Effect of rocker shoes on plantar pressure pattern in healthy female runners

Human-in-the-loop optimization of rocker shoe to reduce plantar pressure and collision work simultaneously

BACKGROUND

Rocker shoes can be used to reduce foot pressure and adjust lower limb kinetics for various patient population, such as people with diabetic peripheral neuropathy. Selecting adequate properties of the rocker sole is of great importance for its efficacy. This study investigated the capability of human-in-the-loop optimization (HILO) to individually optimize apex position and angle of rocker shoe to reduce peak pressure and collision work simultaneously.

METHODS

Peak pressure, kinetic, and kinematic data were recorded from 10 healthy participants while walking at preferred speed wearing rocker shoes with adjustable apex position and angle. An evolutionary algorithm was used to find optimal apex parameters to reduce both peak pressure in medial forefoot and collision work. The optimized shoe (HILO shoe) was compared with generic optimal rocker settings (Chapman settings) and normal shoe.

FINDINGS

Compared to normal shoe, the HILO shoe had lower plantar pressure (pHILO = 0.007; pChapman = 0.044) and Chapman shoe showed higher collision work (pHILO = 0.025; pChapman = 0.014). Both HILO and Chapman shoe had smaller push-off work than normal shoe (pHILO = 0.001; pChapman < 0.001) with the Chapman shoe exhibited earlier push-off onset (pHILO = 0.257; pChapman = 0.016).

INTERPRETATION

The Human-in-the-loop optimization approach resulted in individualized apex settings which performed on average similar to Chapman settings but, were superior in selected cases. In these cases, medial forefoot could be further offloaded with apex angles larger than generic settings. The larger apex angle might increase the external ankle moment arm and push-off work. However, there is limited room for improvement on collision work compared to generic settings.

Towards functionally individualised designed footwear recommendation for overuse injury prevention: a scoping review

Injury prevention is essential in running due to the risk of overuse injury development. Tailoring running shoes to individual needs may be a promising strategy to reduce this risk. Novel manufacturing processes allow the production of individualised running shoes that incorporate features that meet individual biomechanical and experiential needs. However, specific ways to individualise footwear to reduce injury risk are poorly understood. Therefore, this scoping review provides an overview of (1) footwear design features that have the potential for individualisation; and (2) the literature on the differential responses to footwear design features between selected groups of individuals. These purposes focus exclusively on reducing the risk of overuse injuries. We included studies in the English language on adults that analysed: (1) potential interaction effects between footwear design features and subgroups of runners or covariates (e.g., age, sex) for running-related biomechanical risk factors or injury incidences; (2) footwear comfort perception for a systematically modified footwear design feature. Most of the included articles (n = 107) analysed male runners. Female runners may be more susceptible to footwear-induced changes and overuse injury development; future research should target more heterogonous sampling. Several footwear design features (e.g., midsole characteristics, upper, outsole profile) show potential for individualisation. However, the literature addressing individualised footwear solutions and the potential to reduce biomechanical risk factors is limited. Future studies should leverage more extensive data collections considering relevant covariates and subgroups while systematically modifying isolated footwear design features to inform footwear individualisation.

Gender differences in footwear characteristics between half and full marathons in China: a cross-sectional survey

There are concerns about the risk of injuries caused by marathons in China. Since male and female runners have different injury risks, gender differences in running shoe functionality should be further complemented. A supervised questionnaire survey of 626 marathon runners was collected. The questionnaire was categorized into four sections: (1) participant profile, (2) importance of shoe properties, (3) functional evaluation of shoe properties and (4) importance ranking of shoe properties. The Mann-Whitney U test, Fisher's exact test of cross tabulation and Chi-square test, and two-way ANOVA were used to analyze the results of this survey. The significance level was set at P < 0.05. The full marathon participants were older than the half marathon participants. There was no gender difference in the importance of shoe features to elite runners. In addition, women are more concerned about upper elasticity and have higher requirements for running shoes than men. Women were more focused on injury prevention, while men were more focused on running performance. Heel cushioning was identified by all participants as the most important running shoe feature. There were no gender differences between elite players' demand for running shoes, but significant gender differences were found between genders at other running levels.

