[Forefoot relief with shoe inserts : Effects of different construction strategies].

PubMed

Baur, H; Merz, N; Muster, A; Flückiger, G; Hirschmüller, A

2018-04-01

Shoe inserts and shoe modifications are used to reduce plantar peak pressure. The effects of different shoe inserts and shoe construction strategies for relief of the forefoot have not yet been sufficiently evaluated. The aim of this study was to analyze the effects of shoe inserts and shoe construction strategies (e.g. metatarsal pad, forefoot cushioning and control) and shoe modifications (e.g. flexible or stiff) on the peak plantar pressure in the forefoot region. In this study 15 healthy subjects were recruited. Plantar pressure distribution was measured using an in-shoe system during walking (3.5km∙h -1 ) on a treadmill and the average plantar peak pressure (kPa) in the forefoot was calculated. The statistics for testing the hypothesis were carried out using 2‑factorial ANOVA with repeat measurements (factors: shoe, insert; α = 0.05). The metatarsal pad and forefoot cushioning led to a reduction of peak pressure, which was statistically significant compared to the control condition (p = 0.009). No differences were observed between both shoe inserts (p > 0.05). A comparison between stiff and flexible shoes revealed a statistically significant pressure reduction in favor of stiff shoes (p = 0.0001). The metatarsal pad led to a peak pressure increase in the midfoot of 12% and by 21% compared to control and forefoot cushioning, respectively. A peak pressure reduction in the forefoot can be achieved with a metatarsal pad or with cushioning; however, the metatarsal pad resulted in a subsequent increase in midfoot pressure. Moreover, shoe construction is crucial because a stiff shoe contributes to a better peak pressure reduction compared to a flexible shoe. Prospective clinical studies should be carried out to prove whether this results in beneficial effects for patients with metatarsalgia.

Form and function of the human and chimpanzee forefoot: implications for early hominin bipedalism

PubMed Central

Fernández, Peter J.; Holowka, Nicholas B.; Demes, Brigitte; Jungers, William L.

2016-01-01

During bipedal walking, modern humans dorsiflex their forefoot at the metatarsophalangeal joints (MTPJs) prior to push off, which tightens the plantar soft tissues to convert the foot into a stiff propulsive lever. Particular features of metatarsal head morphology such as “dorsal doming” are thought to facilitate this stiffening mechanism. In contrast, chimpanzees are believed to possess MTPJ morphology that precludes high dorsiflexion excursions during terrestrial locomotion. The morphological affinity of the metatarsal heads has been used to reconstruct locomotor behavior in fossil hominins, but few studies have provided detailed empirical data to validate the assumed link between morphology and function at the MTPJs. Using three-dimensional kinematic and morphometric analyses, we show that humans push off with greater peak dorsiflexion angles at all MTPJs than do chimpanzees during bipedal and quadrupedal walking, with the greatest disparity occurring at MTPJ 1. Among MTPJs 2–5, both species exhibit decreasing peak angles from medial to lateral. This kinematic pattern is mirrored in the morphometric analyses of metatarsal head shape. Analyses of Australopithecus afarensis metatarsals reveal morphology intermediate between humans and chimpanzees, suggesting that this species used different bipedal push-off kinematics than modern humans, perhaps resulting in a less efficient form of bipedalism. PMID:27464580

Changes in foot and shank coupling due to alterations in foot strike pattern during running.

PubMed

Pohl, Michael B; Buckley, John G

2008-03-01

Determining if and how the kinematic relationship between adjacent body segments changes when an individual's gait pattern is experimentally manipulated can yield insight into the robustness of the kinematic coupling across the associated joint(s). The aim of this study was to assess the effects on the kinematic coupling between the forefoot, rearfoot and shank during ground contact of running with alteration in foot strike pattern. Twelve subjects ran over-ground using three different foot strike patterns (heel strike, forefoot strike, toe running). Kinematic data were collected of the forefoot, rearfoot and shank, which were modelled as rigid segments. Coupling at the ankle-complex and midfoot joints was assessed using cross-correlation and vector coding techniques. In general good coupling was found between rearfoot frontal plane motion and transverse plane shank rotation regardless of foot strike pattern. Forefoot motion was also strongly coupled with rearfoot frontal plane motion. Subtle differences were noted in the amount of rearfoot eversion transferred into shank internal rotation in the first 10-15% of stance during heel strike running compared to forefoot and toe running, and this was accompanied by small alterations in forefoot kinematics. These findings indicate that during ground contact in running there is strong coupling between the rearfoot and shank via the action of the joints in the ankle-complex. In addition, there was good coupling of both sagittal and transverse plane forefoot with rearfoot frontal plane motion via the action of the midfoot joints.

A comparison of cleat types during two football-specific tasks on FieldTurf.

PubMed

Queen, R M; Charnock, B L; Garrett, W E; Hardaker, W M; Sims, E L; Moorman, C T

2008-04-01

To examine the effect of different cleat plate configurations on plantar pressure during two tasks. Thirty-six athletes ran an agility course 5 times while wearing 4 different types of Nike Vitoria cleats: (1) bladed, (2) elliptical firm ground, (3) hard ground and (4) turf. Plantar pressure data were recorded during a side cut and a cross cut using Pedar-X insoles. Controlled laboratory study No history of lower extremity injury in the past 6 months, no previous foot or ankle surgery, not currently wearing foot orthotics and play a cleated sport at least twice a week. Total foot contact time, contact area, maximum force, peak pressure and the force-time integral (FTI) in the medial, middle and lateral regions of the forefoot were collected. A 1x4 ANOVA (alpha = 0.05) was performed on each dependent variable. A Bonferroni adjustment was conducted (alpha = 0.008). In the cross cut task, statistical differences between cleats were observed in three variables: total foot peak pressure, lateral forefoot FTI, and lateral forefoot normalised maximum force. In the side cut task, statistical differences between cleats were observed in 4 variables: total foot peak pressure, the medial and middle forefoot FTI, and the medial and middle forefoot normalised maximum force. Significant differences in forefoot loading patterns existed between cleat types. Based on the results of this study, it might be beneficial to increase the forefoot cushioning in cleats in an attempt to decrease loading in these regions of the foot.

Biomechanical Factors in Tibial Stress Fracture

DTIC Science & Technology

2001-08-01

Relationship between Loading Rates and Tibial Accelerometry in Forefoot Strike Runners. Presented at the Annual American Society of Biomechanics Mtg...of the APTA, Seattle, WA, 2/99. McClay, IS, Williams, DS, and Manal, KT. Lower Extremity Mechanics of Runners with a Converted Forefoot Strike ...Management, Inc, 1998-1999 The Effect of Different Orthotic Devices on Lower Extremity Mechanics of Rearfoot and Forefoot Strikers, $3,500. Foot Management

Vibrotactile Presentation of Musical Notes to the Glabrous Skin for Adults with Normal Hearing or a Hearing Impairment: Thresholds, Dynamic Range and High-Frequency Perception

PubMed Central

Maté-Cid, Saúl; Fulford, Robert; Seiffert, Gary; Ginsborg, Jane

2016-01-01

Presentation of music as vibration to the skin has the potential to facilitate interaction between musicians with hearing impairments and other musicians during group performance. Vibrotactile thresholds have been determined to assess the potential for vibrotactile presentation of music to the glabrous skin of the fingertip, forefoot and heel. No significant differences were found between the thresholds for sinusoids representing notes between C1 and C6 when presented to the fingertip of participants with normal hearing and with a severe or profound hearing loss. For participants with normal hearing, thresholds for notes between C1 and C6 showed the characteristic U-shape curve for the fingertip, but not for the forefoot and heel. Compared to the fingertip, the forefoot had lower thresholds between C1 and C3, and the heel had lower thresholds between C1 and G2; this is attributed to spatial summation from the Pacinian receptors over the larger contactor area used for the forefoot and heel. Participants with normal hearing assessed the perception of high-frequency vibration using 1s sinusoids presented to the fingertip and were found to be more aware of transient vibration at the beginning and/or end of notes between G4 and C6 when stimuli were presented 10dB above threshold, rather than at threshold. An average of 94% of these participants reported feeling continuous vibration between G4 and G5 with stimuli presented 10dB above threshold. Based on the experimental findings and consideration of health effects relating to vibration exposure, a suitable range of notes for vibrotactile presentation of music is identified as being from C1 to G5. This is more limited than for human hearing but the fundamental frequencies of the human voice, and the notes played by many instruments, lie within it. However, the dynamic range might require compression to avoid the negative effects of amplitude on pitch perception. PMID:27191400

Variation in Foot Strike Patterns during Running among Habitually Barefoot Populations

PubMed Central

Hatala, Kevin G.; Dingwall, Heather L.; Wunderlich, Roshna E.; Richmond, Brian G.

2013-01-01

Endurance running may have a long evolutionary history in the hominin clade but it was not until very recently that humans ran wearing shoes. Research on modern habitually unshod runners has suggested that they utilize a different biomechanical strategy than runners who wear shoes, namely that barefoot runners typically use a forefoot strike in order to avoid generating the high impact forces that would be experienced if they were to strike the ground with their heels first. This finding suggests that our habitually unshod ancestors may have run in a similar way. However, this research was conducted on a single population and we know little about variation in running form among habitually barefoot people, including the effects of running speed, which has been shown to affect strike patterns in shod runners. Here, we present the results of our investigation into the selection of running foot strike patterns among another modern habitually unshod group, the Daasanach of northern Kenya. Data were collected from 38 consenting adults as they ran along a trackway with a plantar pressure pad placed midway along its length. Subjects ran at self-selected endurance running and sprinting speeds. Our data support the hypothesis that a forefoot strike reduces the magnitude of impact loading, but the majority of subjects instead used a rearfoot strike at endurance running speeds. Their percentages of midfoot and forefoot strikes increased significantly with speed. These results indicate that not all habitually barefoot people prefer running with a forefoot strike, and suggest that other factors such as running speed, training level, substrate mechanical properties, running distance, and running frequency, influence the selection of foot strike patterns. PMID:23326341

Variation in foot strike patterns during running among habitually barefoot populations.

PubMed

Hatala, Kevin G; Dingwall, Heather L; Wunderlich, Roshna E; Richmond, Brian G

2013-01-01

Endurance running may have a long evolutionary history in the hominin clade but it was not until very recently that humans ran wearing shoes. Research on modern habitually unshod runners has suggested that they utilize a different biomechanical strategy than runners who wear shoes, namely that barefoot runners typically use a forefoot strike in order to avoid generating the high impact forces that would be experienced if they were to strike the ground with their heels first. This finding suggests that our habitually unshod ancestors may have run in a similar way. However, this research was conducted on a single population and we know little about variation in running form among habitually barefoot people, including the effects of running speed, which has been shown to affect strike patterns in shod runners. Here, we present the results of our investigation into the selection of running foot strike patterns among another modern habitually unshod group, the Daasanach of northern Kenya. Data were collected from 38 consenting adults as they ran along a trackway with a plantar pressure pad placed midway along its length. Subjects ran at self-selected endurance running and sprinting speeds. Our data support the hypothesis that a forefoot strike reduces the magnitude of impact loading, but the majority of subjects instead used a rearfoot strike at endurance running speeds. Their percentages of midfoot and forefoot strikes increased significantly with speed. These results indicate that not all habitually barefoot people prefer running with a forefoot strike, and suggest that other factors such as running speed, training level, substrate mechanical properties, running distance, and running frequency, influence the selection of foot strike patterns.

Shin splints and forefoot contact running: a case report.

PubMed

Cibulka, M T; Sinacore, D R; Mueller, M J

1994-08-01

Many athletes develop shin splints after athletic activity. The purpose of this case report is to describe the treatment of a patient with posteromedial tibial pain (shin splints) who habitually ran with a forefoot contact running style. The 20-year-old male patient, who played volleyball and basketball about 7 hours a week, complained of pain in the middle one-third of the posteromedial tibia after an acute but prolonged episode of running. Routine observational analysis and in-shoe pressure analysis of the patient's running style showed that he habitually ran on his toes with an absence of heelstrike (forefoot contact running). After instructing the patient on heel-toe running, he no longer complained of posteromedial tibial bone pain. Several possible reasons are proposed for the reduction of leg pain following cessation of forefoot contact running. This case report proposes forefoot contact running as a possible contributor to posteromedial shin splints and that a change in running style may be the optimal treatment for some patients.

Leg Muscle Usage Effects on Tibial Elasticity during Running

DTIC Science & Technology

2007-01-01

such a strike mechanics and surface incline, also modulate bone elasticity during running. Because these modulators may operate on the tibia via...co- Investigators (PS) as a prototypical forefoot runner. We have obtained a video showing 6 well-defined forefoot -running without coaching and...completion for 8 subjects. • Baseline data for 3 subjects who started but did not complete study. • Development of training video for forefoot running

Selected plantar pressure characteristics associated with the skating performance of national in-line speed skaters.

PubMed

Wu, Wen-Lan; Hsu, Hsiu-Tao; Chu, I-Hua; Tsai, Feng-Hua; Liang, Jing-Min

2017-06-01

In order to help coaches analyse the techniques of professional in-line speed skaters for making the required fine adjustments and corrections in their push-off work, this study analysed the specific plantar pressure characteristics during a 300-m time-trial test. Fourteen elite in-line speed skaters from the national team were recruited in this study. The total completion time of the 300-m time-trial test, duration of each skating phase, and plantar pressure distribution were measured. The correlation between plantar pressure distribution and skating performance was assessed using Pearson correlation analyses. The results showed that the contact time of the total foot and force-time integral (FTI) in the medial forefoot were significantly correlated with the duration of the start phase, and the FTIs in the medial forefoot of the gliding (left) leg and lateral forefoot of the pushing (right) leg were significantly correlated with the duration of the turning phase. The maximum force in the medial heel, medial forefoot, and median forefoot and the FTI in the medial heel and medial forefoot were significantly correlated with the duration of the linear acceleration phase. The results suggest that a correct plantar loading area and push-off strategy can enhance the skating performance.

Effects of forefoot bending stiffness of badminton shoes on agility, comfort perception and lower leg kinematics during typical badminton movements.

PubMed

Park, Sang-Kyoon; Lam, Wing-Kai; Yoon, Sukhoon; Lee, Ki-Kwang; Ryu, Jiseon

2017-09-01

This study investigated whether an increase in the forefoot bending stiffness of a badminton shoe would positively affect agility, comfort and biomechanical variables during badminton-specific movements. Three shoe conditions with identical shoe upper and sole designs with different bending stiffness (Flexible, Regular and Stiff) were used. Elite male badminton players completed an agility test on a standard badminton court involving consecutive lunges in six directions, a comfort test performed by a pair of participants conducting a game-like practice trial and a biomechanics test involving a random assignment of consecutive right forward lunges. No significant differences were found in agility time and biomechanical variables among the three shoes. The players wearing the shoe with a flexible forefoot outsole demonstrated a decreased perception of comfort in the forefoot cushion compared to regular and stiffer conditions during the comfort test (p < 0.05). The results suggested that the modification of forefoot bending stiffness would influence individual perception of comfort but would not influence performance and lower extremity kinematics during the tested badminton-specific tasks. It was concluded that an optimisation of forefoot structure and materials in badminton shoes should consider the individual's perception to maximise footwear comfort in performance.

Orthotic intervention in forefoot and rearfoot strike running patterns.

PubMed

Stackhouse, Carrie Laughton; Davis, Irene McClay; Hamill, Joseph

2004-01-01

To compare the differential effect of custom orthoses on the lower extremity mechanics of a forefoot and rearfoot strike pattern. Fifteen subjects ran with both a forefoot and a rearfoot strike pattern with and without orthoses. Lower extremity kinematic and kinetic variables were compared between strike pattern and orthotic conditions. Foot orthoses have been shown to be effective in controlling excessive rearfoot motion in rearfoot strikers. The effect of orthotic intervention on rearfoot motion in forefoot strikers has not been previously reported. Five trials were collected for each condition. Peak rearfoot eversion, eversion excursion, eversion velocity, peak inversion moment, and inversion work were compared between conditions. Kinematic variables in the sagittal plane of the rearfoot and in the frontal and sagittal plane of the knee were also determined. Increased rearfoot excursions and velocities and decreased peak eversion were noted in the forefoot strike pattern compared to the rearfoot strike pattern. Orthotic intervention, however,did not significantly change rearfoot motion in either strike pattern. Reductions in internal rotation and abduction of the knee were noted with orthotic intervention. Foot orthoses do not differentially effect rearfoot motion of a rearfoot strike and a forefoot strike running pattern. Orthotic intervention has a larger and more systematic effect on rearfoot kinetics compared to rearfoot kinematics.

Evaluation of the relationship between the static measurement of transverse arch flexibility of the forefoot and gait parameters in healthy subjects.

PubMed

Kondo, Takashi; Muneta, Takeshi; Fukui, Tsutomu

2017-03-01

[Purpose] To investigate the relationship between the static measurement of the transverse arch of the forefoot, using a 3-dimensional (3D) foot scanner, and kinetics and kinematics of gait parameters in the sagittal plane. [Subjects and Methods] Twenty healthy subjects participated in this study. The transverse arch of the forefoot was measured under three conditions as follows: condition 1, sitting; condition 2, standing; and condition 3, foot forward and lower leg tilting anteriorly to the maximum position with heel contact. Gait parameters were recorded using a 3D motion analysis system and force plate. Correlation coefficients between TAF for each comparison of conditions and gait parameters were calculated using the Spearman correlation analysis. [Results] Rates of the transverse arch of the forefoot width and height between condition 2 and condition 3 were significantly correlated with the anterior and posterior component of ground reaction forces, the hip joint extension angle, and the ankle plantar flexion moment. [Conclusion] Our study's findings indicated that increased stiffness of the transverse arch of the forefoot was related to the increase in ankle plantar moment, and decreased stiffness of the transverse arch of the forefoot was related to the increase in hip joint extension angle during gait.

Evaluation of the relationship between the static measurement of transverse arch flexibility of the forefoot and gait parameters in healthy subjects

PubMed Central

Kondo, Takashi; Muneta, Takeshi; Fukui, Tsutomu

2017-01-01

[Purpose] To investigate the relationship between the static measurement of the transverse arch of the forefoot, using a 3-dimensional (3D) foot scanner, and kinetics and kinematics of gait parameters in the sagittal plane. [Subjects and Methods] Twenty healthy subjects participated in this study. The transverse arch of the forefoot was measured under three conditions as follows: condition 1, sitting; condition 2, standing; and condition 3, foot forward and lower leg tilting anteriorly to the maximum position with heel contact. Gait parameters were recorded using a 3D motion analysis system and force plate. Correlation coefficients between TAF for each comparison of conditions and gait parameters were calculated using the Spearman correlation analysis. [Results] Rates of the transverse arch of the forefoot width and height between condition 2 and condition 3 were significantly correlated with the anterior and posterior component of ground reaction forces, the hip joint extension angle, and the ankle plantar flexion moment. [Conclusion] Our study’s findings indicated that increased stiffness of the transverse arch of the forefoot was related to the increase in ankle plantar moment, and decreased stiffness of the transverse arch of the forefoot was related to the increase in hip joint extension angle during gait. PMID:28356622

Running with a minimalist shoe increases plantar pressure in the forefoot region of healthy female runners.

PubMed

Bergstra, S A; Kluitenberg, B; Dekker, R; Bredeweg, S W; Postema, K; Van den Heuvel, E R; Hijmans, J M; Sobhani, S

2015-07-01

Minimalist running shoes have been proposed as an alternative to barefoot running. However, several studies have reported cases of forefoot stress fractures after switching from standard to minimalist shoes. Therefore, the aim of the current study was to investigate the differences in plantar pressure in the forefoot region between running with a minimalist shoe and running with a standard shoe in healthy female runners during overground running. Randomized crossover design. In-shoe plantar pressure measurements were recorded from eighteen healthy female runners. Peak pressure, maximum mean pressure, pressure time integral and instant of peak pressure were assessed for seven foot areas. Force time integral, stride time, stance time, swing time, shoe comfort and landing type were assessed for both shoe types. A linear mixed model was used to analyze the data. Peak pressure and maximum mean pressure were higher in the medial forefoot (respectively 13.5% and 7.46%), central forefoot (respectively 37.5% and 29.2%) and lateral forefoot (respectively 37.9% and 20.4%) for the minimalist shoe condition. Stance time was reduced with 3.81%. No relevant differences in shoe comfort or landing strategy were found. Running with a minimalist shoe increased plantar pressure without a change in landing pattern. This increased pressure in the forefoot region might play a role in the occurrence of metatarsal stress fractures in runners who switched to minimalist shoes and warrants a cautious approach to transitioning to minimalist shoe use. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Mobility and Human Factors Evaluation of Three Prototype Assault Snowshoes.

DTIC Science & Technology

1994-01-01

toe of snowshoe beats shins (bruised) when running (3) Snowshoe tails strike your back when falling in prone position (n) - Number of subjects who...user’s boot and cradle his forefoot in the proper position. This feature worked adequately with the vapor barrier boot but was not compatible with the

Foot speed, foot-strike and footwear: linking gait mechanics and running ground reaction forces.

PubMed

Clark, Kenneth P; Ryan, Laurence J; Weyand, Peter G

2014-06-15

Running performance, energy requirements and musculoskeletal stresses are directly related to the action-reaction forces between the limb and the ground. For human runners, the force-time patterns from individual footfalls can vary considerably across speed, foot-strike and footwear conditions. Here, we used four human footfalls with distinctly different vertical force-time waveform patterns to evaluate whether a basic mechanical model might explain all of them. Our model partitions the body's total mass (1.0 Mb) into two invariant mass fractions (lower limb=0.08, remaining body mass=0.92) and allows the instantaneous collisional velocities of the former to vary. The best fits achieved (R(2) range=0.95-0.98, mean=0.97 ± 0.01) indicate that the model is capable of accounting for nearly all of the variability observed in the four waveform types tested: barefoot jog, rear-foot strike run, fore-foot strike run and fore-foot strike sprint. We conclude that different running ground reaction force-time patterns may have the same mechanical basis. © 2014. Published by The Company of Biologists Ltd.

Effects of the AirLift PTTD brace on foot kinematics in subjects with stage II posterior tibial tendon dysfunction.

PubMed

Neville, Christopher; Flemister, A Samuel; Houck, Jeff R

2009-03-01

Experimental laboratory study. To investigate the effect of inflation of the air bladder component of the AirLift PTTD brace on relative foot kinematics in subjects with stage II posterior tibial tendon dysfunction (PTTD). Orthotic devices are commonly recommended in the conservative management of stage II PTTD to improve foot kinematics. Ten female subjects with stage II PTTD walked in the laboratory wearing the AirLift PTTD brace during 3 testing conditions (air bladder inflation to 0, 4, and 7 PSI [SI equivalent: 0, 27,579, and 48,263 Pa]). Kinematics were recorded from the tibia, calcaneus (hindfoot), and first metatarsal (forefoot), using an Optotrak motion analysis system. Comparisons were made between air bladder inflation and the 0-PSI condition for each of the dependent kinematic variables (hindfoot eversion, forefoot abduction, and forefoot dorsiflexion). Greater hindfoot inversion was observed with air bladder inflation during the second rocker (mean, 1.7 degrees; range, -0.7 degrees to 6.1 degrees). Less consistent changes in forefoot plantar flexion and forefoot adduction occurred with air bladder inflation. The greatest change toward forefoot plantar flexion was observed during the third rocker (mean, 1.4 degrees; range, -3.8 degrees to 3.9 degrees). The greatest change towards adduction was observed during the third rocker (mean, 2.3 degrees; range, -3.4 degrees to 6.5 degrees). On average, the air bladder component of the AirLift PTTD brace was successful in reducing the amount of hindfoot eversion observed in subjects with stage II PTTD; however, the effect on forefoot motion was more variable. Some subjects tested had marked improvement in foot kinematics, while 2 subjects demonstrated negative results. Specific foot characteristics are hypothesized to explain these varied results.

The Influence of Foot-Strike Technique on the Neuromechanical Function of the Foot.

PubMed

Kelly, Luke A; Farris, Dominic J; Lichtwark, Glen A; Cresswell, Andrew G

2018-01-01

The aim of this study was to investigate the influence of foot-strike technique on longitudinal arch mechanics and intrinsic foot muscle function during running. Thirteen healthy participants ran barefoot on a force-instrumented treadmill at 2.8 ms with a forefoot (FFS) and rearfoot (RFS; habitual) running technique, whereas kinetic, kinematic, and electromyographic data from the intrinsic foot muscles were collected simultaneously. The longitudinal arch was modeled as a single "midfoot" joint representing motion of the rearfoot (calcaneus) relative to the forefoot (metatarsals). An inverse dynamic analysis was performed to estimate joint moments generated about the midfoot, as well as mechanical work and power. The midfoot was more plantar flexed (higher arch) at foot contact when running with a forefoot running technique (RFS 0.2 ± 1.8 vs FFS 6.9 ± 3.0°, effect size (ES) = 2.7); however, there was no difference in peak midfoot dorsiflexion in stance (RFS -11.6 ± 3.0 vs FFS -11.4 ± 3.4°, ES = 0.63). When running with a forefoot technique, participants generated greater moments about the midfoot (27% increase, ES = 1.1) and performed more negative work (240% increase, ES = 2.2) and positive work (42% increase, ES = 1.1) about the midfoot. Average stance-phase muscle activation was greater for flexor digitorum brevis (20% increase, ES = 0.56) and abductor hallucis (17% increase, ES = 0.63) when running with a forefoot technique. Forefoot running increases loading about the longitudinal arch and also increases the mechanical work performed by the intrinsic foot muscles. These findings have substantial implications in terms of injury prevention and management for runners who transition from a rearfoot to a forefoot running technique.

Biomechanical properties of the forefoot plantar soft tissue as measured by an optical coherence tomography-based air-jet indentation system and tissue ultrasound palpation system.

PubMed

Chao, Clare Y L; Zheng, Yong-Ping; Huang, Yan-Ping; Cheing, Gladys L Y

2010-07-01

The forefoot medial plantar area withstand high plantar pressure during locomotion, and is a common site that develops foot lesion problems among elderly people. The aims of the present study were to (1) determine the correlation between the biomechanical properties of forefoot medial plantar soft tissue measured by a newly developed optical coherence tomography-based air-jet indentation system and by tissue ultrasound palpation system, and (2) to compare the biomechanical properties of plantar soft tissues of medial forefoot between a young and old adult group. Thirty healthy subjects were classified as the young or older group. The biomechanical properties of plantar soft tissues measured at the forefoot by the air-jet indentation system and tissue ultrasound palpation system were performed, and the correlation of the findings obtained in the two systems were compared. A strong positive correlation was obtained from the findings in the two systems (r=0.88, P<0.001). The forefoot plantar soft tissue of the older group was significantly stiffer at the second metatarsal head and thinner at both metatarsal heads than that of the young group (all P<0.05). The stiffness coefficient at the second metatarsal head was 28% greater than that at the first metatarsal head in both study groups. Older subjects showed a loss of elasticity and reduced thickness in their forefoot plantar soft tissue, with the second metatarsal head displaying stiffer and thicker plantar tissue than the first metatarsal head. The air-jet indentation system is a useful instrument for characterizing the biomechanical properties of soft tissue. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Biomechanical Analysis of Military Boots. Phase 1. Materials Testing of Military and Commercial Footwear

DTIC Science & Technology

1992-10-01

N=8) and Results of 44 Statistical Analyses for Impact Test Performed on Forefoot of Unworn Footwear A-2. Summary Statistics (N=8) and Results of...on Forefoot of Worn Footwear Vlll Tables (continued) Table Page B-2. Summary Statistics (N=4) and Results of 76 Statistical Analyses for Impact...used tests to assess heel and forefoot shock absorption, upper and sole durability, and flexibility (Cavanagh, 1978). Later, the number of tests was

Can orthoses and navicular drop affect foot motion patterns during running?

PubMed

Eslami, Mansour; Ferber, Reed

2013-07-01

The purpose of this study was to examine the influence of semi-rigid foot orthoses on forefoot-rearfoot joint coupling patterns in individuals with different navicular drop measures during heel-toe running. Ten trials were collected from twenty-three male subjects who ran slowly shod at 170 steps per minute (2.23m/s) with a semi-rigid orthoses and without. Forefoot-rearfoot coupling motions were assessed using a vector coding technique during four intervals across the first 50% of stance. Subjects were divided into two groups based on navicular drop measures. A three way ANOVA was performed to examine the interaction and main effects of stance interval, orthoses condition and navicular drop (p<0.05). There were no interaction effects among stance interval, orthoses condition, or navicular drop (p=0.14) whereas an interaction effect of orthoses condition and stance interval was observed (p=0.01; effect size=0.74). Forefoot-rearfoot coupling motion in the no-orthoses condition increased from heel-strike to foot-flat phase at a rate faster than the orthoses condition (p=0.02). Foot orthoses significantly decrease the forefoot-rearfoot joint coupling angle by reducing forefoot frontal plane motion relative to the rearfoot. Navicular drop measures did not influence joint coupling relationships between the forefoot and rearfoot during the first 50% of stance regardless of orthotic condition. Copyright © 2012 Sports Medicine Australia. All rights reserved.

Are muscle activation patterns altered during shod and barefoot running with a forefoot footfall pattern?

PubMed

Ervilha, Ulysses Fernandes; Mochizuki, Luis; Figueira, Aylton; Hamill, Joseph

2017-09-01

This study aimed to investigate the activation of lower limb muscles during barefoot and shod running with forefoot or rearfoot footfall patterns. Nine habitually shod runners were asked to run straight for 20 m at self-selected speed. Ground reaction forces and thigh and shank muscle surface electromyographic (EMG) were recorded. EMG outcomes (EMG intensity [iEMG], latency between muscle activation and ground reaction force, latency between muscle pairs and co-activation index between muscle pairs) were compared across condition (shod and barefoot), running cycle epochs (pre-strike, strike, propulsion) and footfall (rearfoot and forefoot) by ANOVA. Condition affected iEMG at pre-strike epoch. Forefoot and rearfoot strike patterns induced different EMG activation time patterns affecting co-activation index for pairs of thigh and shank muscles. All these timing changes suggest that wearing shoes or not is less important for muscle activation than the way runners strike the foot on the ground. In conclusion, the guidance for changing external forces applied on lower limbs should be pointed to the question of rearfoot or forefoot footfall patterns.

On the relationship between tibia torsional deformation and regional muscle contractions in habitual human exercises in vivo.

PubMed

Yang, Peng-Fei; Kriechbaumer, Andreas; Albracht, Kirsten; Sanno, Maximilian; Ganse, Bergita; Koy, Timmo; Shang, Peng; Brüggemann, Gert-Peter; Müller, Lars Peter; Rittweger, Jörn

2015-02-05

The mechanical relationship between bone and muscle has been long recognized. However, it still remains unclear how muscles exactly load on bone. In this study, utilizing an optical segment tracking technique, the in vivo tibia loading regimes in terms of tibia segment deformation in humans were investigated during walking, forefoot and rear foot stair ascent and running and isometric plantar flexion. Results suggested that the proximal tibia primarily bends to the posterior aspect and twists to the external aspect with respect to the distal tibia. During walking, peak posterior bending and peak torsion occurred in the first half (22%) and second half (76%) of the stance phase, respectively. During stair ascent, two noticeable peaks of torsion were found with forefoot strike (38% and 82% of stance phase), but only one peak of torsion was found with rear foot strike (78% of stance phase). The torsional deformation angle during both stair ascent and running was larger with forefoot strike than rear foot strike. During isometric plantar flexion, the tibia deformation regimes were characterized more by torsion (maximum 1.35°) than bending (maximum 0.52°). To conclude, bending and torsion predominated the tibia loading regimes during the investigated activities. Tibia torsional deformation is closely related to calf muscle contractions, which further confirm the notion of the muscle-bone mechanical link and shift the focus from loading magnitude to loading regimes in bone mechanobiology. It thus is speculated that torsion is another, yet under-rated factor, besides the compression and tension, to drive long bone mechano-adaptation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Tanker Structural Analysis for Minor Collisions

DTIC Science & Technology

1975-12-01

transverse deflections of the stiffened hull may be assumed to vary linearly from the elevation of the forefoot of the striking bow down to zero at the bilge...Transverse de- flections of the stiffened hull may be assumed to vary linearly from the elevation of the forefoot of the striking bow down to zero... Striking Ship CL L-CL - uer panel 0! Forefoot of Bow of Striking Ship C L,’/Y (Ier rane1) 3d Limit of Shearing Plastic Energy TRANSVERSE SECTION AT WEB

Effects of the lapidus arthrodesis and chevron bunionectomy on plantar forefoot pressures.

PubMed

King, Christy M; Hamilton, Graham A; Ford, Lawrence A

2014-01-01

Hallux valgus with or without first ray insufficiency has been strongly implicated as a contributing factor in lesser metatarsal overload. The principle goals of a bunionectomy are to relieve the pain, correct the deformity, and restore first metatarsophalangeal joint congruity. Until now, little evidence has been available to assess the effects of bunionectomy procedures on forefoot pressure. The primary aim of the present prospective study was to evaluate the preoperative and postoperative plantar pressures after 2 specific bunionectomies: the chevron bunionectomy and Lapidus arthrodesis. A total of 68 subjects, 34 in each group, were included for radiographic and pedographic evaluation. Both procedures demonstrated radiographic improvements in the mean intermetatarsal and hallux abductus angles. The mean hallux plantar pressure decreased significantly in both procedure groups (p < .001). However, Lapidus group exhibited an increase in the mean fifth metatarsal head plantar pressure (p = .008) and pressure under the fifth metatarsal as a percentage of the total forefoot pressure (p = .01). Furthermore, the pressure under the second metatarsal as a percentage of the total forefoot pressure decreased significantly (p = .01). This study suggests that the Lapidus arthrodesis and chevron bunionectomy both provide correction for hallux valgus deformity, but when comparing forefoot load sharing pressures, the Lapidus arthrodesis appeared to have greater influence on the load sharing distribution of forefoot pressure than did the bunionectomy employing the chevron osteotomy. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Foot strike and injury rates in endurance runners: a retrospective study.

PubMed

Daoud, Adam I; Geissler, Gary J; Wang, Frank; Saretsky, Jason; Daoud, Yahya A; Lieberman, Daniel E

2012-07-01

This retrospective study tests if runners who habitually forefoot strike have different rates of injury than runners who habitually rearfoot strike. We measured the strike characteristics of middle- and long-distance runners from a collegiate cross-country team and quantified their history of injury, including the incidence and rate of specific injuries, the severity of each injury, and the rate of mild, moderate, and severe injuries per mile run. Of the 52 runners studied, 36 (69%) primarily used a rearfoot strike and 16 (31%) primarily used a forefoot strike. Approximately 74% of runners experienced a moderate or severe injury each year, but those who habitually rearfoot strike had approximately twice the rate of repetitive stress injuries than individuals who habitually forefoot strike. Traumatic injury rates were not significantly different between the two groups. A generalized linear model showed that strike type, sex, race distance, and average miles per week each correlate significantly (P < 0.01) with repetitive injury rates. Competitive cross-country runners on a college team incur high injury rates, but runners who habitually rearfoot strike have significantly higher rates of repetitive stress injury than those who mostly forefoot strike. This study does not test the causal bases for this general difference. One hypothesis, which requires further research, is that the absence of a marked impact peak in the ground reaction force during a forefoot strike compared with a rearfoot strike may contribute to lower rates of injuries in habitual forefoot strikers.

Effects of shoe sole hardness on plantar pressure and comfort in older people with forefoot pain.

PubMed

Lane, Tamara J; Landorf, Karl B; Bonanno, Daniel R; Raspovic, Anita; Menz, Hylton B

2014-01-01

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. Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.

Injury Prevention Effectiveness of Modifications of Shoe Type on Injuries and Risk Factors Associated with Pain and Discomfort in the US Army Band, Fort Meyer, Virginia 2007-2008

DTIC Science & Technology

2009-06-30

shown to reduce mean USACHPPM Epidemiological Report No. 12-HF-05WC-07 3 peak pressure during heel strike and forefoot landing(15). For...such as outsoles that have built in compression pads in the heel and forefoot , and Cooltech®. Cooltech theoretically improves breathability by...in the heel and forefoot , and Cooltech® which presumably improves breathability by increasing ventilation through eyeleted vent holes on the sides

Trabecular bone in the calcaneus of runners

PubMed Central

Holt, Brigitte; Troy, Karen; Hamill, Joseph

2017-01-01

Trabecular bone of the human calcaneus is subjected to extreme repetitive forces during endurance running and should adapt in response to this strain. To assess possible bone functional adaptation in the posterior region of the calcaneus, we recruited forefoot-striking runners (n = 6), rearfoot-striking runners (n = 6), and non-runners (n = 6), all males aged 20–41 for this institutionally approved study. Foot strike pattern was confirmed for each runner using a motion capture system. We obtained high resolution peripheral computed tomography scans of the posterior calcaneus for both runners and non-runners. No statistically significant differences were found between runners and nonrunners or forefoot strikers and rearfoot strikers. Mean trabecular thickness and mineral density were greatest in forefoot runners with strong effect sizes (<0.80). Trabecular thickness was positively correlated with weekly running distance (r2 = 0.417, p<0.05) and years running (r2 = 0.339, p<0.05) and negatively correlated with age at onset of running (r2 = 0.515, p<0.01) Trabecular thickness, mineral density and bone volume ratio of nonrunners were highly correlated with body mass (r2 = 0.824, p<0.05) and nonrunners were significantly heavier than runners (p<0.05). Adjusting for body mass revealed significantly thicker trabeculae in the posterior calcaneus of forefoot strikers, likely an artifact of greater running volume and earlier onset of running in this subgroup; thus, individuals with the greatest summative loading stimulus had, after body mass adjustment, the thickest trabeculae. Further study with larger sample sizes is necessary to elucidate the role of footstrike on calcaneal trabecular structure. To our knowledge, intraspecific body mass correlations with measures of trabecular robusticity have not been reported elsewhere. We hypothesize that early adoption of running and years of sustained moderate volume running stimulate bone modeling in trabeculae of the posterior calcaneus. PMID:29141022

Trabecular bone in the calcaneus of runners.

