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Kirmizi M, Sengul YS, Akcali O, Angin S. Effects of foot exercises and customized arch support insoles on foot posture, plantar force distribution, and balance in people with flexible flatfoot: A randomized controlled trial. Gait Posture 2024; 113:106-114. [PMID: 38865799 DOI: 10.1016/j.gaitpost.2024.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/19/2024] [Accepted: 05/28/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Exercises strengthening foot muscles and customized arch support insoles are recommended for improving foot posture in flexible flatfoot. However, it is not known what the effects of exercises and insoles on plantar force distribution obtained during walking at different speeds. Also, randomized controlled trials comparing the effects of exercises and insoles are limited. RESEARCH QUESTION What are the effects of foot exercises, customized arch support insoles, and exercises plus insoles on foot posture, plantar force distribution, and balance in people with flexible flatfoot? Do exercises, insoles, and exercises plus insoles affect outcome measures differently? METHODS Forty-five people with flexible flatfoot were randomly divided into three groups and 40 of those completed the study. The exercise group performed tibialis posterior strengthening and short foot exercises three days a week for six weeks. The insole group used their customized arch support insoles for six weeks. The exercise plus insole group received both interventions for six weeks. The assessments were performed three times: before the interventions and at the 6th and 12th weeks. Outcome measures were (1) foot posture, (2) plantar force distribution in the following conditions: static standing, barefoot walking at different speeds, and walking immediately after the heel-rise test, and (3) balance. RESULTS Foot posture improved in all groups, but insole was less effective than exercise and exercise plus insole (p<0.05). Plantar force variables obtained during standing and walking changed in all groups (p<0.05). The superiority of the interventions differed according to the plantar regions and walking speed conditions (p<0.05). Static balance improved in all groups, but limits of stability improved in the exercise plus insole and exercise groups (p<0.05). SIGNIFICANCE The superiority of the interventions differed according to the assessed parameter. The management of flexible flatfoot should be tailored based on the assessment results of each individual.
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Affiliation(s)
- Muge Kirmizi
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir Katip Celebi University, Izmir, Turkey; Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey.
| | - Yesim Salik Sengul
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
| | - Omer Akcali
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Dokuz Eylul University, Izmir, Turkey
| | - Salih Angin
- Faculty of Health Sciences, Cyprus International University, Nicosia, Cyprus
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Custom-made foot orthoses with and without heel plugs and their effect on plantar pressures during treadmill walking. Prosthet Orthot Int 2022; 46:e357-e361. [PMID: 35315833 DOI: 10.1097/pxr.0000000000000101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 01/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Foot orthoses have consistently demonstrated an improvement in pain scores for plantar fasciitis. The fabrication of custom-made foot orthoses (CFOs) can vary between clinicians and may include the use of different materials and casting techniques. This cross-sectional study's objective was to quantify plantar pressure for two CFOs, one with a heel plug (HP) and one without. METHODS Fourteen healthy participants (8 men and 6 women; 35.4 ± 7.7 years) were cast by the same practitioner. Both CFOs were made with the same materials and specifications, except for the HP orthosis, which replaced hard material under the heel with a softer blue PORON ® plug for added cushioning. Plantar pressures were recorded during treadmill walking for both devices in a running shoe. Average pressure, peak pressure, and pressure contact area were determined for three regions of the foot: hindfoot, midfoot, and forefoot. A paired samples t -test determined differences in each region ( P < 0.05). RESULTS The HP orthosis reduced the overall means of average pressure, peak pressure, and pressure contact area in the hindfoot while tending to increase these measures in the midfoot and forefoot. The three measures showed statistically significant decreases in the hindfoot, whereas a statistically significant increase was seen in average and peak pressures in the midfoot ( P < 0.05). CONCLUSIONS CFOs with HPs are more effective than regular CFOs in offloading plantar pressures in the hindfoot while increasing pressures in the midfoot. This is an important finding because offloading the hindfoot is critical in pathologies such as plantar fasciitis to decrease pain and increase function.
