics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Jeremy Y. Chan
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Jonathan T. Deland
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Scott J. Ellis
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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18
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Naraghi R, Bremner A, Slack-Smith L, Bryant A. Radiographic Analysis of Feet With and Without Morton's Neuroma. Foot Ankle Int 2017; 38:310-317. [PMID: 27837053 DOI: 10.1177/1071100716674998] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this research was to investigate the association of various structural measurements of the forefoot with Morton's neuroma (MN). METHODS Weightbearing anteroposterior and lateral foot radiographs of subjects attending the University of Western Australia (UWA) Podiatry Clinic and the first author's private practice were included in this study. A single assessor measured the following angles: lateral intermetatarsal angle (LIMA), intermetatarsal angle (IMA), hallux valgus angle (HVA), digital divergence between the second and third digits (DD23), digital divergence between the third and fourth digits (DD34) and relative metatarsal lengths of the first to fifth metatarsals (Met1-5), and the effect of MN size as measured by ultrasonograph on digital divergence. Intratester reliability of all radiographic measurements was assessed on all radiographic measurements. The study included 101 subjects, of whom 69 were diagnosed with MN and 32 were control subjects without MN. The mean (± standard deviation) age of MN subjects was 52 (±15) years and for control subjects, 48 (±12) years. RESULTS When comparing all feet, there were no significant differences in the LIMA, HVA, IMA, digital divergence angles and the relative metatarsal distances between subjects with MN and control subjects. No relationship between MN size and digital divergence was found in either foot, or in either neuroma location. CONCLUSION We were unable to demonstrate any relationship in this study between radiographic metatarsal length and angular measurements in a symptomatic MN group compared to a control group. In addition, we did not find any correlation between the size of MN as measured from ultrasonographic images and radiographic evidence of digital divergence. LEVEL OF EVIDENCE Level III, case control study.
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Affiliation(s)
- Reza Naraghi
- 1 Podiatric Medicine Unit M422, School of Surgery, University of Western Australia, Crawley, Western Australia, Australia
| | - Alexandra Bremner
- 2 School of Population Health M431, University of Western Australia, Crawley, Western Australia, Australia
| | - Linda Slack-Smith
- 3 School of Dentistry M512, University of Western Australia, Crawley, Western Australia, Australia
| | - Alan Bryant
- 1 Podiatric Medicine Unit M422, School of Surgery, University of Western Australia, Crawley, Western Australia, Australia
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19
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Xu C, Yan YB, Zhao X, Wen XX, Shang L, Huang LY, Lei W. Pedobarographic Analysis Following Pemberton's Pericapsular Osteotomy for Unilateral Developmental Dysplasia of the Hip: An Observational Study. Medicine (Baltimore) 2015; 94:e932. [PMID: 26061319 PMCID: PMC4616480 DOI: 10.1097/md.0000000000000932] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Successful clinical and radiographic outcomes have been reported in patients with unilateral developmental dysplasia of the hip (DDH) following Pemberton pericapsular osteotomy (PPO). However, residual gait deviations are seen in both the affected and unaffected limbs. To date it is not known whether these deviations result in abnormal plantar pressure in such patients. This study investigated this possibility by performing pedobarographic, clinical, and radiographic examinations after PPO in 20 patients (age: 102.5 ± 19.0 months) with unilateral DDH who underwent PPO at 34.2 ± 9.8 months of age. Plantar pressure was evaluated using the Footscan pressure plate (RsScan International, Olen, Belgium). Each foot was subdivided into 10 zones and peak pressure, force-time integral as a percentage of total FTI, and contact time as a percentage of total stance time was estimated. The minimum duration of follow-up was 24 months (mean: 68.3 ± 20.3 months). The data were compared with 20 age- and weight-matched healthy controls. Despite clinical and radiographic examinations showing satisfactory results according to modified McKay and Severin criteria, significant differences in plantar pressure parameters were identified between the affected limbs, the unaffected limbs, and normal controls. No significant differences were found between patients classified as "excellent or good" and those rated as "fair" according to the modified Severin criteria. Pedobarographic results showed the existence of the residual plantar pressure deviations during walking in patients treated with PPO for unilateral DDH. Longer follow-up will be needed to more fully evaluate the effect of these deviations on gait.
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Affiliation(s)
- Chao Xu
- From Department of Orthopaedics, Xijing Hospital (CX, YBY, XZ, XXW, LYH, WL); and Department of Health Statistics, Faculty of Preventive Medicine, the Fourth Military Medical University, Xi'an, PR China (LS)
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20
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RIDDIFORD-HARLAND DIANEL, STEELE JULIER, CLIFF DYLANP, OKELY ANTHONYD, MORGAN PHILIPJ, JONES RACHELA, BAUR LOUISEA. Lower Activity Levels Are Related to Higher Plantar Pressures in Overweight Children. Med Sci Sports Exerc 2015; 47:357-62. [DOI: 10.1249/mss.0000000000000403] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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21
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Koller U, Willegger M, Windhager R, Wanivenhaus A, Trnka HJ, Schuh R. Plantar pressure characteristics in hallux valgus feet. J Orthop Res 2014; 32:1688-93. [PMID: 25130961 DOI: 10.1002/jor.22707] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 07/03/2014] [Indexed: 02/04/2023]
Abstract
Due to the pathoanatomical changes in hallux valgus feet, the plantar flexion moment of the first metatarsophalangeal joint is reduced. Therefore, load bearing of the hallux is decreased during push-off. We assessed loading parameters in hallux valgus feet. Based on dorsal-plantar weight bearing radiographs of 61 feet, the intermetatarsal-, hallux valgus-, distal metatarsal articulation-angle, and sesamoid position were evaluated. Plantar pressure assessment was performed with the emed® system during level walking. We found negative correlations between hallux valgus angle and peak pressure in the great toe (r=-0.301, p<0.023), the maximum force of the hallux (r=-0.481, p<0.001), and contact time of the great toe (r=-0.448, p<0.001), and positive correlations for force time integral (r=0.348, p<0.001), contact area (r=0.307, p<0.020), maximum force (r=0.430, p<0.001), and peak pressure (r=0.361, p<0.006) of the fifth metatarsal head. A positive correlation between the sesamoid and the metatarsal subluxation regarding maximum force (r=0.294, p<0.034), and a negative correlation between the contact area of the hallux (r=-0.232, p<0.020) was shown. Depending on the severity, hallux valgus angle, and sesamoid subluxation, load shows significant lateral transmission in hallux valgus feet.