PubMed

Best, Andrew; Holt, Brigitte; Troy, Karen; Hamill, Joseph

2017-01-01

Trabecular bone of the human calcaneus is subjected to extreme repetitive forces during endurance running and should adapt in response to this strain. To assess possible bone functional adaptation in the posterior region of the calcaneus, we recruited forefoot-striking runners (n = 6), rearfoot-striking runners (n = 6), and non-runners (n = 6), all males aged 20-41 for this institutionally approved study. Foot strike pattern was confirmed for each runner using a motion capture system. We obtained high resolution peripheral computed tomography scans of the posterior calcaneus for both runners and non-runners. No statistically significant differences were found between runners and nonrunners or forefoot strikers and rearfoot strikers. Mean trabecular thickness and mineral density were greatest in forefoot runners with strong effect sizes (<0.80). Trabecular thickness was positively correlated with weekly running distance (r2 = 0.417, p<0.05) and years running (r2 = 0.339, p<0.05) and negatively correlated with age at onset of running (r2 = 0.515, p<0.01) Trabecular thickness, mineral density and bone volume ratio of nonrunners were highly correlated with body mass (r2 = 0.824, p<0.05) and nonrunners were significantly heavier than runners (p<0.05). Adjusting for body mass revealed significantly thicker trabeculae in the posterior calcaneus of forefoot strikers, likely an artifact of greater running volume and earlier onset of running in this subgroup; thus, individuals with the greatest summative loading stimulus had, after body mass adjustment, the thickest trabeculae. Further study with larger sample sizes is necessary to elucidate the role of footstrike on calcaneal trabecular structure. To our knowledge, intraspecific body mass correlations with measures of trabecular robusticity have not been reported elsewhere. We hypothesize that early adoption of running and years of sustained moderate volume running stimulate bone modeling in trabeculae of the posterior calcaneus.

The effects of preferred and non-preferred running strike patterns on tissue vibration properties.

PubMed

Enders, Hendrik; von Tscharner, Vinzenz; Nigg, Benno M

2014-03-01

To characterize soft tissue vibrations during running with a preferred and a non-preferred strike pattern in shoes and barefoot. Cross-sectional study. Participants ran at 3.5 m s(-1) on a treadmill in shoes and barefoot using a rearfoot and a forefoot strike for each footwear condition. The preferred strike patterns for the subjects were a rearfoot strike and a forefoot strike for shod and barefoot running, respectively. Vibrations were recorded with an accelerometer overlying the belly of the medial gastrocnemius. Thirteen non-linearly scaled wavelets were used for the analysis. Damping was calculated as the overall decay of power in the acceleration signal post ground contact. A higher damping coefficient indicates higher damping capacities of the soft tissue. The shod rearfoot strike showed a 93% lower damping coefficient than the shod forefoot strike (p<0.001). A lower damping coefficient indicates less damping of the vibrations. The barefoot forefoot strike showed a trend toward a lower damping coefficient compared to a barefoot rearfoot strike. Running barefoot with a forefoot strike resulted in a significantly lower damping coefficient than a forefoot strike when wearing shoes (p<0.001). The shod rearfoot strike showed lower damping compared to a barefoot rearfoot strike (p<0.001). While rearfoot striking showed lower vibration frequencies in shod and barefoot running, it did not consistently result in lower damping coefficients. This study showed that the use of a preferred movement resulted in lower damping coefficients of running related soft tissue vibrations. Copyright © 2013 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Effects of shoe inserts and heel height on foot pressure, impact force, and perceived comfort during walking.

PubMed

Yung-Hui, Lee; Wei-Hsien, Hong

2005-05-01

Studying the impact of high-heeled shoes on kinetic changes and perceived discomfort provides a basis to advance the design and minimize the adverse effects on the human musculoskeletal system. Previous studies demonstrated the effects of inserts on kinetics and perceived comfort in flat or running shoes. No study attempted to investigate the effectiveness of inserts in high heel shoes. The purpose of this study was to determine whether increasing heel height and the use of shoe inserts change foot pressure distribution, impact force, and perceived comfort during walking. Ten healthy females volunteered for the study. The heel heights were 1.0cm (flat), 5.1cm (low), and 7.6cm (high). The heel height effects were examined across five shoe-insert conditions of shoe only; heel cup, arch support, metatarsal pad, and total contact insert (TCI). The results indicated that increasing heel height increases impact force (p<0.01), medial forefoot pressure (p<0.01), and perceived discomfort (p<0.01) during walking. A heel cup insert for high-heeled shoes effectively reduced the heel pressure and impact force (p<0.01), an arch support insert reduced the medial forefoot pressure, and both improved footwear comfort (p<0.01). In particular, a TCI reduced heel pressure by 25% and medial forefoot pressure by 24%, attenuate the impact force by 33.2%, and offered higher perceived comfort when compared to the non-insert condition.

Sagittal plane kinematics of passive dorsiflexion of the foot in adolescent athletes.

PubMed

Gatt, Alfred; Chockalingam, Nachiappan; Falzon, Owen

2013-01-01

Although assessment of passive maximum foot dorsiflexion angle is performed routinely, there is a paucity of information regarding adolescents' foot and foot segment motion during this procedure. There are currently no trials investigating the kinematics of the adolescent foot during passive foot dorsiflexion. A six-camera optoelectronic motion capture system was used to collect kinematic data using the Oxford Foot Model. Eight female amateur gymnasts 11 to 16 years old (mean age, 13.2 years; mean height, 1.5 m) participated in the study. A dorsiflexing force was applied to the forefoot until reaching maximum resistance with the foot placed in the neutral, pronated, and supinated positions in random order. The maximum foot dorsiflexion angle and the range of movement of the forefoot to hindfoot, tibia to forefoot, and tibia to hindfoot angles were computed. Mean ± SD maximum foot dorsiflexion angles were 36.3° ± 7.2° for pronated, 36.9° ± 4.0° for neutral, and 33.0° ± 4.9° for supinated postures. One-way repeated-measures analysis of variance results were nonsignificant among the 3 groups (P = .70), as were the forefoot to tibia angle and hindfoot to tibia angle variations (P = .091 and P = .188, respectively). Forefoot to hindfoot angle increased with the application of force, indicating that in adolescents, the forefoot does not lock at any particular posture as portrayed by the traditional Rootian paradigm. Participants had very flexible foot dorsiflexion, unlike those in another study assessing adolescent athletes. This finding, together with nonsignificant statistical results, implies that foot dorsiflexion measurement may be performed at any foot posture without notably affecting results.

Effects of footwear and strike type on running economy.

PubMed

Perl, Daniel P; Daoud, Adam I; Lieberman, Daniel E

2012-07-01

This study tests if running economy differs in minimal shoes versus standard running shoes with cushioned elevated heels and arch supports and in forefoot versus rearfoot strike gaits. We measured the cost of transport (mL O(2)·kg(-1)·m(-1)) in subjects who habitually run in minimal shoes or barefoot while they were running at 3.0 m·s(-1) on a treadmill during forefoot and rearfoot striking while wearing minimal and standard shoes, controlling for shoe mass and stride frequency. Force and kinematic data were collected when subjects were shod and barefoot to quantify differences in knee flexion, arch strain, plantar flexor force production, and Achilles tendon-triceps surae strain. After controlling for stride frequency and shoe mass, runners were 2.41% more economical in the minimal-shoe condition when forefoot striking and 3.32% more economical in the minimal-shoe condition when rearfoot striking (P < 0.05). In contrast, forefoot and rearfoot striking did not differ significantly in cost for either minimal- or standard-shoe running. Arch strain was not measured in the shod condition but was significantly greater during forefoot than rearfoot striking when barefoot. Plantar flexor force output was significantly higher in forefoot than in rearfoot striking and in barefoot than in shod running. Achilles tendon-triceps surae strain and knee flexion were also lower in barefoot than in standard-shoe running. Minimally shod runners are modestly but significantly more economical than traditionally shod runners regardless of strike type, after controlling for shoe mass and stride frequency. The likely cause of this difference is more elastic energy storage and release in the lower extremity during minimal-shoe running.

Central polydactyly of the foot: surgical management with plantar and dorsal advancement flaps.

PubMed

Osborn, Emily J; Davids, Jon R; Leffler, Lauren C; Gibson, Thomas W; Pugh, Linda I

2014-01-01

Central polydactyly is the least common form of foot polydactyly, and the intercalary location of the duplicated ray makes the surgical exposure, excision, and closure more complex. For these reasons there is little consensus concerning the optimal technique for surgical management. A retrospective case series of 22 patients with 27 feet with central polydactyly, treated surgically by the dorsal and plantar advancement flap technique, was performed. Change in width of the forefoot was measured from radiographs by the metatarsal gap ratio. Functional outcomes were assessed by the Foot and Ankle Ability Measure. Signficant narrowing of the forefoot, as measured radiographically by the metatarsal gap ratio, was achieved after surgery (P<0.0001). This radiographic narrowing was maintained with growth after a mean follow-up of 8 years (P=0.0001). In 7 of the unilateral cases, the mean forefoot radiographic width of the affected side, after surgical resection and reconstruction of the central polydactyly, was 2% greater than the contralateral, uninvolved side. Persistent clinical widening of the forefoot after surgery was reported in the majority (82%) of cases. The Foot and Ankle Ability Measure results showed near-normal functional outcomes in itemized activities of daily living, itemized sports, and overall function categories. The few reports of less than normal foot function were related to shoe wear issues and incisional scarring that was painful or cosmetically unappealing. The radiographic and functional outcomes after surgical management of central polydactyly with the dorsal and plantar advancement flap technique are excellent. The technique successfully narrows the forefoot on radiographs, and this narrowing is maintained with growth over time. However, families should be advised that persistent perceived widening of the forefoot relative to normal is common, despite successful radiographic narrowing after surgery. IV.

Walking, running and the evolution of short toes in humans.

PubMed

Rolian, Campbell; Lieberman, Daniel E; Hamill, Joseph; Scott, John W; Werbel, William

2009-03-01

The phalangeal portion of the forefoot is extremely short relative to body mass in humans. This derived pedal proportion is thought to have evolved in the context of committed bipedalism, but the benefits of shorter toes for walking and/or running have not been tested previously. Here, we propose a biomechanical model of toe function in bipedal locomotion that suggests that shorter pedal phalanges improve locomotor performance by decreasing digital flexor force production and mechanical work, which might ultimately reduce the metabolic cost of flexor force production during bipedal locomotion. We tested this model using kinematic, force and plantar pressure data collected from a human sample representing normal variation in toe length (N=25). The effect of toe length on peak digital flexor forces, impulses and work outputs was evaluated during barefoot walking and running using partial correlations and multiple regression analysis, controlling for the effects of body mass, whole-foot and phalangeal contact times and toe-out angle. Our results suggest that there is no significant increase in digital flexor output associated with longer toes in walking. In running, however, multiple regression analyses based on the sample suggest that increasing average relative toe length by as little as 20% doubles peak digital flexor impulses and mechanical work, probably also increasing the metabolic cost of generating these forces. The increased mechanical cost associated with long toes in running suggests that modern human forefoot proportions might have been selected for in the context of the evolution of endurance running.

Leg Muscle Usage Effects on Tibial Elasticity During Running

DTIC Science & Technology

2006-01-01

stress, such a strike mechanics and surface incline, also modulate bone elasticity during running. Because these modulators may operate on the tibia via...prototypical forefoot runner. We have obtained a video showing well-defined forefoot -running without coaching and have developed a short training video for

Total contact cast wall load in patients with a plantar forefoot ulcer and diabetes.

PubMed

Begg, Lindy; McLaughlin, Patrick; Vicaretti, Mauro; Fletcher, John; Burns, Joshua

2016-01-01

The total contact cast (TCC) is an effective intervention to reduce plantar pressure in patients with diabetes and a plantar forefoot ulcer. The walls of the TCC have been indirectly shown to bear approximately 30 % of the plantar load. A new direct method to measure inside the TCC walls with capacitance sensors has shown that the anterodistal and posterolateral-distal regions of the lower leg bear the highest load. The objective of this study was to directly measure these two regions in patients with Diabetes and a plantar forefoot ulcer to further understand the mechanism of pressure reduction in the TCC. A TCC was applied to 17 patients with Diabetes and a plantar forefoot ulcer. TCC wall load (contact area, peak pressure and max force) at the anterodistal and posterolateral-distal regions of the lower leg were evaluated with two capacitance sensor strips measuring 90 cm(2) (pliance®, novel GmbH, Germany). Plantar load (contact area, peak pressure and max force) was measured with a capacitance sensor insole (pedar®, novel GmbH, Germany) placed inside the TCC. Both pedar® and pliance® collected data simultaneously at a sampling rate of 50Hz synchronised to heel strike. The magnitude of TCC wall load as a proportion of plantar load was calculated. The TCC walls were then removed to determine the differences in plantar loading between the TCC and the cut down shoe-cast for the whole foot, rearfoot, midfoot and forefoot (region of interest). TCC wall load was substantial. The anterodistal lower leg recorded 48 % and the posterolateral-distal lower leg recorded 34 % of plantar contact area. The anterodistal lower leg recorded 28 % and the posterolateral-distal lower leg recorded 12 % of plantar peak pressure. The anterodistal lower leg recorded 12 % and the posterolateral-distal lower leg recorded 4 % of plantar max force. There were significant differences in plantar load between the TCC and the cut down shoe-cast for the whole foot, rearfoot, midfoot and forefoot (region of ulcer). Contact area significantly increased by 5 % beneath the whole foot, 8 % at the midfoot and 6 % at the forefoot in the shoe-cast (p < 0.05). Peak pressure significantly increased by 8 % beneath the midfoot and 13 % at the forefoot in the shoe-cast (p < 0.05). Max force significantly increased 6 % beneath the midfoot in the (shoe-cast p < 0.05). In patients with diabetes and a plantar forefoot ulcer, the walls of the TCC bear considerable load. Reduced plantar contact area in the TCC compared to the shoe-cast suggests that the foot is suspended by the considerable load bearing capacity of the walls of the TCC which contributes mechanically to the pressure reduction and redistribution properties of the TCC.

The effects of altering initial ground contact in the running gait of an individual with transtibial amputation.

PubMed

Waetjen, Linda; Parker, Matthew; Wilken, Jason M

2012-09-01

High rates of osteoarthritis of the knee joint of the intact limb in persons with amputation have raised concern about the long-term consequence of running. The purpose of this intervention was to determine if loading of the knee on the intact limb of a person with transtibial amputation during running could be decreased by changing the intact limb initial ground contact from rear foot to forefoot strike. This study compared kinematic, kinetic and temporal-spatial data collected while a 27-year-old male, who sustained a traumatic unilateral transtibial amputation of the left lower extremity, ran using a forefoot ground contact and again while using a heel first ground contact. Changing initial ground contact from rear foot strike to forefoot strike resulted in decreases in vertical ground reaction forces at impact, peak knee moments in stance, peak knee powers, and improved symmetry in step length. This case suggests forefoot initial contact of the intact limb may minimize loading of the knee on the intact limb in individuals with transtibial amputation.

Manipulation of Foot Strike and Footwear Increases Achilles Tendon Loading During Running.

PubMed

Rice, Hannah; Patel, Mubarak

2017-08-01

The Achilles tendon is the most common site of tendon overuse injury in humans. Running with a forefoot strike pattern and in minimal shoes is a topic of recent interest, yet evidence is currently limited regarding the combined influence of foot strike and footwear on Achilles tendon loading. To investigate the influence of both foot strike and footwear on Achilles tendon loading in habitual rearfoot strike runners. Controlled laboratory study. Synchronized kinematic and force data were collected from 22 habitual rearfoot strikers (11 male), who habitually ran in nonminimal running shoes, during overground running at 3.6 m·s -1 . Participants ran in 3 different footwear conditions (standard running shoe, minimal running shoe, and barefoot) with both a rearfoot strike (RFS) and an imposed forefoot strike (FFS) in each footwear condition. Achilles tendon loading was estimated by use of inverse dynamics, where the Achilles tendon moment arm was determined with a regression equation. A 2-way, repeated-measures analysis of variance was used to compare conditions. Achilles tendon impulse was greater when subjects ran with an FFS rather than an RFS in minimal shoes. Achilles tendon loading rates were higher when subjects ran either in minimal shoes or barefoot than in standard shoes, regardless of foot strike. In runners who habitually rearfoot strike in standard running shoes, running in minimal shoes or barefoot increased the rate of tendon loading, and running with a forefoot strike in minimal shoes increased the magnitude of tendon loading. Transitioning to these running conditions may increase the risk of tendinopathy.

Forefoot ulcer risk is associated with foot type in patients with diabetes and neuropathy.

PubMed

Molines-Barroso, R J; Lázaro-Martínez, J L; Aragón-Sánchez, F J; Álvaro-Afonso, F J; García-Morales, E; García-Álvarez, Y

2016-04-01

To stratify the ulceration risk according to the foot morphology in people with diabetes and a history of forefoot neuropathic ulceration. A cross-sectional study was performed on 139 neuropathic individuals with diabetes and previous forefoot ulcers between January 2012 and February 2014. Foot position of the participants was evaluated by using the foot-posture index. A multivariate analysis adjusted for confounding variables was performed with the ulceration risk factors that were found in the univariate analysis. Two hundred and fifty-eight feet were analysed, 104 (40.3%) feet had a history of ulceration on the forefoot and 154 (59.7%) feet had no previous ulceration. Two positive tests of neuropathy (p<0.001; CI[1.961-6.249] OR 3.500), presence of deformities (p=0.043; CI[1.020-3.599] OR 1.916) and foot type (p=0.039) showed an association with ulceration risk in multivariate analyses. Pronated feet showed a higher risk of ulceration than supinated feet (p=0.011; CI[1.253-5.708] OR 2.675), while significant differences between neutral and supinated feet were not found (p=0.221; CI[0.719-2.753] OR 1.476). A pronated foot has a higher risk of ulceration on the forefoot in neuropathic people with deformities and diabetes mellitus. Foot type should be evaluated in people at risk of ulceration. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Contribution of Lateral Column Lengthening to Correction of Forefoot Abduction in Stage IIb Adult Acquired Flatfoot Deformity Reconstruction.

PubMed

Chan, Jeremy Y; Greenfield, Stephen T; Soukup, Dylan S; Do, Huong T; Deland, Jonathan T; Ellis, Scott J

2015-12-01

Correction of forefoot abduction in stage IIb adult acquired flatfoot likely depends on the amount of lateral column lengthening (LCL) performed, although this represents only one aspect of a successful reconstruction. The purpose of this study was to evaluate the correlation between common reconstructive variables and the observed change in forefoot abduction. Forty-one patients who underwent flatfoot reconstruction involving an Evans-type LCL were assessed retrospectively. Preoperative and postoperative anteroposterior (AP) radiographs of the foot at a minimum of 40 weeks (mean, 2 years) after surgery were reviewed to determine correction in forefoot abduction as measured by talonavicular coverage (TNC) angle, talonavicular uncoverage percent, talus-first metatarsal (T-1MT) angle, and lateral incongruency angle. Fourteen demographic and intraoperative variables were evaluated for association with change in forefoot abduction including age, gender, height, weight, body mass index, as well as the amount of LCL and medializing calcaneal osteotomy performed, LCL graft type, Cotton osteotomy, first tarsometatarsal fusion, flexor digitorum longus transfer, spring ligament repair, gastrocnemius recession and any one of the modified McBride/Akin/Silver procedures. Two variables significantly affected the change in lateral incongruency angle. These were weight (P = .04) and the amount of LCL performed (P < .001). No variables were associated with the change in TNC angle, talonavicular uncoverage percent, or T-1MT angle. Multivariate regression analysis revealed that LCL was the only significant predictor of the change in lateral incongruency angle. The final regression model for LCL showed a good fit (R2 = 0.70, P < .001). Each millimeter of LCL corresponded to a 6.8-degree change in lateral incongruency angle. Correction of forefoot abduction in flatfoot reconstruction was primarily determined by the LCL procedure and could be modeled linearly. We believe that the lateral incongruency angle can serve as a valuable preoperative measurement to help surgeons titrate the proper amount of correction performed intraoperatively. © The Author(s) 2015.

Botulinum toxin effects on gasatrocnemius strength and plantar pressure in diabetics with peripheral neuropathy and forefoot ulceration.

PubMed

Hastings, Mary K; Mueller, Michael J; Sinacore, David R; Strube, Michael J; Crowner, Beth E; Johnson, Jeffrey E; Racette, Brad R

2012-05-01

High forefoot plantar pressure is associated with plantar ulcers in people with diabetes and peripheral neuropathy. The purpose of this pilot study was to determine the safety and efficacy of botulinum toxin A injected into the gastrocnemius-soleus muscles to reduce muscle strength and plantar pressure. This double blind, randomized clinical trial studied 17 people with diabetes mellitus, peripheral neuropathy and a forefoot plantar ulcer. Subjects were randomized into one of three groups receiving gastrocnemius-soleus muscle injections on the involved side with; 1) Saline (n = 5, weight =99± 21 kg), 2) 200-units of Botox® (n = 7, weight = 101± 5 kg), or 3) 300-units of Botox® (n = 5, weight = 129± 22 kg). Botox® dose was converted to units/kg, the majority received between 1.9 and 2.4 units/kg (n = 11) and one 3.2 units/kg. Plantarflexor peak torque and forefoot peak plantar pressure were quantified prior and 2 weeks post-injection. There were no complications from the injections. Plantarflexor peak torque on the involved side increased in the placebo and 300 groups (3± 4 Nm and 6± 10 Nm, respectively) and decreased -8± 11 Nm in the 200 group. There was no relationship between units/kg of Botox® for each subject and change in plantarflexor peak torque. Forefoot peak plantar pressure did not change in the placebo and 300 groups (0± 11 and 0± 5 N/cm(2), respectively) and decreased -4± 16 N/cm2 (4%) for the 200 group. There were no adverse events associated with the Botox® injections. This study was unable to determine the dose to consistently reduce plantarflexor strength and forefoot plantar pressure. Additional research is needed to investigate diabetes mellitus specific physiological changes and their impact of BoNT-A effectiveness in order to guide appropriate dosing.

Tissue Engineering Initiative

DTIC Science & Technology

2000-08-01

forefoot with the foot in the neutral position, and (b) similar to (a) but with heel landing. Although the authors reported no absolute strain values...diameter of sensors (or, in the case of a rectangular sensor, width as measured along pin axis). Worst case : Strike line from inside edges of sensors...potoroo it is just prior to "toe strike ". The locomotion of the potoroo is described as digitigrade, unlike humans, who walk in a plantigrade manner

Multi-segment foot kinematics and ground reaction forces during gait of individuals with plantar fasciitis.

PubMed

Chang, Ryan; Rodrigues, Pedro A; Van Emmerik, Richard E A; Hamill, Joseph

2014-08-22

Clinically, plantar fasciitis (PF) is believed to be a result and/or prolonged by overpronation and excessive loading, but there is little biomechanical data to support this assertion. The purpose of this study was to determine the differences between healthy individuals and those with PF in (1) rearfoot motion, (2) medial forefoot motion, (3) first metatarsal phalangeal joint (FMPJ) motion, and (4) ground reaction forces (GRF). We recruited healthy (n=22) and chronic PF individuals (n=22, symptomatic over three months) of similar age, height, weight, and foot shape (p>0.05). Retro-reflective skin markers were fixed according to a multi-segment foot and shank model. Ground reaction forces and three dimensional kinematics of the shank, rearfoot, medial forefoot, and hallux segment were captured as individuals walked at 1.35 ms(-1). Despite similarities in foot anthropometrics, when compared to healthy individuals, individuals with PF exhibited significantly (p<0.05) (1) greater total rearfoot eversion, (2) greater forefoot plantar flexion at initial contact, (3) greater total sagittal plane forefoot motion, (4) greater maximum FMPJ dorsiflexion, and (5) decreased vertical GRF during propulsion. These data suggest that compared to healthy individuals, individuals with PF exhibit significant differences in foot kinematics and kinetics. Consistent with the theoretical injury mechanisms of PF, we found these individuals to have greater total rearfoot eversion and peak FMPJ dorsiflexion, which may put undue loads on the plantar fascia. Meanwhile, increased medial forefoot plantar flexion at initial contact and decreased propulsive GRF are suggestive of compensatory responses, perhaps to manage pain. Copyright © 2014 Elsevier Ltd. All rights reserved.

Metatarsal pain and plantar hyperkeratosis in the forefeet of female professional flamenco dancers.

PubMed

Castillo-López, José M; Vargas-Macías, Alfonso; Domínguez-Maldonado, Gabriel; Lafuente-Sotillos, Guillermo; Ramos-Ortega, Javier; Palomo-Toucedo, Inmaculada C; Reina-Bueno, María; Munuera-Martínez, Pedro V

2014-12-01

The objectives of this study were to determine the frequency of metatarsal pain and of hyperkeratosis on the plantar forefoot in female professional flamenco dancers, and to determine whether there is a relationship between the two disorders. Forty-four female professional flamenco dancers, with a minimum activity of 25 hrs/wk, participated in this cross-sectional study. The presence or absence of metatarsal pain while dancing was recorded, and plantar pressures were measured on a pressure platform, both barefoot and shod with the usual dance shoe. The heel height of the dance shoe was also measured. Of the dancers, 80.7% experienced metatarsal pain while dancing, and 84.1% presented with plantar hyperkeratosis. Plantar hyperkeratosis coincided with the presence of metatarsal pain in 67.04% of the feet studied. The maximum load point in the feet when the dancers were barefoot was located 59.5% in the rearfoot and 40.5% in the forefoot; when dancers wore their specific flamenco dancing shoes, it was located 52.4% in the rearfoot and 47.6% in the forefoot. Metatarsal pain and plantar hyperkeratosis in the forefoot are common foot disorders in female flamenco dancing. The incidence of the maximum load point being located in the forefoot, and the difference between the results of the tests while shod or barefoot, are both too low to support the idea that the raised heels of flamenco shoes are a major contributing factor for these injuries. Therefore, these disorders may be caused by chronic repetitive trauma suffered during the practice of footwork dancing.

High probability of healing without amputation of plantar forefoot ulcers in patients with diabetes.

PubMed

Örneholm, Hedvig; Apelqvist, Jan; Larsson, Jan; Eneroth, Magnus

2015-01-01

Diabetic foot ulcer is an important entity which in many cases is the first serious complication in diabetes. Although a plantar forefoot location is common, there are few studies on larger cohorts and in such studies there is often a combination of various types of ulcer and ulcer locations. The purpose of this study is to discern the outcome of plantar forefoot ulcers and their specific characteristics in a large cohort. All patients (n = 770), presenting with a plantar forefoot ulcer at a multidisciplinary diabetes foot clinic from January 1, 1983 to December 31, 2012 were considered for the study. Seven hundred one patients (median age 67 [22-95]) fulfilled the inclusion criteria and were followed according to a preset protocol until final outcome (healing or death). Severe peripheral vascular disease was present in 26% of the patients and 14% had evidence of deep infection upon arrival at the foot clinic. Fifty-five percent (385/701) of the patients healed without foot surgery, 25% (173/701) healed after major debridement, 9% (60/701) healed after minor or major amputation and 12% (83/701) died unhealed. Median healing time was 17 weeks. An ulcer classified as Wagner grade 1 or 2 at inclusion and independent living were factors associated with a higher healing rate. Seventy-nine percent of 701 patients with diabetes and a plantar forefoot ulcer treated at a multidisciplinary diabetes foot clinic healed without amputation. For one third some form of foot surgery was needed to achieve healing. © 2015 by the Wound Healing Society.

Acute changes in foot strike pattern and cadence affect running parameters associated with tibial stress fractures.

PubMed

Yong, Jennifer R; Silder, Amy; Montgomery, Kate L; Fredericson, Michael; Delp, Scott L

2018-05-18

Tibial stress fractures are a common and debilitating injury that occur in distance runners. Runners may be able to decrease tibial stress fracture risk by adopting a running pattern that reduces biomechanical parameters associated with a history of tibial stress fracture. The purpose of this study was to test the hypothesis that converting to a forefoot striking pattern or increasing cadence without focusing on changing foot strike type would reduce injury risk parameters in recreational runners. Running kinematics, ground reaction forces and tibial accelerations were recorded from seventeen healthy, habitual rearfoot striking runners while running in their natural running pattern and after two acute retraining conditions: (1) converting to forefoot striking without focusing on cadence and (2) increasing cadence without focusing on foot strike. We found that converting to forefoot striking decreased two risk factors for tibial stress fracture: average and peak loading rates. Increasing cadence decreased one risk factor: peak hip adduction angle. Our results demonstrate that acute adaptation to forefoot striking reduces different injury risk parameters than acute adaptation to increased cadence and suggest that both modifications may reduce the risk of tibial stress fractures. Copyright © 2018 Elsevier Ltd. All rights reserved.

Gait Retraining From Rearfoot Strike to Forefoot Strike does not change Running Economy.

PubMed

Roper, Jenevieve Lynn; Doerfler, Deborah; Kravitz, Len; Dufek, Janet S; Mermier, Christine

2017-12-01

Gait retraining is a method for management of patellofemoral pain, which is a common ailment among recreational runners. The present study investigated the effects of gait retraining from rearfoot strike to forefoot strike on running economy, heart rate, and respiratory exchange ratio immediately post-retraining and one-month post-retraining in recreational runners with patellofemoral pain. Knee pain was also measured. Sixteen participants (n=16) were randomly placed in the control (n=8) or experimental (n=8) group. A 10-minute treadmill RE test was performed by all subjects. The experimental group performed eight gait retraining running sessions where foot strike pattern was switched from rearfoot strike to forefoot strike, while the control group received no intervention. There were no significant differences for running economy (p=0.26), respiratory exchange ratio (p=0.258), or heart rate (p=0.248) between the groups. Knee pain reported on a visual analog scale was also significantly reduced (p<0.05) as a result of retraining. The present study demonstrates that retraining from rearfoot strike to forefoot strike did not affect running economy up to one-month post-retraining while reducing running-related patellofemoral pain. © Georg Thieme Verlag KG Stuttgart · New York.

Kinematic adaptations of the hindfoot, forefoot, and hallux during cross-slope walking.

PubMed

Damavandi, Mohsen; Dixon, Philippe C; Pearsall, David J

2010-07-01

Despite cross-slope surfaces being a regular feature of our environment, little is known about segmental adaptations required to maintain both balance and forward locomotion. The purpose of this study was to determine kinematic adaptations of the foot segments in relation to transverse (cross-sloped) walking surfaces. Ten young adult males walked barefoot along an inclinable walkway (level, 0° and cross-slope, 10°). Kinematic adaptations of hindfoot with respect to tibia (HF/TB), forefoot with respect to hindfoot (FF/HF), and hallux with respect to forefoot (HX/FF) in level walking (LW), inclined walking up-slope (IWU), i.e., the foot at the higher elevation, and inclined walking down-slope (IWD), i.e., the foot at the lower elevation, were measured. Multivariate analysis of variance (MANOVA) for repeated measures was used to analyze the data. In the sagittal plane, the relative FF/HF and HX/FF plantar/dorsiflexion angles differed across conditions (p=0.024 and p=0.026, respectively). More importantly, numerous frontal plane alterations occurred. For the HF/TB angle, inversion of IWU and eversion of IWD was seen at heel-strike (p<0.001). This pattern reversed with IWU showing eversion and IWD inversion in early stance (p=0.024). For the FF/HF angle, significant differences were observed in mid-stance with IWD revealing inversion while IWU was everted (p<0.004). At toe-off, the pattern switched to eversion of IWD and inversion of IWU (p=0.032). The information obtained from this study enhances our understanding of the kinematics of the human foot in stance during level and cross-slope walking. Copyright © 2010 Elsevier B.V. All rights reserved.

Forefoot running improves pain and disability associated with chronic exertional compartment syndrome.

PubMed

Diebal, Angela R; Gregory, Robert; Alitz, Curtis; Gerber, J Parry

2012-05-01

Anterior compartment pressures of the leg as well as kinematic and kinetic measures are significantly influenced by running technique. It is unknown whether adopting a forefoot strike technique will decrease the pain and disability associated with chronic exertional compartment syndrome (CECS) in hindfoot strike runners. For people who have CECS, adopting a forefoot strike running technique will lead to decreased pain and disability associated with this condition. Case series; Level of evidence, 4. Ten patients with CECS indicated for surgical release were prospectively enrolled. Resting and postrunning compartment pressures, kinematic and kinetic measurements, and self-report questionnaires were taken for all patients at baseline and after 6 weeks of a forefoot strike running intervention. Run distance and reported pain levels were recorded. A 15-point global rating of change (GROC) scale was used to measure perceived change after the intervention. After 6 weeks of forefoot run training, mean postrun anterior compartment pressures significantly decreased from 78.4 ± 32.0 mm Hg to 38.4 ± 11.5 mm Hg. Vertical ground-reaction force and impulse values were significantly reduced. Running distance significantly increased from 1.4 ± 0.6 km before intervention to 4.8 ± 0.5 km 6 weeks after intervention, while reported pain while running significantly decreased. The Single Assessment Numeric Evaluation (SANE) significantly increased from 49.9 ± 21.4 to 90.4 ± 10.3, and the Lower Leg Outcome Survey (LLOS) significantly increased from 67.3 ± 13.7 to 91.5 ± 8.5. The GROC scores at 6 weeks after intervention were between 5 and 7 for all patients. One year after the intervention, the SANE and LLOS scores were greater than reported during the 6-week follow-up. Two-mile run times were also significantly faster than preintervention values. No patient required surgery. In 10 consecutive patients with CECS, a 6-week forefoot strike running intervention led to decreased postrunning lower leg intracompartmental pressures. Pain and disability typically associated with CECS were greatly reduced for up to 1 year after intervention. Surgical intervention was avoided for all patients.

The effect of shoe toe box shape and volume on forefoot interdigital and plantar pressures in healthy females

PubMed Central

2013-01-01

Background Ill-fitting footwear can be detrimental to foot health with the forefoot being an area for most discomfort. Studies on footwear have primarily examined sports or orthopaedic prescription shoes and little is known about the effects that everyday flat shoes have on the forefoot. The aim of this study was to investigate the effect of toe box shape in a popular slip-on pump on dorsal and plantar pressures with particular interest around the forefoot in a healthy female population. Method A convenience sample of 27 female participants with no known foot pathologies was recruited. After assessment of foot size, plantar foot pressure and interdigital pressures were recorded for each of the 3 different toe box styles; round, square and pointed. Participants walked at a self-selected speed over a 10 m walkway whilst wearing each of the 3 styles of shoe and also whilst barefoot. Processed and analysed data extracted included peak pressure, time to peak pressure, contact time and pressure time integral. ANOVA and Freidman analysis was used to test for statistical significance. Results Shoes with a round toe showed least pressure around the medial aspect of the toes whilst the pointed shoe had least pressure on the lateral toes. Contact times for the plantar regions were not altered in any shoe condition yet contact around the medial aspect of the toes was highest in the pointed shoe. Conclusion This study highlights that the shape of the toe box in footwear can significantly influence the amount of pressure applied to the forefoot. Furthermore, the contours of the shoe also have an impact on the contact time and pressure time integral around the forefoot and also the peak plantar pressure in the toe region. The changes observed could be significant in the development of pathology in certain footwear toe box shapes. Consideration should be given to footwear design around the toe box to improve fit and reduce pressure. Further work is required to investigate the effect of toe box shape and volume on a pathological population with pressure related lesions. PMID:23886242

Radiographic-directed local coordinate systems critical in kinematic analysis of walking in diabetes-related medial column foot deformity.

PubMed

Hastings, Mary K; Woodburn, James; Mueller, Michael J; Strube, Michael J; Johnson, Jeffrey E; Beckert, Krista S; Stein, Michelle L; Sinacore, David R

2014-01-01

Diabetic foot deformity onset and progression maybe associated with abnormal foot and ankle motion. The modified Oxford multi-segmental foot model allows kinematic assessment of inter-segmental foot motion. However, there are insufficient anatomical landmarks to accurately representation the alignment of the hindfoot and forefoot segments during model construction. This is most notable for the sagittal plane which is referenced parallel to the floor, allowing comparison of inter-segmental excursion but not capturing important sagittal hind-to-forefoot deformity associated with diabetic foot disease and can potentially underestimate true kinematic differences. The purpose of the study was to compare walking kinematics using local coordinate systems derived from the modified Oxford model and the radiographic directed model which incorporated individual calcaneal and 1st metatarsal declination pitch angles for the hindfoot and forefoot. We studied twelve participants in each of the following groups: (1) diabetes mellitus, peripheral neuropathy and medial column foot deformity (DMPN+), (2) DMPN without medial column deformity (DMPN-) and (3) age- and weight-match controls. The modified Oxford model coordinate system did not identify differences between groups in the initial, peak, final, or excursion hindfoot relative to shank or forefoot relative to hindfoot dorsiflexion/plantarflexion during walking. The radiographic coordinate system identified the DMPN+ group to have an initial, peak and final position of the forefoot relative to hindfoot that was more dorsiflexed (lower arch phenotype) than the DMPN- group (p<.05). Use of radiographic alignment in kinematic modeling of those with foot deformity reveals segmental motion occurring upon alignment indicative of a lower arch. Copyright © 2014 Elsevier B.V. All rights reserved.

EFFECTS OF FOREFOOT RUNNING ON CHRONIC EXERTIONAL COMPARTMENT SYNDROME: A CASE SERIES

PubMed Central

Gregory, Robert; Alitz, Curtis; Gerber, J. Parry

2011-01-01

Introduction: Chronic exertional compartment syndrome (CECS) is a condition that occurs almost exclusively with running whereby exercise increases intramuscular pressure compromising circulation, prohibiting muscular function, and causing pain in the lower leg. Currently, a lack of evidence exists for the effective conservative management of CECS. Altering running mechanics by adopting forefoot running as opposed to heel striking may assist in the treatment of CECS, specifically with anterior compartment symptoms. Case Description: The purpose of this case series is to describe the outcomes for subjects with CECS through a systematic conservative treatment model focused on forefoot running. Subject one was a 21 y/o female with a 4 year history of CECS and subject two was a 21 y/o male, 7 months status-post two-compartment right leg fasciotomy with a return of symptoms and a new onset of symptoms on the contralateral side. Outcome: Both subjects modified their running technique over a period of six weeks. Kinematic and kinetic analysis revealed increased step rate while step length, impulse, and peak vertical ground reaction forces decreased. In addition, leg intracompartmental pressures decreased from pre-training to post-training. Within 6 weeks of intervention subjects increased their running distance and speed absent of symptoms of CECS. Follow-up questionnaires were completed by the subjects at 7 months following intervention; subject one reported running distances up to 12.87 km pain-free and subject two reported running 6.44 km pain-free consistently 3 times a week. Discussion: This case series describes a potentially beneficial conservative management approach to CECS in the form of forefoot running instruction. Further research in this area is warranted to further explore the benefits of adopting a forefoot running technique for CECS as well as other musculoskeletal overuse complaints. PMID:22163093

Effects of forefoot running on chronic exertional compartment syndrome: a case series.