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Daryabor A, Kobayashi T, Saeedi H, Lyons SM, Maeda N, Naimi SS. Effect of 3D printed insoles for people with flatfeet: a systematic review. Assist Technol 2022; 35:169-179. [PMID: 35882078 DOI: 10.1080/10400435.2022.2105438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
This systematic review aimed to evaluate custom-made 3D printed insoles for people with flatfeet. PubMed, Embase, ISI web of knowledge, ProQuest, Scopus, and Cochrane databases, were searched from inception until January 2022. The quality assessment of included studies was performed through the Downs and Black checklist. A narrative analysis was performed since a meta-analysis could not be conducted. Ten studies including 225 subjects with flexible flatfeet were chosen for final evaluation. Although the evidence from selected literature was generally weak, using insoles with 3D printing technology may positively affect pain (comfort score) and foot function, with no significant change in vertical loading rate during walking or running. There were discrepancies among studies for plantar pressures, center of pressure trajectories, 3D ankle joint kinematics and kinetics of gait while wearing these insoles. Dose-response effects of medial posting on 3D printed insoles suggested beneficial effects on lower limb gait biomechanics in people with flatfeet. There was insufficient evidence to conclude the comparison between 3D printed insoles and other types of insoles. In conclusion, using a 3D printed insole may improve comfort score and foot function in people with flatfeet.
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Affiliation(s)
- Aliyeh Daryabor
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong, China
| | - Hassan Saeedi
- School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Samuel M Lyons
- Motion Analysis and Sports Performance Lab, Department of Orthopedic Sports Medicine, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Noriaki Maeda
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Sedighe Sadat Naimi
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mo Y, Qaiser Z, Ou H, Johnson S. A Reconfigurable and Adjustable Compliance System for the Measurement of Interface Orthotic Properties. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1886-1894. [PMID: 34478374 DOI: 10.1109/tnsre.2021.3109977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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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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Bader DL, Worsley PR, Gefen A. Bioengineering considerations in the prevention of medical device-related pressure ulcers. Clin Biomech (Bristol, Avon) 2019; 67:70-77. [PMID: 31077978 DOI: 10.1016/j.clinbiomech.2019.04.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND In recent years, it has become increasingly apparent that medical device-related pressure ulcers represent a significant burden to both patients and healthcare providers. Medical devices can cause damage in a variety of patients from neonates to community based adults. To date, devices have typically incorporated generic designs with stiff polymer materials, which impinge on vulnerable soft tissues. As a result, medical devices that interact with the skin and underlying soft tissues can cause significant deformations due to high interface pressures caused by strapping or body weight. METHODS This review provides a detailed analysis of the latest bioengineering tools to assess device related skin and soft tissue damage and future perspectives on the prevention of these chronic wounds. This includes measurement at the device-skin interface, imaging deformed tissues, and the early detection of damage through biochemical and biophysical marker detection. In addition, we assess the potential of computational modelling to provide a means for device design optimisation and material selection. INTERPRETATION Future collaboration between academics, industrialists and clinicians should provide the basis to improve medical device design and prevent the formation of these potentially life altering wounds. Ensuring clinicians report devices that cause pressure ulcers to regulatory agencies will provide the opportunity to identify and improve devices, which are not fit for purpose.
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Affiliation(s)
- D L Bader
- School of Health Sciences, University of Southampton, Southampton, UK
| | - P R Worsley
- School of Health Sciences, University of Southampton, Southampton, UK.