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Affiliation(s)
- Ulrich Koller
- Department of Orthopaedics, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
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22
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Menz HB. Biomechanics of the Ageing Foot and Ankle: A Mini-Review. Gerontology 2014; 61:381-8. [DOI: 10.1159/000368357] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/15/2014] [Indexed: 11/19/2022] Open
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23
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Matheis EA, Spratley EM, Hayes CW, Adelaar RS, Wayne JS. Plantar measurements to determine success of surgical correction of Stage IIb adult acquired flatfoot deformity. J Foot Ankle Surg 2014; 53:562-6. [PMID: 24796888 DOI: 10.1053/j.jfas.2014.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Indexed: 02/03/2023]
Abstract
Adult acquired flatfoot deformity is a degenerative disease causing medial arch dysfunction. Surgical correction has typically involved tendon reconstruction with calcaneal osteotomy; however, the postoperative changes have not been fully characterized. The present study assessed the success of surgical correction of Stage IIb adult acquired flatfoot deformity through changes in plantar pressures and patient-generated outcome scores. With Institutional Review Board approval, 6 participants were evaluated before and after surgery using pedobarography, the Foot and Ankle Outcome Score, and the Medical Outcomes Study 36-item short-form questionnaire. The plantar pressures were recorded using a TekScan HRMat(®) during walking and in a 1- and 2-foot stance. The resulting contour maps were segmented into 9 regions, with the peak pressure, normalized force, and arch index calculated. Surgical effects were analyzed using paired t tests. Postoperatively, the Foot and Ankle Outcome Score and Medical Outcomes Study 36-item short-form questionnaire scores increased significantly from 180 ± 78 to 360 ± 136 (p < .03) and 47 ± 18 to 71 ± 19 (p = .06), respectively. During the 2-foot stance, the normalized force had increased significantly in the lateral midfoot (p < .03), although no significant differences were found in peak pressures. No significant differences were observed in the 1-foot stance. During walking, the normalized force increased significantly in the lateral mid- and forefoot (p < .05). The peak pressure increased significantly in the lateral forefoot (p < .01). The arch index values demonstrated no significant changes. The increased questionnaire scores indicated that surgical correction improved the self-perceived health of the participants. Lateral shifts in the peak pressure and normalized force suggest that forefoot and midfoot loading is altered postoperatively, consistent with the goal of offloading the dysfunctional arch. Thus, the present study has demonstrated that surgical treatment of adult acquired flatfoot deformity can be accurately assessed using patient-reported outcome measures and plantar pressures.
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Affiliation(s)
- Erika A Matheis
- Graduate Student, Orthopaedic Research Laboratory, Departments of Biomedical Engineering and Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA
| | - E Meade Spratley
- Graduate Student, Orthopaedic Research Laboratory, Departments of Biomedical Engineering and Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA
| | - Curtis W Hayes
- Professor, Department of Radiology, Virginia Commonwealth University, Richmond, VA
| | - Robert S Adelaar
- Professor and Chair, Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA
| | - Jennifer S Wayne
- Professor, Department of Biomedical Engineering, and Director, Orthopaedic Research Laboratory, Virginia Commonwealth University, Richmond, VA.
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24
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Lane TJ, Landorf KB, Bonanno DR, Raspovic A, Menz HB. Effects of shoe sole hardness on plantar pressure and comfort in older people with forefoot pain. Gait Posture 2014; 39:247-51. [PMID: 23968972 DOI: 10.1016/j.gaitpost.2013.07.116] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 07/19/2013] [Accepted: 07/23/2013] [Indexed: 02/02/2023]
Abstract
Plantar forefoot pain is common in older people and is related to increased peak pressures under the foot during gait. Variations in the hardness of the shoe sole may therefore influence both the magnitude of loading under the foot and the perceived comfort of the shoe in this population. The aim of this investigation was to determine the effect of varying shoe sole hardness on plantar pressures and comfort in older people with forefoot pain. In-shoe plantar pressures under the forefoot, midfoot and rearfoot were recorded from 35 older people (mean age 73.2, SD 4.5 years) with current or previous forefoot pain using the pedar-X(®) system. Participants walked at their normal comfortable speed along an 8m walkway in shoes with three different levels of sole hardness: soft (Shore A25), medium (Shore A40) and hard (Shore A58). Shoe comfort was measured on a 100mm visual analogue scale. There were statistically significant differences in peak pressure of between 5% and 23% across the forefoot, midfoot and rearfoot (p<0.01). The hard-soled shoe registered the highest peak pressures and the soft-soled shoe the lowest peak pressures. However, no differences in comfort scores across the three shoe conditions were observed. These findings demonstrate that as shoe sole hardness increases, plantar pressure increases, however this does not appear to have a significant effect on shoe comfort.
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Affiliation(s)
- Tamara J Lane
- Department of Podiatry, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria 3086 Australia
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