PubMed

Diebal, Angela R; Gregory, Robert; Alitz, Curtis; Gerber, J Parry

2011-12-01

Chronic exertional compartment syndrome (CECS) is a condition that occurs almost exclusively with running whereby exercise increases intramuscular pressure compromising circulation, prohibiting muscular function, and causing pain in the lower leg. Currently, a lack of evidence exists for the effective conservative management of CECS. Altering running mechanics by adopting forefoot running as opposed to heel striking may assist in the treatment of CECS, specifically with anterior compartment symptoms. The purpose of this case series is to describe the outcomes for subjects with CECS through a systematic conservative treatment model focused on forefoot running. Subject one was a 21 y/o female with a 4 year history of CECS and subject two was a 21 y/o male, 7 months status-post two-compartment right leg fasciotomy with a return of symptoms and a new onset of symptoms on the contralateral side. Both subjects modified their running technique over a period of six weeks. Kinematic and kinetic analysis revealed increased step rate while step length, impulse, and peak vertical ground reaction forces decreased. In addition, leg intracompartmental pressures decreased from pre-training to post-training. Within 6 weeks of intervention subjects increased their running distance and speed absent of symptoms of CECS. Follow-up questionnaires were completed by the subjects at 7 months following intervention; subject one reported running distances up to 12.87 km pain-free and subject two reported running 6.44 km pain-free consistently 3 times a week. This case series describes a potentially beneficial conservative management approach to CECS in the form of forefoot running instruction. Further research in this area is warranted to further explore the benefits of adopting a forefoot running technique for CECS as well as other musculoskeletal overuse complaints.

Influence of basketball shoe mass, outsole traction, and forefoot bending stiffness on three athletic movements.

PubMed

Worobets, Jay; Wannop, John William

2015-09-01

Prior research has shown that footwear can enhance athletic performance. However, public information is not available on what basketball shoe properties should be selected to maximise movement performance. Therefore, the purpose of the study was to investigate the influence of basketball shoe mass, outsole traction, and forefoot bending stiffness on sprinting, jumping, and cutting performance. Each of these three basketball shoe properties was systematically varied by ± 20% to produce three shoe conditions of varying mass, three conditions of varying traction, and three conditions of varying bending stiffness. Each shoe was tested by 20 recreational basketball players completing maximal effort sprints, vertical jumps, and a cutting drill. Outsole traction had the largest influence on performance, as the participants performed significantly worse in all tests when traction was decreased by 20% (p < 0.001), and performed significantly better in the cutting drill when traction was increased by 20% (p = 0.005). Forefoot bending stiffness had a moderate effect on sprint and cutting performance (p = 0.013 and p = 0.016 respectively) and shoe mass was found to have no effect on performance. Therefore, choosing a shoe with relatively high outsole traction and forefoot bending stiffness should be prioritised, and less concern should be focused on selecting the lightest shoe.

Reliability of a Seven-Segment Foot Model with Medial and Lateral Midfoot and Forefoot Segments During Walking Gait.

PubMed

Cobb, Stephen C; Joshi, Mukta N; Pomeroy, Robin L

2016-12-01

In-vitro and invasive in-vivo studies have reported relatively independent motion in the medial and lateral forefoot segments during gait. However, most current surface-based models have not defined medial and lateral forefoot or midfoot segments. The purpose of the current study was to determine the reliability of a 7-segment foot model that includes medial and lateral midfoot and forefoot segments during walking gait. Three-dimensional positions of marker clusters located on the leg and 6 foot segments were tracked as 10 participants completed 5 walking trials. To examine the reliability of the foot model, coefficients of multiple correlation (CMC) were calculated across the trials for each participant. Three-dimensional stance time series and range of motion (ROM) during stance were also calculated for each functional articulation. CMCs for all of the functional articulations were ≥ 0.80. Overall, the rearfoot complex (leg-calcaneus segments) was the most reliable articulation and the medial midfoot complex (calcaneus-navicular segments) was the least reliable. With respect to ROM, reliability was greatest for plantarflexion/dorsiflexion and least for abduction/adduction. Further, the stance ROM and time-series patterns results between the current study and previous invasive in-vivo studies that have assessed actual bone motion were generally consistent.

Engineering For Ship Production: A Textbook

DTIC Science & Technology

1986-06-01

content. (g) Bulbous Bow. Bulbous bows are wave-resistance-reducing devices. They incorporate displacement at the bow forefoot , which sets up a surface...displacement from the fore body in way of the load waterline entrance to the bow forefoot in the form of a faired-in bulb. More recently, the...install open-ended sounding tubes with striking plates welded to the tank bottom. Where the sounding tuba slopes at the end, it is common to close the

Leg Muscle Usage on Tibial Elasticity During Running

DTIC Science & Technology

2005-01-01

relative risk of forefoot versus heel- strike running. In summary, there is no evidence in the literature that either study arm is at more risk than...tested in TSF, or even studied in runners. These basic validation studies will determine if modulators of tibial stress, .such as heel- strike mechanics...the other for acute injuries, although it was agreed that forefoot runners will be periodically evaluated for injuries to the Achilles tendon. After

CLINICAL COMMENTARY ON MIDFOOT AND FOREFOOT INVOLVEMENT IN LATERAL ANKLE SPRAINS AND CHRONIC ANKLE INSTABILITY. PART 2: CLINICAL CONSIDERATIONS

PubMed Central

Feger, Mark A.; Hertel, Jay

2016-01-01

Lateral ankle sprains (LAS) and chronic ankle instability (CAI) are common musculoskeletal injuries that are a result of inversion injury during sport. The midfoot and forefoot is frequently injured during a LAS, is often overlooked during clinical examination, and maybe contributory to the development of CAI. The purpose of part two of this clinical commentary and current concept review is to increase clinician's awareness of the contribution of midfoot and forefoot impairment to functional limitation and disability of individuals who experience LAS and CAI and to facilitate future research in this area. The importance of multisegmented foot and ankle assessment from a clinical and research perspective is stressed. Select physical assessment and manual therapeutic techniques are presented to assist the clinician in examination and treatment of the ankle-foot complex in patients with LAS and CAI. PMID:27999731

Barefoot running: biomechanics and implications for running injuries.

PubMed

Altman, Allison R; Davis, Irene S

2012-01-01

Despite the technological developments in modern running footwear, up to 79% of runners today get injured in a given year. As we evolved barefoot, examining this mode of running is insightful. Barefoot running encourages a forefoot strike pattern that is associated with a reduction in impact loading and stride length. Studies have shown a reduction in injuries to shod forefoot strikers as compared with rearfoot strikers. In addition to a forefoot strike pattern, barefoot running also affords the runner increased sensory feedback from the foot-ground contact, as well as increased energy storage in the arch. Minimal footwear is being used to mimic barefoot running, but it is not clear whether it truly does. The purpose of this article is to review current and past research on shod and barefoot/minimal footwear running and their implications for running injuries. Clearly more research is needed, and areas for future study are suggested.

Open-Water Resistance and Seakeeping Characteristics of Ships with Icebreaking Bows

DTIC Science & Technology

1991-05-13

of a Knuckled Forefoot on a Typical Icebreaker ...... ................... . 19 3-2. Lines Plan, T-AGS OCEAN (ICE) . * * .... . 23 3-3. Curve of...the ice. As the stem strikes the ice, initial failure of the ice occurs by simple crushing. Then the raked stem of the icebreaker rides up onto the ice...bossings, skegs, rudders, 18 and special stem forefoot shapes were not included in the shapes tested. To ensure that the parent and its variants

The Science Behind Surgical Innovations of the Forefoot.

PubMed

Baumhauer, Judith F; Marcolongo, Michele

2016-12-01

One of the areas of foot and ankle surgery that has had particular attention over the last 5 years has been forefoot surgery. Common procedures include correction of the lessor metatarsophalangeal joints and hammertoe deformities, specifically metatarsal shortening osteotomies and proximal interphalangeal joint fusions. The goals of these surgeries are to improve patient function and allow patients to fit into shoes more comfortably in metatarsal shortening and hammertoe. Copyright © 2016 Elsevier Inc. All rights reserved.

Skeletal morphology of the forefoot in shrews (Mammalia: Soricidae) of the genus Cryptotis, as revealed by digital x-rays

USGS Publications Warehouse

Woodman, N.; Morgan, J.P.J.

2005-01-01

Variation in the forefoot skeleton of small-eared shrews (family Soricidae, genus Cryptotis) has been previously documented, but the paucity of available skeletons for most taxa makes assessment of the degrees of intraspecific and interspecific variation difficult. We used a digital X-ray system to extract images of the forefoot skeleton from 101 dried skins of eight taxa (seven species, including two subspecies of one species) of these shrews. Lengths and widths of each of the four bones of digit III were measured directly from the digital images, and we used these data to quantify variation within and among taxa. Analysis of the images and measurements showed that interspecific variation exceeds intraspecific variation. In fact, most taxa could be distinguished in multivariate and some bivariate plots. Our quantitative data helped us define a number of specific forefoot characters that we subsequently used to hypothesize evolutionary relationships among the taxa using the exhaustive search option in PAUP, a computer program for phylogenetic analysis. The resulting trees generally concur with previously published evolutionary hypotheses for small-eared shrews. Cryptotis meridensis, a taxon not previously examined in recent phylogenies, is rooted at the base of the branch leading to the C. mexicana group of species. The position of this species suggests that the mostly South American C. thomasi group shares an early ancestor with the C. mexicana group.

A clinically applicable six-segmented foot model.

PubMed

De Mits, Sophie; Segers, Veerle; Woodburn, Jim; Elewaut, Dirk; De Clercq, Dirk; Roosen, Philip

2012-04-01

We describe a multi-segmented foot model comprising lower leg, rearfoot, midfoot, lateral forefoot, medial forefoot, and hallux for routine use in a clinical setting. The Ghent Foot Model describes the kinematic patterns of functional units of the foot, especially the midfoot, to investigate patient populations where midfoot deformation or dysfunction is an important feature, for example, rheumatoid arthritis patients. Data were obtained from surface markers by a 6 camera motion capture system at 500 Hz. Ten healthy subjects walked barefoot along a 12 m walkway at self-selected speed. Joint angles (rearfoot to shank, midfoot to rearfoot, lateral and medial forefoot to midfoot, and hallux to medial forefoot) in the sagittal, frontal, and transverse plane are reported according to anatomically based reference frames. These angles were calculated and reported during the foot rollover phases in stance, detected by synchronized plantar pressure measurements. Repeated measurements of each subject revealed low intra-subject variability, varying between 0.7° and 2.3° for the minimum values, between 0.5° and 2.1° for the maximum values, and between 0.8° and 5.8° for the ROM. The described movement patterns were repeatable and consistent with biomechanical and clinical knowledge. As such, the Ghent Foot model permits intersegment, in vivo motion measurement of the foot, which is crucial for both clinical and research applications. Copyright © 2011 Orthopaedic Research Society.

Effects of forefoot bending elasticity of running shoes on gait and running performance.

PubMed

Chen, Chia-Hsiang; Tu, Kuan-Hua; Liu, Chiang; Shiang, Tzyy-Yuang

2014-12-01

The aim of this study was to investigate the effects of forefoot bending elasticity of running shoes on kinetics and kinematics during walking and running. Twelve healthy male participants wore normal and elastic shoes while walking at 1.5m/s, jogging at 2.5m/s, and running at 3.5m/s. The elastic shoes were designed by modifying the stiffness of flexible shoes with elastic bands added to the forefoot part of the shoe sole. A Kistler force platform and Vicon system were used to collect kinetic and kinematic data during push-off. Electromyography was used to record the muscle activity of the medial gastrocnemius and medial tibialis anterior. A paired dependent t-test was used to compare the various shoes and the level of significance was set at α=.05. The range of motion of the ankle joint and the maximal anterior-posterior propulsive force differed significantly between elastic and flexible shoes in walking and jogging. The contact time and medial gastrocnemius muscle activation in the push-off phase were significantly lower for the elastic shoes compared with the flexible shoes in walking and jogging. The elastic forefoot region of shoes can alter movement characteristics in walking and jogging. However, for running, the elasticity used in this study was not strong enough to exert a similar effect. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

Gender differences associated with rearfoot, midfoot, and forefoot kinematics during running.

PubMed

Takabayashi, Tomoya; Edama, Mutsuaki; Nakamura, Masatoshi; Nakamura, Emi; Inai, Takuma; Kubo, Masayoshi

2017-11-01

Females, as compared with males, have a higher proportion of injuries in the foot region. However, the reason for this gender difference regarding foot injuries remains unclear. This study aimed to investigate gender differences associated with rearfoot, midfoot, and forefoot kinematics during running. Twelve healthy males and 12 females ran on a treadmill. The running speed was set to speed which changes from walking to running. Three-dimensional kinematics of rearfoot, midfoot, and forefoot were collected and compared between males and females. Furthermore, spatiotemporal parameters (speed, cadence, and step length) were measured. In the rearfoot angle, females showed a significantly greater peak value of plantarflexion and range of motion in the sagittal plane as compared with males (effect size (ES) = 1.55 and ES = 1.12, respectively). In the midfoot angle, females showed a significantly greater peak value of dorsiflexion and range of motion in the sagittal plane as compared with males (ES = 1.49 and ES = 1.71, respectively). The forefoot peak angles and ranges of motion were not significantly different between the genders in all three planes. A previous study suggested that a gender-related difference in excessive motions of the lower extremities during running has been suggested as a contributing factor to running injuries. Therefore, the present investigation may provide insight into the reason for the high incidence of foot injuries in females.

A prospective study on gait-related intrinsic risk factors for lower leg overuse injuries.

PubMed

Ghani Zadeh Hesar, N; Van Ginckel, A; Cools, A; Peersman, W; Roosen, P; De Clercq, D; Witvrouw, E

2009-12-01

To determine prospectively gait-related risk factors for lower leg overuse injury (LLOI). A prospective cohort study. Male and female recruits from a start-to-run (STR) programme during a 10-week training period. 131 healthy subjects (20 men and 111 women), without a history of any lower leg complaint, participated in the study. Before the start of the 10-week STR programme, plantar force measurements during running were performed. During STR, lower leg injuries were diagnosed and registered by a sports physician. Plantar force measurements during running were performed using a footscan pressure plate. During the STR, 27 subjects (five men and 22 women) developed a LLOI. Logistic regression analysis revealed that subjects who developed a LLOI had a significantly more laterally directed force distribution at first metatarsal contact and forefoot flat, a more laterally directed force displacement in the forefoot contact phase, foot flat phase and at heel-off. These subjects also had a delayed change of the centre of force (COF) at forefoot flat, a higher force and loading underneath the lateral border of the foot, and a significantly higher directed force displacement of the COF at forefoot flat. These findings suggest that a less pronated heel strike and a more laterally directed roll-off can be considered as risk factors for LLOI. Clinically, the results of this study can be considered important in identifying individuals at risk of LLOI.

Changes in plantar loading based on shoe type and sex during a jump-landing task.

PubMed

Debiasio, Justin C; Russell, Mary E; Butler, Robert J; Nunley, James A; Queen, Robin M

2013-01-01

Metatarsal stress fractures are common in cleated-sport athletes. Previous authors have shown that plantar loading varies with footwear, sex, and the athletic task. To examine the effects of shoe type and sex on plantar loading in the medial midfoot (MMF), lateral midfoot (LMF), medial forefoot (MFF), middle forefoot (MidFF), and lateral forefoot (LFF) during a jump-landing task. Crossover study. Laboratory. Twenty-seven recreational athletes (14 men, 13 women) with no history of lower extremity injury in the last 6 months and no history of foot or ankle surgery. The athletes completed 7 jumping trials while wearing bladed-cleat, turf-cleat, and running shoes. Maximum force, contact area, contact time, and the force-time integral were analyzed in each foot region. We calculated 2 × 3 analyses of variance (α = .05) to identify shoe-condition and sex differences. We found no shoe × sex interactions, but the MMF, LMF, MFF, and LFF force-time integrals were greater in men (P < .03). The MMF maximum force was less with the bladed-cleat shoes (P = .02). Total foot and MidFF maximum force was less with the running shoes (P < .01). The MFF and LFF maximum forces were different among all shoe conditions (P < .01). Total foot contact area was less in the bladed-cleat shoes (P = .01). The MMF contact area was greatest in the running shoes (P < .01). The LFF contact area was less in the running shoes (P = .03). The MFF and LFF force-time integrals were greater with the bladed-cleat shoes (P < .01). The MidFF force-time integral was less in the running shoes (P < .01). Independent of shoe, men and women loaded the foot differently during a jump landing. The bladed cleat increased forefoot loading, which may increase the risk for forefoot injury. The type of shoe should be considered when choosing footwear for athletes returning to activity after metatarsal stress fractures.

Trauma as Pathogenesis of a Plantar Forefoot Fibrolipoma: First Case and Review of the Literature

PubMed Central

Vasconcelos, Juliana S. P.; Gharaibeh, Faris; Nittinger, Hans-Christoph

2013-01-01

Lipomas and their variants are benign soft-tissue tumors that occur at any age and most frequently on the upper back and neck, shoulder, and abdomen. The foot is a relatively uncommon site for soft-tissue neoplasia and the etiology is not usually related to trauma. We describe a case of a pedunculated fibrolipoma of the forefoot that originated from a cut wound at the Atlantic Ocean. A brief review of the literature is also given. PMID:24455388

Influence of a Viscoelastic Insole on Foot, Knee and Back Pain among Members of the United States Army Band

DTIC Science & Technology

2010-07-13

band members by providing them shoes with some favorable properties such as outsoles with built in compression pads in the heel and forefoot as well...compared to a no insole condition49 and that peak pressure generated at the forefoot and heel have been reduced by 24 percent and 37 percent...Attenuation of spinal transients at heel strike using viscoelastic heel insoles: an in vivo study. Preventive Medicine. 2004;39:351-354. 30

Changes in gluteal muscle forces with alteration of footstrike pattern during running.

PubMed

Vannatta, Charles Nathan; Kernozek, Thomas W; Gheidi, Naghmeh

2017-10-01

Gait retraining is a common form of treatment for running related injuries. Proximal factors at the hip have been postulated as having a role in the development of running related injuries. How altering footstrike affects hip muscles forces and kinematics has not been described. Thus, we aimed to quantify differences in hip muscle forces and hip kinematics that may occur when healthy runners are instructed to alter their foot strike pattern from their habitual rear-foot strike to a forefoot strike. This may gain insight on the potential etiology and treatment methods of running related lower extremity injury. Twenty-five healthy female runners completed a minimum of 10 running trials in a controlled laboratory setting under rear-foot strike and instructed forefoot strike conditions. Kinetic and kinematic data were used in an inverse dynamic based static optimization to estimate individual muscle forces during running. Within subject differences were investigated using a repeated measures multi-variate analysis of variance. Peak gluteus medius and minimus and hamstring forces were reduced while peak gluteus maximus force was increased when running with an instructed forefoot strike pattern. Peak hip adduction, hip internal rotation, and heel-COM distance were also reduced. Therefore, instructing habitual rearfoot strike runners to run with a forefoot strike pattern resulted in changes in peak gluteal and hamstring muscle forces and hip kinematics. These changes may be beneficial to the development and treatment of running related lower extremity injury. Copyright © 2017 Elsevier B.V. All rights reserved.

Plantar flaps based on perforators of the plantar metatarsal/common digital arteries.

PubMed

Valentin, Georgescu Alexandru; Rodica, Matei Ileana; Manuel, Llusa

2014-09-01

Because of the unique characteristics of its integument, the affirmation "replacing like with like" becomes more than evident in the reconstruction of defects of the ultraspecialized plantar skin. But, the paucity of local resources, and especially in the forefoot, transforms this attempt in a very challenging problem. Many techniques, including skin grafts and various types of flaps were used in the management of defects in the forefoot. We present a new useful flap in the reconstruction of skin defects in the forefoot, based on small perforator vessels originating either from the plantar metatarsal arteries or plantar common digital arteries. Starting with June 2011, this flap was performed, as plantar transposition perforator flap, plantar propeller flap, or plantar propeller perforator plus flap, in seven patients with ulcers over the plantar forefoot. During a follow-up of 7 to 17 months (mean, 9.8 months), the local evolution regarding flap integration, pain, relapse, sensitive recovery, donor site, and footwear quality was analyzed. We registered a 100% survival rate of the flaps, with delayed healing in only one case. The gait resumption was possible after 6 weeks in all cases. This new flap, based on small perforator vessels from the plantar metatarsal or common digital arteries, and which provides a good, stable, and sensory recovery, seems to be a promising method in the reconstruction of plantar skin defects over the metatarsal heads. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Novel In-Shoe Exoskeleton for Offloading of Forefoot Pressure for Individuals With Diabetic Foot Pathology.

PubMed

Roser, Mark C; Canavan, Paul K; Najafi, Bijan; Cooper Watchman, Marcy; Vaishnav, Kairavi; Armstrong, David G

2017-09-01

Infected diabetic foot ulcers are the leading cause of lower limb amputation. This study evaluated the ability of in-shoe exoskeletons to redirect forces outside of body and through an exoskeleton as an effective means of offloading plantar pressure, the major contributing factor of ulceration. We compared pressure in the forefoot and hind-foot of participants (n = 5) shod with novel exoskeleton footwear. Plantar pressure readings were taken during a 6-m walk at participant's self-selected speed, and five strides were averaged. Results were taken with Achilles exotendon springs disengaged as a baseline, followed by measurements taken with the springs engaged. When springs were engaged, all participants demonstrated a decrease in forefoot pressure, averaging a 22% reduction ( P < .050). Patient feedback was universally positive, preferring the exotendon springs to be engaged and active. Offloading is standard of care for reducing harmful plantar pressure, which may lead to foot ulcers. However, current offloading modalities are limited and have issues. This proof-of-concept study proposed a novel offloading approach based on an exoskeleton solution. Results suggest that when the novel exoskeletons were deployed in footwear and exotendon springs engaged, force was successfully transferred from the lower leg through the exoskeleton-enabled shoe to ground, reducing load on the forefoot. The results need to be confirmed in a larger sample. Another study is warranted to examine the effectiveness of this offloading to prevent diabetic foot ulcer, while minimizing gait alteration in daily physical activities.

Classification of Forefoot Plantar Pressure Distribution in Persons with Diabetes: A Novel Perspective for the Mechanical Management of Diabetic Foot?

PubMed Central

Deschamps, Kevin; Matricali, Giovanni Arnoldo; Roosen, Philip; Desloovere, Kaat; Bruyninckx, Herman; Spaepen, Pieter; Nobels, Frank; Tits, Jos; Flour, Mieke; Staes, Filip

2013-01-01

Background The aim of this study was to identify groups of subjects with similar patterns of forefoot loading and verify if specific groups of patients with diabetes could be isolated from non-diabetics. Methodology/Principal Findings Ninety-seven patients with diabetes and 33 control participants between 45 and 70 years were prospectively recruited in two Belgian Diabetic Foot Clinics. Barefoot plantar pressure measurements were recorded and subsequently analysed using a semi-automatic total mapping technique. Kmeans cluster analysis was applied on relative regional impulses of six forefoot segments in order to pursue a classification for the control group separately, the diabetic group separately and both groups together. Cluster analysis led to identification of three distinct groups when considering only the control group. For the diabetic group, and the computation considering both groups together, four distinct groups were isolated. Compared to the cluster analysis of the control group an additional forefoot loading pattern was identified. This group comprised diabetic feet only. The relevance of the reported clusters was supported by ANOVA statistics indicating significant differences between different regions of interest and different clusters. Conclusion/s Significance There seems to emerge a new era in diabetic foot medicine which embraces the classification of diabetic patients according to their biomechanical profile. Classification of the plantar pressure distribution has the potential to provide a means to determine mechanical interventions for the prevention and/or treatment of the diabetic foot. PMID:24278219

Gender differences in plantar loading during three soccer-specific tasks.

PubMed

Sims, E L; Hardaker, W M; Queen, R M

2008-04-01

Examine the effect of gender on plantar loading during three football-specific tasks. Thirty-four athletes (17 men, 17 women) ran an agility course five times while wearing the Nike Vitoria hard ground cleat. Plantar loading data were recorded during a side cut, a cross-over cut and a forward acceleration task using Pedar-X insoles. Controlled laboratory study. No history of lower extremity injury in the past 6 months, no previous foot or ankle surgery, not currently wearing foot orthotics and play a cleated sport at least two times per week. Contact area, maximum force and the force-time integral (FTI) in the medial and lateral midfoot, medial, middle and lateral forefoot as well as the hallux. A univariate ANCOVA (alpha = 0.05) was performed on each dependent variable (covariate was course speed). Significant gender differences existed in the force and force-time integral beneath the lateral midfoot and forefoot during the cross-over cut task as well as in the middle forefoot during the side cut task with the men demonstrating an increased force. No significant differences existed in the loading on the medial side of the foot during any tasks. The results of this study indicate that the increase in plantar loading on the lateral portion of the midfoot and forefoot in men could be one possible explanation for the increased incidence of fifth metatarsal stress fractures in men. Gender differences in loading patterns need to be considered when comparing different movements as well as different footwear conditions.

Ichnotaxonomy of the Laetoli trackways: The earliest hominin footprints

NASA Astrophysics Data System (ADS)

Meldrum, D. J.; Lockley, Martin G.; Lucas, Spencer G.; Musiba, Charles

2011-04-01

At 3.6 Ma, the Laetoli Pliocene hominin trackways are the earliest direct evidence of hominin bipedalism. Three decades since their discovery, not only is the question of their attribution still discussed, but marked differences in interpretation concerning the footprints' qualitative features and the inferred nature of the early hominin foot morphology remain. Here, we establish a novel ichnotaxon, Praehominipes laetoliensis, for these tracks and clarify the distinctions of these footprints from those of later hominins, especially modern humans. We also contrast hominin, human, and ape footprints to establish morphological features of these footprints correlated with a midtarsal break versus a stiff longitudinal arch. Original photos, including stereo photographs, and casts of footprints from the 1978 Laetoli excavation, confirm midtarsal flexibility, and repeatedly indicate an associated midfoot pressure ridge. In contrast, the modern human footprint reflects the derived arched-foot architecture, combined with a stiff-legged striding gait. Fossilized footprints of unshod modern human pedestrians in Hawaii and Nicaragua unambiguously illustrate these contrasts. Some points of comparisons with ape footprints are complicated by a variable hallucal position and the distinct manner of ape facultative bipedalism. In contrast to the comparatively rigid platform of the modern human foot, midtarsal flexibility is present in the chimpanzee foot. In ape locomotion, flexion at the transverse tarsal joint, referred to as the "midtarsal break," uncouples the respective functions of the prehensile forefoot and the propulsive hindfoot during grasp-climbing. At some point after the transition to habitual bipedalism, these grasp-climb adaptations, presumed to be present in the last common ancestor of apes and humans, were initially compromised by the loss of divergence of the hallux. An analogous trajectory is evident along an array of increasingly terrestrial extant ape species. However, a flexible midfoot was retained, presumably to spare lateral toes from bending stresses by concentrating push-off from the forefoot, beneath the metatarsals. Only later did the evolution of the longitudinal arch permit increased mechanical advantage of the plantarflexors for speed and improved economy of endurance distance walking and running.

Changes in Plantar Loading Based on Shoe Type and Sex During a Jump-Landing Task

PubMed Central

DeBiasio, Justin C.; Russell, Mary E.; Butler, Robert J.; Nunley, James A.; Queen, Robin M.

2013-01-01

Context: Metatarsal stress fractures are common in cleated-sport athletes. Previous authors have shown that plantar loading varies with footwear, sex, and the athletic task. Objective: To examine the effects of shoe type and sex on plantar loading in the medial midfoot (MMF), lateral midfoot (LMF), medial forefoot (MFF), middle forefoot (MidFF), and lateral forefoot (LFF) during a jump-landing task. Design: Crossover study. Setting: Laboratory. Patients or Other Participants: Twenty-seven recreational athletes (14 men, 13 women) with no history of lower extremity injury in the last 6 months and no history of foot or ankle surgery. Main Outcome Measure(s): The athletes completed 7 jumping trials while wearing bladed-cleat, turf-cleat, and running shoes. Maximum force, contact area, contact time, and the force-time integral were analyzed in each foot region. We calculated 2 × 3 analyses of variance (α = .05) to identify shoe-condition and sex differences. Results: We found no shoe × sex interactions, but the MMF, LMF, MFF, and LFF force-time integrals were greater in men (P < .03). The MMF maximum force was less with the bladed-cleat shoes (P = .02). Total foot and MidFF maximum force was less with the running shoes (P < .01). The MFF and LFF maximum forces were different among all shoe conditions (P < .01). Total foot contact area was less in the bladed-cleat shoes (P = .01). The MMF contact area was greatest in the running shoes (P < .01). The LFF contact area was less in the running shoes (P = .03). The MFF and LFF force-time integrals were greater with the bladed-cleat shoes (P < .01). The MidFF force-time integral was less in the running shoes (P < .01). Conclusions: Independent of shoe, men and women loaded the foot differently during a jump landing. The bladed cleat increased forefoot loading, which may increase the risk for forefoot injury. The type of shoe should be considered when choosing footwear for athletes returning to activity after metatarsal stress fractures. PMID:24067149

Outcome of Joint-Preserving Arthroplasty for Rheumatoid Forefoot Deformities.

PubMed

Fukushi, Jun-ichi; Nakashima, Yasuharu; Okazaki, Ken; Yamada, Hisakata; Mawatari, Taro; Ohishi, Masanobu; Oyamada, Akiko; Akasaki, Yukio; Iwamoto, Yukihide

2016-03-01

Along with the recent advances in the pharmacological management of rheumatoid arthritis, there is a trend toward the use of joint-preserving surgery in the treatment of rheumatoid forefoot deformities. However, the clinical outcomes of joint-preserving surgery for rheumatoid forefoot deformities have not been assessed in comparison to resection arthroplasty. We retrospectively evaluated 23 feet in 17 patients with rheumatoid forefoot deformities who underwent surgery between January 2010 and December 2013. The patients included 1 male (1 foot) and 16 females (22 feet), with a mean age of 62 years. The mean length of follow-up was 28 months. The patients were treated by 3 surgeons. One surgeon performed joint-preserving procedures (JP group) to the feet in which (1) no pain with motion existed, and (2) the range of motion in the first metatarsophalangeal (MTP) joint was greater than 30 degrees (n = 10); otherwise, resection arthroplasty with arthrodesis of the first MTP joint was performed (n = 3). The other surgeons performed resection arthroplasty in all cases (n = 10) (RA group, n = 13 in total). The clinical outcomes of the patients were evaluated using the Japanese Society for Surgery of the Foot (JSSF) hallux and lesser toe scales. There were no significant differences in the preoperative total JSSF scores for either the hallux (54.5 and 61.4 points) or the lesser toe (45.2 and 57.4 points) between the RA and JP groups, respectively. Postoperatively, the total JSSF scores for both the hallux (79.4 and 88.2 points) and lesser toes (73.6 and 87.7 points) showed significant improvement in both the RA and JP groups, respectively; however, the JP group showed a greater postoperative improvement. The scores relating to the function category on the hallux scale and the alignment category on the lesser toe scale were significantly higher in the JP group. With regard to the function of the hallux and the alignment of the lesser toes, the joint-preserving procedures for rheumatoid forefoot deformities resulted in better clinical outcomes than resection arthroplasty. Level III, comparative case series. © The Author(s) 2015.

Clinical Implications of Changing Parameters on an Elliptical Trainer.

PubMed

Kaplan, Yonatan; Nyska, Meir; Palmanovich, Ezequiel; Shanker, Rebecca

2014-06-01

Specific weightbearing instructions continue to be a part of routine orthopaedic clinical practice on an injured or postoperative extremity. Researchers and clinicians have struggled to define the best weightbearing strategies to maximize clinical outcomes. To investigate the average percentage body weight (APBW) values, weightbearing distribution percentages (WBDP), and cadence values on the entire foot, hindfoot, and forefoot during changing resistance and incline on an elliptical trainer, as well as to suggest clinical implications. Descriptive laboratory study. An original research study was performed consisting of 30 asymptomatic subjects (mean age, 29.54 ± 12.64 years; range, 21-69 years). The protocol included 3 consecutive tests of changing resistance and incline within a speed range of 70 to 95 steps/min. The SmartStep weightbearing gait analysis system was utilized to measure the values. The APBW values for the entire foot ranged between 70% and 81%, the hindfoot values were between 27% and 57%, and the forefoot values between 42% and 70%. With regard to WBDP, the forefoot remained planted on the pedal (stance phase) 2 to 3 times more as compared with the hindfoot raise in the swing phase. The study findings highlight the fact that elliptical training significantly reduces weightbearing in the hindfoot, forefoot, and entire foot even at higher levels of resistance and incline. Weightbearing on the hindfoot consistently displayed the lowest weightbearing values. Orthopaedic surgeons, now equipped with accurate weightbearing data, may recommend using the elliptical trainer as a weightbearing exercise early on following certain bony or soft tissue pathologies and lower limb surgical procedures.

Comparative biomechanical effectiveness of over-the-counter devices for individuals with a flexible flatfoot secondary to forefoot varus.

PubMed

Hurd, Wendy J; Kavros, Steven J; Kaufman, Kenton R

2010-11-01

Evaluate effects of a new off-the-shelf insert on frontal plane foot biomechanics and compare effectiveness of the new and an existing off-the-shelf insert and a motion-control shoe in neutralizing frontal plane foot biomechanics. Descriptive. Biomechanics laboratory. Fifteen uninjured subjects with a flexible flatfoot secondary to forefoot varus. Three-dimensional kinematic and kinetic data were collected as subjects walked and jogged at their self-selected speed while wearing a motion-control running shoe, the shoe with a new off-the-shelf insert, and the shoe with an existing off-the-shelf insert. Frontal plane kinematics and rearfoot kinetics were evaluated during stance. Statistical analysis was performed using a repeated measures analysis of variance and Student-Newman-Keuls post hoc tests (α ≤ 0.05). The new insert and motion-control shoe placed the forefoot in a less-everted position than the existing off-the-shelf insert during walking. There were no differences in forefoot kinematics during jogging, nor were there differences in rearfoot motion during walking or jogging. The rearfoot eversion moment was significantly lower with the new off-the-shelf insert compared with the motion-control shoe and the existing insert during walking and jogging. A new off-the-shelf device is available that promotes more neutral frontal plane biomechanics, thus providing a theoretical rationale for using this device for injury prevention and treatment. The comparative biomechanical effectiveness of a motion-control shoe and the orthotic inserts may assist health care professionals in selecting a device to correct the flatfoot structure.

Biomechanical consequences of plantar fascial release or rupture during gait. Part II: alterations in forefoot loading.

PubMed

Sharkey, N A; Donahue, S W; Ferris, L

1999-02-01

With a model using feet from cadavers, we tested the hypothesis that plantar fascial release or rupture alters the loading environment of the forefoot during the latter half of the stance phase of gait. The model simulated the position and loading environment of the foot at two instants: early in terminal stance immediately after heel-off and late in terminal stance just preceding contralateral heel strike. Eight feet were loaded at both positions by simulated plantar flexor contraction, and the distribution of plantar pressure was measured before and after progressive release of the plantar fascia. Strain in the diaphysis of the second metatarsal was also measured, from which the bending moments and axial force imposed on the metatarsal were calculated. Cutting the medial half of the central plantar fascial band significantly increased peak pressure under the metatarsal heads but had little effect on pressures in other regions of the forefoot or on second metatarsal strain and loading. Dividing the entire central band or completely releasing the plantar fascia from the calcaneus had a much greater effect and caused significant shifts in plantar pressure and force from the toes to beneath the metatarsal heads. These shifts were accompanied by significantly increased strain and bending in the second metatarsal. Complete fasciotomy increased the magnitude of strain in the dorsal aspect of the second metatarsal by more than 80%, suggesting that plantar fascial release or rupture accelerates the accumulation of fatigue damage in these bones. Altered forefoot loading may be a potential complication of plantar fasciotomy.

Immediate effects of a distal gait modification during stair descent in individuals with patellofemoral pain.

PubMed

Aliberti, Sandra; Mezêncio, Bruno; Amadio, Alberto Carlos; Serrão, Julio Cerca; Mochizuki, Luis

2018-05-23

Knee pain during stair managing is a common complaint among individuals with PFP and can negatively affect their activities of daily living. Gait modification programs can be used to decrease patellofemoral pain. Immediate effects of a stair descent distal gait modification session that intended to emphasize forefoot landing during stair descent are described in this study. To analyze the immediate effects of a distal gait modification session on lower extremity movements and intensity of pain in women with patellofemoral pain during stair descent. Nonrandomized controlled trial. Sixteen women with patellofemoral pain were allocated into two groups: (1) Gait Modification Group (n = 8); and 2) Control Group (n = 8). The intensity of pain (visual analog scale) and kinematics of knee, ankle, and forefoot (multi-segmental foot model) during stair descent were assessed before and after the intervention. After the gait modification session, there was an increase of forefoot eversion and ankle plantarflexion as well as a decrease of knee flexion. An immediate decrease in patellofemoral pain intensity during stair descent was also observed. The distal gait modification session changed the lower extremity kinetic chain strategy of movement, increasing foot and ankle movement contribution and decreasing knee contribution to the task. An immediate decrease in patellofemoral pain intensity during stair descent was also observed. To emphasize forefoot landing may be a useful intervention to immediately relieve pain in patients with patellofemoral pain during stair descent. Clinical studies are needed to verify the gait modification session effects in medium and long terms.