| | - A Gefen
- Department of Biomedical Engineering, Tel Aviv University, Israel
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Mo S, Leung SH, Chan ZY, Sze LK, Mok KM, Yung PS, Ferber R, Cheung RT. The biomechanical difference between running with traditional and 3D printed orthoses. J Sports Sci 2019; 37:2191-2197. [DOI: 10.1080/02640414.2019.1626069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Shiwei Mo
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Sam H.S. Leung
- Department of Orthopaedics & Traumatology, Chinese University of Hong Kong, Hong Kong
| | - Zoe Y.S. Chan
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Louis K.Y. Sze
- Persona Surgical Modelling, Hong Kong Science Park, Hong Kong
| | - Kam-Ming Mok
- Department of Orthopaedics & Traumatology, Chinese University of Hong Kong, Hong Kong
| | - Patrick S.H. Yung
- Department of Orthopaedics & Traumatology, Chinese University of Hong Kong, Hong Kong
| | - Reed Ferber
- Faculties of Kinesiology and Nursing, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Running Injury Clinic, University of Calgary, Calgary, Alberta, Canada
| | - Roy T.H. Cheung
- Gait & Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
- Department of Orthopaedics & Traumatology, Chinese University of Hong Kong, Hong Kong
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Nakagawa R, Yamaguchi S, Kimura S, Sadamasu A, Yamamoto Y, Muramatsu Y, Sato Y, Akagi R, Sasho T, Ohtori S. Efficacy of foot orthoses as nonoperative treatment for hallux valgus: A 2-year follow-up study. J Orthop Sci 2019; 24:526-531. [PMID: 30509733 DOI: 10.1016/j.jos.2018.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/15/2018] [Accepted: 11/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The purpose of this study was to clarify the 2-year clinical and radiological outcomes of nonoperative treatment using foot orthosis for hallux valgus patients. METHODS Patients who underwent nonoperative treatment using foot orthosis were surveyed prospectively. Foot orthoses were made by one certified orthotist using the standardized method. Pain and quality of life were evaluated using subjective and objective assessment measures at 3, 6, 12, 18, and 24 months. Furthermore, radiological outcomes, patient satisfaction, and adherence to treatment were surveyed. RESULTS A total of 53 patients (50 women and 3 men; median age, 63 years) were included for analysis. The pain visual analogue scale score significantly decreased over time, with the lowest score observed at 12 months. The treatment effect was maintained over 24 months (median score, 52, 21, and 27 points at baseline, 12 months, and 24 months, respectively; P < .001). The Japanese Society for Surgery of the Foot hallux scale, American Academy of Orthopaedic Surgeons Foot and Ankle Scale, and 36-Item Short-Form Health Survey bodily pain subscale also improved, although the treatment effects were maximal at 6 months and decreased thereafter. At 24 months, 43 (81%) patients continued to use the orthosis, with the median visual analogue scale score for patient satisfaction of 76 points. The hallux valgus angle and intermetatarsal angle did not change during the 24-month period. CONCLUSION Nonoperative treatment using foot orthoses decreased pain in patients with hallux valgus. The effect of treatment was maintained up to 2 years with a relatively high degree of patient satisfaction. However, treating physicians should inform patients to set realistic expectations and be aware that a limited degree of pain reduction is expected.
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Affiliation(s)
- Ryosuke Nakagawa
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Satoshi Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan; Collage of Liberal Arts and Sciences, Chiba University, Japan.
| | - Seiji Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Aya Sadamasu
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Yohei Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Yuta Muramatsu
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Yasunori Sato
- Chiba University Hospital Clinical Research Center, Japan
| | - Ryuichiro Akagi
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Takahisa Sasho
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan; Center for Preventive Medical Sciences, Chiba University, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
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9
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Yurt Y, Şener G, Yakut Y. The effect of different foot orthoses on pain and health related quality of life in painful flexible flat foot: a randomized controlled trial. Eur J Phys Rehabil Med 2019; 55:95-102. [DOI: 10.23736/s1973-9087.18.05108-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Parker DJ, Nuttall GH, Bray N, Hugill T, Martinez-Santos A, Edwards RT, Nester C. A randomised controlled trial and cost-consequence analysis of traditional and digital foot orthoses supply chains in a National Health Service setting: application to feet at risk of diabetic plantar ulceration. J Foot Ankle Res 2019; 12:2. [PMID: 30636974 PMCID: PMC6325812 DOI: 10.1186/s13047-018-0311-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/10/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Diabetic foot ulceration is a considerable cost to the NHS and foot orthotic provision is a core strategy for the management of the people with diabetes and a moderate to high risk of foot ulceration. The traditional process to produce a custom-made foot orthotic device is to use manual casting of foot shape and physical moulding of orthoses materials. Parts of this process can be undertaken using digital tools rather than manual processes with potential advantages. The aim of this trial was to provide the first comparison of a traditional orthoses supply chain to a digital supply chain over a 6 month period. The trial used plantar pressure, health status, and health service time and cost data to compare the two supply chains. METHODS Fifty-seven participants with diabetes were randomly allocated to each supply chain. Plantar pressure data and health status (EQ5D, ICECAP) was assessed at point of supply and at six-months. The costs for orthoses and clinical services accessed by participants were assessed over the 6 months of the trial. Primary outcomes were: reduction in peak plantar pressure at the site of highest pressure, assessed for non-inferiority to current care. Secondary outcomes were: reduction in plantar pressure at foot regions identified as at risk (> 200 kPa), cost-consequence analysis (supply chain, clinician time, service use) and health status. RESULTS At point of supply pressure reduction for the digital supply chain was non-inferior to a predefined margin and superior (p < 0.1) to the traditional supply chain, but both supply chains were inferior to the margin after 6 months. Custom-made orthoses significantly reduced pressure for at risk regions compared to a flat control (traditional - 13.85%, digital - 20.52%). The digital supply chain was more expensive (+£13.17) and required more clinician time (+ 35 min). There were no significant differences in health status or service use between supply chains. CONCLUSIONS Custom made foot orthoses reduce pressure as expected. Given some assumptions about the cost models we used, the supply chain process adopted to produce the orthoses seems to have marginal impact on overall costs and health status. TRIAL REGISTRATION Retrospectively registered on ISRCTN registry (ISRCTN10978940, 04/11/2015).