Effects of rocker radii with two longitudinal bending stiffnesses on plantar pressure distribution in the forefoot

INTRODUCTION

Outsole parameters of the shoe can be adapted to offload regions of pain or region of high pressures. Previous studies already showed reduced plantar pressures in the forefoot due to a proximally placed apex position and higher longitudinal bending stiffness (LBS). The aim of this study was to determine the effect of changes in rocker radii and high LBS on the plantar pressure profile during gait.

METHOD

10 participants walked in seven shoe conditions of which one control shoe and six rocker shoes with small, medium and large rocker radii and low and high longitudinal bending stiffness. Pedar in-shoe plantar pressure measuring system was used to quantify plantar pressures while walking on a treadmill at self-selected walking speed. Peak plantar pressure, maximum mean pressure and force-time integral were analyzed with Generalized Estimated Equation (GEE) and Tukey post hoc correction (α = .05).

RESULTS

Significantly lower plantar pressures were found in the first toe, toes 2-5, distal and proximal forefoot in all rocker shoe conditions as compared to the control shoe. Plantar pressures in the first toe and toes 2-5 were significantly lower in the small radius compared to medium and large radii. For the distal forefoot both small and medium radii significantly reduced plantar pressure compared to large radii. Low LBS reduced plantar pressure at the first toe significantly compared to high LBS independent of the rocker radius. Plantar pressures in the distal forefoot and toes 2-5 were lower in high LBS compared to low LBS.

CONCLUSION

Manipulation of the rocker radius and LBS can effectively reduce peak plantar pressures in the forefoot region during gait. In line with previous studies, we showed that depending on the exact target location for offloading, different combinations of rocker radius and LBS need to be adopted to maximize treatment effects.

The effect of shoe cushioning on gait and balance in females with multiple sclerosis

Gait and balance deficits are significant concerns for people with multiple sclerosis (MS). Shoe cushioning can influence mobility and balance, but its effect on walking and balance remains unknown in MS. This study aimed to determine how shoe cushioning affects gait and balance in females with MS (FwMS). We hypothesized that extra cushioning would improve gait but reduce balance performance. FwMS performed gait (n = 18) and balance (n = 17) assessments instrumented using inertial sensors in two different shoe conditions: a standard-cushioned and an extra-cushioned shoe. Care was taken to ensure minimal differences between shoe types other than midsole cushioning, but shoe construction was not identical between conditions. Spatiotemporal gait parameters were assessed during a 2-min walk test, while postural sway measures were evaluated using the modified Clinical Test of Sensory Interaction and Balance. In the extra-cushioned shoe, FwMS spent less time in the double support and stance phase with more time in the single support and swing phase. No differences in stride length, gait speed, or elevation at midswing were observed between shoe conditions. Decreased path length, RMS sway, and sway velocity were observed in the extra-cushioned shoe. No differences were observed in the gait cycle's spatial composition between shoe conditions, but FwMS demonstrated improvements in the gait cycle's temporal parameters and postural sway in the extra-cushioned shoe. This may suggest a less cautious walking strategy and improved balance when wearing a shoe with extra cushioning.

Effect of different forefoot rocker radii on lower-limb joint biomechanics in healthy individuals

INTRODUCTION

Previous studies showed that rocker shoes with a stiff forefoot rocker profile significantly reduce peak plantar flexion moment at the ankle (PFM) and peak ankle dorsiflexion (DF). Both parameters are related to Achilles tendon and Plantar Fascia unloading. The shape of an outsole with a forefoot rocker is described with multiple rocker design parameters. The aim of this research is, to determine the relation between different forefoot rocker radii on peak DF and peak PFM at a self-selected walking speed.

METHODS

10 participants walked in standard shoes and three experimental pairs of shoes with different forefoot rocker radii. Lower extremity kinematics and kinetics were collected while walking on an instrumented treadmill at preferred walking speed and analysed with Statistical Parametric Mapping (SPM) (α = .05; post-hoc α = .05/6).