Plantar Pressures After Nonoperative Treatment for Clubfoot: Intermediate Follow-up at Age 5 Years.

PubMed

Jeans, Kelly A; Erdman, Ashley L; Karol, Lori A

2017-01-01

Worldwide, a nonoperative approach in the treatment of idiopathic clubfoot has been taken in an attempt to reduce the incidence of surgical outcomes. Although both the Ponseti casting (Ponseti) and the French physiotherapy (PT) methods have shown gait and pedobarograph differences at age 2 years, improved gait results have been reported by age 5 years. The purpose of this study was to assess plantar pressures in feet treated with the Ponseti versus the PT methods at this intermediate stage. Clubfoot patients treated nonoperatively (Ponseti or PT) underwent pedobarograph data collection at age 5 years. The foot was subdivided into the medial/lateral hindfoot, midfoot, and forefoot regions. Variables included Peak Pressure, Maximum Force, Contact Area%, Contact Time%, Pressure Time Integral, the hindfoot-forefoot angle, and displacement of the center of pressure (COP) line. Twenty controls were used for comparison. Pedobarograph data from 164 patients (238 feet; 122 Ponseti and 116 PT) showed no significant differences between the Ponseti and the PT feet, except the PT feet had a significantly less medial movement of the COP than the Ponseti feet (P=0.0379). Compared with controls, both groups had decreased plantar pressures in the hindfoot and first metatarsal regions, whereas the midfoot and lateral forefoot experienced significant increases compared with controls. This lateralization was also reflected in the hindfoot-forefoot angle and the COP. Feet that remain nonoperative and avoid surgical intervention are considered a good clinical result. However, pedobarograph results indicate mild residual deformity in these feet despite clinically successful outcomes. Level II-therapeutic.

Sensitivity of biomechanical outcomes to independent variations of hindfoot and forefoot stiffness in foot prostheses.

PubMed

Adamczyk, Peter Gabriel; Roland, Michelle; Hahn, Michael E

2017-08-01

Many studies have reported the effects of different foot prostheses on gait, but most results cannot be generalized because the prostheses' properties are seldom reported. We varied hindfoot and forefoot stiffness in an experimental foot prosthesis, in increments of 15N/mm, and tested the parametric effects of these variations on treadmill walking in unilateral transtibial amputees, at speeds from 0.7 to 1.5m/s. We computed outcomes such as prosthesis energy return, center of mass (COM) mechanics, ground reaction forces, and joint mechanics, and computed their sensitivity to component stiffness. A stiffer hindfoot led to reduced prosthesis energy return, increased ground reaction force (GRF) loading rate, and greater stance-phase knee flexion and knee extensor moment. A stiffer forefoot resulted in reduced prosthetic-side ankle push-off and COM push-off work, and increased knee extension and knee flexor moment in late stance. The sensitivity parameters obtained from these tests may be useful in clinical prescription and further research into compensatory mechanisms of joint function. Copyright © 2017 Elsevier B.V. All rights reserved.

A biomechanical investigation of right-forward lunging step among badminton players.

PubMed

Mei, Qichang; Gu, Yaodong; Fu, Fengqin; Fernandez, Justin

2017-03-01

This study presents the kinematics and plantar pressure characteristics of eight elite national-level badminton athletes and eight recreational college-level badminton players while performing a right-forward lunge movement in a laboratory-simulated badminton court. The hypothesis was that recreational players would be significantly different from elite players in kinematics and plantar pressure measures. Vicon ® motion capture and Novel ® insole plantar pressure measurement were simultaneously taken to record the lower extremity kinematics and foot loading during stance. Recreational players showed significantly higher peak pressure in the lateral forefoot (P = 0.002) and force time integral in the lateral forefoot (P = 0.013) and other toes (P = 0.005). Elite athletes showed higher peak pressure in the medial forefoot (P = 0.003), hallux (P = 0.037) and force time integral in the medial forefoot (P = 0.009). The difference in landing techniques for the lunge step between elite athletes and recreational players was observed with peak ankle eversion (-38.2°±2.4° for athletes and -11.1°±3.9° for players, P = 0.015); smaller knee range of motion in the coronal and transverse planes, with differences in peak knee adduction (28.9°±6.8° for athletes and 15.7°±6.2° for players, P = 0.031); peak knee internal rotation (20.3°±1.3° for athletes and 11.8°±3.2° for players, P = 0.029) and peak hip flexion (77.3°±4.1° for athletes and 91.3°±9.3° for players, P = 0.037).

Prevalence estimation and familial tendency of common forefoot deformities in Turkey: A survey of 2662 adults.

PubMed

Şaylı, Uğur; Altunok, Elif Çiğdem; Güven, Melih; Akman, Budak; Biros, Jnev; Şaylı, Ayşe

2018-02-19

This survey was designed to evaluate the prevalence estimations of HV, bunionette, hammertoe as well as their relations to shoe wearing and also familial tendency, in Turkey. Two thousand six hundred sixty two volunteers (1615 females and 1047 males) with a mean age of 34.15 ± 14.23 (range; 18 to 96) years were asked to answer the predetermined questionnaire between January and June, 2016. Hallux valgus, hammertoe and bunionette images were provided as references and every adult participant without any known forefoot problems or past forefoot surgery history was asked to rate his/her foot and to respond the questions about family history and shoe wearing habits. Responses were statistically analyzed. The prevalence estimations of hallux valgus, bunionette and hammertoe were calculated as 54.3%, 13.8% and 8.9% and positive family history rates were 53.2%, 61.2% and 56.1%, respectively. All three deformities were more common in females than in males (p < 0.001). Nonetheless the older age group reported significantly higher prevalence rates for only HV (p < 0.001). Likewise, among the three deformities, females reported a higher rate of positive family history only in HV compared to men (p < 0.001). Constricting shoe wear was found to affect HV incidence in women (p < 0.001) and bunionette incidence in both sexes (p < 0.01). This study concludes that forefoot deformities are common with high familial tendency. Hence it is worthwhile to work on molecular genetics and this may enable the anticipation of forthcoming deformities in order to take early action in prevention, in nearly the half of the population. Copyright © 2018 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

A comparison of foot kinematics in people with normal- and flat-arched feet using the Oxford Foot Model.

PubMed

Levinger, Pazit; Murley, George S; Barton, Christian J; Cotchett, Matthew P; McSweeney, Simone R; Menz, Hylton B

2010-10-01

Foot posture is thought to influence predisposition to overuse injuries of the lower limb. Although the mechanisms underlying this proposed relationship are unclear, it is thought that altered foot kinematics may play a role. Therefore, this study was designed to investigate differences in foot motion between people with normal- and flat-arched feet using the Oxford Foot Model (OFM). Foot posture in 19 participants was documented as normal-arched (n=10) or flat-arched (n=9) using a foot screening protocol incorporating measurements from weightbearing antero-posterior and lateral foot radiographs. Differences between the groups in triplanar motion of the tibia, rearfoot and forefoot during walking were evaluated using a three-dimensional motion analysis system incorporating a multi-segment foot model (OFM). Participants with flat-arched feet demonstrated greater peak forefoot plantar-flexion (-13.7° ± 5.6° vs -6.5° ± 3.7°; p=0.004), forefoot abduction (-12.9° ± 6.9° vs -1.8° ± 6.3°; p=0.002), and rearfoot internal rotation (10.6° ± 7.5° vs -0.2°± 9.9°; p=0.018) compared to those with normal-arched feet. Additionally, participants with flat-arched feet demonstrated decreased peak forefoot adduction (-7.0° ± 9.2° vs 5.6° ± 7.3°; p=0.004) and a trend towards increased rearfoot eversion (-5.8° ± 4.4° vs -2.5° ± 2.6°; p=0.06). These findings support the notion that flat-arched feet have altered motion associated with greater pronation during gait; factors that may increase the risk of overuse injury. Copyright © 2010 Elsevier B.V. All rights reserved.

An Apparatus to Quantify Anteroposterior and Mediolateral Shear Reduction in Shoe Insoles

PubMed Central

Belmont, Barry; Wang, Yancheng; Ammanath, Peethambaran; Wrobel, James S.; Shih, Albert

2013-01-01

Background Many of the physiological changes that lead to diabetic foot ulceration, such as muscle atrophy and skin hardening, are manifested at the foot–ground interface via pressure and shear points. Novel shear-reducing insoles have been developed, but their magnitude of shear stiffness has not yet been compared with regular insoles. The aim of this study was to develop an apparatus that would apply shear force and displacement to an insole’s forefoot region, reliably measure deformation, and calculate insole shear stiffness. Methods An apparatus consisting of suspended weights was designed to test the forefoot region of insoles. Three separate regions representing the hallux; the first and second metatarsals; and the third, fourth, and fifth metatarsals were sheared at 20 mm/min for displacements from 0.1 to 1.0 mm in both the anteroposterior and mediolateral directions for two types of insoles (regular and shear reducing). Results Shear reduction was found to be significant for the intervention insoles under all testing conditions. The ratio of a regular insole’s effective stiffness and the experimental insole’s effective stiffness across forefoot position versus shear direction, gait instance versus shear direction, and forefoot position versus gait instance was 270% ± 79%, 270% ± 96%, and 270% ± 86%, respectively. The apparatus was reliable with an average measured coefficient of variation of 0.034 and 0.069 for the regular and shear-reducing insole, respectively. Conclusions An apparatus consisting of suspended weights resting atop three locations of interest sheared across an insole was demonstrated to be capable of measuring the insole shear stiffness accurately, thus quantifying shear-reducing effects of a new type of insole. PMID:23567000

Parkinsonian abnormality of foot strike: a phenomenon of ageing and/or one responsive to levodopa therapy?

PubMed Central

Hughes, J R; Bowes, S G; Leeman, A L; O'Neill, C J; Deshmukh, A A; Nicholson, P W; Dobbs, S M; Dobbs, R J

1990-01-01

1. Normally during walking, the heel strikes the ground before the forefoot. Abnormalities of foot strike in idiopathic Parkinson's disease may be amenable to therapy: objective measurements may reveal response which is not clinically apparent. Occult changes in foot strike leading to instability may parallel the normal, age-related loss of striatal dopamine. 2. The nature of foot strike was studied using pedobarography in 160 healthy volunteers, aged 15 to 91 years. Although 16% of strikes were made simultaneously by heel and forefoot, there were no instances of the forefoot preceding the heel. No significant effect of age on an index of normality of foot strikes was detected (P greater than 0.3). 3. The effect on foot strike of substituting placebo for a morning dose of a levodopa/carbidopa combination was studied in a double-blind, cross-over trial in 14 patients, aged 64 to 88 years, with no overt fluctuations in control of their idiopathic Parkinson's disease in relation to dosing. On placebo treatment there was a highly significant (P = 0.004) reduction in the number of more normal strikes, i.e. heel strikes plus simultaneous heel and forefoot strikes. The effect appeared unrelated to the corresponding difference between active and placebo treatments in plasma concentration of levodopa or a metabolite of long half-time, 3-O-methyldopa (3OMD). However, it correlated negatively (P less than 0.05) with the mean of the 3OMD concentrations. 4. It appears that some abnormalities of foot strike due to Parkinson's disease are reversible. Employing test conditions, designed to provoke abnormalities of foot strike, might be useful in screening for pre-clinical Parkinson's disease. PMID:2306409

Forefoot Adduction Is a Risk Factor for Jones Fracture.

PubMed

Fleischer, Adam E; Stack, Rebecca; Klein, Erin E; Baker, Jeffrey R; Weil, Lowell; Weil, Lowell Scott

Jones fractures are among the most common fractures of the foot; however, much remains unknown about their etiology. The purpose of the present study was to further examine the risk factors of forefoot and hindfoot alignment on Jones fractures using an epidemiologic study design. We used a retrospective, matched, case-control study design. Cases consisted of patients with acute, isolated Jones fractures confirmed on plain film radiographs seen at our institute from January 2009 to December 2013. Patients presenting with pain unrelated to metatarsal fractures served as controls. Controls were matched to cases by age (±2 years), gender, and year of presentation. Weightbearing foot radiographs were assessed for 13 angular relationships by a single rater. Conditional multivariable logistic regression was used to identify important risk factors. Fifty patients with acute Jones fractures and 200 controls were included. The only significant variables in the final multivariable model were the metatarsus adductus angle (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.08 to 1.25) and fourth/fifth intermetatarsal angle (OR 0.69, 95% CI 0.57 to 0.83)-both measures of static forefoot adduction. The presence of metatarsus adductus (defined as >15°) on foot radiographs was associated with a 2.4 times greater risk of a Jones fracture (adjusted OR 2.4, 95% CI 1.2 to 4.8). We have concluded that the risk of Jones fracture increases with an adducted forefoot posture. In our population, which consisted primarily of patients presenting after a fall (10 of 50; 20%) or misstep/inversion injury (19 of 50; 38%), the hindfoot alignment appeared to be a less important factor. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Foot Placement Characteristics and Plantar Pressure Distribution Patterns during Stepping on Ground in Neonates

PubMed Central

Sylos-Labini, F.; Magnani, S.; Cappellini, G.; La Scaleia, V.; Fabiano, A.; Picone, S.; Paolillo, P.; Di Paolo, A.; Lacquaniti, F.; Ivanenko, Y.

2017-01-01

Stepping on ground can be evoked in human neonates, though it is rather irregular and stereotyped heel-to-toe roll-over pattern is lacking. Such investigations can provide insights into the role of contact- or load-related proprioceptive feedback during early development of locomotion. However, the detailed characteristics of foot placements and their association with motor patterns are still incompletely documented. We elicited stepping in 33 neonates supported on a table. Unilateral limb kinematics, bilateral plantar pressure distribution and EMG activity from up to 11 ipsilateral leg muscles were recorded. Foot placement characteristics in neonates showed a wide variation. In ~25% of steps, the swinging foot stepped onto the contralateral foot due to generally small step width. In the remaining steps with separate foot placements, the stance phase could start with forefoot (28%), midfoot (47%), or heel (25%) touchdowns. Despite forefoot or heel initial contacts, the kinematic and loading patterns markedly differed relatively to toe-walking or adult-like two-peaked vertical force profile. Furthermore, while the general stepping parameters (cycle duration, step length, range of motion of proximal joints) were similar, the initial foot contact was consistently associated with specific center-of-pressure excursion, range of motion in the ankle joint, and the center-of-activity of extensor muscles (being shifted by ~5% of cycle toward the end of stance in the “heel” relative to “forefoot” condition). In sum, we found a variety of footfall patterns in conjunction with associated changes in motor patterns. These findings suggest the potential contribution of load-related proprioceptive feedback and/or the expression of variations in the locomotor program already during early manifestations of stepping on ground in human babies. PMID:29066982

Relationship between foot strike pattern, running speed, and footwear condition in recreational distance runners.

PubMed

Cheung, Roy T H; Wong, Rodney Y L; Chung, Tim K W; Choi, R T; Leung, Wendy W Y; Shek, Diana H Y

2017-06-01

Compared to competitive runners, recreational runners appear to be more prone to injuries, which have been associated with foot strike patterns. Surprisingly, only few studies had examined the foot strike patterns outside laboratories. Therefore, this study compared the foot strike patterns in recreational runners at outdoor tracks with previously reported data. We also investigated the relationship between foot strike pattern, speed, and footwear in this cohort. Among 434 recreational runners analysed, 89.6% of them landed with rearfoot strike (RFS). Only 6.9 and 3.5% landed with midfoot and forefoot, respectively. A significant shift towards non-RFS was observed in our cohort, when compared with previously reported data. When speed increased by 1 m/s, the odds of having forefoot strike and midfoot strike relative to RFS increased by 2.3 times and 2.6 times, respectively. Runners were 9.2 times more likely to run with a forefoot strike in minimalists compared to regular running shoes, although 70% of runners in minimalists continued to use a RFS. These findings suggest that foot strike pattern may differ across running conditions and runners should consider these factors in order to mitigate potential injury.

A kinematic method for footstrike pattern detection in barefoot and shod runners.

PubMed

Altman, Allison R; Davis, Irene S

2012-02-01

Footstrike patterns during running can be classified discretely into a rearfoot strike, midfoot strike and forefoot strike by visual observation. However, the footstrike pattern can also be classified on a continuum, ranging from 0% to 100% (extreme rearfoot to extreme forefoot) using the strike index, a measure requiring force plate data. When force data are not available, an alternative method to quantify the strike pattern must be used. The purpose of this paper was to quantify the continuum of foot strike patterns using an easily attainable kinematic measure, and compare it to the strike index measure. Force and kinematic data from twenty subjects were collected as they ran across an embedded force plate. Strike index and the footstrike angle were identified for the four running conditions of rearfoot strike, midfoot strike and forefoot strike, as well as barefoot. The footstrike angle was calculated as the angle of the foot with respect to the ground in the sagittal plane. Results indicated that the footstrike angle was significantly correlated with strike index. The linear regression model suggested that strike index can be accurately estimated, in both barefoot and shod conditions, in the absence of force data. Copyright © 2011 Elsevier B.V. All rights reserved.

Kinematic and kinetic comparison of barefoot and shod running in mid/forefoot and rearfoot strike runners.

PubMed

Thompson, M A; Lee, S S; Seegmiller, J; McGowan, C P

2015-05-01

Barefoot running has been associated with decreased stride length and switching from a rearfoot strike (RFS) pattern to a mid/forefoot strike (M/FFS) pattern. However, some individuals naturally contact the ground on their mid/forefoot, even when wearing cushioned running shoes. The purpose of this study was to determine if the mechanics of barefoot running by natural shod RFS runners differed from natural shod M/FFS runners. Twenty habitually shod runners (ten natural M/FFS and ten natural RFS) participated in this study. Three-dimensional motion analysis and ground reaction force data were captured as subjects ran at their preferred running speed in both barefoot and shod conditions. M/FFS experienced only a decrease in stride length when switching from shod to barefoot running. Whereas, when switching from shod to barefoot running, RFS individuals experienced a decrease in stride length, switched to a plantarflexed position at ground contact and saw reduced impact peak magnitudes. These results suggest that when barefoot, the RFS group ran similar to the M/FFS group running barefoot or shod. Copyright © 2015 Elsevier B.V. All rights reserved.

Magnitude and Spatial Distribution of Impact Intensity Under the Foot Relates to Initial Foot Contact Pattern.

PubMed

Breine, Bastiaan; Malcolm, Philippe; Segers, Veerle; Gerlo, Joeri; Derie, Rud; Pataky, Todd; Frederick, Edward C; De Clercq, Dirk

2017-12-01

In running, foot contact patterns (rear-, mid-, or forefoot contact) influence impact intensity and initial ankle and foot kinematics. The aim of the study was to compare impact intensity and its spatial distribution under the foot between different foot contact patterns. Forty-nine subjects ran at 3.2 m·s -1 over a level runway while ground reaction forces (GRF) and shoe-surface pressures were recorded and foot contact pattern was determined. A 4-zone footmask (forefoot, midfoot, medial and lateral rearfoot) assessed the spatial distribution of the vertical GRF under the foot. We calculated peak vertical instantaneous loading rate of the GRF (VILR) per foot zone as the impact intensity measure. Midfoot contact patterns were shown to have the lowest, and atypical rearfoot contact patterns the highest impact intensities, respectively. The greatest local impact intensity was mainly situated under the rear- and midfoot for the typical rearfoot contact patterns, under the midfoot for the atypical rearfoot contact patterns, and under the mid- and forefoot for the midfoot contact patterns. These findings indicate that different foot contact patterns could benefit from cushioning in different shoe zones.

Effects of Foot Strike and Step Frequency on Achilles Tendon Stress During Running.

PubMed

Lyght, Michael; Nockerts, Matthew; Kernozek, Thomas W; Ragan, Robert

2016-08-01

Achilles tendon (AT) injuries are common in runners. The AT withstands high magnitudes of stress during running which may contribute to injury. Our purpose was to examine the effects of foot strike pattern and step frequency on AT stress and strain during running utilizing muscle forces based on a musculoskeletal model and subject-specific ultrasound-derived AT cross-sectional area. Nineteen female runners performed running trials under 6 conditions, including rearfoot strike and forefoot strike patterns at their preferred cadence, +5%, and -5% preferred cadence. Rearfoot strike patterns had less peak AT stress (P < .001), strain (P < .001), and strain rate (P < .001) compared with the forefoot strike pattern. A reduction in peak AT stress and strain were exhibited with a +5% preferred step frequency relative to the preferred condition using a rearfoot (P < .001) and forefoot (P=.005) strike pattern. Strain rate was not different (P > .05) between step frequencies within each foot strike condition. Our results suggest that a rearfoot pattern may reduce AT stress, strain, and strain rate. Increases in step frequency of 5% above preferred frequency, regardless of foot strike pattern, may also lower peak AT stress and strain.

Foot and Ankle Kinematics During Descent From Varying Step Heights.

PubMed

Gerstle, Emily E; O'Connor, Kristian; Keenan, Kevin G; Cobb, Stephen C

2017-12-01

In the general population, one-third of incidences during step negotiation occur during the transition to level walking. Furthermore, falls during curb negotiation are a common cause of injury in older adults. Distal foot kinematics may be an important factor in determining injury risk associated with transition step negotiation. The purpose of this study was to identify foot and ankle kinematics of uninjured individuals during descent from varying step heights. A 7-segment foot model was used to quantify kinematics as participants walked on a level walkway, stepped down a single step (heights: 5 cm, 15 cm, 25 cm), and continued walking. As step height increased, landing strategy transitioned from the rearfoot to the forefoot, and the rearfoot, lateral and medial midfoot, and medial forefoot became more plantar flexed. During weight acceptance, sagittal plane range of motion of the rearfoot, lateral midfoot, and medial and lateral forefoot increased as step height increased. The changes in landing strategy and distal foot function suggest a less stable ankle position at initial contact and increased demand on the distal foot at initial contact and through the weight acceptance phase of transition step negotiation as step height increases.

Quantifying coordination among the rearfoot, midfoot, and forefoot segments during running.

PubMed

Takabayashi, Tomoya; Edama, Mutsuaki; Yokoyama, Erika; Kanaya, Chiaki; Kubo, Masayoshi

2018-03-01

Because previous studies have suggested that there is a relationship between injury risk and inter-segment coordination, quantifying coordination between the segments is essential. Even though the midfoot and forefoot segments play important roles in dynamic tasks, previous studies have mostly focused on coordination between the shank and rearfoot segments. This study aimed to quantify coordination among rearfoot, midfoot, and forefoot segments during running. Eleven healthy young men ran on a treadmill. The coupling angle, representing inter-segment coordination, was calculated using a modified vector coding technique. The coupling angle was categorised into four coordination patterns. During the absorption phase, rearfoot-midfoot coordination in the frontal planes was mostly in-phase (rearfoot and midfoot eversion with similar amplitudes). The present study found that the eversion of the midfoot with respect to the rearfoot was comparable in magnitude to the eversion of the rearfoot with respect to the shank. A previous study has suggested that disruption of the coordination between the internal rotation of the shank and eversion of the rearfoot leads to running injuries such as anterior knee pain. Thus, these data might be used in the future to compare to individuals with foot deformities or running injuries.

Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers.

PubMed

Tang, Ulla Hellstrand; Zügner, Roland; Lisovskaja, Vera; Karlsson, Jon; Hagberg, Kerstin; Tranberg, Roy

2015-01-01

Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP) and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and high plantar pressure. Patients diagnosed with type 1 (n=27) or type 2 (n=47) diabetes (mean age 60.0±15.0 years) were included in this cross-sectional study. Assessments included the registration of foot deformities; test of gross function at the hip, knee, and ankle joints; a stratification of the risk of developing foot ulcers according to the Swedish National Diabetes Register; a walking test; and self-reported questionnaires including the SF-36 health survey. In-shoe PP was measured in seven regions of interests on the sole of the foot using F-Scan(®). An exploratory analysis of the association of risk factors with PP was performed. Neuropathy was present in 28 (38%), and 39 (53%) had callosities in the heel region. Low forefoot arch was present in 57 (77%). Gait-related parameters, such as the ability to walk on the forefoot or heel, were normal in all patients. Eighty percent had normal function at the hip and ankle joints. Gait velocity was 1.2±0.2 m/s. All patients were stratified to risk group 3. Hallux valgus and hallux rigidus were associated with an increase in the PP in the medial forefoot. A higher body mass index (BMI) was found to increase the PP at metatarsal heads 4 and 5. Pes planus was associated with a decrease in PP at metatarsal head 1. Neuropathy did not have a high association with PP. This study identified several potential risk factors for the onset of diabetic foot ulcers (DFU). Hallux valgus and hallux rigidus appeared to increase the PP under the medial forefoot and a high BMI appeared to increase the PP under the lateral forefoot. There is a need to construct a simple, valid, and reliable assessment routine to detect potential risk factors for the onset of DFU.

[The Akin procedure as closing wedge osteotomy for the correction of a hallux valgus interphalangeus deformity].

PubMed

Arnold, Heino

2008-12-01

Realignment of the great toe in the case of a hallux valgus interphalangeus by means of a medially based closing wedge osteotomy. Hallux valgus interphalangeus deformity, characterized by an enlarged distal articular surface angle (> 10 degrees). Correction of a hallux valgus interphalangeus deformity as an additional procedure in the case of hallux valgus surgery. Incongruent first metatarsophalangeal joint with lateral subluxation of the proximal phalanx. Isolated procedure to correct hallux valgus deformity. Lack of patient compliance. Neurovascular disturbance of the forefoot. Medially based closing wedge osteotomy of the proximal phalanx to reduce the distal articular surface angle. Fixation with a lag screw, cannulated Herbert screw, memory cramp, threaded Kirschner wire, or interosseous suture. Wound dressing to assure the position of the great toe. Radiographic documentation of the forefoot in two planes. Strict elevation of the operated foot to prevent postoperative swelling. Mobilization of the patient with a forefoot relief orthosis, until consolidation of the osteotomy is verified radiologically (4-5 weeks). Low-molecular-weight heparin for at least 1 week. Hallux valgus bandage or functional taping for 6 weeks postoperatively in patients with additional metatarsal osteotomy. Clinical and radiologic follow-up based on 32 patients showed good results. The postoperative Hallux Score of the American Orthopaedic Foot and Ankle Society improved to 89 points.

Effect of selected exercises on in-shoe plantar pressures in people with diabetes and peripheral neuropathy

PubMed Central

Shah, Kshamata M.; Mueller, Michael J.

2012-01-01

BACKGROUND In people with diabetes and peripheral neuropathy (DM+PN), injury risk is not clearly known for weight bearing (WB) vs. non-weight bearing (NWB) exercise. In-shoe peak plantar pressures (PPP) often are used as a surrogate indicator of injury to the insensitive foot. OBJECTIVE Compare PPPs in people with DM+PN during selected WB and NWB exercises. METHODS 15 subjects with DM+PN participated. PPPs were recorded for the forefoot, midfoot, and heel during level walking and compared to; WB exercises - treadmill walking, heel and toe raises, sit to stands, stair climbing, single leg standing; and NWB exercises - stationary bicycling, balance ball exercise and plantar flexion exercise. RESULTS Compared to level walking; mean forefoot PPP during treadmill walking was 13% higher, but this difference was eliminated when walking speed was used as a covariate. Mean PPPs were similar or substantially lower for other exercises, except for higher forefoot PPP with heel raise exercises. CONCLUSIONS Slow progression and regular monitoring of insensitive feet are recommended for all exercises, but especially for heel raises, and increases in walking speed. The remaining WB and NWB exercises pose no greater risk to the insensitive foot due to increases in PPP compared to level walking. PMID:22677098

Can static foot posture measurements predict regional plantar surface area?

PubMed

McPoil, Thomas G; Haager, Mathew; Hilt, John; Klapheke, John; Martinez, Ray; VanSteenwyk, Cory; Weber, Nicholas; Cornwall, Mark W; Bade, Michael

2014-12-01

The intent of this study was to determine if the use of a single or combination of static foot posture measurements can be used to predict rearfoot, midfoot, and forefoot plantar surface area in individuals with pronated or normal foot types. Twelve foot measurements were collected on 52 individuals (mean age 25.8 years) with the change in midfoot width used to place subjects in a pronated or normal foot mobility group. Dynamic plantar contact area was collected during walking with a pressure sensor platform. The 12 measures were entered into a stepwise regression analysis to determine the optimal set of measures associated with regional plantar surface area. A two variable model was found to describe the relationship between the foot measurements and forefoot plantar contact area (r(2)=0.79, p<0.0001). A four variable model was found to describe the relationship between the foot measurements and midfoot plantar contact area (r(2)=0.85, p<0.0001) in those individuals with a 1.26cm or greater change in midfoot width. The results indicate that clinicians can use a combination of simple, reliable and time efficient foot measures to explain 79% and 85% of the plantar surface area in the forefoot and midfoot, respectively. Copyright © 2014 Elsevier Ltd. All rights reserved.

Variation in Foot Strike Patterns among Habitually Barefoot and Shod Runners in Kenya.

PubMed

Lieberman, Daniel E; Castillo, Eric R; Otarola-Castillo, Erik; Sang, Meshack K; Sigei, Timothy K; Ojiambo, Robert; Okutoyi, Paul; Pitsiladis, Yannis

2015-01-01

Runners are often categorized as forefoot, midfoot or rearfoot strikers, but how much and why do individuals vary in foot strike patterns when running on level terrain? This study used general linear mixed-effects models to explore both intra- and inter-individual variations in foot strike pattern among 48 Kalenjin-speaking participants from Kenya who varied in age, sex, body mass, height, running history, and habitual use of footwear. High speed video was used to measure lower extremity kinematics at ground contact in the sagittal plane while participants ran down 13 meter-long tracks with three variables independently controlled: speed, track stiffness, and step frequency. 72% of the habitually barefoot and 32% of the habitually shod participants used multiple strike types, with significantly higher levels of foot strike variation among individuals who ran less frequently and who used lower step frequencies. There was no effect of sex, age, height or weight on foot strike angle, but individuals were more likely to midfoot or forefoot strike when they ran on a stiff surface, had a high preferred stride frequency, were habitually barefoot, and had more experience running. It is hypothesized that strike type variation during running, including a more frequent use of forefoot and midfoot strikes, used to be greater before the introduction of cushioned shoes and paved surfaces.

Influence of step length and landing pattern on patellofemoral joint kinetics during running.

PubMed

Willson, J D; Ratcliff, O M; Meardon, S A; Willy, R W

2015-12-01

Elevated patellofemoral joint kinetics during running may contribute to patellofemoral joint symptoms. The purpose of this study was to test for independent effects of foot strike pattern and step length on patellofemoral joint kinetics while running. Effects were tested relative to individual steps and also taking into account the number of steps required to run a kilometer with each step length. Patellofemoral joint reaction force and stress were estimated in 20 participants running at their preferred speed. Participants ran using a forefoot strike and rearfoot strike pattern during three different step length conditions: preferred step length, long (+10%) step length, and short (-10%) step length. Patellofemoral kinetics was estimated using a biomechanical model of the patellofemoral joint that accounted for cocontraction of the knee flexors and extensors. We observed independent effects of foot strike pattern and step length. Patellofemoral joint kinetics per step was 10-13% less during forefoot strike conditions and 15-20% less with a shortened step length. Patellofemoral joint kinetics per kilometer decreased 12-13% using a forefoot strike pattern and 9-12% with a shortened step length. To the extent that patellofemoral joint kinetics contribute to symptoms among runners, these running modifications may be advisable for runners with patellofemoral pain. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Independent effects of step length and foot strike pattern on tibiofemoral joint forces during running.

PubMed

Bowersock, Collin D; Willy, Richard W; DeVita, Paul; Willson, John D

2017-10-01

The purpose of this study was to examine the effects of step length and foot strike pattern along with their interaction on tibiofemoral joint (TFJ) and medial compartment TFJ kinetics during running. Nineteen participants ran with a rear foot strike pattern at their preferred speed using a short (-10%), preferred, and long (+10%) step length. These step length conditions were then repeated using a forefoot strike pattern. Regardless of foot strike pattern, a 10% shorter step length resulted in decreased peak contact force, force impulse per step, force impulse per kilometre, and average loading rate at the TFJ and medial compartment, while a 10% increased step length had the opposite effects (all P < 0.05). A forefoot strike pattern significantly lowered TFJ and medial compartment TFJ average loading rates compared with a rear foot strike pattern (both <0.05) but did not change TFJ or medial compartment peak force, force impulse per step, or force impulse per km. The combination of a shorter step length and forefoot strike pattern produced the greatest reduction in peak medial compartment contact force (P < 0.05). Knowledge of these running modification effects may be relevant to the management or prevention of TFJ injury or pathology among runners.

Increased plantar force and impulse in American football players with high arch compared to normal arch

PubMed Central

Carson, Daniel W.; Myer, Gregory D.; Hewett, Timothy E.; Heidt, Robert S.; Ford, Kevin R.

2014-01-01

Background Risk of overuse injury among athletes is high due in part to repeated loading of the lower extremities. Compared to individuals with normal arch (NA) structure, those with high (HA) or low arch (LA) may be at increased risk of specific overuse injuries, including stress fractures. A high medial longitudinal arch may result in decreased shock absorbing properties due to increased rigidity in foot mechanics. While the effect of arch structure on dynamic function has been examined in straight line walking and running, the relationship between the two during multi-directional movements remains unstudied. Objective The purpose of this study was to determine if differences in plantar loading in football players occur during both walking and pivoting movements. Method Plantar loading was examined in 9 regions of the foot for 26 participants (16 NA, 10 HA). Results High arch athletes demonstrated increased maximum force in the lateral rear foot and medial forefoot, and force time integral in the medial forefoot while walking. HA athletes also demonstrated increased maximum force in the medial rear foot and medial and central forefoot during rapid pivoting. Conclusions The current findings demonstrate that loading patterns differ between football players with high and normal arch structure, which could possibly influence injury risk in this population. PMID:23141809

[Grading of the functional sport shoe parameter "cushioning" and "forefoot flexibility" on running shoes].

PubMed

Kleindienst, F I; Krabbe, B; Walther, M; Brüggemann, G-P

2006-03-01

On nearly every running event a heterogeneous structure of participants regarding body height and body weight can be observed. This study should figure out whether the running shoe manufacturers will consider this anthropometric variability. Moreover it should be investigated the runners needs based on different anthropometrics regarding preferred cushioning and forefoot flexibility properties. In order to check whether the running shoe manufacturers will apply a grading pattern, a dynamic material study with conventional running shoes in different sizes was conducted. In a second step a field study in Middle Europe and North America with 244 female and 227 male runners was organized. Every subject had to run and evaluate 7 different shoe modifications. Based on the material study it is to state, that the running shoe manufacturers currently do not consider a systematic grading of cushioning and forefoot flexibility properties. In contrast to this, the field study reveals the necessity to grade these properties. A shoe size dependent and a geographic grading concept are suggested. It is supposed, that the application of these grading concepts do not only provide a comfort improvement, but they also contribute to a reduction of joint loads of the lower extremities and consequently to a prevention of overuse injuries.

Forefoot deformity, pain, and mobility in rheumatoid and nonarthritic subjects.

PubMed

O'Connell, P G; Lohmann Siegel, K; Kepple, T M; Stanhope, S J; Gerber, L H

1998-09-01

To evaluate how painful metatarsal arthritis affects foot and ankle mechanics and mobility. We studied 16 symptomatic forefeet in 10 patients with rheumatoid arthritis (RA) and compared them with 14 asymptomatic forefeet in 7 nonarthritic subjects. RA limbs with significant disease at other locations were excluded. We measured pain and deformity of the foot using a visual analog scale and a modified articular index. A video based 3 dimensional gait analysis system and force platform were used to collect data on subjects walking barefoot at a self-selected pace according to an established protocol. Mobility level was quantified using the Sickness Impact Profile (SIP) ambulation subscale. We observed considerable pain and deformity of the forefeet of RA subjects. During gait, motion and force measures revealed that RA subjects significantly (p < 0.005) delayed and reduced forefoot loading, which minimized use of the foot as a rigid level for push off. As a result, stride lengths were shorter and gait was slower compared to nonarthritic subjects. SIP scores revealed that these changes in gait resulted in moderate disability in RA subjects (p=0.05). Impairments of the forefoot due to RA include pain and deformity, which produce characteristic stance phase abnormalities in foot function, a slow walking speed, and moderate disability.

Analysis of foot kinematics wearing high heels using the Oxford foot model.

PubMed

Wang, Meizi; Gu, Yaodong; Baker, Julien Steven

2018-04-29

Wearing high heels is thought to lead to various foot disorders and injuries such as metatarsal pain, Achilles tendon tension, plantar fasciitis and Haglund malformation. However, there is little available information explaining the specific mechanisms and reasons why wearing high heels causes foot deformity. Therefore, the purpose of this study was to investigate the foot kinematics of high heel wearers and compare any differences with barefoot individuals using the Oxford Foot Model (OFM). Fifteen healthy women aged 20-25 years were measured while walking barefoot and when wearing high heels. The peak value of angular motion for the hallux with respect to the forefoot, the forefoot with respect to the hind foot, and the hind foot with respect to the tibia were all analyzed. Compared to the barefoot, participants wearing high heels demonstrated larger hallux dorsiflexion (22.55∘± 1.62∘ VS 26.6∘± 2.33∘ for the barefoot; P= 0.001), and less hallux plantarflexion during the initial stance phase (-4.86∘± 2.32∘ VS -8.68∘± 1.13∘; P< 0.001). There were also greater forefoot adduction (16.15∘± 1.37∘ VS 13.18∘± 0.79∘; P< 0.001), but no significant differences were found in forefoot abduction between the two conditions. The hind foot demonstrated a larger dorsiflexion in the horizontal plane (16.59∘± 1.69∘ VS 12.08∘± 0.9∘; P< 0.001), greater internal rotation (16.72∘± 0.48∘ VS 7.97∘± 0.55∘; P< 0.001), and decreased peak hind foot extension rotation (-5.49∘± 0.69∘ VS -10.73∘± 0.42∘; P= 0.001). These findings complement existing kinematic evidence that wearing high heels can lead to foot deformities and injuries.

Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers

PubMed Central

Tang, Ulla Hellstrand; Zügner, Roland; Lisovskaja, Vera; Karlsson, Jon; Hagberg, Kerstin; Tranberg, Roy

2015-01-01

Objective Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP) and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and high plantar pressure. Patients and methods Patients diagnosed with type 1 (n=27) or type 2 (n=47) diabetes (mean age 60.0±15.0 years) were included in this cross-sectional study. Assessments included the registration of foot deformities; test of gross function at the hip, knee, and ankle joints; a stratification of the risk of developing foot ulcers according to the Swedish National Diabetes Register; a walking test; and self-reported questionnaires including the SF-36 health survey. In-shoe PP was measured in seven regions of interests on the sole of the foot using F-Scan®. An exploratory analysis of the association of risk factors with PP was performed. Results Neuropathy was present in 28 (38%), and 39 (53%) had callosities in the heel region. Low forefoot arch was present in 57 (77%). Gait-related parameters, such as the ability to walk on the forefoot or heel, were normal in all patients. Eighty percent had normal function at the hip and ankle joints. Gait velocity was 1.2±0.2 m/s. All patients were stratified to risk group 3. Hallux valgus and hallux rigidus were associated with an increase in the PP in the medial forefoot. A higher body mass index (BMI) was found to increase the PP at metatarsal heads 4 and 5. Pes planus was associated with a decrease in PP at metatarsal head 1. Neuropathy did not have a high association with PP. Conclusions This study identified several potential risk factors for the onset of diabetic foot ulcers (DFU). Hallux valgus and hallux rigidus appeared to increase the PP under the medial forefoot and a high BMI appeared to increase the PP under the lateral forefoot. There is a need to construct a simple, valid, and reliable assessment routine to detect potential risk factors for the onset of DFU. PMID:26087865

[Dynamic plantar pressure distribution after percutaneous hallux valgus correction using the Reverdin-Isham osteotomy].

PubMed

Rodríguez-Reyes, Gerardo; López-Gavito, Eduardo; Pérez-Sanpablo, Alberto Isaac; Galván Duque-Gastélum, Carlos; Alvarez-Camacho, Michelín; Mendoza-Cruz, Felipe; Parra-Téllez, Patricia; Vázquez-Escamilla, Jesús; Quiñones-Urióstegui, Ivett

2014-07-01

Percutaneous surgical techniques are suitable for the correction of the hallux valgus deformity. Satisfactory aesthetic and functional results obtained with the Reverdin- Isham osteotomy have been reported. The aim of this study was to describe dynamic plantar pressure redistribution after the correction of the deformity using this technique. A sample of 20 feet with mild or moderate hallux valgus was conformed and surgically treated using the Reverdin-Isham osteotomy. Clinical, radiological, surface and pressure assessments were performed pre and postoperatively. Postoperative mean (± SD) values of the American Orthopaedic Foot and Ankle Society (AOFAS) score, metatarsophalangeal, first intermetatarsal and proximal articular sect angles were 95.7 (3.3), 15.5° (5.4), 9.5° (1.5) y 5.3° (3.0), respectively. A significant decrease was observed in surface values of both lateral (P = 0.003) and medial (P = 0.001) masks of the forefoot. Mean pressure values of the lateral forefoot region denoted a significant increase (P < 0.001) while the medial forefoot region showed no change (P = 0.137). There is evidence that this particular surgical technique promotes a new plantar pressure pattern in the foot that might significantly favour the increase of the pressure observed under the lesser metatarsal heads and might not induce meaningful changes in the mean pressure registered under the first metatarsal head and hallux.

Influence of in-shoe heel lifts on plantar pressure and center of pressure in the medial-lateral direction during walking.

PubMed

Zhang, Xianyi; Li, Bo

2014-04-01

The aim of this study was to investigate how the height and material of in-shoe heel lifts affect plantar pressure and center of pressure (COP) trajectory in the medial-lateral direction during walking. Seventeen healthy young male adults were asked to walk along an 8m walkway while wearing a high-cut flat shoe and 5 different heel lifts. Peak pressure (PP), pressure-time integral (PTI) and contact area (CA) were measured by Pedar insole system for three foot regions: forefoot, midfoot and heel. Range and velocity of medial-lateral (ML) COP during forefoot contact phase (FFCP) and foot flat phase (FFP) were collected using Footscan pressure plate. Forefoot pressure and ML-COP parameters increased as the heel was elevated. Statistically significant attenuation of heel peak plantar pressure was provided by all heel lifts except for the hard lift. Post hoc tests suggest that material had a greater influence on the range and velocity of ML-COP during FFCP than heel height, while during FFP, heel height seemed to affect these parameters more. The findings from this study suggest that thick heel lifts should be used with caution, and that a heel lift made of materials with good support and elastic properties might be more appropriate to improve footwear comfort and medial-lateral motion control. Copyright © 2013 Elsevier B.V. All rights reserved.

Variation in Foot Strike Patterns among Habitually Barefoot and Shod Runners in Kenya

PubMed Central

Lieberman, Daniel E.; Castillo, Eric R.; Otarola-Castillo, Erik; Sang, Meshack K.; Sigei, Timothy K.; Ojiambo, Robert; Okutoyi, Paul; Pitsiladis, Yannis

2015-01-01

Runners are often categorized as forefoot, midfoot or rearfoot strikers, but how much and why do individuals vary in foot strike patterns when running on level terrain? This study used general linear mixed-effects models to explore both intra- and inter-individual variations in foot strike pattern among 48 Kalenjin-speaking participants from Kenya who varied in age, sex, body mass, height, running history, and habitual use of footwear. High speed video was used to measure lower extremity kinematics at ground contact in the sagittal plane while participants ran down 13 meter-long tracks with three variables independently controlled: speed, track stiffness, and step frequency. 72% of the habitually barefoot and 32% of the habitually shod participants used multiple strike types, with significantly higher levels of foot strike variation among individuals who ran less frequently and who used lower step frequencies. There was no effect of sex, age, height or weight on foot strike angle, but individuals were more likely to midfoot or forefoot strike when they ran on a stiff surface, had a high preferred stride frequency, were habitually barefoot, and had more experience running. It is hypothesized that strike type variation during running, including a more frequent use of forefoot and midfoot strikes, used to be greater before the introduction of cushioned shoes and paved surfaces. PMID:26154285

Foot strike patterns of recreational and sub-elite runners in a long-distance road race.

PubMed

Larson, Peter; Higgins, Erin; Kaminski, Justin; Decker, Tamara; Preble, Janine; Lyons, Daniela; McIntyre, Kevin; Normile, Adam

2011-12-01

Although the biomechanical properties of the various types of running foot strike (rearfoot, midfoot, and forefoot) have been studied extensively in the laboratory, only a few studies have attempted to quantify the frequency of running foot strike variants among runners in competitive road races. We classified the left and right foot strike patterns of 936 distance runners, most of whom would be considered of recreational or sub-elite ability, at the 10 km point of a half-marathon/marathon road race. We classified 88.9% of runners at the 10 km point as rearfoot strikers, 3.4% as midfoot strikers, 1.8% as forefoot strikers, and 5.9% of runners exhibited discrete foot strike asymmetry. Rearfoot striking was more common among our sample of mostly recreational distance runners than has been previously reported for samples of faster runners. We also compared foot strike patterns of 286 individual marathon runners between the 10 km and 32 km race locations and observed increased frequency of rearfoot striking at 32 km. A large percentage of runners switched from midfoot and forefoot foot strikes at 10 km to rearfoot strikes at 32 km. The frequency of discrete foot strike asymmetry declined from the 10 km to the 32 km location. Among marathon runners, we found no significant relationship between foot strike patterns and race times.

Reliability of Baropodometry on the Evaluation of Plantar Load Distribution: A Transversal Study.

PubMed

Baumfeld, Daniel; Baumfeld, Tiago; da Rocha, Romário Lopes; Macedo, Benjamim; Raduan, Fernando; Zambelli, Roberto; Alves Silva, Thiago Alexandre; Nery, Caio

2017-01-01

Introduction . Baropodometry is used to measure the load distribution on feet during rest and walking. The aim of this study was to evaluate changes in plantar foot pressures distribution due to period of working and due to stretching exercises of the posterior muscular chain. Methods . In this transversal study, all participants were submitted to baropodometric evaluation at two different times: before and after the working period and before and after stretching the muscles of the posterior chain. Results . We analyzed a total of 54 feet of 27 participants. After the working period, there was an average increase in the forefoot pressure of 0.16 Kgf/cm 2 and an average decrease in the hindfoot pressure of 0.17 Kgf/cm 2 . After stretching the posterior muscular chain, the average increase in the forefoot pressure was 0.56 Kgf/cm 2 and the hindfoot average pressure decrease was 0.56 Kgf/cm 2 . These changes were not statistically significant. Discussion . It was reported that the strength of the Achilles tendon generates greater forefoot load transferred from the hindfoot. In our study, no significant variation in the distribution of plantar pressure was observed. It can be inferred that baropodometry was a reliable instrument to determine the plantar pressure, regardless of the tension of the posterior chain muscles.

[Case report: comprehensive treatment of forefoot with double brachymetatarsia in one surgical stage].

PubMed

Caldiño-Lozada, I; Gallegos-de la Torre, O; Esperón-Hernández, R

2017-01-01

Brachymetatarsia (shortening of the metatarsal) directly affects the transversal arch of the foot causing severe deformities, such as hallux valgus, divergent toes, overlapping toes, metatarsalgia, all of these alter the biomechanics of the foot and gait. Treatment consists of two main techniques, one-stage lengthening with bone graft or elongation through callotaxis with external fixator; there are variants of both techniques used to minimize the disadvantages of each. The objective of treatment must be to return the structural harmony to the forefoot, improving the biomechanics, resulting in a satisfactory outcome for the patients. This article presents a surgical treatment for feet with closed physis to obtain the appropriate metatarsal formula and to reestablish aesthetics and function. This case was treated by means of one-stage lengthening with bone graft to the affected metatarsal; shortening of the adjacent metatarsals; hallux valgus alignment through the necessary osteotomies and the treatment of deformities of the lesser toes as needed. This surgical technique has as one of its advantages the correction of the entire forefoot at one time, without the need of an external fixator and its required postoperative care. Its main disadvantages are its dependence on structural bone graft and the need of postoperative dressing until healing of the bone has taken place. Satisfactory clinical and radiographical outcomes were obtained in treated patient.

Walking ability as a measure of treatment effect in early rheumatoid arthritis.

PubMed

Hamilton, J; Brydson, G; Fraser, S; Grant, M

2001-04-01

To assess the clinical usefulness of a prototype walkmat system in patients with early rheumatoid arthritis (RA). Twenty-four subjects with early RA and symptomatic forefoot disease requiring therapy with second-line drugs were recruited. Each subject underwent clinical assessment together with gait analysis on the contact sensitive walkmat system and Kistler forceplate before and after six months of treatment with second-line drugs. Two subjects were lost to follow-up. There was the expected improvement in disease activity in response to therapy. Significant differences were also demonstrated in defined gait parameters that indicated improved weight-bearing and enhanced forefoot propulsion. Medical therapy improved walking ability in patients with RA and the walkmat system provided a useful adjunct to existing outcome measures in the assessment of lower limb function.

A finite element model of the foot and ankle for automotive impact applications.

PubMed

Shin, Jaeho; Yue, Neng; Untaroiu, Costin D

2012-12-01

A finite element (FE) model of the foot and leg was developed to improve understanding of injury mechanisms of the ankle and subtalar joints during vehicle collisions and to aid in the design of injury countermeasures. The FE model was developed based on the reconstructed geometry of a male volunteer close to the anthropometry of a 50th percentile male and a commercial anatomical database. While the forefoot bones were defined as rigid bodies connected by ligament models, the surrounding bones of the ankle and subtalar joints and the leg bones were modeled as deformable structures. The material and structural properties were selected based on a synthesis of current knowledge of the constitutive models for each tissue. The whole foot and leg model was validated in different loading conditions including forefoot impact, axial rotation, dorsiflexion, and combined loadings. Overall results obtained in the model validation indicated improved biofidelity relative to previous FE models. The developed model was used to investigate the injury tolerance of the ankle joint under brake pedal loading for internally and externally rotated feet. Ligament failures were predicted as the main source of injury in this loading condition. A 12% variation of failure moment was observed in the range of axial foot rotations (±15°). The most vulnerable position was the internally rotated (15°) posture among three different foot positions. Furthermore, the present foot and ankle model will be coupled together with other body region FE models into the state-of-art human FE model to be used in the field of automotive safety.

Metabolic and mechanical aspects of foot landing type, forefoot and rearfoot strike, in human running.

PubMed

Ardigò, L P; Lafortuna, C; Minetti, A E; Mognoni, P; Saibene, F

1995-09-01

The study was undertaken to assess the metabolic and the mechanical aspects of two different foot strike patterns in running, i.e. forefoot and rearfoot striking (FFS and RFS), and to understand whether there is some advantage for a runner to use one or the other of the two landing styles. Eight subjects performed two series of runs (FFS and RFS) on a treadmill at an average speed of 2.50, 2.78, 3.06, 3.33, 3.61, 3.89, 4.17 m s-1. Step frequency, oxygen uptake, mechanical work, and its two components, external and internal, were measured. No differences were found for step frequency, mechanical internal work per unit time and oxygen uptake, while external and total mechanical work per unit time were significantly higher, 7-12%, for FFS. The higher external work was the result of an increase of the work performed against both gravitational and inertial forces. As the energy expenditure was the same it has been speculated that a higher storage and release of energy takes place in the elastic structures of the lower leg with FFS. In a different series of experiments on six subjects contact time, time of deceleration and time of acceleration were measured by means of a video camera while running on the treadmill at 2.50, 3.33 and 4.17 m s-1, both FFS and RFS. Time of deceleration is similar for FFS and RFS, but contact time and time of acceleration are shorter, respectively 12 and 25%, for FFS.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of low-dye taping on plantar pressure pre and post exercise: an exploratory study.

PubMed

Nolan, Damien; Kennedy, Norelee

2009-04-21

Low-Dye taping is used for excessive pronation at the subtalar joint of the foot. Previous research has focused on the tape's immediate effect on plantar pressure. Its effectiveness following exercise has not been investigated. Peak plantar pressure distribution provides an indirect representation of subtalar joint kinematics. The objectives of the study were 1) To determine the effects of Low-Dye taping on peak plantar pressure immediately post-application. 2) To determine whether any initial effects are maintained following exercise. 12 asymptomatic subjects participated; each being screened for excessive pronation (navicular drop > 10 mm). Plantar pressure data was recorded, using the F-scan, at four intervals during the testing session: un-taped, baseline-taped, post-exercise session 1, and post-exercise session 2. Each exercise session consisted of a 10-minute walk at a normal pace. The foot was divided into 6 regions during data analysis. Repeated-measures analysis of variance (ANOVA) was used to assess regional pressure variations across the four testing conditions. Reduced lateral forefoot peak plantar pressure was the only significant difference immediately post tape application (p = 0.039). This effect was lost after 10 minutes of exercise (p = 0.036). Each exercise session resulted in significantly higher medial forefoot peak pressure compared to un-taped; (p = 0.015) and (p = 0.014) respectively, and baseline-taped; (p = 0.036) and (p = 0.015) respectively. Medial and lateral rearfoot values had also increased after the second session (p = 0.004), following their non-significant reduction at baseline-taped. A trend towards a medial-to-lateral shift in pressure present in the midfoot immediately following tape application was still present after 20 minutes of exercise. Low-Dye tape's initial effect of reduced lateral forefoot peak plantar pressure was lost after a 10-minute walk. However, the tape continued to have an effect on the medial forefoot after 20 minutes of exercise. Further studies with larger sample sizes are required to examine the important finding of the anti-pronatory trend present in the midfoot.

Selective plantar fascia release for nonhealing diabetic plantar ulcerations.

PubMed

Kim, J Young; Hwang, Seungkeun; Lee, Yoonjung

2012-07-18

Achilles tendon lengthening can decrease plantar pressures, leading to resolution of forefoot ulceration in patients with diabetes mellitus. However, this procedure has been reported to have a complication rate of 10% to 30% and can require a long period of postoperative immobilization. We have developed a new technique, selective plantar fascia release, as an alternative to Achilles tendon lengthening for managing these forefoot ulcers. We evaluated sixty patients with diabetes for a mean of 23.5 months after selective plantar fascia release for the treatment of nonhealing diabetic neuropathic ulcers in the forefoot. Preoperative and postoperative dorsiflexion range of motion of the affected metatarsophalangeal joint and wound-healing data were used to evaluate the effectiveness of the procedure and to determine the relationship between plantar fascia release and ulcer healing. Complications were recorded. Thirty-six (56%) of the ulcers healed within six weeks, including twenty-nine (60%) of the plantar toe ulcers and seven (44%) of the metatarsophalangeal joint ulcers. The mean range of motion of the affected metatarsophalangeal joint increased from 15.3° ± 7.8° to 30.6° ± 14.1° postoperatively (p < 0.05). All patients in whom the preoperative dorsiflexion of the affected metatarsophalangeal joint was between 5° and 30° and in whom the range of motion of that joint increased by ≥13° after the procedure experienced healing of the ulcer. No ulcer recurrence in the original location was identified during follow-up. No patients experienced any complications associated with the selective plantar fascia release. Our results suggest that selective plantar fascia release can lead to healing of neuropathic plantar forefoot ulcers in diabetic patients. Ulcers in patients in whom the preoperative dorsiflexion angle of the affected metatarsophalangeal joint is between 5° and 30° and in whom the increase in range of motion is ≥13° postoperatively have the greatest chance of being cured. Therapeutic level IV. See Instructions for Authors for a complete description of the levels of evidence.

Is there evidence to support a forefoot strike pattern in barefoot runners? A review.

PubMed

Lorenz, Daniel S; Pontillo, Marisa

2012-11-01

Barefoot running is a trend among running enthusiasts that is the subject of much controversy. At this time, benefits appear to be more speculative and anecdotal than evidence based. Additionally, the risk of injuries is not well established. A PubMed search was undertaken for articles published in English from 1980 to 2011. Additional references were accrued from reference lists of research articles. While minimal data exist that definitively support barefoot running, there are data lending support to the argument that runners should use a forefoot strike pattern in lieu of a heel strike pattern to reduce ground reaction forces, ground contact time, and step length. Whether there is a positive or negative effect on injury has yet to be determined. Unquestionably, more research is needed before definitive conclusions can be drawn.

Static ankle joint equinus: toward a standard definition and diagnosis.

PubMed

Charles, James; Scutter, Sheila D; Buckley, Jonathan

2010-01-01

Equinus is characterized by reduced dorsiflexion of the ankle joint, but there is a lack of consensus regarding criteria for definition and diagnosis. This review examines the literature relating to the definition, assessment, diagnosis, prevalence, and complications of equinus. Articles on equinus and assessment of ankle joint range of motion were identified by searching the EMBASE, Medline, PubMed, EBSCOhost, Cinahl, and Cochrane databases and by examining the reference lists of the articles found. There is inconsistency regarding the magnitude of reduction in dorsiflexion required to constitute a diagnosis of equinus and no standard method for assessment; hence, the prevalence of equinus is unknown. Goniometric assessment of ankle joint range of motion was shown to be unreliable, whereas purpose-built tools demonstrated good reliability. Reduced dorsiflexion is associated with alterations in gait, increased forefoot pressure, and ankle injury, the magnitude of reduction in range of motion required to predispose to foot or lower-limb abnormalities is not known. In the absence of definitive data, we propose a two-stage definition of equinus: the first stage would reflect dorsiflexion of less than 10 degrees with minor compensation and a minor increase in forefoot pressure, and the second stage would reflect dorsiflexion of less than 5 degrees with major compensation and a major increase in forefoot pressure. This proposed definition of equinus will assist with standardizing the diagnosis and will provide a basis for future studies of the prevalence, causes, and complications of this condition.

The effects of prosthetic foot roll-over shape arc length on the gait of trans-tibial prosthesis users.

PubMed

Hansen, Andrew H; Meier, Margrit R; Sessoms, Pinata H; Childress, Dudley S

2006-12-01

The Shape&Roll prosthetic foot was used to examine the effect of roll-over shape arc length on the gait of 14 unilateral trans-tibial prosthesis users. Simple modifications to the prosthetic foot were used to alter the effective forefoot rocker length, leaving factors such as alignment, limb length, and heel and mid-foot characteristics unchanged. Shortening the roll-over shape arc length caused a significant reduction in the maximum external dorsiflexion moment on the prosthetic side at all walking speeds (p < 0.001 for main effect of arc length), due to a reduction in forefoot leverage (moment arm) about the ankle. Roll-over shape arc length significantly affected the initial loading on the sound limb at normal and fast speeds (p = 0.001 for the main effect of arc length), with participants experiencing larger first peaks of vertical ground reaction forces on their sound limbs when using the foot with the shortest effective forefoot rocker arc length. Additionally, the difference between step lengths on the sound and prosthetic limbs was larger with the shortest arc length condition, although this difference was not statistically significant (p = 0.06 for main effect). It appears that prosthesis users may experience a drop-off effect at the end of single limb stance on prosthetic feet with short roll-over shape arc lengths, leading to increased loading and/or a shortened step on the contralateral limb.

Effects of prosthetic foot forefoot flexibility on oxygen cost and subjective preference rankings of unilateral transtibial prosthesis users.

PubMed

Klodd, Elizabeth; Hansen, Andrew; Fatone, Stefania; Edwards, Mark

2010-01-01

The investigators conducted a double-blind randomized crossover study to determine the effects of prosthetic foot forefoot flexibility on oxygen cost and subjective preference rankings of 13 unilateral transtibial prosthesis users. Five experimental feet were fabricated for use in the study: F1, F2, F3, F4, and F5. F1 was most flexible, F5 was least flexible, and F3 was designed to conform to a biomimetic ankle-foot roll-over shape. The experimental feet were modeled after the Shape&Roll prosthetic foot (originally produced by Northwestern University, Chicago, Illinois; now in public domain) but had different numbers of saw cuts within the forefoot members, allowing more or less flexibility during walking. Participants walked at the same comfortable, freely selected speed on the treadmill for 7 min with each foot while energy expenditure was measured. No significant difference was found in oxygen cost (mL O(2)/kg/m) between the different feet (p = 0.17), and the order of use was also not significant (p = 0.94). However, the preference ranking was significantly affected by the flexibility of the feet (p = 0.002), with the most flexible foot (F1) ranking significantly poorer than feet F3 (p = 0.003) and F4 (p = 0.004). Users may prefer prosthetic feet that match the flexibility of an intact ankle-foot system, even though we did not detect an energetic benefit at freely selected speeds.

Interaction effects of stride angle and strike pattern on running economy.

PubMed

Santos-Concejero, J; Tam, N; Granados, C; Irazusta, J; Bidaurrazaga-Letona, I; Zabala-Lili, J; Gil, S M

2014-12-01

This study aimed to investigate the relationship between stride angle and running economy (RE) in athletes with different foot strike patterns. 30 male runners completed 4 min running stages on a treadmill at different velocities. During the test, biomechanical variables such as stride angle, swing time, contact time, stride length and frequency were recorded using an optical measurement system. Their foot strike pattern was determined, and VO2 at velocities below the lactate threshold were measured to calculate RE. Midfoot/forefoot strikers had better RE than rearfoot strikers (201.5±5.6 ml · kg(-1) · km(-1) vs. 213.5±4.2 ml · kg(-1) · km(-1)respectively; p=0.019). Additionally, midfoot/fore-foot strikers presented higher stride angles than rearfoot strikers (p=0.043). Linear modelling analysis showed that stride angle is closely related to RE (r=0.62, p<0.001) and that the effect of stride angle on RE was different in the 2 groups. From an arbitrary value of 4°, a rearfoot strike pattern is likely to be more economical, whereas at any lower degree, the midfoot/forefoot strike pattern appears to be more desirable. A biomechanical running technique characterised by high stride angles and a midfoot/forefoot strike pattern is advantageous for a better RE. Athletes may find stride angle useful for improving RE. © Georg Thieme Verlag KG Stuttgart · New York.

Lower extremity joint loads in habitual rearfoot and mid/forefoot strike runners with normal and shortened stride lengths.

PubMed

Boyer, Elizabeth R; Derrick, Timothy R

2018-03-01

Our purpose was to compare joint loads between habitual rearfoot (hRF) and habitual mid/forefoot strikers (hFF), rearfoot (RFS) and mid/forefoot strike (FFS) patterns, and shorter stride lengths (SLs). Thirty-eight hRF and hFF ran at their normal SL, 5% and 10% shorter, as well as with the opposite foot strike. Three-dimensional ankle, knee, patellofemoral (PF) and hip contact forces were calculated. Nearly all contact forces decreased with a shorter SL (1.2-14.9% relative to preferred SL). In general, hRF had higher PF (hRF-RFS: 10.8 ± 1.4, hFF-FFS: 9.9 ± 2.0 BWs) and hip loads (axial hRF-RFS: -9.9 ± 0.9, hFF-FFS: -9.6 ± 1.0 BWs) than hFF. Many loads were similar between foot strike styles for the two groups, including axial and lateral hip, PF, posterior knee and shear ankle contact forces. Lateral knee and posterior hip contact forces were greater for RFS, and axial ankle and knee contact forces were greater for FFS. The tibia may be under greater loading with a FFS because of these greater axial forces. Summarising, a particular foot strike style does not universally decrease joint contact forces. However, shortening one's SL 10% decreased nearly all lower extremity contact forces, so it may hold potential to decrease overuse injuries associated with excessive joint loads.

Validation of an algorithm to predict reulceration in amputation patients with diabetes.

PubMed

Molines-Barroso, Raúl J; Lázaro-Martínez, José L; Álvaro-Afonso, Francisco J; Sanz-Corbalán, Irene; García-Klepzig, José L; Aragón-Sánchez, Javier

2017-06-01

The aim of this article was to assess the ability to predict reulceration in people with diabetes and a history of minor amputation according to the formula proposed by Miller et al. A retrospective study was performed on 156 consecutive records of patients with a recent history of simple or multiple forefoot amputation. The sample was divided according to Miller's formula into patients at low risk of reulceration and those at high risk; those were further divided into two subgroups according to whether or not the first segment of the forefoot had been amputated. Forty-eight (47·1%) individuals suffered forefoot reulceration, showing a median reulceration-free survival time of 8 months [interquartile range (IR) 3·6-14·8]. Nephropathy (P = 0.005) and Miller's formula (P = 0.028) were risk factors for reulceration-free survival time in the univariate analysis. The pattern relating to the first segment amputated [hazard ratio (HR) 2·853; P = 0·004; 95% confidence interval (CI) 1·391-5·849] and nephropathy (HR 2·468; P = 0.004; 95% CI 1.328-4.587) showed a significant hazard ratio in the multivariate Cox model. Participants with first segment amputation and one other amputation showed an association with the probability of reulceration in comparison with any other specific type of minor amputation. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

The Effectiveness of Calf Muscle Electrostimulation on Vascular Perfusion and Walking Capacity in Patients Living With Type 2 Diabetes Mellitus and Peripheral Artery Disease.

PubMed

Ellul, Christian; Formosa, Cynthia; Gatt, Alfred; Hamadani, Auon Abbas; Armstrong, David G

2017-06-01

The aim of the study was to explore calf muscle electrostimulation on arterial inflow and walking capacity in claudicants with peripheral artery disease and diabetes mellitus. A prospective, 1-group, pretest-posttest study design was used on 40 high-risk participants (n = 40) who exhibited bilateral limb ischemia (ankle brachial pressure index [ABPI] <0.90), diabetes mellitus, and calf muscle claudication. A program of calf muscle electrical stimulation with varying frequency (1-250 Hz) was prescribed for 1 hour per day for 12 weeks. Spectral waveforms analysis, ABPI, absolute claudication distance (ACD), and thermographic temperature patterns across 4 specified regions of interest (hallux, medial forefoot, lateral forefoot, heel) at rest and after exercise, were recorded at baseline and following intervention to evaluate for therapeutic outcomes. A significant improvement in ACD and ABPI was registered following the intervention ( P = .000 and P = .001, respectively). Resting foot temperatures increased significantly ( P = .000) while the postexercise temperature drops were halved across all regions at follow-up, with hallux ( P = .005) and lateral forefoot ( P = .038) reaching statistical significance. Spectral Doppler waveforms were comparable ( P = .304) between both serial assessments. Electrical stimulation of varying frequency for 1 hour per day for 12 consecutive weeks registered statistically significant improvement in outcome measures that assess arterial inflow and walking capacity in claudicants with diabetes mellitus. These results favor the use of electrostimulation as a therapeutic measure in this high-risk population.

Effect of body mass and midsole hardness on kinetic and perceptual variables during basketball landing manoeuvres.

PubMed

Nin, Darren Z; Lam, Wing K; Kong, Pui W

2016-01-01

This study investigated the effects of body mass and shoe midsole hardness on kinetic and perceptual variables during the performance of three basketball movements: (1) the first and landing steps of layup, (2) shot-blocking landing and (3) drop landing. Thirty male basketball players, assigned into "heavy" (n = 15, mass 82.7 ± 4.3 kg) or "light" (n = 15, mass 63.1 ± 2.8 kg) groups, performed five trials of each movement in three identical shoes of varying midsole hardness (soft, medium, hard). Vertical ground reaction force (VGRF) during landing was sampled using multiple wooden-top force plates. Perceptual responses on five variables (forefoot cushioning, rearfoot cushioning, forefoot stability, rearfoot stability and overall comfort) were rated after each movement condition using a 150-mm Visual Analogue Scale (VAS). A mixed factorial analysis of variance (ANOVA) (Body Mass × Shoe) was applied to all kinetic and perceptual variables. During the first step of the layup, the loading rate associated with rearfoot contact was 40.7% higher in the "heavy" than "light" groups (P = .014) and 12.4% higher in hard compared with soft shoes (P = .011). Forefoot peak VGRF in a soft shoe was higher (P = .011) than in a hard shoe during shot-block landing. Both "heavy" and "light" groups preferred softer to harder shoes. Overall, body mass had little effect on kinetic or perceptual variables.

Range of Motion and Plantar Pressure Evaluation for the Effects of Self-Care Foot Exercises on Diabetic Patients with and Without Neuropathy.

PubMed

Cerrahoglu, Lale; Koşan, Umut; Sirin, Tuba Cerrahoglu; Ulusoy, Aslihan

2016-05-01

We aimed to investigate whether a home exercise for self-care program that consists of range of motion (ROM), stretching, and strengthening exercises could improve ROM for foot joints and plantar pressure distribution during walking in diabetic patients to prevent diabetic foot complications. Seventy-six diabetic patients were recruited (38 with neuropathy and 38 without neuropathy). Neuropathy and nonneuropathy groups were randomly divided into a home exercise group (n = 19) and a control group (n = 19). Exercise groups performed their own respective training programs for 4 weeks, whereas no training was done in the control group. Total contact area and plantar pressure under six foot areas before and after the exercise program were measured. Ankle and first metatarsophalangeal joint ROM were measured before and after the exercise program. In the exercise group, there were significant improvements in ROM for the ankle and first metatarsophalangeal joints (P < .001); static pedobarographic values showed significant reduction in right forefoot-medial pressure (P = .010); and significant decreases were seen in dynamic pedobarographic values of peak plantar pressure at the left forefoot medial (P = .007), right forefoot lateral (P = .018), left midfoot (P < .001), and right hindfoot (P = .021) after exercise. No significant positive or negative correlation was found between the neuropathy and nonneuropathy groups (P > .05). A home exercise program could be an effective preventive method for improving ROM for foot joints and plantar pressure distribution in diabetic patients independent of the presence of neuropathy.

Biomechanical variables and perception of comfort in running shoes with different cushioning technologies.

PubMed

Dinato, Roberto C; Ribeiro, Ana P; Butugan, Marco K; Pereira, Ivye L R; Onodera, Andrea N; Sacco, Isabel C N

2015-01-01

To investigate the relationships between the perception of comfort and biomechanical parameters (plantar pressure and ground reaction force) during running with four different types of cushioning technology in running shoes. Randomized repeated measures. Twenty-two men, recreational runners (18-45 years) ran 12km/h with running shoes with four different cushioning systems. Outcome measures included nine items related to perception of comfort and 12 biomechanical measures related to the ground reaction forces and plantar pressures. Repeated measure ANOVAs, Pearson correlation coefficients, and step-wise multiple regression analyses were employed (p≤0.05). No significant correlations were found between the perception of comfort and the biomechanical parameters for the four types of investigated shoes. Regression analysis revealed that 56% of the perceived general comfort can be explained by the variables push-off rate and pressure integral over the forefoot (p=0.015) and that 33% of the perception of comfort over the forefoot can be explained by second peak force and push-off rate (p=0.016). The results did not demonstrate significant relationships between the perception of comfort and the biomechanical parameters for the three types of shoes investigated (Gel, Air, and ethylene-vinyl acetate). Only the shoe with Adiprene+ technology had its general comfort and cushioning perception predicted by the loads over the forefoot. Thus, in general, one cannot predict the perception of comfort of a running shoe through impact and plantar pressure received. Copyright © 2013 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Comparisons of foot anthropometry and plantar arch indices between German and Brazilian children.

PubMed

Sacco, Isabel C N; Onodera, Andrea N; Bosch, Kerstin; Rosenbaum, Dieter

2015-02-12

Nowadays, trades and research have become closely related between different countries and anthropometric data are important for the development in global markets. The appropriate use of anthropometry may improve wellbeing, health, comfort and safety especially for footwear design. For children a proper fit of footwear is very important, not constraining foot growth and allowing a normal development. The aim of this study was to compare the anthropometric characteristics of German and Brazilian children's feet from 3 to 10 years of age. We compared five indirect measures of two databases of children's feet. Forefoot, midfoot and rearfoot widths were measured in static footprints and the Chippaux-Smirak and Staheli indices of the longitudinal arch were calculated. Brazilian children showed a significantly narrower forefoot from 5 to 10 years, wider rearfoot from 3 to 4 years, wider midfoot for 4 year-olds and narrower midfoot for 10 year-old children. Nevertheless, the Chippaux-Smirak and Staheli indices showed no group differences. The only exception was for 4 year-old Brazilian children who showed a higher Chippaux-Smirak index compared to German children (48.4 ± 17.7%; 42.1 ± 13.8%). Our study revealed anthropometric differences in absolute forefoot and rearfoot widths of German and Brazilian children, but a similar longitudinal arch development. At 4 years of age, Brazilian children present a foot anthropometry similar to the 3 year-olds and develop the plantar longitudinal arch from 4 to 5 years more rapidly when compared to German children.

[Inserts for foot deformities].

PubMed

Stinus, H; Weber, F

2005-08-01

Inserts are orthopedic aids in the treatment of foot disorders that result from changes of the static or dynamic situation. Provision of appropriate orthopedic devices can relieve the pain caused by forefoot deformities either in lieu of surgical intervention or in rare cases also following surgical treatment to improve the symptoms of residual pain.Available materials provide support, padding, and cushioning. Inserts are custom-made to measure and/or based on a plaster impression. Determining the indication, prescribing the inlay, and checking the orthosis are the tasks of the physician. One treatment option for relieving the pain of forefoot deformities consists in conservative therapy with an insert combining features of padding and support as well as adjusting a ready-made shoe. The shoe and inlay should constitute a functional unit since often the optimal effect is only achieved with a combination of insert and orthopedic adjustment of the ready-made shoe.

Is There Evidence to Support a Forefoot Strike Pattern in Barefoot Runners? A Review

PubMed Central

Lorenz, Daniel S.; Pontillo, Marisa

2012-01-01

Context: Barefoot running is a trend among running enthusiasts that is the subject of much controversy. At this time, benefits appear to be more speculative and anecdotal than evidence based. Additionally, the risk of injuries is not well established. Evidence acquisition: A PubMed search was undertaken for articles published in English from 1980 to 2011. Additional references were accrued from reference lists of research articles. Results: While minimal data exist that definitively support barefoot running, there are data lending support to the argument that runners should use a forefoot strike pattern in lieu of a heel strike pattern to reduce ground reaction forces, ground contact time, and step length. Conclusions: Whether there is a positive or negative effect on injury has yet to be determined. Unquestionably, more research is needed before definitive conclusions can be drawn. PMID:24179586

Prediction of anthropometric foot characteristics in children.

PubMed

Morrison, Stewart C; Durward, Brian R; Watt, Gordon F; Donaldson, Malcolm D C

2009-01-01

The establishment of growth reference values is needed in pediatric practice where pathologic conditions can have a detrimental effect on the growth and development of the pediatric foot. This study aims to use multiple regression to evaluate the effects of multiple predictor variables (height, age, body mass, and gender) on anthropometric characteristics of the peripubescent foot. Two hundred children aged 9 to 12 years were recruited, and three anthropometric measurements of the pediatric foot were recorded (foot length, forefoot width, and navicular height). Multiple regression analysis was conducted, and coefficients for gender, height, and body mass all had significant relationships for the prediction of forefoot width and foot length (P < or = .05, r > or = 0.7). The coefficients for gender and body mass were not significant for the prediction of navicular height (P > or = .05), whereas height was (P < or = .05). Normative growth reference values and prognostic regression equations are presented for the peripubescent foot.

Treadmill based reference running data for healthy subjects is dependent on speed and morphological parameters.

PubMed

Schulze, Stephan; Schwesig, René; Edel, Melanie; Fieseler, Georg; Delank, Karl-Stefan; Hermassi, Souhail; Laudner, Kevin G

2017-10-01

To obtain spatiotemporal and dynamic running parameters of healthy participants and to identify relationships between running parameters, speed, and physical characteristics. A dynamometric treadmill was used to collect running data among 417 asymptomatic subjects during speeds ranging from 10 to 24km/h. Spatiotemporal and dynamic running parameters were calculated and measured. Results of the analyses showed that assessing running parameters is dependent on running speed. Body height correlated with stride length (r=0.5), cadence (r=-0.5) and plantar forefoot force (r=0.6). Body mass also had a strong relationship to plantar forefoot forces at 14 and 24km/h and plantar midfoot forces at 14 and 24km/h. This reference data base can be used in the kinematic and kinetic evaluation of running under a wide range of speeds. Copyright © 2017 Elsevier B.V. All rights reserved.

Comparison of Multisegmental Foot and Ankle Motion Between Total Ankle Replacement and Ankle Arthrodesis in Adults.