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Affiliation(s)
- D. J. Parker
- School of Health Sciences, University of Salford, Salford, UK
| | | | - N. Bray
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - T. Hugill
- East Lancashire Hospitals NHS Trust, Burnley, UK
| | | | - R. T. Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - C. Nester
- School of Health Sciences, University of Salford, Salford, UK
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Márquez MJM, Vidalón PT, Hurtado NL, Ramos-Ortega J. Comparative Study Between the Different Techniques of Molding and the Morphology of the Foot in Weightbearing. J Am Podiatr Med Assoc 2018; 108:375-382. [PMID: 34670340 DOI: 10.7547/17-019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Taking a mold of the foot is an important advance for podiatric medicine and an indispensable procedure for the individualization of orthopedic treatments. We sought to determine which method of measuring molds (plaster cast in weightbearing and nonweightbearing and phenolic foam in weightbearing) reproduces with more reliability the expansion of the foot in weightbearing by comparing the widths of the forefoot and hindfoot in the different methods and in barefoot weightbearing. METHODS In 54 patients, we studied the differences in width between the forefoot and hindfoot in barefoot weightbearing compared with in the different mold obtainment techniques. A descriptive, observational, and transversal study was performed in which foot molds were obtained with the different techniques, without corrective maneuvers, followed by scanning of each as well as barefoot weightbearing. RESULTS Significant differences among the techniques were shown, with phenolic foam being more similar to barefoot weightbearing in forefoot and hindfoot width. CONCLUSIONS The method that reproduces the expansion of the foot in weightbearing with more reliability is phenolic foam. The forefoot width is superior in barefoot weightbearing versus the three foot casts studied. The hindfoot width is superior in the foot cast with plaster in weightbearing compared with barefoot weightbearing and the other two foot casts.
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Gijon-Nogueron G, Ramos-Petersen L, Ortega-Avila AB, Morales-Asencio JM, Garcia-Mayor S. Effectiveness of foot orthoses in patients with rheumatoid arthritis related to disability and pain: a systematic review and meta-analysis. Qual Life Res 2018; 27:3059-3069. [PMID: 29922913 DOI: 10.1007/s11136-018-1913-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epidemiological studies consistently report a 90% prevalence of foot pain. Mechanical and other non-pharmacological interventions such as orthoses and footwear can play an important role in managing foot pathology in patients whose systemic disease is controlled. The effectiveness of treatment with insoles has been examined in various randomised controlled trials, which have reported immediate clinical improvements, with reduced foot pain and disability and enhanced functionality. The aim of this systematic review is to determine the effectiveness of foot orthoses in patients with rheumatoid arthritis (RA), in comparison with other treatments, in terms of enhanced disability and reduced pain. METHODS A systematic review and meta-analysis was conducted of a number of randomised controlled trials focusing on patients with RA. The search was conducted in Cochrane, CINAHL, PubMed, EMBASE, SCOPUS and Cuiden, by means of an independent peer review. The Mesh terms and fields used were foot, ankle, joint, RA, foot, orthosis, insole and foot orthosis. RESULTS Of the initial 118 studies considered, 5 were included in the final systematic review and meta-analysis. These five studies had enrolled a total of 301 participants, with follow-up periods ranging from 4 to 36 months. Although the use of orthoses seems to alleviate foot pain, our meta-analysis did not reveal statistically significant differences between control and intervention groups regarding long- and short-term pain relief and/or reduced disability. CONCLUSIONS Foot orthoses can relieve pain and disability and enhance patients, but no significant differences were found between control and intervention groups.