RESULTS

Peak value analyses showed significant decreases in peak DF, peak PFM, and peak ankle power generation for the rocker conditions. No relevant significant differences were found in spatio-temporal parameters and total work at the ankle joint. SPM showed a significant decrease (% gait cycle) in DF (40-69 %), PFM (7-15 %; 41-68 %; 69-81 %), ankle power (10-15 %; 32-51 %; 55-64 %; 64-67 %; 72-80 %) and foot-to-horizontal angle (FHA) (0-4 %; 40-62 %; 92-100 %) and an increased shank-to-vertical angle (SVA) (44-84 %) for the rocker conditions.

CONCLUSION

The results of this study suggest that rocker shoes with a proximally placed apex significantly reduce DF and PFM during the third rocker compared with control shoes. This effect is mainly explained by a change in the FHA. Smaller radii cause the largest reductions in DF and PFM, so therefore, a uniform standardisation of the forefoot rocker radius is essential.

Effect of Rocker Soled Shoe Design on Walking Economy in Females with Pes Planus

Introduction

The energy cost is increased during walking in pes planus condition whereas, energy cost during walking using rocker bottom shoes is debatable.

Aim

To determine the walking economy with rocker soled shoes, when compared with bare feet walking in females with pes planus over treadmill.

Materials and Methods

Seventeen collegiate flat footed females aged 18-25 years were recruited in accordance with inclusion and exclusion criteria. Subjects were asked to walk barefooted and with rocker soled shoes on treadmill for four minutes at a speed of 3.8 km/hour. Oxygen consumption (VO₂) was measured directly using PowerLab 8/35 data acquisition system with Lab Chart Pro (AD Instruments, Australia) one minute before walking, four minutes during walking and one minute after walking. Rating of Perceived Exertion (RPE) was taken after termination of walking.

Results

VO₂ during barefoot walking was significantly lower than rocker soled shoe walking during four-five minutes (p<0.001) and during recovery (p=0.04). RPE is significantly lower during barefoot walking than rocker soled shoe walking (p<0.001) over treadmill.

Conclusion

Oxygen consumption and RPE were increased during walking with rocker soled shoe design in comparison to bare feet walking over treadmill at same speed.

Effects of flexible and rigid rocker profiles on in-shoe pressure

Rocker profiles are commonly used in the prevention of diabetic foot ulcers. Rockers are mostly stiffened to restrict toe plantarflexion to ensure proper offloading. It is also described that toe dorsiflexion should be restricted. However, the difference in effect on plantar pressure between rigid rockers that restrict this motion and flexible rockers that do not is unknown. In-shoe plantar pressure data were collected for a control shoe and the same shoe with rigid and flexible rockers with the apex positioned at 50% and 60%. For 29 healthy female adults peak plantar pressure (PP), maximum mean pressure (MMP) and force-time integral (FTI) were determined for seven regions of the foot. Generalized estimate equation was used to analyse the effect of the different shoes on the outcome measures for these regions. Compared to the control shoe a significant increase of PP and FTI was found at the first toe for both rigid rockers and the flexible rocker with the apex positioned at 60%, while MMP was significantly increased in rockers with an apex position of 60% (p<0.001). PP at the first toe was significantly lower in flexible rockers when compared to rigid rockers (p<0.001). For both central and lateral forefoot PP and MMP were significantly more reduced in rigid rockers (p<0.001), while for the medial forefoot no differences were found. The use of rigid rockers results in larger reductions of forefoot plantar pressures, but in worse increase of plantar pressures at the first toe compared to rockers that allow toe dorsiflexion.