PubMed

Seo, Sang Gyo; Kim, Eo Jin; Lee, Doo Jae; Bae, Kee Jeong; Lee, Kyoung Min; Lee, Dong Yeon

2017-09-01

Total ankle replacement (TAR) and ankle arthrodesis (AA) are usually performed for severe ankle arthritis. We compared postoperative foot segmental motion during gait in patients treated with TAR and AA. Gait analysis was performed in 17 and 7 patients undergoing TAR and AA, respectively. Subjects were evaluated using a 3-dimensional multisegmental foot model with 15 markers. Temporal gait parameters were calculated. The maximum and minimum values and the differences in hallux, forefoot, hindfoot, and arch in 3 planes (sagittal, coronal, transverse) were compared between the 2 groups. One hundred healthy adults were evaluated as a control. Gait speed was faster in the TAR ( P = .028). On analysis of foot and ankle segmental motion, the range of hindfoot sagittal motion was significantly greater in the TAR (15.1 vs 10.2 degrees in AA; P = .004). The main component of motion increase was hindfoot dorsiflexion (12.3 and 8.6 degrees). The range of forefoot sagittal motion was greater in the TAR (9.3 vs 5.8 degrees in AA; P = .004). Maximum ankle power in the TAR (1.16) was significantly higher than 0.32 in AA; P = .008). However, the range of hindfoot and forefoot sagittal motion was decreased in both TAR and AA compared with the control group ( P = .000). Although biomechanical results of TAR and AA were not similar to those in the normal controls, joint motions in the TAR more closely matched normal values. Treatment decision making should involve considerations of the effect of surgery on the adjacent joints. Level III, case-control study.

Foot and hip contributions to high frontal plane knee projection angle in athletes: a classification and regression tree approach.

PubMed

Bittencourt, Natalia F N; Ocarino, Juliana M; Mendonça, Luciana D M; Hewett, Timothy E; Fonseca, Sergio T

2012-12-01

Cross-sectional. To investigate predictors of increased frontal plane knee projection angle (FPKPA) in athletes. The underlying mechanisms that lead to increased FPKPA are likely multifactorial and depend on how the musculoskeletal system adapts to the possible interactions between its distal and proximal segments. Bivariate and linear analyses traditionally employed to analyze the occurrence of increased FPKPA are not sufficiently robust to capture complex relationships among predictors. The investigation of nonlinear interactions among biomechanical factors is necessary to further our understanding of the interdependence of lower-limb segments and resultant dynamic knee alignment. The FPKPA was assessed in 101 athletes during a single-leg squat and in 72 athletes at the moment of landing from a jump. The investigated predictors were sex, hip abductor isometric torque, passive range of motion (ROM) of hip internal rotation (IR), and shank-forefoot alignment. Classification and regression trees were used to investigate nonlinear interactions among predictors and their influence on the occurrence of increased FPKPA. During single-leg squatting, the occurrence of high FPKPA was predicted by the interaction between hip abductor isometric torque and passive hip IR ROM. At the moment of landing, the shank-forefoot alignment, abductor isometric torque, and passive hip IR ROM were predictors of high FPKPA. In addition, the classification and regression trees established cutoff points that could be used in clinical practice to identify athletes who are at potential risk for excessive FPKPA. The models captured nonlinear interactions between hip abductor isometric torque, passive hip IR ROM, and shank-forefoot alignment.

The effects of gait retraining in runners with patellofemoral pain: A randomized trial.

PubMed

Roper, Jenevieve L; Harding, Elizabeth M; Doerfler, Deborah; Dexter, James G; Kravitz, Len; Dufek, Janet S; Mermier, Christine M

2016-06-01

Running popularity has increased resulting in a concomitant increase in running-related injuries with patellofemoral pain most commonly reported. The purpose of this study was to determine whether gait retraining by modifying footstrike patterns from rearfoot strike to forefoot strike reduces patellofemoral pain and improves associated biomechanical measures, and whether the modification influences risk of ankle injuries. Sixteen subjects (n=16) were randomly placed in the control (n=8) or experimental (n=8) group. The experimental group performed eight gait retraining running sessions over two weeks where footstrike pattern was switched from rearfoot strike to forefoot strike, while the control group performed running sessions with no intervention. Variables were recorded pre-, post-, and one-month post-running trials. Knee pain was significantly reduced post-retraining (P<0.05; effect size=0.294) and one-month follow-up (P<0.05; effect size=0.294). Knee abduction was significantly improved post-retraining (P<0.05; effect size=0.291) and one-month follow-up (P<0.05; effect size=0.291). Ankle flexion was significantly different post-retraining (P<0.05; effect size=0.547), as well as ankle range of motion post-retraining (P<0.05; effect size=0.425) and one-month follow-up (P<0.05; effect size=0.425). Findings suggest running with a forefoot strike pattern leads to reduced knee pain, and should be considered a possible strategy for management of patellofemoral pain in recreational runners. This trial is registered at the US National Institutes of Health (clinicaltrials.gov) #NCT02567123. Published by Elsevier Ltd.

Association Between Second Metatarsal Length and Forefoot Loading Under the Second Metatarsophalangeal Joint.

PubMed

Fleischer, Adam E; Hshieh, Shenche; Crews, Ryan T; Waverly, Brett J; Jones, Jacob M; Klein, Erin E; Weil, Lowell; Weil, Lowell Scott

2018-05-01

Metatarsal length is believed to play a role in plantar plate dysfunction, although the mechanism through which progressive injury occurs is still uncertain. We aimed to clarify whether length of the second metatarsal was associated with increased plantar pressure measurements in the forefoot while walking. Weightbearing radiographs and corresponding pedobarographic data from 100 patients in our practice walking without a limp were retrospectively reviewed. Radiographs were assessed for several anatomic relationships, including metatarsal length, by a single rater. Pearson correlation analyses and multiple linear regression models were used to determine whether metatarsal length was associated with forefoot loading parameters. The relative length of the second to first metatarsal was positively associated with the ratio of peak pressure beneath the respective metatarsophalangeal joints ( r = 0.243, P = .015). The relative length of the second to third metatarsal was positively associated with the ratios of peak pressure ( r = 0.292, P = .003), pressure-time integral ( r = 0.249, P = .013), and force-time integral ( r = 0.221, P = .028) beneath the respective metatarsophalangeal joints. Although the variability in loading predicted by the various regression analyses was not large (4%-14%), the relative length of the second metatarsal (to the first and to the third) was maintained in each of the multiple regression models and remained the strongest predictor (highest standardized β-coefficient) in each of the models. Patients with longer second metatarsals exhibited relatively higher loads beneath the second metatarsophalangeal joint during barefoot walking. These findings provide a mechanism through which elongated second metatarsals may contribute to plantar plate injuries. Level III, comparative study.

Minimally important change, measurement error, and responsiveness for the Self-Reported Foot and Ankle Score

PubMed Central

Cöster, Maria C; Nilsdotter, Anna; Brudin, Lars; Bremander, Ann

2017-01-01

Background and purpose Patient-reported outcome measures (PROMs) are increasingly used to evaluate results in orthopedic surgery. To enhance good responsiveness with a PROM, the minimally important change (MIC) should be established. MIC reflects the smallest measured change in score that is perceived as being relevant by the patients. We assessed MIC for the Self-reported Foot and Ankle Score (SEFAS) used in Swedish national registries. Patients and methods Patients with forefoot disorders (n = 83) or hindfoot/ankle disorders (n = 80) completed the SEFAS before surgery and 6 months after surgery. At 6 months also, a patient global assessment (PGA) scale—as external criterion—was completed. Measurement error was expressed as the standard error of a single determination. MIC was calculated by (1) median change scores in improved patients on the PGA scale, and (2) the best cutoff point (BCP) and area under the curve (AUC) using analysis of receiver operating characteristic curves (ROCs). Results The change in mean summary score was the same, 9 (SD 9), in patients with forefoot disorders and in patients with hindfoot/ankle disorders. MIC for SEFAS in the total sample was 5 score points (IQR: 2–8) and the measurement error was 2.4. BCP was 5 and AUC was 0.8 (95% CI: 0.7–0.9). Interpretation As previously shown, SEFAS has good responsiveness. The score change in SEFAS 6 months after surgery should exceed 5 score points in both forefoot patients and hindfoot/ankle patients to be considered as being clinically relevant. PMID:28464751

Is there still a place for Achilles tendon lengthening?

PubMed

Tagoe, Mark T; Reeves, Neil D; Bowling, Frank L

2016-01-01

Patients with diabetes and ankle equinus are at particularly high risk for forefoot ulceration because of the development of high forefoot pressures. Stiffness in the triceps surae muscles and tendons are thought to be largely responsible for equinus in patients with diabetes and underpins the surgical rationale for Achilles tendon lengthening (ATL) procedures to alleviate this deformity and reduce ulcer risk. The established/traditional surgical approach is the triple hemisection along the length of the Achilles tendon. Although the percutaneous approach has been successful in achieving increases in ankle dorsiflexion >30°, the tendon rupture risk has led to some surgeons looking at alternative approaches. The gastrocnemius aponeurosis may be considered as an alternative because of the Achilles tendon's poor blood supply. ATL procedures are a balance between achieving adequate tendon lengthening and minimizing tendon rupture risk during or after surgery. After ATL surgery, the first 7 days should involve reduced loading and protected range of motion to avoid rupture, after which gradual reintroduction to loading should be encouraged to increase tendon strength. In summary, there is a moderate level of evidence to support surgical intervention for ankle joint equinus in patients with diabetes and forefoot ulceration that is non-responsive to other conservative treatments. Areas of caution for ATL procedures include the risk for overcorrection, tendon rupture and the tendon's poor blood supply. Further prospective randomized control trials are required to confirm the benefits of ATL procedures over conservative care and the most optimal anatomical sites for surgical intervention. Copyright © 2016 John Wiley & Sons, Ltd.

Three-Dimensional Biomechanical Analysis of Rearfoot and Forefoot Running.

PubMed

Knorz, Sebastian; Kluge, Felix; Gelse, Kolja; Schulz-Drost, Stefan; Hotfiel, Thilo; Lochmann, Matthias; Eskofier, Björn; Krinner, Sebastian

2017-07-01

In the running community, a forefoot strike (FFS) pattern is increasingly preferred compared with a rearfoot strike (RFS) pattern. However, it has not been fully understood which strike pattern may better reduce adverse joint forces within the different joints of the lower extremity. To analyze the 3-dimensional (3D) stress pattern in the ankle, knee, and hip joint in runners with either a FFS or RFS pattern. Descriptive laboratory study. In 22 runners (11 habitual rearfoot strikers, 11 habitual forefoot strikers), RFS and FFS patterns were compared at 3.0 m/s (6.7 mph) on a treadmill with integrated force plates and a 3D motion capture analysis system. This combined analysis allowed characterization of the 3D biomechanical forces differentiated for the ankle, knee, and hip joint. The maximum peak force (MPF) and maximum loading rate (LR) were determined in their 3 ordinal components: vertical, anterior-posterior (AP), and medial-lateral (ML). For both strike patterns, the vertical components of the MPF and LR were significantly greater than their AP or ML components. In the vertical axis, FFS was generally associated with a greater MPF but significantly lower LR in all 3 joints. The AP components of MPF and LR were significantly lower for FFS in the knee joint but significantly greater in the ankle and hip joints. The ML components of MPF and LR tended to be greater for FFS but mostly did not reach a level of significance. FFS and RFS were associated with different 3D stress patterns in the ankle, knee, and hip joint, although there was no global advantage of one strike pattern over the other. The multimodal individual assessment for the different anatomic regions demonstrated that FFS seems favorable for patients with unstable knee joints in the AP axis and RFS may be recommended for runners with unstable ankle joints. Different strike patterns show different 3D stress in joints of the lower extremity. Due to either rehabilitation after injuries or training in running sports, rearfoot or forefoot running should be preferred to prevent further damage or injuries caused by inadequate biomechanical load. Runners with a history of knee joint injuries may benefit from FFS whereas RFS may be favorable for runners with a history of ankle joint injuries.

Three-Dimensional Biomechanical Analysis of Rearfoot and Forefoot Running

PubMed Central

Knorz, Sebastian; Kluge, Felix; Gelse, Kolja; Schulz-Drost, Stefan; Hotfiel, Thilo; Lochmann, Matthias; Eskofier, Björn; Krinner, Sebastian

2017-01-01

Background: In the running community, a forefoot strike (FFS) pattern is increasingly preferred compared with a rearfoot strike (RFS) pattern. However, it has not been fully understood which strike pattern may better reduce adverse joint forces within the different joints of the lower extremity. Purpose: To analyze the 3-dimensional (3D) stress pattern in the ankle, knee, and hip joint in runners with either a FFS or RFS pattern. Study Design: Descriptive laboratory study. Methods: In 22 runners (11 habitual rearfoot strikers, 11 habitual forefoot strikers), RFS and FFS patterns were compared at 3.0 m/s (6.7 mph) on a treadmill with integrated force plates and a 3D motion capture analysis system. This combined analysis allowed characterization of the 3D biomechanical forces differentiated for the ankle, knee, and hip joint. The maximum peak force (MPF) and maximum loading rate (LR) were determined in their 3 ordinal components: vertical, anterior-posterior (AP), and medial-lateral (ML). Results: For both strike patterns, the vertical components of the MPF and LR were significantly greater than their AP or ML components. In the vertical axis, FFS was generally associated with a greater MPF but significantly lower LR in all 3 joints. The AP components of MPF and LR were significantly lower for FFS in the knee joint but significantly greater in the ankle and hip joints. The ML components of MPF and LR tended to be greater for FFS but mostly did not reach a level of significance. Conclusion: FFS and RFS were associated with different 3D stress patterns in the ankle, knee, and hip joint, although there was no global advantage of one strike pattern over the other. The multimodal individual assessment for the different anatomic regions demonstrated that FFS seems favorable for patients with unstable knee joints in the AP axis and RFS may be recommended for runners with unstable ankle joints. Clinical Relevance: Different strike patterns show different 3D stress in joints of the lower extremity. Due to either rehabilitation after injuries or training in running sports, rearfoot or forefoot running should be preferred to prevent further damage or injuries caused by inadequate biomechanical load. Runners with a history of knee joint injuries may benefit from FFS whereas RFS may be favorable for runners with a history of ankle joint injuries. PMID:28812039

6. VIEW OF BOW OF VESSEL FROM STARBOARD SIDE, SHOWING ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

6. VIEW OF BOW OF VESSEL FROM STARBOARD SIDE, SHOWING DOCKING CREW PREPARING TO REMOVE FOREFOOT FROM VESSEL'S STEM IN ORDER TO DRAW VESSEL OFF LIFT DOCK - Bugeye "Louise Travers", Intersection of Routes 2 & 4, Solomons, Calvert County, MD

The identification of higher forefoot temperatures associated with peripheral arterial disease in type 2 diabetes mellitus as detected by thermography.

PubMed

Gatt, Alfred; Cassar, Kevin; Falzon, Owen; Ellul, Christian; Camilleri, Kenneth P; Gauci, Jean; Mizzi, Stephen; Mizzi, Anabelle; Sturgeon, Cassandra; Chockalingam, Nachiappan; Formosa, Cynthia

2018-08-01

The purpose of this study was to investigate whether heat emitted from the feet of patients with type 2 diabetes (DM) and peripheral arterial disease (PAD) differed from those with type 2 diabetes without complications (DM). A non-experimental, comparative prospective study design was employed in a tertiary referral hospital. Out of 223 randomly selected participants (430 limbs) who were initially tested, 62 limbs were categorized as DM+PAD and 22 limbs as DM without PAD. Subjects with evidence of peripheral neuropathy were excluded. Participants underwent thermographic imaging. Automatic segmentation of regions of interest extracted the temperature data. A significant difference in temperature in all the toes between the two groups was found (p=0.005, p=0.033, p=0.015, p=0.038 and p=0.02 for toes 1-5 respectively). The mean forefoot temperature in DM+PAD was significantly higher than that in DM (p=.019), with DM+PAD having a higher mean temperature (28.3°C) compared to DM (26.2°C). Similarly, the toes of subjects with DM+PAD were significantly warmer than those of subjects with DM only. Contrary to expectations the mean toe and forefoot temperatures in DM patients with PAD is higher than in those with DM only. This unexpected result could be attributed to disruption of noradrenergic vasoconstrictor thermoregulatory mechanisms with resulting increased flow through cutaneous vessels and subsequent increased heat emissivity. These results demonstrate that thermography may have potential in detecting PAD and associated temperature differences. Copyright © 2018 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Sensitivity of the Oxford Foot Model to marker misplacement: A systematic single-case investigation.

PubMed

Carty, Christopher P; Walsh, Henry P J; Gillett, Jarred G

2015-09-01

The purpose of this paper was to systematically assess the effect of Oxford Foot Model (OFM) marker misplacement on hindfoot relative to tibia, and forefoot relative to hindfoot kinematic calculations during the stance phase of gait. Marker trajectories were recorded with an 8-camera motion analysis system (Vicon Motion Systems Ltd., UK) and ground reaction forces were recorded from three force platforms (AMTI, USA). A custom built marker cluster consisting of 4 markers in a square arrangement (diagonal distance 2 cm) was used to assess the effect of marker misplacement in the superior, inferior, anterior and posterior direction for the sustentaculum tali (STL), the proximal 1st metatarsal (P1M), distal 5th metatarsal (D5M), proximal 5th metatarsal (P5M) and lateral calcaneus (LCA) markers. In addition manual movement of the heel complex 1 cm superiorly, inferiorly, medially and laterally, and also an alignment error of 10° inversion and 10° eversion was assessed. Clinically meaningful effects of marker misplacement were determined using a threshold indicating the minimal clinically important difference. Misplacement of the heel-wand complex had the most pronounced effect on mean kinematic profiles during the stance phase across all degrees-of-freedom with respect to hindfoot-tibia and forefoot-hindfoot angles. Vertical marker misplacement of the D5M and P5M markers affected the sagittal plane, and to a lesser extent frontal plane, forefoot-hindfoot kinematics. In conclusion, the OFM is highly sensitive to misplacement of the heel-wand complex in all directions and the P5M marker in the vertical direction. Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.

Multiple linear regression approach for the analysis of the relationships between joints mobility and regional pressure-based parameters in the normal-arched foot.

PubMed

Caravaggi, Paolo; Leardini, Alberto; Giacomozzi, Claudia

2016-10-03

Plantar load can be considered as a measure of the foot ability to transmit forces at the foot/ground, or foot/footwear interface during ambulatory activities via the lower limb kinematic chain. While morphological and functional measures have been shown to be correlated with plantar load, no exhaustive data are currently available on the possible relationships between range of motion of foot joints and plantar load regional parameters. Joints' kinematics from a validated multi-segmental foot model were recorded together with plantar pressure parameters in 21 normal-arched healthy subjects during three barefoot walking trials. Plantar pressure maps were divided into six anatomically-based regions of interest associated to corresponding foot segments. A stepwise multiple regression analysis was performed to determine the relationships between pressure-based parameters, joints range of motion and normalized walking speed (speed/subject height). Sagittal- and frontal-plane joint motion were those most correlated to plantar load. Foot joints' range of motion and normalized walking speed explained between 6% and 43% of the model variance (adjusted R 2 ) for pressure-based parameters. In general, those joints' presenting lower mobility during stance were associated to lower vertical force at forefoot and to larger mean and peak pressure at hindfoot and forefoot. Normalized walking speed was always positively correlated to mean and peak pressure at hindfoot and forefoot. While a large variance in plantar pressure data is still not accounted for by the present models, this study provides statistical corroboration of the close relationship between joint mobility and plantar pressure during stance in the normal healthy foot. Copyright © 2016 Elsevier Ltd. All rights reserved.

Computer-aided design of customized foot orthoses: reproducibility and effect of method used to obtain foot shape.

PubMed

Telfer, Scott; Gibson, Kellie S; Hennessy, Kym; Steultjens, Martijn P; Woodburn, Jim

2012-05-01

To determine, for a number of techniques used to obtain foot shape based around plaster casting, foam box impressions, and 3-dimensional scanning, (1) the effect the technique has on the overall reproducibility of custom foot orthoses (FOs) in terms of inter- and intracaster reliability and (2) the reproducibility of FO design by using computer-aided design (CAD) software in terms of inter- and intra-CAD operator reliability for all these techniques. Cross-sectional study. University laboratory. Convenience sample of individuals (N=22) with noncavus foot types. Not applicable. Parameters of the FO design (length, width at forefoot, width at rearfoot, and peak medial arch height), the forefoot to rearfoot angle of the foot shape, and overall volume match between device designs. For intra- and intercaster reliability of the different methods of obtaining the foot shape, all methods fell below the reproducibility quality threshold for the medial arch height of the device, and volume matching was <80% for all methods. The more experienced CAD operator was able to achieve excellent reliability (intraclass correlation coefficients >0.75) for all variables with the exception of forefoot to rearfoot angle, with overall volume matches of >87% of the devices. None of the techniques for obtaining foot shape met all the criteria for excellent reproducibility, with the peak arch height being particularly variable. Additional variability is added at the CAD stage of the FO design process, although with adequate operator experience good to excellent reproducibility may be achieved at this stage. Taking only basic linear or angular measurement parameters from the device may fail to fully capture the variability in FO design. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Plantar loading during cutting while wearing a rigid carbon fiber insert.

PubMed

Queen, Robin M; Abbey, Alicia N; Verma, Ravi; Butler, Robert J; Nunley, James A

2014-01-01

Stress fractures are one of the most common injuries in sports, accounting for approximately 10% of all overuse injuries. Treatment of fifth metatarsal stress fractures involves both surgical and nonsurgical interventions. Fifth metatarsal stress fractures are difficult to treat because of the risks of delayed union, nonunion, and recurrent injuries. Most of these injuries occur during agility tasks, such as those performed in soccer, basketball, and lacrosse. To examine the effect of a rigid carbon graphite footplate on plantar loading during 2 agility tasks. Crossover study. Laboratory. A total of 19 recreational male athletes with no history of lower extremity injury in the past 6 months and no previous metatarsal stress fractures were tested. Seven 45° side-cut and crossover-cut tasks were completed in a shoe with or without a full-length rigid carbon plate. Testing order between the shoe conditions and the 2 cutting tasks was randomized. Plantar-loading data were recorded using instrumented insoles. Peak pressure, maximum force, force-time integral, and contact area beneath the total foot, the medial and lateral midfoot, and the medial, middle, and lateral forefoot were analyzed. A series of paired t tests was used to examine differences between the footwear conditions (carbon graphite footplate, shod) for both cutting tasks independently (α = .05). During the side-cut task, the footplate increased total foot and lateral midfoot peak pressures while decreasing contact area and lateral midfoot force-time integral. During the crossover-cut task, the footplate increased total foot and lateral midfoot peak pressure and lateral forefoot force-time integral while decreasing total and lateral forefoot contact area. Although a rigid carbon graphite footplate altered some aspects of the plantar-pressure profile during cutting in uninjured participants, it was ineffective in reducing plantar loading beneath the fifth metatarsal.

Forefoot plantar pressure reduction of off-the-shelf rocker bottom provisional footwear.

PubMed

Kavros, Steven J; Van Straaten, Meegan G; Coleman Wood, Krista A; Kaufman, Kenton R

2011-08-01

Increased plantar pressures have been shown to be a risk factor in ulceration of the neuropathic foot. Prescriptive footwear is a common medical treatment, yet evidence regarding the efficacy of these prescriptions is underdeveloped. The purpose of this study is to determine the off-loading properties of four provisional shoes; a rocker sole compared to a flat sole shoe with and without the addition of a 1.25 cm plastizote insert. Fifteen subjects with peripheral neuropathy and a normal longitudinal arch were recruited to compare four types of provisional (post-operative) footwear. Plantar surface foot pressures were measured while wearing a rocker sole shoe or a flat stiff sole shoe. Both shoes were worn with and without a 1.25 cm plastizote insert. Peak plantar pressures were recorded for the hallux, metatarsal heads (1-5), midfoot, and heel. The rocker sole shoe with plastizote had the best off-loading properties. While wearing this footwear, mean peak plantar pressure was 2.8 kg/cm(2) (range: 1.7 to 4.5 kg/cm(2), 50% mean reduction from flat sole shoe without plastizote) and 1.9 kg/cm(2) (range: 0.7 to 3.6 kg/cm(2), 35% mean reduction) at the five metatarsal heads and hallux, respectively. For patients with a normal longitudinal arch and forefeet, either at risk of developing an ulcer or are healing a forefoot ulcer, a provisional shoe with a rocker sole and plastizote insole provides plantar pressure reduction of the forefoot. However, when results were analyzed for the subjects individually the amount of off-loading varied. Copyright © 2011 Elsevier Ltd. All rights reserved.

Pneumatic bracing and total contact casting have equivocal effects on plantar pressure relief.

PubMed

Hartsell, H D; Fellner, C; Saltzman, C L

2001-06-01

The purpose was to examine and compare plantar pressures produced in healthy subjects while wearing a running shoe (RS), total contact cast (TCC) and 'customized' pneumatic pre-fabricated walking brace (PWB). A repeated measures design was used to compare the plantar pressures recorded for three footwear types (RS, TCC, PWB) in two body regions (forefoot, heel). Nine healthy subjects walked at a self-selected walking pace on a motorized treadmill while wearing the RS, TCC and PWB (ordered randomization). Following a five-minute acclimatization period on the treadmill with each footwear device, plantar pressures were recorded from 84 constant gait speed and step length steps using the Pedar system of in-shoe array of capacitive sensors embedded in an insert. Mean spatially averaged peak plantar pressures were recorded for the metatarsal heads and heel region for each footwear device worn by each subject. A two-way analysis of variance with repeated measures and post-hoc Tukey tests analysed the data with a significance level of p=.05. The main effects of footwear (p=.005) and body region (p=.000), and interaction effect (body region x footwear device) (p=.000) were significant. Unloading of the forefoot was 63.72% and 58.77% for the TCC and PWB, respectively, whereas loading under the heel was increased 37.09% and 34.11% for the same two devices, respectively. Patients who develop neuropathic plantar ulcers in the forefoot region, but not in the heel region, may benefit from a reduction in plantar pressures by using either the TCC or a 'customized' PWB. An alternative footwear device still needs to be found for those patients with heel ulceration.

Foot strike pattern differently affects the axial and transverse components of shock acceleration and attenuation in downhill trail running.

PubMed

Giandolini, Marlene; Horvais, Nicolas; Rossi, Jérémy; Millet, Guillaume Y; Samozino, Pierre; Morin, Jean-Benoît

2016-06-14

Trail runners are exposed to a high number of shocks, including high-intensity shocks on downhill sections leading to greater risk of osseous overuse injury. The type of foot strike pattern (FSP) is known to influence impact severity and lower-limb kinematics. Our purpose was to investigate the influence of FSP on axial and transverse components of shock acceleration and attenuation during an intense downhill trail run (DTR). Twenty-three trail runners performed a 6.5-km DTR (1264m of negative elevation change) as fast as possible. Four tri-axial accelerometers were attached to the heel, metatarsals, tibia and sacrum. Accelerations were continuously recorded at 1344Hz and analyzed over six sections (~400 steps per subject). Heel and metatarsal accelerations were used to identify the FSP. Axial, transverse and resultant peak accelerations, median frequencies and shock attenuation within the impact-related frequency range (12-20Hz) were assessed between tibia and sacrum. Multiple linear regressions showed that anterior (i.e. forefoot) FSPs were associated with higher peak axial acceleration and median frequency at the tibia, lower transverse median frequencies at the tibia and sacrum, and lower transverse peak acceleration at the sacrum. For resultant acceleration, higher tibial median frequency but lower sacral peak acceleration were reported with forefoot striking. FSP therefore differently affects the components of impact shock acceleration. Although a forefoot strike reduces impact severity and impact frequency content along the transverse axis, a rearfoot strike decreases them in the axial direction. Globally, the attenuation of axial and resultant impact-related vibrations was improved using anterior FSPs. Copyright © 2016 Elsevier Ltd. All rights reserved.

Joint kinetics in rearfoot versus forefoot running: implications of switching technique.

PubMed

Stearne, Sarah M; Alderson, Jacqueline A; Green, Benjamin A; Donnelly, Cyril J; Rubenson, Jonas

2014-08-01

To better understand the mechanical factors differentiating forefoot and rearfoot strike (RFS) running, as well as the mechanical consequences of switching techniques, we assessed lower limb joint kinetics in habitual and imposed techniques in both groups. All participants performed both RFS and forefoot strike (FFS) techniques on an instrumented treadmill at 4.5 m·s while force and kinematic data were collected. Total (sum of ankle, knee, and hip) lower limb work and average power did not differ between habitual RFS and FFS runners. However, moments, negative work and negative instantaneous and average power during stance were greater at the knee in RFS and at the ankle in FFS techniques. When habitual RFS runners switched to an imposed FFS, they were able to replicate the sagittal plane mechanics of a habitual FFS; however, the ankle internal rotation moment was increased by 33%, whereas the knee abduction moments were not reduced, remaining 48.5% higher than a habitual FFS. In addition, total positive and negative lower limb average power was increased by 17% and 9%, respectively. When habitual FFS runners switched to an imposed RFS, they were able to match the mechanics of habitual RFS runners with the exception of knee abduction moments, which remained 38% lower than a habitual RFS and, surprisingly, a reduction of total lower limb positive average power of 10.5%. There appears to be no clear overall mechanical advantage of a habitual FFS or RFS. Switching techniques may have different injury implications given the altered distribution in loading between joints but should be weighed against the overall effects on limb mechanics; adopting an imposed RFS may prove the most beneficial given the absence of any clear mechanical performance decrements.

Biomechanical Differences of Foot-Strike Patterns During Running: A Systematic Review With Meta-analysis.

PubMed

Almeida, Matheus O; Davis, Irene S; Lopes, Alexandre D

2015-10-01

Systematic review with meta-analysis. To determine the biomechanical differences between foot-strike patterns used when running. Strike patterns during running have received attention in the recent literature due to their potential mechanical differences and associated injury risks. Electronic databases (MEDLINE, Embase, LILACS, SciELO, and SPORTDiscus) were searched through July 2014. Studies (cross-sectional, case-control, prospective, and retrospective) comparing the biomechanical characteristics of foot-strike patterns during running in distance runners at least 18 years of age were included in this review. Two independent reviewers evaluated the risk of bias. A meta-analysis with a random-effects model was used to combine the data from the included studies. Sixteen studies were included in the final analysis. In the meta-analyses of kinematic variables, significant differences between forefoot and rearfoot strikers were found for foot and knee angle at initial contact and knee flexion range of motion. A forefoot-strike pattern resulted in a plantar-flexed ankle position and a more flexed knee position, compared to a dorsiflexed ankle position and a more extended knee position for the rearfoot strikers, at initial contact with the ground. In the comparison of rearfoot and midfoot strikers, midfoot strikers demonstrated greater ankle dorsiflexion range of motion and decreased knee flexion range of motion compared to rearfoot strikers. For kinetic variables, the meta-analysis revealed that rearfoot strikers had higher vertical loading rates compared to forefoot strikers. There are differences in kinematic and kinetic characteristics between foot-strike patterns when running. Clinicians should be aware of these characteristics to help in the management of running injuries and advice on training.

In-shoe plantar pressure distribution during running on natural grass and asphalt in recreational runners.

PubMed

Tessutti, Vitor; Trombini-Souza, Francis; Ribeiro, Ana Paula; Nunes, Ana Luiza; Sacco, Isabel de Camargo Neves

2010-01-01

The type of surface used for running can influence the load that the locomotor apparatus will absorb and the load distribution could be related to the incidence of chronic injuries. As there is no consensus on how the locomotor apparatus adapts to loads originating from running surfaces with different compliance, the objective of this study was to investigate how loads are distributed over the plantar surface while running on natural grass and on a rigid surface--asphalt. Forty-four adult runners with 4+/-3 years of running experience were evaluated while running at 12 km/h for 40 m wearing standardised running shoes and Pedar insoles (Novel). Peak pressure, contact time and contact area were measured in six regions: lateral, central and medial rearfoot, midfoot, lateral and medial forefoot. The surfaces and regions were compared by three ANOVAS (2 x 6). Asphalt and natural grass were statistically different in all variables. Higher peak pressures were observed on asphalt at the central (p<0.001) [grass: 303.8(66.7)kPa; asphalt: 342.3(76.3)kPa] and lateral rearfoot (p<0.001) [grass: 312.7(75.8)kPa; asphalt: 350.9(98.3)kPa] and lateral forefoot (p<0.001) [grass: 221.5(42.9)kPa; asphalt: 245.3(55.5)kPa]. For natural grass, contact time and contact area were significantly greater at the central rearfoot (p<0.001). These results suggest that natural grass may be a surface that provokes lighter loads on the rearfoot and forefoot in recreational runners. Copyright (c) 2008 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Simplified versus geometrically accurate models of forefoot anatomy to predict plantar pressures: A finite element study.

PubMed

Telfer, Scott; Erdemir, Ahmet; Woodburn, James; Cavanagh, Peter R

2016-01-25

Integration of patient-specific biomechanical measurements into the design of therapeutic footwear has been shown to improve clinical outcomes in patients with diabetic foot disease. The addition of numerical simulations intended to optimise intervention design may help to build on these advances, however at present the time and labour required to generate and run personalised models of foot anatomy restrict their routine clinical utility. In this study we developed second-generation personalised simple finite element (FE) models of the forefoot with varying geometric fidelities. Plantar pressure predictions from barefoot, shod, and shod with insole simulations using simplified models were compared to those obtained from CT-based FE models incorporating more detailed representations of bone and tissue geometry. A simplified model including representations of metatarsals based on simple geometric shapes, embedded within a contoured soft tissue block with outer geometry acquired from a 3D surface scan was found to provide pressure predictions closest to the more complex model, with mean differences of 13.3kPa (SD 13.4), 12.52kPa (SD 11.9) and 9.6kPa (SD 9.3) for barefoot, shod, and insole conditions respectively. The simplified model design could be produced in <1h compared to >3h in the case of the more detailed model, and solved on average 24% faster. FE models of the forefoot based on simplified geometric representations of the metatarsal bones and soft tissue surface geometry from 3D surface scans may potentially provide a simulation approach with improved clinical utility, however further validity testing around a range of therapeutic footwear types is required. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effects of turf and cleat footwear on plantar load distributions in adolescent American football players during resisted pushing.

PubMed

Taylor, Jeffrey B; Nguyen, Anh-Dung; Griffin, Janet R; Ford, Kevin R

2018-06-01

Metatarsal and midfoot injuries are common in American football. Footwear design may influence injury rates by altering plantar foot loading patterns in these regions. The purpose of this study was to determine the effect of cleat design on in-shoe plantar foot loading during a football-specific, resisted pushing task. Twenty competitive football players (age 14.7 ± 1.8 years, height 1.72 ± 0.10 m, and mass 71.8 ± 26.9 kg) completed three trials of pushing a weighted sled at maximal effort in a standard shoe (CLEAT) and artificial turf-specific shoe (TURF), with flexible in-shoe force measuring insoles. Repeated measures ANOVAs identified mean differences in maximum force and relative load under all regions of the foot. Results showed higher forces in the CLEAT under the medial (p < 0.001) and lateral (p = 0.004) midfoot, central (p = 0.007) and lateral (p < 0.001) forefoot, and lesser toes (p = 0.01), but lower forces in the hallux (p = 0.02) compared to the TURF shoe. Additionally, relative loading was higher in the CLEAT under the medial (p < 0.001) and lateral (p = 0.002) midfoot and lateral (p < 0.001) forefoot, but lower in the medial forefoot (p = 0.006) and hallux (p < 0.001) compared to the TURF shoe. The two shoes elicited distinct plantar loading profiles and may influence shoe selection decisions during injury prevention or rehabilitation practices.

Cadence, age, and weight as determinants of forefoot plantar pressures using the Biofoot in-shoe system.

PubMed

Martínez-Nova, Alfonso; Pascual Huerta, Javier; Sánchez-Rodríguez, Raquel

2008-01-01

We evaluated normal plantar pressures and studied the effect of weight, cadence, and age on forefoot plantar pressures in healthy subjects by using the Biofoot (Instituto de Biomecánica de Valencia, Valencia, Spain) in-shoe measurement system. The feet of 45 healthy subjects with no evident foot or lower-limb diseases were measured with the Biofoot in-shoe system. The forefoot was divided into seven areas: the first through fifth metatarsal heads, the hallux, and the second through fifth lesser toes. Three trials of 8 sec each were recorded twice in each subject, and the mean was used to analyze peak and mean plantar pressures. A multiple regression model including weight, age, and cadence was run for each metatarsal head, the hallux, and the lesser toes. Intraclass correlation coefficients and coefficients of variation were also calculated to assess reliability. The second metatarsal head had the greatest peak (960 kPa) and mean (585.1 kPa) pressures, followed by the third metatarsal head. Weight and cadence combined explained 18% and 23% of peak plantar pressure at the second and third metatarsal heads, respectively (P < .001). The intraclass correlation coefficient varied from 0.76 to 0.96 for all variables. The coefficient of variation between sessions ranged from 5.8% to 9.0%. The highest peak and mean plantar pressures were found at the second and third metatarsal heads in healthy subjects. Weight, cadence, and age explained a low variability of this pressure pattern. The Biofoot in-shoe system has good reliability to measure plantar pressures. These data will have implications for the understanding of normal foot biomechanics and its determinants.

Increasing preferred step rate during running reduces plantar pressures.

PubMed

Gerrard, James M; Bonanno, Daniel R

2018-01-01

Increasing preferred step rate during running is a commonly used strategy in the management of running-related injuries. This study investigated the effect of different step rates on plantar pressures during running. Thirty-two healthy runners ran at a comfortable speed on a treadmill at five step rates (preferred, ±5%, and ±10%). For each step rate, plantar pressure data were collected using the pedar-X in-shoe system. Compared to running with a preferred step rate, a 10% increase in step rate significantly reduced peak pressure (144.5±46.5 vs 129.3±51 kPa; P=.033) and maximum force (382.3±157.6 vs 334.0±159.8 N; P=.021) at the rearfoot, and reduced maximum force (426.4±130.4 vs 400.0±116.6 N; P=.001) at the midfoot. In contrast, a 10% decrease in step rate significantly increased peak pressure (144.5±46.5 vs 161.5±49.3 kPa; P=.011) and maximum force (382.3±157.6 vs 425.4±155.3 N; P=.032) at the rearfoot. Changing step rate by 5% provided no effect on plantar pressures, and no differences in plantar pressures were observed at the medial forefoot, lateral forefoot or hallux between the step rates. This study's findings indicate that increasing preferred step rate by 10% during running will reduce plantar pressures at the rearfoot and midfoot, while decreasing step rate by 10% will increase plantar pressures at the rearfoot. However, changing preferred step rate by 5% will provide no effect on plantar pressures, and forefoot pressures are unaffected by changes in step rate. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Comparison of a self-administered foot evaluation questionnaire (SAFE-Q) between joint-preserving arthroplasty and resection-replacement arthroplasty in forefoot surgery for patients with rheumatoid arthritis.