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Affiliation(s)
- Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, University of Malaga, Instituto de Investigación Biomedica de Malaga (IBIMA), Malaga, Spain
| | - Laura Ramos-Petersen
- Department of Nursing and Podiatry, University of Malaga, Instituto de Investigación Biomedica de Malaga (IBIMA), Malaga, Spain
| | - Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Faculty of Health Sciences, Arquitecto Francisco Peñalosa, 3, Ampliacion de Campus de Teatinos, 29071, Malaga, Spain.
| | - Jose Miguel Morales-Asencio
- Department of Nursing and Podiatry, University of Malaga, Instituto de Investigación Biomedica de Malaga (IBIMA), Malaga, Spain
| | - Silvia Garcia-Mayor
- Department of Nursing and Podiatry, University of Malaga, Instituto de Investigación Biomedica de Malaga (IBIMA), Malaga, Spain
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Gatt A, Grech M, Chockalingam N, Formosa C. A Preliminary Study on the Effect of Computer-Aided Designed and Manufactured Orthoses on Chronic Plantar Heel Pain. Foot Ankle Spec 2018; 11:112-116. [PMID: 28513217 DOI: 10.1177/1938640017709906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Chronic plantar heel pain (CPHP) is a significant, painful condition referring to a range of undifferentiated foot conditions that affect the heel of the foot. METHOD Participants presenting with CPHP of more than 6 months' duration were recruited on a first through the door basis. Computer-Aided Design and Computer-Aided Manufactured (CAD-CAM) orthoses were designed and constructed for each participant, then dispensed as per normal practice. Pre- and postintervention assessment of pain was performed at baseline and after 6 weeks of use, utilizing the pain subset of the Foot Function Index (FFI). RESULTS There was a significant reduction in the mean pain scores for all participants in all constructs of the FFI. Total FFI score was also significant ( P = .003). CONCLUSION CAD-CAM orthoses have the potential to become a treatment modality of choice in CPHP since they have resulted in a significant improvement in heel pain after only 6 weeks' use. LEVELS OF EVIDENCE Therapeutic, Level IV: Prospective, comparative trial.
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Affiliation(s)
- Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida, Malta (AG, MG, CF).,Faculty of Health Sciences, Staffordshire University, Stoke on Trent, UK (NC)
| | - Mark Grech
- Faculty of Health Sciences, University of Malta, Msida, Malta (AG, MG, CF).,Faculty of Health Sciences, Staffordshire University, Stoke on Trent, UK (NC)
| | - Nachiappan Chockalingam
- Faculty of Health Sciences, University of Malta, Msida, Malta (AG, MG, CF).,Faculty of Health Sciences, Staffordshire University, Stoke on Trent, UK (NC)
| | - Cynthia Formosa
- Faculty of Health Sciences, University of Malta, Msida, Malta (AG, MG, CF).,Faculty of Health Sciences, Staffordshire University, Stoke on Trent, UK (NC)
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Comparison of plantar pressure distribution in CAD-CAM and prefabricated foot orthoses in patients with flexible flatfeet. Foot (Edinb) 2017; 33:76-80. [PMID: 29128666 DOI: 10.1016/j.foot.2017.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/22/2017] [Accepted: 07/06/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUNDS The effect of foot orthoses on plantar pressure distribution has been proven by researchers but there are some controversies about advantages of custom-made foot orthoses to less expensive prefabricated foot orthoses. METHODS Nineteen flatfeet adults between 18 and 45 participated in this study. CAD-CAM foot orthoses were made for these patients according to their foot scan. Prefabricated foot orthoses were prepared according to their foot size. Plantar pressure, force and contact area were measured using pedar®-x in-shoe system wearing shoe alone, wearing CAD-CAM foot orthoses and wearing prefabricated foot orthoses. Repeated measures ANOVA model with post-hoc, Bonferroni comparison were used to test differences. RESULTS CAD-CAM and prefabricated foot orthoses both decreased pressure and force under 2nd, 3-5 metatarsal and heel regions comparing to shoe alone condition. CAD-CAM foot orthosis increased pressure under lateral toe region in comparison to shoe alone and prefabricated foot orthosis. Both foot orthoses increased pressure and contact area in medial midfoot region comparing to shoe alone condition. Increased forces were seen at hallux and lateral toes by prefabricated foot orthoses in comparison with CAD-CAM foot orthoses and control condition, respectively. CONCLUSION According to the results, both foot orthoses could decrease the pressure under heel and metatarsal area. It seems that the special design of CAD-CAM foot orthoses could not make great differences in plantar pressure distribution in this sample. Further research is required to determine whether these results are associated with different scan systems or design software.
