Load distribution to minimise pressure-related pain on foot: a model

Changes in Baropodometric Evaluation and Discomfort during the Workday in Assembly-Line Workers

Prolonged standing at work is associated with health risks. The appearance of lower-limb and lower-back discomfort is one of the most prevalent factors in prolonged standing workers. The aim of this research was to evaluate the effect of an eight-hour workday on foot pressure and musculoskeletal discomfort in standing workers. Thirty-six assembly-line workers (six women) were recruited to participate in a cross-sectional study to assess foot pressure and surface, foot, knee, and lower-back discomfort before and after a real workday. Baropodometry outcomes (surface and pressure) were evaluated by the pressure platform SensorMedica and musculoskeletal discomfort was evaluated by Cornell's Musculoskeletal Discomfort Questionaire. Total foot surface (p = 0.01) and foot discomfort (p = 0.03) increased significantly at the end of the workday. Prolonged standing during 8 h workday increased the foot discomfort and total foot surface in assembly-line workers. No foot pressure variable (forefoot, rearfoot, or total) was significantly modified after the workday in assembly-line workers.

Calculation of the Rearfoot Angle Representing Flatfoot from Comparison to the Cavanagh Arch Index

A type of flatfoot can be analyzed accurately using the footprint when a human is standing; however, this method cannot be applied when a human is wearing orthotic shoes. This study aims to analyze flatfoot using the rearfoot angle (RFA) measurement. The result is then compared to a footprint measurement known as Cavanagh’s Arch Index (AI). A total of 31 static footprints of the participants consisting of 14 males and 17 females aged 18 to 25 years were collected. According to Cavanagh’s AI as a gold standard, the correlation equation was obtained as RFA = 46.04AI − 6.41 and RFA = 45.32AI − 6.26 for left and right foot, respectively. The correlation coefficient R2 for the left and the right foot is 0.63 and 0.73, respectively. Other statistical analyses using ANOVA and t-tests are presented in this paper. The correlation results obtained from this study are necessary for estimating the reduction in the degree of flatfoot when using orthotic shoes, which is difficult to calculate using the typical AI method from footprint measurements.

A Reconfigurable and Adjustable Compliance System for the Measurement of Interface Orthotic Properties

Custom foot orthoses (CFOs) have shown treatment effectiveness by providing improved pressure/load redistribution, skeletal support and comfort level. However, the current design methodologies of CFOs have some problems: (1) the plantar surface is captured without considering the soft tissue impedance, (2) the stiffness of the CFOs is limited to rigid, semi-rigid and soft, which ignores the potential effect of local variation of stiffness on the interface pressure/load distribution and subjective evaluations, and (3) the lack of a human-in-the-loop may lead to multiple design-to-deliver iterations. A new prescription methodology of CFOs is required to satisfy the pressure/load distribution, improve comfort level and decrease iterations.

METHOD

A measurement system which provides INterface with Tunable Ergonomic properties using a Reconfigurable Framework with Adjustable Compliant Elements (INTERFACE system) is developed to implement the Rapid Evaluate and Adjust Device (READ) methodology. The geometry and stiffness of the Medial Longitudinal Arch (MLA) support provided by the INTERFACE system can be adjusted via linear actuators and tunable stiffness mechanisms, based on objective interface pressure/load distribution and subjective feedback evaluations. Validation tests were conducted on 13 subjects to measure the plantar pressure/load distribution and record the subjective feedback in different combinations of geometry and stiffness.

RESULTS

The interface pressure/load distribution and subjective feedback of the support level indicate the efficacy of the adjustable geometry and stiffness. As the stiffness and geometrical height increased, the plantar loadings increased in the MLA region and decreased in the rear foot. Geometrical fitting can be achieved with the reconfigurable MLA support. The integration of locally adjustable stiffness makes it possible to fine tune the plantar pressure/load and provides the subjects with options of orthotic stiffness.

CONCLUSION

The proposed INTERFACE system can be applied to conduct the measurement of the desired orthotic properties which satisfy the interface pressure/load requirement and the subject's comfort.