A framework for the etiology of running-related injuries

The etiology of running-related injury is important to consider as the effectiveness of a given running-related injury prevention intervention is dependent on whether etiologic factors are readily modifiable and consistent with a biologically plausible causal mechanism. Therefore, the purpose of the present article was to present an evidence-informed conceptual framework outlining the multifactorial nature of running-related injury etiology. In the framework, four mutually exclusive parts are presented: (a) Structure-specific capacity when entering a running session; (b) structure-specific cumulative load per running session; (c) reduction in the structure-specific capacity during a running session; and (d) exceeding the structure-specific capacity. The framework can then be used to inform the design of future running-related injury prevention studies, including the formation of research questions and hypotheses, as well as the monitoring of participation-related and non-participation-related exposures. In addition, future research applications should focus on addressing how changes in one or more exposures influence the risk of running-related injury. This necessitates the investigation of how different factors affect the structure-specific load and/or the load capacity, and the dose-response relationship between running participation and injury risk. Ultimately, this direction allows researchers to move beyond traditional risk factor identification to produce research findings that are not only reliably reported in terms of the observed cause-effect association, but also translatable in practice.

[Orthopedic shoe treatment: Inserts]

The use of inserts and orthopedic shoe adjustment represents an essential component of the conservative therapy of degenerative diseases and deformities of the musculoskeletal system. Inserts can have supportive, bedding and corrective effects and are used in particular for complaints of the feet and ankles. The combination of diverse materials allows a high level of cushioning and supporting features and corresponding longevity to be accomplished. The production is carried out on an individual basis and if necessary computer-assisted in order to achieve an optimal fit. For severe and rigid deformities the formation of pressure ulcers can be prevented by orthopedic shoe adjustment and by the use of orthopedic tailor-made shoes.

A new insole measurement system to detect bending and torsional moments at the human foot during footwear condition: a technical report

Background

Stress occurring at the feet while wearing footwear is often determined using pressure measurement systems. However, other forms of stress, such as bending, torsional and shear loadings, cannot be detected in shoes during day-to-day activities. Nevertheless, the detection of these types of stresses would be helpful for understanding the mechanical aspects of various kinds of hard and soft tissue injuries. Therefore, we describe the development of a new measuring device that allows the reliable determination of bending and torsional load at the foot in shoes.

Methods

The system consists of a measuring insole and an analogue device with Bluetooth interface. The specific shape of the insole base layer, the positions of the strain gauges, and the interconnections between them have all been selected in such a way so as to isolate bending and torsional moment detections in the medial and lateral metatarsal region. The system was calibrated using a classical two-point test procedure. A single case study was executed to evaluate the new device for practical use. This application consisted of one subject wearing neutral shoes walking on a treadmill.

Results

The calibration results (coefficients of determination R² > 0.999) show that bending and torsional load can be reliably detected using the measurement system presented. In the single case study, alternating bending and torsional load can be detected during walking, and the shape of the detected bending moments can be confirmed by the measurements of Arndt et al. (J Biomech 35:621–8, 2002).

Conclusions

Despite some limitations, the presented device allows for the reliable determination of bending and torsional stresses at the foot in shoes.

Assessing Footwear Effects from Principal Features of Plantar Loading during Running

PURPOSE

The effects of footwear on the musculoskeletal system are commonly assessed by interpreting the resultant force at the foot during the stance phase of running. However, this approach overlooks loading patterns across the entire foot. An alternative technique for assessing foot loading across different footwear conditions is possible using comprehensive analysis tools that extract different foot loading features, thus enhancing the functional interpretation of the differences across different interventions. The purpose of this article was to use pattern recognition techniques to develop and use a novel comprehensive method for assessing the effects of different footwear interventions on plantar loading.

METHODS

A principal component analysis was used to extract different loading features from the stance phase of running, and a support vector machine (SVM) was used to determine whether and how these loading features were different across three shoe conditions.

RESULTS

The results revealed distinct loading features at the foot during the stance phase of running. The loading features determined from the principal component analysis allowed successful classification of all three shoe conditions using the SVM. Several differences were found in the location and timing of the loading across each pairwise shoe comparison using the output from the SVM.

CONCLUSIONS

The analysis approach proposed can successfully be used to compare different loading patterns with a much greater resolution than has been reported previously. This study has several important applications. One such application is that it would not be relevant for a user to select a shoe or for a manufacturer to alter a shoe's construction if the classification across shoe conditions would not have been significant.