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Caravaggi P, Giangrande A, Lullini G, Padula G, Berti L, Leardini A. In shoe pressure measurements during different motor tasks while wearing safety shoes: The effect of custom made insoles vs. prefabricated and off-the-shelf. Gait Posture 2016; 50:232-238. [PMID: 27662483 DOI: 10.1016/j.gaitpost.2016.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 09/08/2016] [Accepted: 09/10/2016] [Indexed: 02/02/2023]
Abstract
Health and safety regulations in many countries require workers at risk to wear safety shoes in a factory environment. These shoes are often heavy, rigid, and uncomfortable. Wearing safety shoes daily leads to foot problems, discomfort and fatigue, resulting also in the loss of numerous working days. Currently, knowledge of the biomechanical effects of insoles in safety shoes, during working activities, is very limited. Seventeen workers from a metalworking factory were selected and clinically examined for any foot conditions. Workers feet were 3D scanned, with regards to their plantar view, and the images used to design 34 custom-insoles, based on foot and safety shoe models. Three insoles were blind-tested by each worker: custom (CUS); prefabricated with the safety-shoe (PSS), and off-the-shelf (OTS). Foot-to-insole pressure distribution was measured in seven motor tasks replicating typical working activities: single and double-leg standing; weight lifting; stair ascending and descending; normal and fast walking. Wearing CUS within safety shoes resulted in a greater uniform pressure distribution across plantar regions for most of the working activities. Peak pressure at the forefoot during normal walking was the lowest in the custom insole (CUS 275.9±55.3kPa; OTS 332.7±75.5kPa; PSS 304.5±54.2kPa). Normal and fast walking were found to be the most demanding activities in terms of peak pressure. Wearing safety shoes results in high pedobarographic parameters in several foot regions. The use of custom insoles designed on the foot morphology helps decrease peak pressure and pressure-time integral compared to prefabricated featureless insoles.
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Affiliation(s)
- Paolo Caravaggi
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy.
| | - Alessia Giangrande
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy.
| | - Giada Lullini
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy.
| | - Giuseppe Padula
- Università degli Studi della Repubblica di S. Marino, San Marino.
| | - Lisa Berti
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy.
| | - Alberto Leardini
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy.
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Blasimann A, Eichelberger P, Brülhart Y, El-Masri I, Flückiger G, Frauchiger L, Huber M, Weber M, Krause FG, Baur H. Non-surgical treatment of pain associated with posterior tibial tendon dysfunction: study protocol for a randomised clinical trial. J Foot Ankle Res 2015; 8:37. [PMID: 26279682 PMCID: PMC4536665 DOI: 10.1186/s13047-015-0095-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 08/04/2015] [Indexed: 12/31/2022] Open
Abstract
Background Symptoms associated with pes planovalgus or flatfeet occur frequently, even though some people with a flatfoot deformity remain asymptomatic. Pes planovalgus is proposed to be associated with foot/ankle pain and poor function. Concurrently, the multifactorial weakness of the tibialis posterior muscle and its tendon can lead to a flattening of the longitudinal arch of the foot. Those affected can experience functional impairment and pain. Less severe cases at an early stage are eligible for non-surgical treatment and foot orthoses are considered to be the first line approach. Furthermore, strengthening of arch and ankle stabilising muscles are thought to contribute to active compensation of the deformity leading to stress relief of soft tissue structures. There is only limited evidence concerning the numerous therapy approaches, and so far, no data are available showing functional benefits that accompany these interventions. Methods After clinical diagnosis and clarification of inclusion criteria (e.g., age 40–70, current complaint of foot and ankle pain more than three months, posterior tibial tendon dysfunction stage I & II, longitudinal arch flattening verified by radiography), sixty participants with posterior tibial tendon dysfunction associated complaints will be included in the study and will be randomly assigned to one of three different intervention groups: (i) foot orthoses only (FOO), (ii) foot orthoses and eccentric exercise (FOE), or (iii) sham foot orthoses only (FOS). Participants in the FOO and FOE groups will be allocated individualised foot orthoses, the latter combined with eccentric exercise for ankle stabilisation and strengthening of