PubMed

Ebina, Kosuke; Hirao, Makoto; Hashimoto, Jun; Nampei, Akihide; Shi, Kenrin; Tomita, Tetsuya; Futai, Kazuma; Kunugiza, Yasuo; Noguchi, Takaaki; Yoshikawa, Hideki

2017-09-01

To clarify the difference of patient-based outcome between joint-preserving arthroplasty and resection-replacement arthroplasty in forefoot surgery for patients with rheumatoid arthritis (RA). A total of 63 feet of 49 RA patients who underwent forefoot surgery were asked to answer pre-operative and post-operative self-administered foot evaluation questionnaire (SAFE-Q). Patients were treated with either (1) metatarsal head resection-replacement arthroplasty (28 feet, post-operative mean age 63.8 years, follow-up 4.2 years, DAS28-CRP 2.2) or (2) metatarsophalangeal joint-preserving arthroplasty (35 feet, post-operative mean age 63.1 years, follow-up 3.6 years, DAS28-CRP 2.1) at each surgeon's discretion. Mean pre-operative and post-operative subscale scores of SAFE-Q of group (1) and (2) were as follows. Pain and pain-related [(1) pre-op 36.8 to post-op 75.0 vs. (2) pre-op 42.2 to post-op 82.6], physical functioning and daily-living [(1) 43.2-68.8 vs. (2) 52.778.1], social functioning [(1) 44.3-72.0 vs. (2) 52.5-81.9], general health and well-being [(1) 48.4-68.4 vs. (2) 45.5-84.4], and shoe-related [(1) 30.1-50.3 vs. (2) 30.6-64.4]. Both general health and well-being subscale scores (p < 0.05) and shoe-related subscale scores (p < 0.05) were significantly more improved in group (2) compared with group (1). Joint-preserving arthroplasty resulted in better patient-based outcomes than resection-replacement arthroplasty.

Biomechanical consequences of adding plantar fascia release to metatarsal osteotomies: Changes in forefoot plantar pressures.

PubMed

Aydogan, Umur; Roush, Evan P; Moore, Blake E; Andrews, Seth H; Lewis, Gregory S

2017-04-01

Destruction of the normal metatarsal arch by a long metatarsal is often a cause for metatarsalgia. When surgery is warranted, distal oblique, or proximal dorsiflexion osteotomies of the long metatarsal bones are commonly used. The plantar fascia has anatomical connection to all metatarsal heads. There is controversial scientific evidence on the effect of plantar fascia release on forefoot biomechanics. In this cadaveric biomechanical study, we hypothesized that plantar fascia release would augment the plantar metatarsal pressure decreasing effects of two common second metatarsal osteotomy techniques. Six matched pairs of foot and ankle specimens were mounted on a pressure mat loading platform. Two randomly assigned surgery groups, which had received either distal oblique, or proximal dorsiflexion osteotomy of the second metatarsal, were evaluated before and after plantar fasciectomy. Specimens were loaded up to a ground reaction force of 400 N at varying Achilles tendon forces. Average pressures, peak pressures, and contact areas were analyzed. Supporting our hypothesis, average pressures under the second metatarsal during 600 N Achilles load were decreased by plantar fascia release following proximal osteotomy (p < 0.05). However contrary to our hypothesis, peak pressures under the second metatarsal were significantly increased by plantar fascia release following modified distal osteotomy, under multiple Achilles loading conditions (p < 0.05). Plantar fasciotomy should not be added to distal metatarsal osteotomy in the treatment of metatarsalgia. If proximal dorsiflexion osteotomy would be preferred, plantar fasciotomy should be approached cautiously not to disturb the forefoot biomechanics. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:800-804, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Effects of medially posted insoles on foot and lower limb mechanics across walking and running in overpronating men.

PubMed

Kosonen, Jukka; Kulmala, Juha-Pekka; Müller, Erich; Avela, Janne

2017-03-21

Anti-pronation orthoses, like medially posted insoles (MPI), have traditionally been used to treat various of lower limb problems. Yet, we know surprisingly little about their effects on overall foot motion and lower limb mechanics across walking and running, which represent highly different loading conditions. To address this issue, multi-segment foot and lower limb mechanics was examined among 11 overpronating men with normal (NORM) and MPI insoles during walking (self-selected speed 1.70±0.19m/s vs 1.72±0.20m/s, respectively) and running (4.04±0.17m/s vs 4.10±0.13m/s, respectively). The kinematic results showed that MPI reduced the peak forefoot eversion movement in respect to both hindfoot and tibia across walking and running when compared to NORM (p<0.05-0.01). No differences were found in hindfoot eversion between conditions. The kinetic results showed no insole effects in walking, but during running MPI shifted center of pressure medially under the foot (p<0.01) leading to an increase in frontal plane moments at the hip (p<0.05) and knee (p<0.05) joints and a reduction at the ankle joint (p<0.05). These findings indicate that MPI primarily controlled the forefoot motion across walking and running. While kinetic response to MPI was more pronounced in running than walking, kinematic effects were essentially similar across both modes. This suggests that despite higher loads placed upon lower limb during running, there is no need to have a stiffer insoles to achieve similar reduction in the forefoot motion than in walking. Copyright © 2017 Elsevier Ltd. All rights reserved.

Variations in plantar pressure variables across five cardiovascular exercises.

PubMed

Burnfield, Judith M; Jorde, Amy G; Augustin, Tanner R; Augustin, Tate A; Bashford, Gregory R

2007-11-01

To quantify variations in plantar pressure variables in healthy adults across five cardiovascular exercises. Ten young (19-35 yr old) and 10 middle-aged (45-60 yr old) individuals participated. After equipment familiarization, plantar pressure data were recorded during walking, running, elliptical training, stair climbing, and recumbent biking. Separate one-way analyses of variance with repeated measures identified significant differences in pressure variables across exercises and between age groups under the forefoot, arch, and heel. Forefoot: Peak pressures were higher during walking (253 kPa), running (251 kPa), and elliptical training (213 kPa) than stair climbing (130 kPa) and recumbent biking (41 kPa; P < or = 0.001). Biking pressures were lower than all other conditions (P < 0.001). Arch: Pressures were higher during running (144 kPa) compared with all other conditions (P < or = 0.001). Intermediate-level pressures during walking (119 kPa) and elliptical training (102 kPa) exceeded those during stair climbing (80 kPa; P < or = 0.002). Pressures were lowest during recumbent biking (33 kPa; P < 0.001). Heel: Pressures were highest during walking (215 kPa) and running (188 kPa), exceeding those recorded during all other activities (P < 0.001). Moderate elliptical training pressures (94 kPa) surpassed stair climbing values (66 kPa; P = 0.014). Pressures were lowest during recumbent biking (25 kPa; P < 0.001). The only significant difference identified between age groups was a larger arch contact area in the young compared with middle-aged, when averaged across exercises (P = 0.011). When protection of the forefoot is important (e.g., diabetic foot neuropathies), biking and stair climbing offer optimal pressure reductions. If protecting the heel from high pressures and forces is warranted, recumbent biking, stair climbing, and elliptical training provide greater relief.

Influence of shoe midsole hardness on plantar pressure distribution in four basketball-related movements.

PubMed

Lam, Wing-Kai; Ng, Wei Xuan; Kong, Pui Wah

2017-01-01

This study examined how shoe midsole hardness influenced plantar pressure in basketball-related movements. Twenty male university basketball players wore customized shoes with hard and soft midsoles (60 and 50 Shore C) to perform four movements: running, maximal forward sprinting, maximal 45° cutting and lay-up. Plantar loading was recorded using an in-shoe pressure measuring system, with peak pressure (PP) and pressure time integral (PTI) extracted from 10 plantar regions. Compared with hard shoes, subjects exhibited lower PP in one or more plantar regions when wearing the soft shoes across all tested movements (Ps < 0.05). Lower PTI was also observed in the hallux for 45° cutting, and the toes and forefoot regions during the first step of lay-up in the soft shoe condition (Ps < 0.05). In conclusion, using a softer midsole in the forefoot region may be a plausible remedy to reduce the high plantar loading experienced by basketball players.

Comparative Effect of Orthosis Design on Functional Performance

DTIC Science & Technology

2012-03-21

progresses forward from mid to terminal stance. This also allows forefoot loading during agility and running activities. The modular design allows...patient to adopt a midfoot strike , as the combination of a heel strike with the plantar flexed foot plate leads to knee hyperextension. On average

A Comparison of the Habitual Landing Strategies from Differing Drop Heights of Parkour Practitioners (Traceurs) and Recreationally Trained Individuals.

PubMed

Standing, Regan J; Maulder, Peter S

2015-12-01

Parkour is an activity that encompasses methods of jumping, climbing and vaulting. With landing being a pertinent part of this practise, Parkour participants (traceurs) have devised their own habitual landing strategies, which are suggested to be a safer and more effective style of landing. The purpose of this study was to compare the habitual landing strategies of traceurs and recreationally trained individuals from differing drop heights. Comparisons between landing sound and mechanical parameters were also assessed to gauge the level of landing safety. Ten recreationally trained participants and ten traceurs performed three landings from 25% and 50% body height using their own habitual landing strategies. Results at 25% showed significantly lower maximal vertical force (39.9%, p < 0.0013, ES = -1.88), longer times to maximal vertical force (68.6%, p < 0.0015, ES = 1.72) and lower loading rates (65.1%, p < 0.0002, ES = -2.22) in the traceur group. Maximal sound was also shown to be lower (3.6%), with an effect size of -0.63, however this was not statistically significant (p < 0.1612). At 50%, traceurs exhibited significantly different values within all variables including maximal sound (8.6%, p < 0.03, ES = -1.04), maximal vertical force (49.0%, p < 0.0002, ES = -2.38), time to maximal vertical force (65.9%, p < 0.0067, ES = 1.32) and loading rates (66.3%, p < 0.0002, ES = -2.00). Foot strike analysis revealed traceurs landed using forefoot or forefoot-midfoot strategies in 93.2% of trials; whereas recreationally trained participants used these styles in only 8.3% of these landings. To conclude, the habitual landings of traceurs are more effective at lowering the kinetic landing variables associated with a higher injury risk in comparison to recreationally trained individuals. Sound as a measure of landing effectiveness and safety holds potential significance; however requires further research to confirm. Key pointsHabitual traceur landings were observed to be safer landing techniques in comparison to those utilised by recreationally trained individuals, due to the lower maximal vertical forces, slower times to maximal vertical force, lesser loading rates and lower maximal sound.Traceurs predominantly landed with the forefoot only, whereas recreationally trained individuals habitually utilised a forefoot to heel landing strategy.The habitual landing techniques performed by traceurs may be beneficial for other landing sports to incorporate into training to reduce injury.

Role of gastrocnemius-soleus muscle in forefoot force transmission at heel rise - A 3D finite element analysis.

PubMed

Chen, Wen-Ming; Park, Jaeyoung; Park, Seung-Bum; Shim, Victor Phyau-Wui; Lee, Taeyong

2012-06-26

The functions of the gastrocnemius-soleus (G-S) complex and other plantar flexor muscles are to stabilize and control major bony joints, as well as to provide primary coordination of the foot during the stance phase of gait. Geometric positioning of the foot and transferring of plantar loads can be adversely affected when muscular control is abnormal (e.g., equinus contracture). Although manipulation of the G-S muscle complex by surgical intervention (e.g., tendo-Achilles lengthening) is believed to be effective in restoring normal plantar load transfer in the foot, there is lack of quantitative data supporting that notion. Thus, the objective of this study is to formulate a three-dimensional musculoskeletal finite element model of the foot to quantify the precise role of the G-S complex in terms of biomechanical response of the foot. The model established corresponds to a muscle-demanding posture during heel rise, with simulated activation of major extrinsic plantar flexors. In the baseline (reference) case, required muscle forces were determined from what would be necessary to generate the targeted resultant ground reaction forces. The predicted plantar load transfer through the forefoot plantar surface, as indicated by plantar pressure distribution, was verified by comparison with experimental observations. This baseline model served as a reference for subsequent parametric analysis, where muscle forces applied by the G-S complex were decreased in a step-wise manner. Adaptive changes of the foot mechanism, in terms of internal joint configurations and plantar stress distributions, in response to altered muscular loads were analyzed. Movements of the ankle and metatarsophalangeal joints, as well as forefoot plantar pressure peaks and pressure distribution under the metatarsal heads (MTHs), were all found to be extremely sensitive to reduction in the muscle load in the G-S complex. A 40% reduction in G-S muscle stabilization can result in dorsal-directed rotations of 8.81° at the ankle, and a decreased metatarsophalangeal joint extension of 4.65°. The resulting peak pressure reductions at individual MTHs, however, may be site-specific and possibly dependent on foot structure, such as intrinsic alignment of the metatarsals. The relationships between muscular control, internal joint movements, and plantar load distributions are envisaged to have important clinical implications on tendo-Achilles lengthening procedures, and to provide surgeons with an understanding of the underlying mechanism for relieving forefoot pressure in diabetic patients suffering from ankle equinus contracture. Copyright © 2012 Elsevier Ltd. All rights reserved.

Northern Sea Route and Icebreaking Technology

DTIC Science & Technology

1994-06-01

waterlines at the extreme forward end, extended beam, a low stem angle with an ice-clearing forefoot , and a high flare angle below the water- line. The ice...world. Reports of protests and labor strikes , stemming from poor wages sectors of the economy. The Gross and living conditions, are common. With

Evaluation of the Mechanical Properties and Effectiveness of Countermine Boots.

DTIC Science & Technology

1998-03-01

regarding comfort except that the 60 shanks overall length of approximately 5.7 in should allow normal flexure of the forefoot . Weight, however, is...When the electron beam strikes an element in the sample, electrons are ejected from inner atomic shells to outer shells resulting in ions in the

Medical Aspects of Cold Weather Operations: A Handbook for Medical Officers

DTIC Science & Technology

1993-04-01

forefoot tissues, hammer toe deformities, flexion contracture of the great toe, hyperhidrosis predisposing to skin maceration and dermato- phytosis...Even more striking are the reports of mass deaths among shipwreck survivors, who had been able to climb aboard rescuing ships, only to be found dead

[Influence of the posterior tibial tendon on the medial arch of the foot: an in vitro kinetic and kinematic study].

PubMed

Emmerich, J; Wülker, N; Hurschler, C

2003-04-01

The respective contributions of the active and passive structures of the foot to the stability of the medical arch were investigated using an in vitro kinetic and kinematic model. The effect of the tibialis posterior tendon on foot and ankle movements, and plantar pressure distribution of the foot were tested in a cadaveric human foot. The stance phase from heel-contact to toe-off of normal walking gait and after tibialis posterior tendon rupture was simulated in eight roentenographically normal human feet (age 66 +/- 19 years, males). Ground reaction force and tibial inclination was simulated by means of a tilting angle and force-controlled translation stage. Plantar pressure was measured using a pressure-measuring platform. The force developed by the flexors and extensor muscles of the foot were simulated via cables attached to 7 force-controlled hydraulic cylinders. Tibial rotation was produced by an electric servo-motor, and foot movements measured with an ultrasonic analysis system. The model was verified against the plantar distribution and kinematics of healthy subjects measured during normal gait. Tibialis posterior deficit did not result in any detectable changes in pressure or force-time integral in the medial regions of the foot--a common sign of flat foot (pressure: midfoot 0.2 < or = 0.9; medial forefoot 0.5 < or = p < or = 0.9; hallux 0.5 < or = p < or = 0.9; force-time integral: midfoot p = 0-871; medial forefoot p = 0.632; hallux p = 0.068). Only small tendential changes in the kinematics of the talus and calcaneus were observed in dorsiflexion (0-58 sec; talus 0.1 < or = p < or = 0.6; calcaneus 0.4 < or = p < or = 0.06) and eversion (talus: 0-60 sec. 0.1 < or = p < or = 0.6; calcaneus: 37-60 sec. 0.2 < or = p < or = 0.7). The results of this in vitro study show that defective tibialis posterior alone does not produce significant changes in the kinetics or kinematics of the stance phase of normal gait. This suggests that the development of flat foot observed in degeneration of the tibialis posterior tendon occurs only after fatigue of the passive structures of the foot.

Submarine Rescue. Mooring and Salvage Ships of the Soviet Navy,

DTIC Science & Technology

1983-07-13

motion after they strike the surface of the water, because of which they are carried away from the ship and can no longer endanger the ship. Only four of...they have a characteristic icebreaker bow, while the others have a protruding bulb at the forefoot . Above the waterline - aside from the completely

Measuring Clearance Mechanics Based on Dynamic Leg Length

ERIC Educational Resources Information Center

Khamis, Sam; Danino, Barry; Hayek, Shlomo; Carmeli, Eli

2018-01-01

The aim of this study was to quantify clearance mechanics during gait. Seventeen children diagnosed with hemiplegic cerebral palsy underwent a three-dimensional gait analysis evaluation. Dynamic leg lengths were measured from the hip joint center to the heel, to the ankle joint center and to the forefoot throughout the gait cycle. Significant…

Foot Loading Characteristics of Different Graduations of Partial Weight Bearing

ERIC Educational Resources Information Center

Gusinde, Johannes; Pauser, Johannes; Swoboda, Bernd; Gelse, Kolja; Carl, Hans-Dieter

2011-01-01

Limited weight bearing of the lower extremity is a commonly applied procedure in orthopaedic rehabilitation after reconstructive forefoot surgery, trauma surgery and joint replacement. The most frequent limitations are given as percentage of body weight (BW) and represent 10 or 50% BW. The extent of foot loading under these graduations of partial…

Surgical treatment of AVN of the fibular (lateral) sesamoid.

PubMed

Waizy, Hazibullah; Jäger, Marcus; Abbara-Czardybon, Mona; Schmidt, Troy G; Frank, Daniel

2008-02-01

Despite the fact that the hallucal sesamoids play a crucial role in forefoot mechanics, disorders resulting from pathology of these structures are often overlooked or misdiagnosed. Avascular necrosis (AVN) of the hallucal sesamoids is a rare condition that must be differentiated from other pathologies, such as fractures, pseudarthrosis or osteomyelitis. We report on two patients with AVN of the fibular (lateral) hallucal sesamoid (Morbus Renander). In both patients the necrotic part of the fibular sesamoid was excised surgically after failed conservative therapy. The followup was 29 and 26 months. The clinical and radiological results showed a complete relief of pain in both patients without any complications or forefoot deformities. Recent literature and own experiences support non-operative initial management including anti-inflammatory medications, shoe modification and temporary limited weight bearing. If symptoms persist, surgical treatment with excision of the necrotic part of the sesamoid may be an alternative. Consideration by the surgeon should be given to protecting the neurovascular bundle and reattaching intrinsic tendons and ligaments if necessary. Satisfying results can be achieved by surgical removal.

Foot strike patterns and ground contact times during high-calibre middle-distance races.

PubMed

Hayes, Phil; Caplan, Nicholas

2012-01-01

The aims of this study were to examine ground contact characteristics, their relationship with race performance, and the time course of any changes in ground contact time during competitive 800 m and 1500 m races. Twenty-two seeded, single-sex middle-distance races totalling 181 runners were filmed at a competitive athletics meeting. Races were filmed at 100 Hz. Ground contact time was recorded one step for each athlete, on each lap of their race. Forefoot and midfoot strikers had significantly shorter ground contact times than heel strikers. Forefoot and midfoot strikers had significantly faster average race speed than heel strikers. There were strong large correlations between ground contact time and average race speed for the women's events and men's 1500 m (r = -0.521 to -0.623; P < 0.05), whereas the men's 800 m displayed only a moderate relationship (r = -0.361; P = 0.002). For each event, ground contact time for the first lap was significantly shorter than for the last lap, which might reflect runners becoming fatigued.

Medial compressible forefoot sole elements reduce ankle inversion in lateral SSC jumps.

PubMed

Fleischmann, Jana; Mornieux, Guillaume; Gehring, Dominic; Gollhofer, Albert

2013-06-01

Sideward movements are associated with high incidences of lateral ankle sprains. Special shoe constructions might be able to reduce these injuries during lateral movements. The purpose of this study was to investigate whether medial compressible forefoot sole elements can reduce ankle inversion in a reactive lateral movement, and to evaluate those elements' influence on neuromuscular and mechanical adjustments in lower extremities. Foot placement and frontal plane ankle joint kinematics and kinetics were analyzed by 3-dimensional motion analysis. Electromyographic data of triceps surae, peroneus longus, and tibialis anterior were collected. This modified shoe reduced ankle inversion in comparison with a shoe with a standard sole construction. No differences in ankle inversion moments were found. With the modified shoe, foot placement occurred more internally rotated, and muscle activity of the lateral shank muscles was reduced. Hence, lateral ankle joint stability during reactive sideward movements can be improved by these compressible elements, and therefore lower lateral shank muscle activity is required. As those elements limit inversion, the strategy to control inversion angles via a high external foot rotation does not need to be used.

[Analysis of plantar pressure patterns among obese population].

PubMed

Leidecker, Eleonóra; Kellermann, Péter; Galambosné Tiszberger, Mónika; Molics, Bálint; Bohner-Beke, Aliz; Nyárády, József; Kránicz, János

2016-11-01

Although the role of body weight on foot health and load has been widely documented in research, the effect of the extra load due to body weight on plantar pressure characteristics is not well known. The aim of this study was to evaluate the impact of obesity on plantar pressure patterns among the working-age population. 180 participants were involved. Two groups were evaluated according to body mass index categories regarding eight regions of the plantar area, focusing on the following parameters: contact area, maximum pressure and peak pressure. Compared with non-obese subjects, the peak pressure was the highest on the midfoot (p<0.001) and the forefoot (p<0.001). Regarding the maximum force, significant statistical difference was detected on the toes (p<0.001), with a value lower among the obese group. The contact area on the total foot and the midfoot was lower among the non-obese subjects (p<0.001). Loading is greatly increasing on the whole plantar area, especially at the midfoot and the forefoot region. Orv. Hetil., 2016, 157(48), 1919-1925.

Plantar Loading During Cutting While Wearing a Rigid Carbon Fiber Insert.

PubMed

Queen, Robin M; Abbey, Alicia N; Verma, Ravi; Butler, Robert J; Nunley, James A

2014-02-12

Context : Stress fractures are one of the most common injuries in sports, accounting for approximately 10% of all overuse injuries. Treatment of fifth metatarsal stress fractures involves both surgical and nonsurgical interventions. Fifth metatarsal stress fractures are difficult to treat because of the risks of delayed union, nonunion, and recurrent injuries. Most of these injuries occur during agility tasks, such as those performed in soccer, basketball, and lacrosse. Objective : To examine the effect of a rigid carbon graphite footplate on plantar loading during 2 agility tasks. Design :  Crossover study. Setting : Laboratory. Patients or Other Participants : A total of 19 recreational male athletes with no history of lower extremity injury in the past 6 months and no previous metatarsal stress fractures were tested. Main Outcome Measure(s) :  Seven 45° side-cut and crossover-cut tasks were completed in a shoe with or without a full-length rigid carbon plate. Testing order between the shoe conditions and the 2 cutting tasks was randomized. Plantar-loading data were recorded using instrumented insoles. Peak pressure, maximum force, force-time integral, and contact area beneath the total foot, the medial and lateral midfoot, and the medial, middle, and lateral forefoot were analyzed. A series of paired t tests was used to examine differences between the footwear conditions (carbon graphite footplate, shod) for both cutting tasks independently (α = .05). Results : During the side-cut task, the footplate increased total foot and lateral midfoot peak pressures while decreasing contact area and lateral midfoot force-time integral. During the crossover-cut task, the footplate increased total foot and lateral midfoot peak pressure and lateral forefoot force-time integral while decreasing total and lateral forefoot contact area. Conclusions : Although a rigid carbon graphite footplate altered some aspects of the plantar- pressure profile during cutting in uninjured participants, it was ineffective in reducing plantar loading beneath the fifth metatarsal.

Plantar Loading During Cutting While Wearing a Rigid Carbon Fiber Insert

PubMed Central

Queen, Robin M.; Abbey, Alicia N.; Verma, Ravi; Butler, Robert J.; Nunley, James A.

2014-01-01

Context Stress fractures are one of the most common injuries in sports, accounting for approximately 10% of all overuse injuries. Treatment of fifth metatarsal stress fractures involves both surgical and nonsurgical interventions. Fifth metatarsal stress fractures are difficult to treat because of the risks of delayed union, nonunion, and recurrent injuries. Most of these injuries occur during agility tasks, such as those performed in soccer, basketball, and lacrosse. Objective: To examine the effect of a rigid carbon graphite footplate on plantar loading during 2 agility tasks. Design:  Crossover study. Setting: Laboratory. Patients or Other Participants: A total of 19 recreational male athletes with no history of lower extremity injury in the past 6 months and no previous metatarsal stress fractures were tested. Main Outcome Measure(s):  Seven 45° side-cut and crossover-cut tasks were completed in a shoe with or without a full-length rigid carbon plate. Testing order between the shoe conditions and the 2 cutting tasks was randomized. Plantar-loading data were recorded using instrumented insoles. Peak pressure, maximum force, force-time integral, and contact area beneath the total foot, the medial and lateral midfoot, and the medial, middle, and lateral forefoot were analyzed. A series of paired t tests was used to examine differences between the footwear conditions (carbon graphite footplate, shod) for both cutting tasks independently (α = .05). Results: During the side-cut task, the footplate increased total foot and lateral midfoot peak pressures while decreasing contact area and lateral midfoot force-time integral. During the crossover-cut task, the footplate increased total foot and lateral midfoot peak pressure and lateral forefoot force-time integral while decreasing total and lateral forefoot contact area. Conclusions: Although a rigid carbon graphite footplate altered some aspects of the plantar-pressure profile during cutting in uninjured participants, it was ineffective in reducing plantar loading beneath the fifth metatarsal. PMID:24955620

Influence of heel height and shoe insert on comfort perception and biomechanical performance of young female adults during walking.

PubMed

Hong, Wei-Hsien; Lee, Yung-Hui; Chen, Hsieh-Ching; Pei, Yu-Cheng; Wu, Ching-Yi

2005-12-01

The possible negative effects of high-heeled shoes on subjective comfort perception and objective biomechanical assessment have been noted. Although shoe inserts have been widely applied in footwear to increase comfort and to reduce the frequency of movement-related injury, no study has attempted to identify insert effectiveness in high heels. The purpose of this study was to determine the effects of heel height and shoe inserts on comfort and biomechanics as represented by plantar pressure and ground reaction force (GRF). Twenty young female adults performed the test conditions formed by the cross-matching of shoe inserts (shoe without insert and shoe with total contact insert [TCI]) and heel height (a flat, a low heel [3.8 cm] and a high heel [7.6 cm]). Two-way analyses of variance for repeated measures design were used to test condition effects on comfort rating, plantar pressure, and GRF during gait. To determine the biomechanical variables that can predict comfort, a multiple linear regression with stepwise method was done. The results showed that discomfort increased with heel height. In high heels, the plantar pressure in the heel and midfoot shifted to the medial forefoot, and the vertical and anteroposterior GRF increased. Use of the TCI reduced the peak pressure in the medial forefoot. Interestingly, the effectiveness of the TCI was greater in the higher heels than in the lower heels and in flat heels. The peak pressure in the medial forefoot, impact force, and the first peak vertical GRF could explain 75.6% of the variance of comfort in high-heeled gait. These findings suggest that higher heels result in decreased comfort, which can be reflected by both the subjective rating scale and biomechanical variables. Use of a TCI altered the biomechanics and therefore improved the comfort in high-heeled shoes.

Forefoot strikers exhibit lower running-induced knee loading than rearfoot strikers.

PubMed

Kulmala, Juha-Pekka; Avela, Janne; Pasanen, Kati; Parkkari, Jari

2013-12-01

Knee pain and Achilles tendinopathies are the most common complaints among runners. The differences in the running mechanics may play an important role in the pathogenesis of lower limb overuse injuries. However, the effect of a runner's foot strike pattern on the ankle and especially on the knee loading is poorly understood. The purpose of this study was to examine whether runners using a forefoot strike pattern exhibit a different lower limb loading profile than runners who use rearfoot strike pattern. Nineteen female athletes with a natural forefoot strike (FFS) pattern and pair-matched women with rearfoot strike (RFS) pattern (n = 19) underwent 3-D running analysis at 4 m·s⁻¹. Joint angles and moments, patellofemoral contact force and stresses, and Achilles tendon forces were analyzed and compared between groups. FFS demonstrated lower patellofemoral contact force and stress compared with heel strikers (4.3 ± 1.2 vs 5.1 ± 1.1 body weight, P = 0.029, and 11.1 ± 2.9 vs 13.0 ± 2.8 MPa, P = 0.04). In addition, knee frontal plane moment was lower in the FFS compared with heel strikers (1.49 ± 0.51 vs 1.97 ± 0.66 N·m·kg⁻¹, P =0.015). At the ankle level, FFS showed higher plantarflexor moment (3.12 ± 0.40 vs 2.54 ± 0.37 N·m·kg⁻¹; P = 0.001) and Achilles tendon force (6.3 ± 0.8 vs 5.1 ± 1.3 body weight; P = 0.002) compared with RFS. To our knowledge, this is the first study that shows differences in patellofemoral loading and knee frontal plane moment between FFS and RFS. FFS exhibit both lower patellofemoral stress and knee frontal plane moment than RFS, which may reduce the risk of running-related knee injuries. On the other hand, parallel increase in ankle plantarflexor and Achilles tendon loading may increase risk for ankle and foot injuries.

Medical-grade footwear: the impact of fit and comfort.

PubMed

Hurst, Bessie; Branthwaite, Helen; Greenhalgh, Andrew; Chockalingam, Nachiappan

2017-01-01

Pressure-related skin lesions on the digits are a significant cause of discomfort. Most foot pain related to ill-fitting shoes occurs in the forefoot and digital areas. Pain has been associated with poor shoe fit, reduced toe box volume, as well as contour and shape of the shoe Off-the-shelf medical-grade footwear is designed as an intervention for chronic lesions on the digits. These shoes are designed with a flexible neoprene fabric upper that is thought to reduce pressure on the forefoot and reduce discomfort associated with ill-fitting shoes. The aim of this study was to investigate the effect of an off-the-shelf, medical-grade shoe on dorsal digital pressure and perceived comfort when compared to participant's own preferred shoe. Thirty participants (18 females, 12 males) scored their perceived comfort whilst wearing each footwear style using a visual analog comfort scale. Dorsal digital and interdigital pressures were measured in using the WalkinSense® in-shoe pressure system. Sensors were placed on predetermined anatomical landmarks on the digits. Participants were randomly assigned the test shoe and their own shoe. Once wearing the shoe, the participants walked across a 6 m walkway and pressure data from each sensor was collected and processed to obtain peak pressure, time to peak pressure and contact time. Participants scored the test shoe with higher comfort points than their own footwear. Overall peak pressure, pressure time integral and contact time decreased, whilst the time taken to reach peak pressure increased across all anatomical landmarks whilst wearing the test shoe. Statistically significant changes were observed for all of the measured variables relating to pressure on the medial border of the first metatarsophalangeal joint. The test shoe provided greater comfort and reduced the amount of pressure on the forefoot. The medical-grade footwear therefore, is a viable alternative to custom made prescription footwear and is more suitable than a regular everyday shoe when treating digital lesions associated with pressure.

The relationship between foot posture and plantar pressure during walking in adults: A systematic review.

PubMed

Buldt, Andrew K; Allan, Jamie J; Landorf, Karl B; Menz, Hylton B

2018-02-23

Foot posture is a risk factor for some lower limb injuries, however the underlying mechanism is not well understood. Plantar pressure analysis is one technique to investigate the interaction between foot posture and biomechanical function of the lower limb. The aim of this review was to investigate the relationship between foot posture and plantar pressure during walking. A systematic database search was conducted using MEDLINE, CINAHL, SPORTDiscus and Embase to identify studies that have assessed the relationship between foot posture and plantar pressure during walking. Included studies were assessed for methodological quality. Meta-analysis was not conducted due to heterogeneity between studies. Inconsistencies included foot posture classification techniques, gait analysis protocols, selection of plantar pressure parameters and statistical analysis approaches. Of the 4213 citations identified for title and abstract review, sixteen studies were included and underwent quality assessment; all were of moderate methodological quality. There was some evidence that planus feet display higher peak pressure, pressure-time integral, maximum force, force-time integral and contact area predominantly in the medial arch, central forefoot and hallux, while these variables are lower in the lateral and medial forefoot. In contrast, cavus feet display higher peak pressure and pressure-time integral in the heel and lateral forefoot, while pressure-time integral, maximum force, force-time integral and contact area are lower for the midfoot and hallux. Centre of pressure was more laterally deviated in cavus feet and more medially deviated in planus feet. Overall, effect sizes were moderate, but regression models could only explain a small amount of variance in plantar pressure variables. Despite these significant findings, future research would benefit from greater methodological rigour, particularly in relation to the use of valid foot posture measurement techniques, gait analysis protocols, and standardised approaches for analysis and reporting of plantar pressure variables. Copyright © 2018 Elsevier B.V. All rights reserved.

Variation of plantar pressure in Chinese diabetes mellitus.

PubMed

Yang, Chuan; Xiao, Huisheng; Wang, Chuan; Mai, LiFang; Liu, Dan; Qi, Yiqing; Ren, Meng; Yan, Li

2015-01-01

To investigate dynamic changes in plantar pressure in Chinese diabetes mellitus patients and to provide a basis for further preventing diabetic foot. This is a cross-sectional investigation including 649 Chinese diabetes mellitus patients (diabetes group) and 808 "normal" Chinese persons (nondiabetes group) with normal blood glucose levels. All the subjects provided a complete medical history and underwent a physical examination and a 75-g oral glucose tolerance test. All subjects walked barefoot with their usual gait, and their dynamic plantar forces were measured using the one-step method with a plantar pressure measurement instrument; 5 measurements were performed for each foot. No significant differences were found in age, height, body weight, or body mass index between the two groups. The fasting blood glucose levels, plantar contact time, maximum force, pressure-time integrals and force-time integrals in the diabetes group were significantly higher than those in the nondiabetes group (p < 0.05). However, the maximum pressure was significantly higher in the nondiabetes group than in the diabetes group (p < 0.05). No difference was found in the contact areas between the two groups (p > 0.05). The maximum plantar force distributions were essentially the same, with the highest force found for the medial heel, followed by the medial forefoot and the first toe. The peak plantar pressure was located at the medial forefoot for the nondiabetes group and at the hallucis for the diabetes group. In the diabetes group, the momentum in each plantar region was higher than that in the nondiabetes group; this difference was especially apparent in the heel, the lateral forefoot and the hallucis. The dynamic plantar pressures in diabetic patients differ from those in nondiabetic people with increased maximum force and pressure, a different distribution pattern and significantly increased momentum, which may lead to the formation of foot ulcers. © 2015 by the Wound Healing Society.

A preliminary case study of the effect of shoe-wearing on the biomechanics of a horse’s foot

PubMed Central

Rankin, Jeffery W.; Gatesy, Stephen M.

2016-01-01

Horse racing is a multi-billion-dollar industry that has raised welfare concerns due to injured and euthanized animals. Whilst the cause of musculoskeletal injuries that lead to horse morbidity and mortality is multifactorial, pre-existing pathologies, increased speeds and substrate of the racecourse are likely contributors to foot disease. Horse hooves have the ability to naturally deform during locomotion and dissipate locomotor stresses, yet farriery approaches are utilised to increase performance and protect hooves from wear. Previous studies have assessed the effect of different shoe designs on locomotor performance; however, no biomechanical study has hitherto measured the effect of horseshoes on the stresses of the foot skeleton in vivo. This preliminary study introduces a novel methodology combining three-dimensional data from biplanar radiography with inverse dynamics methods and finite element analysis (FEA) to evaluate the effect of a stainless steel shoe on the function of a Thoroughbred horse’s forefoot during walking. Our preliminary results suggest that the stainless steel shoe shifts craniocaudal, mediolateral and vertical GRFs at mid-stance. We document a similar pattern of flexion-extension in the PIP (pastern) and DIP (coffin) joints between the unshod and shod conditions, with slight variation in rotation angles throughout the stance phase. For both conditions, the PIP and DIP joints begin in a flexed posture and extend over the entire stance phase. At mid-stance, small differences in joint angle are observed in the PIP joint, with the shod condition being more extended than the unshod horse, whereas the DIP joint is extended more in the unshod than the shod condition. We also document that the DIP joint extends more than the PIP after mid-stance and until the end of the stance in both conditions. Our FEA analysis, conducted solely on the bones, shows increased von Mises and Maximum principal stresses on the forefoot phalanges in the shod condition at mid-stance, consistent with the tentative conclusion that a steel shoe might increase mechanical loading. However, because of our limited sample size none of these apparent differences have been tested for statistical significance. Our preliminary study illustrates how the shoe may influence the dynamics and mechanics of a Thoroughbred horse’s forefoot during slow walking, but more research is needed to quantify the effect of the shoe on the equine forefoot during the whole stance phase, at faster speeds/gaits and with more individuals as well as with a similar focus on the hind feet. We anticipate that our preliminary analysis using advanced methodological approaches will pave the way for new directions in research on the form/function relationship of the equine foot, with the ultimate goal to minimise foot injuries and improve animal health and welfare. PMID:27478694

Toe amputations and ray resections.