A Simple Foot Plantar Pressure Measurement Platform System Using Force-Sensing Resistors

Generally, there are two types of working style, i.e., some people work in sitting conditions, and the remaining work mostly in a standing position. For people working in a standing position, they can spend hours in a day doing their work standing. These people do not realize that it can cause medical issues, especially for the feet, namely biometric problems. In addition, several doctors in Indonesia are already aware of this issue and state that the biometric problems faced by those kinds of people can be predicted from the load distribution on the foot. However, the tool used by the doctors in Indonesia to measure biometric problems is not a digital tool. Therefore it is very difficult to measure and predict the biometric problems quantitatively. This study aims to develop a low-cost static load measuring device using force-sensing resistor (FSR) sensors. The measuring instrument is designed in the form of a pressure plate platform which consist of 30 FSR 402 sensors. The sensors are placed right underneath the display area of the foot, 15 sensors on the soles of the left and right feet. Ten students from the Department of Mechanical Engineering, Diponegoro University (five men and five women) were asked to stand on the platform. Each subject also measured foot length (FL) to estimate shoe size, foot area contact (FAC) for validation between genders, and foot type using the digital footprint tools. From the results of measurements obtained for the left foot in the medial mid foot area, i.e., in sensors 5 and 7, not exposed to the load, on almost all subjects except subject number 3 with a load of 0.196 kg on sensor 7. The highest average load occurs in the heel area i.e., sensor 1 measured 0.713 kg and the smallest average load occurs in the five sensors, with 0 kg. A static load gauge that is designed to be used to measure each leg area for subjects with a shoe size of 40–42 with low price to be held in hospital-orthopedic hospitals and biomechanical research centers.

The effectiveness of raising the heel height of shoes to reduce heel pain in patients with calcaneal spurs

[Purpose] To investigate the effect of heel height on the distribution of plantar foot force and heel pain in patients with a heel spur. [Subjects and Methods] Plantar force was measured using 8 force sensors in 16 patients (3 men, 13 women), with symptomatic heel spur for 4 heel heights (0-4 cm). Sensors were located at the hallux (T1); medial to lateral metatarsals (M1 through M3), mid-foot (MF); and at the central, lateral, and medial heel (CH, LH, and MH). Pain was evaluated using the minimum compression force that caused pain and was measured using an algometer. [Results] Load bearing shifted from the heel (CH) to the mid-foot (MF) and hallux (T1) with increasing heel height. Raising the heel from 2 to 3 cm reduced the magnitude of load bearing, relative to the minimum compression force for pain, by 3.70% at the LH and 2.35% at the MH. Excellent clinical outcomes, defined by a 70-100% decrease in pain, were achieved in 10/16 participants with the use of a 2-cm and 3-cm heel height in men and women, respectively. [Conclusion] Increasing heel height effectively decreases the plantar force on the heel during weight-bearing activities.

Pressure thresholds and stiffness on the plantar surface of the human foot

A methodology to assess Pressure Discomfort Thresholds (PDT), Pressure Pain Thresholds (PPT) and tissue stiffness on the plantar surface of the foot was developed. Ten male and 10 female participants volunteered for the study. Foot landmarks were used to create a standardised grid-type template of 95 points. For each test point, PPT and PDT values were obtained, and stiffness was calculated for each of the 20 participants. Cluster analyses were performed to determine the regions of similarity for the three dependent variables, PPT, PDT and stiffness. Moran's-I-index was used to determine the spatial auto correlations. The use of k-means clustering showed five distinct clusters while the three dependent variables showed strong correlations to each other. Morisita's similarity index was used to check the similarity of the grid among all participants. Both male and female participants showed a Morisita's index greater than 0.7 confirming the reliability of the foot template. Practitioner Summary: Pressure Discomfort thresholds (PPT), Pressure pain thresholds (PPT) and tissue stiffness were evaluated at 95 points on the plantar surface of the foot. The PPT and related PDT map are useful to design the footbeds of shoes. Based on the data collected, five distinct clusters of locations were identified.

The influence of lumbar extensor muscle fatigue on lumbar-pelvic coordination during weightlifting

Lumbar muscle fatigue is a potential risk factor for the development of low back pain. In this study, we investigated the influence of lumbar extensor muscle fatigue on lumbar-pelvic coordination patterns during weightlifting. Each of the 15 male subjects performed five repetitions of weightlifting tasks both before and after a lumbar extensor muscle fatiguing protocol. Lumbar muscle electromyography was collected to assess fatigue. Trunk kinematics was recorded to calculate lumbar-pelvic continuous relative phase (CRP) and CRP variability. Results showed that fatigue significantly reduced the average lumbar-pelvic CRP value (from 0.33 to 0.29 rad) during weightlifting. The average CRP variability reduced from 0.17 to 0.15 rad, yet this change ws statistically not significant. Further analyses also discovered elevated spinal loading during weightlifting after the development of lumbar extensor muscle fatigue. Our results suggest that frequently experienced lumbar extensor muscle fatigue should be avoided in an occupational environment.

PRACTITIONER SUMMARY

Lumbar extensor muscle fatigue generates more in-phase lumbar-pelvic coordination patterns and elevated spinal loading during lifting. Such increase in spinal loading may indicate higher risk of back injury. Our results suggest that frequently experienced lumbar muscle fatigue should be avoided to reduce the risk of LBP.