the tibialis posterior muscle. Participants in the FOS group will be allocated sham foot orthoses only. During the intervention period of 12 weeks, all participants will be encouraged to follow an educational program for dosed foot load management (e.g., to stop activity if they experience increasing pain). Functional impairment will be evaluated pre- and post-intervention by the Foot Function Index. Further outcome measures include the Pain Disability Index, Visual Analogue Scale for pain, SF-12, kinematic data from 3D-movement analysis and neuromuscular activity during level and downstairs walking. Measuring outcomes pre- and post-intervention will allow the calculation of intervention effects by 3×3 Analysis of Variance (ANOVA) with repeated measures. Discussion The purpose of this randomised trial is to evaluate the therapeutic benefit of three different non-surgical treatment regimens in participants with posterior tibial tendon dysfunction and accompanying pes planovalgus. Furthermore, the analysis of changes in gait mechanics and neuromuscular control will contribute to an enhanced understanding of functional changes and eventually optimise conservative management strategies for these patients. Trial registration ClinicalTrials.gov Protocol Registration System: ClinicalTrials.gov ID NCT01839669
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Affiliation(s)
- Angela Blasimann
- Bern University of Applied Sciences, Health, Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Patric Eichelberger
- Bern University of Applied Sciences, Health, Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Yvonne Brülhart
- Bern University of Applied Sciences, Health, Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Isam El-Masri
- Salem-Spital, Foot Surgery, Schänzlistrasse 39, 3013 Bern, Switzerland
| | - Gerhard Flückiger
- Sonnenhofspital, Foot Surgery, Buchserstrasse 30, 3006 Bern, Switzerland
| | - Lars Frauchiger
- Spital STS AG, Orthopaedics & Traumatology, Krankenhausstrasse 12, 3600 Thun, Switzerland
| | - Martin Huber
- Outpatient Clinic for Foot Surgery Bern, Schänzlistrasse 33, 3013 Bern, Switzerland
| | - Martin Weber
- Siloah, Clinic for Orthopaedics and Traumatology, Worbstrasse 316, 3073 Gümligen bei Bern, Switzerland
| | - Fabian G Krause
- Department of Orthopaedic Surgery, University of Bern, Inselspital, Freiburgstrasse, 3010 Bern, Switzerland
| | - Heiner Baur
- Bern University of Applied Sciences, Health, Physiotherapy, Murtenstrasse 10, 3008 Bern, Switzerland
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Gijon-Nogueron G, Cortes-Jeronimo E, Cervera-Marin JA, Diaz-Mohedo E, Lopezosa-Reca E, Fernandez-Sanchez M, Luque-Suarez A. The effects of custom-made foot orthosis using the Central Stabilizer Element on foot pain. Prosthet Orthot Int 2015; 39:293-9. [PMID: 24812119 DOI: 10.1177/0309364614531012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 03/06/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Foot orthoses have been applied for the management of lower limb disorders, mainly for those who develop foot pain. The Central Stabilizer Element (CSE) is a new element that contains the midfoot laterally when a plantar insole is manufactured. OBJECTIVES To determine the effect on foot pain of adding the Central Stabilizer Element during the manufacturing process of foot orthosis, and to describe the proportions of Central Stabilizer Element in terms of width and length of this element. STUDY DESIGN A clinical study. METHODS A sample comprising 130 patients (57 males and 73 females) with foot pain was recruited for this study, with the patients having supinated, neutral, pronated and overpronated feet. All the patients received a custom-made foot orthosis with the Central Stabilizer Element. The Central Stabilizer Element was made of resins of polyvinyl chloride, and is a device insert in foot orthosis that contains the midfoot laterally to control pronation and supination movements. Perceived patient's foot pain was collected using a Visual Analog Scale at baseline, 15, 60 and 90 days after treatment. RESULTS A statistically significant decrease was found after foot orthosis application at all times in all foot types. There was a statistically significant correlation between all the ratio proportions according to foot posture (Foot Posture Index scores), except for heel length proportion. CONCLUSIONS The Central Stabilizer Element, applied at midfoot level of a custom-made foot orthoses through a directly mould technique, can reduce foot pain, when a previous foot posture status is considered. CLINICAL RELEVANCE The Central Stabilizer Element can be of interest for those professionals who are involved in the manufacturing process of foot orthosis, throughout the control of an excesive pronated or a supinated foot condition that is provoking foot pain.
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Affiliation(s)
| | | | | | | | - Eva Lopezosa-Reca
- Department Nursing and Podiatry, University of Malaga, Malaga, Spain
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Dombroski CE, Balsdon MER, Froats A. The use of a low cost 3D scanning and printing tool in the manufacture of custom-made foot orthoses: a preliminary study. BMC Res Notes 2014; 7:443. [PMID: 25015013 PMCID: PMC4114407 DOI: 10.1186/1756-0500-7-443] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 06/30/2014] [Indexed: 12/04/2022] Open
Abstract
Background Custom foot orthoses are currently recognized as the gold standard for treatment of foot and lower limb pathology. While foam and plaster casting methods are most widely used in clinical practice, technology has emerged, permitting the use of 3D scanning, computer aided design (CAD) and computer aided manufacturing (CAM) for fabrication of foot molds and custom foot orthotic components. Adoption of 3D printing, as a form of CAM, requires further investigation for use as a clinical tool. This study provides a preliminary description of a new method to manufacture foot orthoses using a novel 3D scanner and printer and compare gait kinematic outputs from shod and traditional plaster casted orthotics. Findings One participant (male, 25 years) was included with no lower extremity injuries. Foot molds were created from both plaster casting and 3D scanning/printing methods. Custom foot orthoses were then fabricated from each mold. Lower body plug-in-gait with the Oxford Foot Model on the right foot was collected for both orthotic and control (shod) conditions. The medial longitudinal arch was measured using arch height index (AHI) where a decrease in AHI represented a drop in arch height. The lowest AHI was 21.2 mm in the running shoes, followed by 21.4 mm wearing the orthoses made using 3D scanning and printing, with the highest AHI of 22.0 mm while the participant wore the plaster casted orthoses. Conclusion This preliminary study demonstrated a small increase in AHI with the 3D printing orthotic compared to the shod condition. A larger sample size may demonstrate significant patterns for the tested conditions.
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Affiliation(s)
- Colin E Dombroski
- Faculty of Health Science, Department of Physical Therapy, Western University, London, ON N6A 5B9, Canada.
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Computer-Aided Design of Customized Foot Orthoses: Reproducibility and Effect of Method Used to Obtain Foot Shape. Arch Phys Med Rehabil 2012; 93:863-70. [DOI: 10.1016/j.apmr.2011.12.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 12/19/2011] [Accepted: 12/20/2011] [Indexed: 11/18/2022]
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Telfer S, Woodburn J. The use of 3D surface scanning for the measurement and assessment of the human foot. J Foot Ankle Res 2010; 3:19. [PMID: 20815914 PMCID: PMC2944246 DOI: 10.1186/1757-1146-3-19] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 09/05/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A number of surface scanning systems with the ability to quickly and easily obtain 3D digital representations of the foot are now commercially available. This review aims to present a summary of the reported use of these technologies in footwear development, the design of customised orthotics, and investigations for other ergonomic purposes related to the foot. METHODS The PubMed and ScienceDirect databases were searched. Reference lists and experts in the field were also consulted to identify additional articles. Studies in English which had 3D surface scanning of the foot as an integral element of their protocol were included in the review. RESULTS Thirty-eight articles meeting the search criteria were included. Advantages and disadvantages of using 3D surface scanning systems are highlighted. A meta-analysis of studies using scanners to investigate the changes in foot dimensions during varying levels of weight bearing was carried out. CONCLUSIONS Modern 3D surface scanning systems can obtain accurate and repeatable digital representations of the foot shape and have been successfully used in medical, ergonomic and footwear development applications. The increasing affordability of these systems presents opportunities for researchers investigating the foot and for manufacturers of foot related apparel and devices, particularly those interested in producing items that are customised to the individual. Suggestions are made for future areas of research and for the standardization of the protocols used to produce foot scans.
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Affiliation(s)
- Scott Telfer
- School of Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - James Woodburn
- School of Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
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