PubMed

Pulla, R J; Kaminsky, K M

1997-10-01

Loss of a part of the lower extremity is an unfortunate complication of diabetes. Indications and general principles of amputation have been established. Distal limb salvage procedures include forefoot amputation alternatives, digital amputations, and ray resections. A variety of risks and complications are associated with these procedures. Postoperative management including prosthetic and accommodative therapy may enhance the successful outcomes of these procedures.

Maritime Standards for Compliance Safety and Health Officers (Instructor Manual). Volume 3

DTIC Science & Technology

1981-03-01

and striking tools "o Hamers "o Sledge hsmers "o Riveting hamners. 7. Hazards and health effects associated with the use of hand tools o Loss of eyes...lettered starting at the keel, A-B-C, etc. Strakes are classified inner skin, outer or cover, clinker or in and out, forefoot , shoe, boss, sheer, and

Gait-related strategies for the prevention of plantar ulcer development in the high risk foot.

PubMed

Bowling, Frank L; Reeves, Neil D; Boulton, Andrew J

2011-05-01

High plantar pressures lead to ulceration in the diabetic foot, particularly in the forefoot region around the metatarsal heads. High plantar pressures persist during gait due to factors such as peripheral neuropathy, foot deformities, limited ankle dorsi flexion range of motion and reduced plantar tissue thickness. Strategies impinging upon gait such as the use of appropriate therapeutic footwear, custom-moulded insoles and injectable silicone can help to reduce plantar pressures and attenuate the risk for ulceration. Shoes adapted with external rocker profiles facilitate plantar flexion and restrict sagittal plane motion of the metatarsophalangeal joint, reducing pressures in the region of the metatarsal heads. Insoles custom-moulded to patient's feet help to reduce plantar pressures and minimise the risk of ulceration in the forefoot region. The loss of subcutaneous fat tissue in the diabetic foot enhances bony prominences and predisposes the foot to high-pressure areas. Silicone is a biocompatible material that can be safely injected into plantar soft tissue to augment tissue thickness and prevent the development of ulceration. This enhancement to the subcutaneous layer is remarkably well retained and is a generally well-adopted procedure in the clinical setting.

Relationship between Achilles tendon properties and foot strike patterns in long-distance runners.

PubMed

Kubo, Keitaro; Miyazaki, Daisuke; Tanaka, Shigeharu; Shimoju, Shozo; Tsunoda, Naoya

2015-01-01

The purpose of this study was to investigate the relationship between Achilles tendon properties and foot strike patterns in long-distance runners. Forty-one highly trained male long-distance runners participated in this study. Elongation of the Achilles tendon and aponeurosis of the medial gastrocnemius muscle were measured using ultrasonography, while the participants performed ramp isometric plantar flexion up to the voluntary maximum. The relationship between the estimated muscle force and tendon elongation during the ascending phase was fit to a linear regression, the slope of which was defined as stiffness. In addition, the cross-sectional area of the Achilles tendon was measured using ultrasonography. Foot strike patterns (forefoot, midfoot and rearfoot) during running were determined at submaximal velocity (18 km · h(-1)) on a treadmill. The number of each foot strike runner was 12 for the forefoot (29.3%), 12 for the midfoot (29.3%) and 17 for the rearfoot (41.5%). No significant differences were observed in the variables measured for the Achilles tendon among the three groups. These results suggested that the foot strike pattern during running did not affect the morphological or mechanical properties of the Achilles tendon in long-distance runners.

Functional outcomes of transmetatarsal amputation in the diabetic foot: timing of revascularization, wound healing and ambulatory status.

PubMed

Mandolfino, T; Canciglia, A; Salibra, M; Ricciardello, D; Cuticone, G

2016-12-01

Transmetatarsal amputation (TMA) is an effective surgical approach to treat forefoot infection and gangrene in diabetic patients. However, a high rate of complications and failure to heal require reamputation in a large number of cases. We analysed the outcomes of TMA to define the role of revascularization, wound healing and ambulatory status. From January 2008 to January 2013, 218 diabetic patients with foot infection and gangrene, submitted to TMA associated to revascularization were followed until healing, amputation or death. Revascularization was done in 202 (92 %) cases. In 16 (7 %) no revascularization was required. The TMA was closed in 135 (62 %) and left open in 83 (38 %) cases. The reamputation rate was 34 % and major amputation 12.6 % at 1-year follow-up. Patient following ranged 2-30 months with a mean of 15 months. The functional outcomes, living at home and ambulation outdoors, were 60 and 36 % at hospital discharge after TMA, 81 and 77 % at 1-year follow-up. TMA associated to revascularization can provide an effective limb salvage and functional results in diabetic patients with forefoot tissue loss and infection.

Wound healing outcomes in a diabetic foot ulcer outpatient clinic at an acute care hospital: a retrospective study.

PubMed

Lu, S H; McLaren, A-M

2017-10-01

Patients with diabetic foot ulcers (DFU) have an increased risk of lower extremity amputation. A retrospective chart review of patients with DFUs attending the Foot Treatment and Assessment chiropodist-led outpatient clinic at an inner-city academic hospital was conducted to determine wound healing outcomes and characteristics contributing to outcomes. We reviewed the complete clinical history of 279 patients with 332 DFUs spanning over a five-year period. The mean age of patients was 61.5±12.5 years and most patients (83.5%) had one DFU. The majority of wounds (82.5%) were in the forefoot. Overall, 267/332 (80.5%) wounds healed. A greater proportion of wounds healed in the forefoot (82.5%) and midfoot (87.1%) than hindfoot (51.9%; p<0.001). Using a logistic regression model, palpable pedal pulse and use of a total contact cast were associated with better wound healing. Our findings are the first to demonstrate the benefits of chiropodists leading an acute care outpatient clinic in the management of DFUs in Canada and delivers wound healing outcomes equivalent to or exceeding those previously published.

Kilovoltage radiotherapy for companion animals: dosimetric comparison of 300 kV, 450 kV, and 6 MV X-ray beams.

PubMed

Seo, Jaehyeon; Son, Jaeman; Cho, Yeona; Park, Nohwon; Kim, Dong Wook; Kim, Jinsung; Yoon, Myonggeun

2018-04-12

Radiotherapy for the treatment of cancer in companion animals is currently administered using megavoltage X-ray machines. Because these machines are expensive, most animal hospitals do not perform radiotherapy. This study evaluated the ability of relatively inexpensive kilovoltage X-ray machines to treat companion animals. A simulation study based on a treatment planning system was performed for tumors of the brain (non-infectious meningoencephalitis), nasal cavity (malignant nasal tumors), forefoot (malignant muscular tumors), and abdomen (malignant intestinal tumors). The results of kilovoltage (300 kV and 450 kV) and megavoltage (6 MV) X-ray beams were compared. Whereas 300 kV and 6 MV X-ray beams provided optimal radiation dose homogeneity and conformity, respectively, for brain tumors, 6 MV X-rays provided optimal homogeneity and radiation conformity for nasal cavity, forefoot and abdominal tumors. Although megavoltage X-ray beams provided better radiation dose distribution in most treated animals, the differences between megavoltage and kilovoltage X-ray beams were relatively small. The similar therapeutic effects of kilovoltage and 6 MV X-ray beams suggest that kilovoltage X-ray beams may be effective alternatives to megavoltage X-ray beams in treating cancers in companion animals.

Intrinsic gait-related risk factors for Achilles tendinopathy in novice runners: a prospective study.

PubMed

Van Ginckel, Ans; Thijs, Youri; Hesar, Narmin Ghani Zadeh; Mahieu, Nele; De Clercq, Dirk; Roosen, Philip; Witvrouw, Erik

2009-04-01

The purpose of this prospective cohort study was to identify dynamic gait-related risk factors for Achilles tendinopathy (AT) in a population of novice runners. Prior to a 10-week running program, force distribution patterns underneath the feet of 129 subjects were registered using a footscan pressure plate while the subjects jogged barefoot at a comfortable self-selected pace. Throughout the program 10 subjects sustained Achilles tendinopathy of which three reported bilateral complaints. Sixty-six subjects were excluded from the statistical analysis. Therefore the statistical analysis was performed on the remaining sample of 63 subjects. Logistic regression analysis revealed a significant decrease in the total posterior-anterior displacement of the Centre Of Force (COF) (P=0.015) and a laterally directed force distribution underneath the forefoot at 'forefoot flat' (P=0.016) as intrinsic gait-related risk factors for Achilles tendinopathy in novice runners. These results suggest that, in contrast to the frequently described functional hyperpronation following a more inverted touchdown, a lateral foot roll-over following heel strike and diminished forward force transfer underneath the foot should be considered in the prevention of Achilles tendinopathy.

Functional aspects of metatarsal head shape in humans, apes, and Old World monkeys.

PubMed

Fernández, Peter J; Almécija, Sergio; Patel, Biren A; Orr, Caley M; Tocheri, Matthew W; Jungers, William L

2015-09-01

Modern human metatarsal heads are typically described as "dorsally domed," mediolaterally wide, and dorsally flat. Despite the apparent functional importance of these features in forefoot stability during bipedalism, the distinctiveness of this morphology has not been quantitatively evaluated within a broad comparative framework. In order to use these features to reconstruct fossil hominin locomotor behaviors with any confidence, their connection to human bipedalism should be validated through a comparative analysis of other primates with different locomotor behaviors and foot postures, including species with biomechanical demands potentially similar to those of bipedalism (e.g., terrestrial digitigrady). This study explores shape variation in the distal metatarsus among humans and other extant catarrhines using three-dimensional geometric morphometrics (3 DGM). Shape differences among species in metatarsal head morphology are well captured by the first two principal components of Procrustes shape coordinates, and these two components summarize most of the variance related to "dorsal doming" and "dorsal expansion." Multivariate statistical tests reveal significant differences among clades in overall shape, and humans are reliably distinguishable from other species by aspects of shape related to a greater degree of dorsal doming. Within quadrupeds, terrestrial species also trend toward more domed metatarsal heads, but not to the extent seen in humans. Certain aspects of distal metatarsus shape are likely related to habitual dorsiflexion of the metatarsophalangeal joints, but the total morphological pattern seen in humans is distinct. These comparative results indicate that this geometric morphometric approach is useful to characterize the complexity of metatarsal head morphology and will help clarify its relationship with function in fossil primates, including early hominins. Published by Elsevier Ltd.

The potential of human toe flexor muscles to produce force

PubMed Central

Goldmann, Jan-Peter; Brüggemann, Gert-Peter

2012-01-01

The maximal force a muscle produces depends among others on the length of the muscle and therefore on the positions of the joints the muscle crosses. Long and short toe flexor muscles (TFM) cross the ankle joints and metatarsal phalangeal joints (MPJ) and work against gravity during human locomotion. The purpose of this study was to describe the maximal moments around the MPJ during maximal voluntary isometric contractions (MVIC) of the TFM as a function of ankle joint and MPJ position. Twenty men performed MVIC of the TFM in a custom-made dynamometer. Ankle and MPJ angles were modified after each contraction. External moments of force around the MPJ were determined. Moments ranged between 6.3 ± 2.6 Nm and 14.2 ± 5.8 Nm. Highest moments were produced at 0°–10° ankle joint dorsal flexion and 25°–45° MPJ dorsal flexion. Lowest moments were generated at 35° ankle joint plantar flexion and 0° MPJ dorsal flexion. In conclusion, if the ankle is plantar-flexed, dorsal flexion of the MPJ avoids a disadvantage of the force–length relationship of TFM. Therefore, MPJ dorsal flexion is a necessary function in the push-off phase of human locomotion to work against the loss of the mechanical output at the forefoot caused by plantar flexion of the ankle. PMID:22747582

Ankle Block vs Single-Shot Popliteal Fossa Block as Primary Anesthesia for Forefoot Operative Procedures: Prospective, Randomized Comparison.

PubMed

Schipper, Oliver N; Hunt, Kenneth J; Anderson, Robert B; Davis, W Hodges; Jones, Carroll P; Cohen, Bruce E

2017-11-01

Postoperative pain is often difficult to control with oral medications, requiring large doses of opioid analgesia. Regional anesthesia may be used for primary anesthesia, reducing the need for general anesthetic and postoperative pain medication requirements in the immediate postoperative period. The purpose of this study was to compare the analgesic effects of an ankle block (AB) to a single-shot popliteal fossa block (PFB) for patients undergoing orthopedic forefoot procedures. All patients having elective outpatient orthopedic forefoot procedures were invited to participate in the study. Patients were prospectively randomized to receive either an ultrasound-guided AB or PFB by a board-certified anesthesiologist prior to their procedure. Intraoperative conversion to general anesthesia and postanesthesia care unit (PACU) opioid requirements were recorded. Postoperative pain was assessed using the visual analog scale (VAS) at regular time intervals until 8 am on postoperative day (POD) 2. Patients rated the effectiveness of the block on a 1 to 5 scale, with 5 being very effective. A total of 167 patients participated in the study with 88 patients (53%) receiving an AB and 79 (47%) receiving a single-shot PFB. There was no significant difference in the rate of conversion to general anesthesia between the 2 groups (13.6% [12/88] AB vs 12.7% [10/79] PFB). PACU morphine requirements and doses were significantly reduced in the PFB group ( P = .004) when compared to the AB group. The VAS was also significantly lower for the PFB patients at 10 pm on POD 0 (4.6 vs 1.6, P < .001), 8 am on POD 1 (5.9 vs 4.2, P = .003), and 12 pm on POD 1 (5.4 vs 4.1, P = .01). Overall complication rates were similar between the groups (AB 9% vs PFB 10.1%, P = .51) and there were no significant differences in residual sensory paresthesias (AB 2.3% [2/88] vs PFB 5.1% [4/79], P = .29), motor loss (0% vs 0%), or block site pain and/or erythema (AB 6.9% [6/88] vs PFB 5.1% [4/79], P = .44). The analgesic effect of the PFB lasted significantly longer when compared to the ankle block (AB 14.5 hours vs PFB 20.9 hours, P < .001). There was no significant difference in patient-perceived effectiveness of the block between the 2 groups, with both blocks being highly effective (AB 4.79/5 vs PFB 4.82/5, P = .68). Regional anesthesia was a safe and reliable adjunct to perioperative pain management and highly effective in patients undergoing elective orthopedic forefoot procedures. However, patients who received a PFB had significantly better pain management and decreased opioid requirements in the immediate perioperative period than patients who received an ankle block. Level I, prospective randomized study.

Arch-Taping Techniques for Altering Navicular Height and Plantar Pressures During Activity

PubMed Central

Newell, Tim; Simon, Janet; Docherty, Carrie L.

2015-01-01

Context Arch tapings have been used to support the arch by increasing navicular height. Few researchers have studied navicular height and plantar pressures after physical activity. Objective To determine if taping techniques effectively support the arch during exercise. Design Crossover study. Setting Athletic training research laboratory. Patients or Other Participants Twenty-five individuals (13 men, 12 women; age = 20.0 ± 1.0 years, height = 172.3 ± 6.6 cm, mass = 70.1 ± 10.2 kg) with a navicular drop of more than 8 mm (12.9 ± 3.3 mm) volunteered. Intervention(s) All individuals participated in 3 days of testing, with 1 day for each tape condition: no tape, low dye, and navicular sling. On each testing day, navicular height and plantar pressures were measured at 5 intervals: baseline; posttape; and after 5, 10, and 15 minutes of running. The order of tape condition was counterbalanced. Main Outcome Measure(s) The dependent variables were navicular height in millimeters and plantar pressures in kilopascals. Plantar pressures were divided into 5 regions: medial forefoot, lateral forefoot, lateral midfoot, lateral rearfoot, and medial rearfoot. Separate repeated-measures analyses of variance were conducted for each dependent variable. Results Navicular height was higher immediately after application of the navicular-sling condition (P = .004) but was reduced after 5 minutes of treadmill running (P = .12). We observed no differences from baseline to posttape for navicular height for the low-dye (P = .30) and no-tape conditions (P = .25). Both the low-dye and navicular-sling conditions increased plantar pressures in the lateral midfoot region compared with the no-tape condition. The low-dye condition created decreased pressure in the medial and lateral forefoot regions compared with the no-tape condition. All changes were identified immediately after application and were maintained during running. No changes were noted in plantar pressures for the no-tape condition (P > .05). Conclusions Both taping techniques effectively changed plantar pressures in the lateral midfoot, and these changes were sustained throughout the 15 minutes of exercise. PMID:26098272

A comparison of customised and prefabricated insoles to reduce risk factors for neuropathic diabetic foot ulceration: a participant-blinded randomised controlled trial

PubMed Central

2012-01-01

Background Neuropathic diabetic foot ulceration may be prevented if the mechanical stress transmitted to the plantar tissues is reduced. Insole therapy is one practical method commonly used to reduce plantar loads and ulceration risk. The type of insole best suited to achieve this is unknown. This trial compared custom-made functional insoles with prefabricated insoles to reduce risk factors for ulceration of neuropathic diabetic feet. Method A participant-blinded randomised controlled trial recruited 119 neuropathic participants with diabetes who were randomly allocated to custom-made functional or prefabricated insoles. Data were collected at issue and six month follow-up using the F-scan in-shoe pressure measurement system. Primary outcomes were: peak pressure, forefoot pressure time integral, total contact area, forefoot rate of load, duration of load as a percentage of stance. Secondary outcomes were patient perceived foot health (Bristol Foot Score), quality of life (Audit of Diabetes Dependent Quality of Life). We also assessed cost of supply and fitting. Analysis was by intention-to-treat. Results There were no differences between insoles in peak pressure, or three of the other four kinetic measures. The custom-made functional insole was slightly more effective than the prefabricated insole in reducing forefoot pressure time integral at issue (27% vs. 22%), remained more effective at six month follow-up (30% vs. 24%, p=0.001), but was more expensive (UK £656 vs. £554, p<0.001). Full compliance (minimum wear 7 hours a day 7 days per week) was reported by 40% of participants and 76% of participants reported a minimum wear of 5 hours a day 5 days per week. There was no difference in patient perception between insoles. Conclusion The custom-made insoles are more expensive than prefabricated insoles evaluated in this trial and no better in reducing peak pressure. We recommend that where clinically appropriate, the more cost effective prefabricated insole should be considered for use by patients with diabetes and neuropathy. Trial registration Clinical trials.gov (NCT00999635). Note: this trial was registered on completion. PMID:23216959

Rearfoot and midfoot or forefoot impacts in habitually shod runners.

PubMed

Boyer, Elizabeth R; Rooney, Brandon D; Derrick, Timothy R

2014-07-01

Shear loading rates (LR) have not been investigated in runners with a mid- or forefoot strike (FFS) versus rearfoot strike (RFS). The purpose of this study was to compare three-dimensional ground reaction forces (GRF) and LR during impact in habitual rearfoot strikers (hRF) and habitual forefoot strikers (hFF) strikers. Thirty competitive runners performed 10 overground running trials with both foot strike styles. Peak three-dimensional and resultant GRF and instantaneous LR during impact were compared. Vertical LR significantly decreased for hRF using an FFS (RFS = 148 ± 36 body weight [BW]·s(-1), FFS = 98 ± 31 BW·s(-1)) but was similar for hFF running with either foot strike (FFS = 136 ± 35 BW·s(-1), RFS = 135 ± 28 BW·s(-1)). Posterior impact forces were present during FFS but not during RFS, and posterior LR was significantly greater for both groups during FFS (-58 ± 17 vs -19 ± 6 BW·s(-1)). Medial impact forces were also present during FFS but not during RFS, and medial LR was significantly larger for both groups during FFS (-21 ± 7 vs -6 ± 6 BW·s(-1)). Interestingly, hFF had greater impact peaks and LR in all directions compared with hRF during FFS. This may be explained by hFF using a smaller strike index (hFF = 62% ± 9%, hRF = 67% ± 9%; P = 0.02), which was significantly inversely related to vertical LR and impact peak. Peak resultant and vertical LR are not ubiquitously lower when using a shod FFS versus RFS despite an absence of resultant and vertical impact peaks. Furthermore, there were impact peaks in the posterior and medial directions, leading also to greater LR in these directions during FFS. Therefore, transitioning from RFS to FFS in traditional running shoes may not offer long-term protection against impact-related running injuries because hFF running with an FFS demonstrated many GRF and LR similar to or greater than RFS.

Altered Kinematics and Time to Stabilization During Drop-Jump Landings in Individuals With or Without Functional Ankle Instability

PubMed Central

Wright, Cynthia J.; Arnold, Brent L.; Ross, Scott E.

2016-01-01

Context It has been proposed that altered dynamic-control strategies during functional activity such as jump landings may partially explain recurrent instability in individuals with functional ankle instability (FAI). Objective To capture jump-landing time to stabilization (TTS) and ankle motion using a multisegment foot model among FAI, coper, and healthy control individuals. Design Cross-sectional study. Setting Laboratory. Patients or Other Participants Participants were 23 individuals with a history of at least 1 ankle sprain and at least 2 episodes of giving way in the past year (FAI), 23 individuals with a history of a single ankle sprain and no subsequent episodes of instability (copers), and 23 individuals with no history of ankle sprain or instability in their lifetime (controls). Participants were matched for age, height, and weight (age = 23.3 ± 3.8 years, height = 1.71 ± 0.09 m, weight = 69.0 ± 13.7 kg). Intervention(s) Ten single-legged drop jumps were recorded using a 12-camera Vicon MX motion-capture system and a strain-gauge force plate. Main Outcome Measures Mediolateral (ML) and anteroposterior (AP) TTS in seconds, as well as forefoot and hindfoot sagittal- and frontal-plane angles at jump-landing initial contact and at the point of maximum vertical ground reaction force were calculated. Results For the forefoot and hindfoot in the sagittal plane, group differences were present at initial contact (forefoot: P = .043, hindfoot: P = .004). At the hindfoot, individuals with FAI displayed more dorsiflexion than the control and coper groups. Time to stabilization differed among groups (AP TTS: P < .001; ML TTS: P = .040). Anteroposterior TTS was longer in the coper group than in the FAI or control groups, and ML TTS was longer in the FAI group than in the control group. Conclusions During jump landings, copers showed differences in sagittal-plane control, including less plantar flexion at initial contact and increased AP sway during stabilization, which may contribute to increased dynamic stability. PMID:26794631

Energy neutral: the human foot and ankle subsections combine to produce near zero net mechanical work during walking.

PubMed

Takahashi, Kota Z; Worster, Kate; Bruening, Dustin A

2017-11-13

The human foot and ankle system is equipped with structures that can produce mechanical work through elastic (e.g., Achilles tendon, plantar fascia) or viscoelastic (e.g., heel pad) mechanisms, or by active muscle contractions. Yet, quantifying the work distribution among various subsections of the foot and ankle can be difficult, in large part due to a lack of objective methods for partitioning the forces acting underneath the stance foot. In this study, we deconstructed the mechanical work production during barefoot walking in a segment-by-segment manner (hallux, forefoot, hindfoot, and shank). This was accomplished by isolating the forces acting within each foot segment through controlling the placement of the participants' foot as it contacted a ground-mounted force platform. Combined with an analysis that incorporated non-rigid mechanics, we quantified the total work production distal to each of the four isolated segments. We found that various subsections within the foot and ankle showed disparate work distribution, particularly within structures distal to the hindfoot. When accounting for all sources of positive and negative work distal to the shank (i.e., ankle joint and all foot structures), these structures resembled an energy-neutral system that produced net mechanical work close to zero (-0.012 ± 0.054 J/kg).

Tarsometatarsal arthrodesis for management of unstable first ray and failed bunion surgery.

PubMed

Espinosa, Norman; Wirth, Stephan H

2011-03-01

This article focuses on arthrodesis of the first tarsometatarsal joint as the primary intervention to treat hypermobility of the first ray or as a salvage procedure to treat prior failed bunion surgery and provides a concise review including historical perspective, definitions, pathomechanics, and treatment of specific forefoot disorders (ie, hypermobility of the first ray and failed bunion surgery). Copyright © 2011 Elsevier Inc. All rights reserved.

Traumatic ipsilateral multiple open metatarsal and calcaneal fractures with first metatarsophalangeal joint dislocation: a case report.

PubMed

Ozkan, Namik Kemal; Unay, Koray; Cift, Hakan; Eceviz, Engin; Ozkan, Korhan

2010-06-01

A 17-year-old man fell from a height of 10 m onto his right forefoot and sustained ipsilateral calcaneal, comminuted cuboid, and second, third, and fourth metatarsal neck fractures and first metatarsophalangeal joint open dislocation. This report discusses this rare injury. The authors believe that initial debridement with immediate surgical fixation and reduction with appropriate antibiotic treatment saved the patient's extremity.

Variation in the myosoricine hand skeleton and its implications for locomotory behavior (Eulipotyphla: Soricidae)

USGS Publications Warehouse

Woodman, Neal; Stabile, Frank A.

2015-01-01

Substrate use and locomotory behavior of mammals are typically reflected in external characteristics of the forefeet, such as the relative proportions of the digits and claws. Although skeletal anatomy of the forefeet can be more informative than external characters, skeletons remain rare in systematic collections. This is particularly true for the Myosoricinae (Eulipotyphla: Soricidae), a small clade of African shrews that includes both ambulatory forest shrews (Myosorex) and semifossorial mole shrews (Surdisorex). Most species in this subfamily have restricted distributions, and their behavior and ecology are mostly unstudied. To better understand the potential range of locomotory behavior among myosoricines, we used digital x-rays to image and facilitate measuring the forefoot skeletons of 9 species. As a gauge of potential variation, we compared them with the ambulatory talpid Uropsilus (Talpidae) and the semifossorial talpid Neurotrichus. The hand morphologies of myosoricines show a graded range of potential substrate use between ambulatory and semifossorial. Some of these shrews exhibit adaptations for increased burrowing efficiency that are similar to those seen in talpids and other mammals, such as longer, broader distal phalanges and claws and shorter, wider metacarpals and proximal and middle phalanges. They also, however, have characteristics that are distinct from talpids, such as maintenance of forefoot asymmetry and an increased emphasis of ray III.

Analysis of a kinetic multi-segment foot model. Part I: Model repeatability and kinematic validity.

PubMed

Bruening, Dustin A; Cooney, Kevin M; Buczek, Frank L

2012-04-01

Kinematic multi-segment foot models are still evolving, but have seen increased use in clinical and research settings. The addition of kinetics may increase knowledge of foot and ankle function as well as influence multi-segment foot model evolution; however, previous kinetic models are too complex for clinical use. In this study we present a three-segment kinetic foot model and thorough evaluation of model performance during normal gait. In this first of two companion papers, model reference frames and joint centers are analyzed for repeatability, joint translations are measured, segment rigidity characterized, and sample joint angles presented. Within-tester and between-tester repeatability were first assessed using 10 healthy pediatric participants, while kinematic parameters were subsequently measured on 17 additional healthy pediatric participants. Repeatability errors were generally low for all sagittal plane measures as well as transverse plane Hindfoot and Forefoot segments (median<3°), while the least repeatable orientations were the Hindfoot coronal plane and Hallux transverse plane. Joint translations were generally less than 2mm in any one direction, while segment rigidity analysis suggested rigid body behavior for the Shank and Hindfoot, with the Forefoot violating the rigid body assumptions in terminal stance/pre-swing. Joint excursions were consistent with previously published studies. Copyright © 2012 Elsevier B.V. All rights reserved.

Development of a Plantar Load Estimation Algorithm for Evaluation of Forefoot Load of Diabetic Patients during Daily Walks Using a Foot Motion Sensor

PubMed Central

Noguchi, Hiroshi; Sanada, Hiromi

2017-01-01

Forefoot load (FL) contributes to callus formation, which is one of the pathways to diabetic foot ulcers (DFU). In this study, we hypothesized that excessive FL, which cannot be detected by plantar load measurements within laboratory settings, occurs in daily walks. To demonstrate this, we created a FL estimation algorithm using foot motion data. Acceleration and angular velocity data were obtained from a motion sensor attached to each shoe of the subjects. The accuracy of the estimated FL was validated by correlation with the FL measured by force sensors on the metatarsal heads, which was assessed using the Pearson correlation coefficient. The mean of correlation coefficients of all the subjects was 0.63 at a level corridor, while it showed an intersubject difference at a slope and stairs. We conducted daily walk measurements in two diabetic patients, and additionally, we verified the safety of daily walk measurement using a wearable motion sensor attached to each shoe. We found that excessive FL occurred during their daily walks for approximately three hours in total, when any adverse event was not observed. This study indicated that FL evaluation method using wearable motion sensors was one of the promising ways to prevent DFUs. PMID:28840130

Determination of Ankle and Metatarsophalangeal Stiffness During Walking and Jogging.

PubMed

Mager, Fabian; Richards, Jim; Hennies, Malika; Dötzel, Eugen; Chohan, Ambreen; Mbuli, Alex; Capanni, Felix

2018-05-29

Forefoot stiffness has been shown to influence joint biomechanics. However, little or no data exists on metatarsophalangeal stiffness. Twenty-four healthy rearfoot strike runners were recruited from a staff and student population at the University of Central Lancashire. Five repetitions of shod, self-selected speed level walking and jogging were performed. Kinetic and kinematic data were collected using retro-reflective markers placed on the lower limb and foot, to create a three-segment foot model using the Calibrated Anatomical System Technique. Ankle and metatarsophalangeal moments and angles were calculated. Stiffness values were calculated using a linear best fit line of moment versus of angle plots. Paired t-tests were used to compare values between walking and jogging conditions. Significant differences were seen in ankle range of motion (ROM), but not in metatarsophalangeal ROM. Maximum moments were significantly greater in the ankle during jogging, but these were not significantly different at the metatarsophalangeal joint. Average ankle joint stiffness exhibited significantly lower stiffness when walking compared to jogging. However, the metatarsophalangeal joint exhibited significantly greater stiffness when walking compared to jogging. A greater understanding of forefoot stiffness may inform the development of footwear, prosthetic feet and orthotic devices, such as ankle-foot orthoses for walking and sporting activities.

Impact attenuation properties of jazz shoes alter lower limb joint stiffness during jump landings.

PubMed

Fong Yan, Alycia; Smith, Richard M; Hiller, Claire E; Sinclair, Peter J

2017-05-01

To quantify the impact attenuation properties of the jazz shoes, and to investigate the in-vivo effect of four jazz shoe designs on lower limb joint stiffness during a dance-specific jump. Repeated measures. A custom-built mechanical shoe tester similar to that used by athletic shoe companies was used to vertically impact the forefoot and heel region of four different jazz shoe designs. Additionally, dancers performed eight sautés in second position in bare feet and the shoe conditions. Force platforms and 3D-motion capture were used to analyse the joint stiffness of the midfoot, ankle, knee and hip during the jump landings. Mechanical testing of the jazz shoes revealed significant differences in impact attenuation characteristics among each of the jazz shoe designs. Gross knee and midfoot joint stiffness were significantly affected by the jazz shoe designs in the dancers' jump landings. The tested jazz shoe designs altered the impact attenuating capacity of jump landing technique in dancers. The cushioned jazz shoes are recommended particularly for injured dancers to reduce impact on the lower limb. Jazz shoe design should consider the impact attenuation properties of the forefoot region, due to the toe-strike landing technique in dance movement. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Joint stiffness and running economy during imposed forefoot strike before and after a long run in rearfoot strike runners.

PubMed

Melcher, Daniel A; Paquette, Max R; Schilling, Brian K; Bloomer, Richard J

2017-12-01

Research has focused on the effects of acute strike pattern modifications on lower extremity joint stiffness and running economy (RE). Strike pattern modifications on running biomechanics have mostly been studied while runners complete short running bouts. This study examined the effects of an imposed forefoot strike (FFS) on RE and ankle and knee joint stiffness before and after a long run in habitual rearfoot strike (RFS) runners. Joint kinetics and RE were collected before and after a long run. Sagittal joint kinetics were computed from kinematic and ground reaction force data that were collected during over-ground running trials in 13 male runners. RE was measured during treadmill running. Knee flexion range of motion, knee extensor moment and ankle joint stiffness were lower while plantarflexor moment and knee joint stiffness were greater during imposed FFS compared with RFS. The long run did not influence the difference in ankle and knee joint stiffness between strike patterns. Runners were more economical during RFS than imposed FFS and RE was not influenced by the long run. These findings suggest that using a FFS pattern towards the end of a long run may not be mechanically or metabolically beneficial for well-trained male RFS runners.

The effect of calf muscle stretching exercises on ankle joint dorsiflexion and dynamic foot pressures, force and related temporal parameters.

PubMed

Macklin, K; Healy, A; Chockalingam, N

2012-03-01

Previous research has found that ankle joint equinus can lead to foot pathologies. Calf stretching exercises are a common treatment prescription; however, no dynamic quantitative data on its effectiveness is available. To investigate the effect of calf muscle stretching on ankle joint dorsiflexion and subsequent changes within dynamic forefoot peak plantar pressures (PPP), force and temporal parameters. Thirteen runners with ankle joint equinus were required to perform calf muscle stretching twice a day (morning and evening) on a Flexeramp. Measurements were collected on day 1, week 4 and week 8. A repeated measures ANOVA with Bonferroni-adjusted post hoc comparisons was used to assess differences across the three data collection sessions. Findings indicated that the calf stretching program increased ankle joint dorsiflexion significantly (from 5° to 16°, p≤0.05). The adaptive kinetics brought about by the increased ankle joint range of motion included significantly increased forefoot PPP and maximum force during stance phase but decreased time between heel contact and heel lift and total stance phase time. The calf stretching programme used in this study was found to increase ankle joint dorsiflexion and hence can be used for first line conservative management of ankle equinus. Copyright © 2011 Elsevier Ltd. All rights reserved.

Development of a Plantar Load Estimation Algorithm for Evaluation of Forefoot Load of Diabetic Patients during Daily Walks Using a Foot Motion Sensor.

PubMed

Watanabe, Ayano; Noguchi, Hiroshi; Oe, Makoto; Sanada, Hiromi; Mori, Taketoshi

2017-01-01

Forefoot load (FL) contributes to callus formation, which is one of the pathways to diabetic foot ulcers (DFU). In this study, we hypothesized that excessive FL, which cannot be detected by plantar load measurements within laboratory settings, occurs in daily walks. To demonstrate this, we created a FL estimation algorithm using foot motion data. Acceleration and angular velocity data were obtained from a motion sensor attached to each shoe of the subjects. The accuracy of the estimated FL was validated by correlation with the FL measured by force sensors on the metatarsal heads, which was assessed using the Pearson correlation coefficient. The mean of correlation coefficients of all the subjects was 0.63 at a level corridor, while it showed an intersubject difference at a slope and stairs. We conducted daily walk measurements in two diabetic patients, and additionally, we verified the safety of daily walk measurement using a wearable motion sensor attached to each shoe. We found that excessive FL occurred during their daily walks for approximately three hours in total, when any adverse event was not observed. This study indicated that FL evaluation method using wearable motion sensors was one of the promising ways to prevent DFUs.

One-stage metatarsal lengthening by allograft interposition: a novel approach for congenital brachymetatarsia.

PubMed

Giannini, Sandro; Faldini, Cesare; Pagkrati, Stavroula; Miscione, Maria Teresa; Luciani, Deianira

2010-07-01

Congenital brachymetatarsia, a shortened metatarsal bone, can be corrected surgically by callus distraction or one-stage lengthening using bone graft. We asked whether one-stage metatarsal lengthening using metatarsal homologous bone graft could improve forefoot function, lead to metatarsal healing, restore metatarsal parabola, and improve cosmetic appearance. We retrospectively reviewed 29 patients (41 feet) in whom we lengthened 50 metatarsals. Surgery consisted of a transverse proximal osteotomy of the metatarsal shaft and interposition of a metatarsal homologous bone graft (average, 13 mm long) fixed with an intramedullary Kirschner wire. Minimum followup was 3 years (mean, 5 years; range, 3-11 years). Bone union was achieved in all cases. The mean preoperative American Orthopaedic Foot and Ankle Society score was 37 points (range, 28-53 points) and the mean postoperative score was 88 points (range, 74-96 points), with an average improvement of 51 points. Radiographically, the mean gain in length was 13 mm (range, 10-15 mm), and the mean percentage increase was 23%. One-stage metatarsal lengthening using interposition of metatarsal homologous bone graft to correct congenital brachymetatarsia has low morbidity for the patient, limited complications, short recovery times, and restores forefoot anatomy. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

A Study of H-Reflexes in Subjects with Acute Ankle Inversion Injuries

DTIC Science & Technology

1996-12-09

stress to the injured ankle at heel- strike .(57) Any increased inversion stress by way of joint loading in the presence of compromised joint...the present study, may play a role in decreasing the degree of calcaneal inversion just prior to heel- strike and minimize the stress on the lateral...Presentation: * Significant edema/ecchymosis on lateral and medial aspects of ankle. * Possible pitting edema on forefoot (several days post- injury

Neuroprosthetics and Solutions for Restoring Sensorimotor Functions

DTIC Science & Technology

2009-01-01

in the stab wound control (A, C) and the 1-week implantation of the electrode (B, D). Striking neurofilament loss occurred surrounding both the stab...force. (Like in heel strike and toe of in normal gait cycle). (B) The Proof Test is a static test for foot ankle unit in which maximum load is...applied on heel and forefoot in one single time successively. Project 1. Develop a somatosensory neural interface (SSNI) -Completed pilot testing of

Macrodactyly, syndactyly, and localized gigantism of the forefoot. A case report.

PubMed

Scapinelli, R; Baggio, M E

2005-01-01

On the basis of the observation of a rare case of lipomatous macrodactyly of the foot associated with syndactyly in a young child, the authors analyze the anatomopathologic and therapeutic aspects of the pathology and report the data found in the literature. This disease initially requires careful surveillance of its progression, and use of correct footwear. Surgery is indicated when deformity achieves unacceptable values, both functional and cosmetic, in early childhood.

Effects of strengthening, stretching and functional training on foot function in patients with diabetic neuropathy: results of a randomized controlled trial

PubMed Central

2014-01-01

Background Foot musculoskeletal deficits are seldom addressed by preventive medicine despite their high prevalence in patients with diabetic polyneuropathy. AIM: To investigate the effects of strengthening, stretching, and functional training on foot rollover process during gait. Methods A two-arm parallel-group randomized controlled trial with a blinded assessor was designed. Fifty-five patients diagnosed with diabetic polyneuropathy, 45 to 65 years-old were recruited. Exercises for foot-ankle and gait training were administered twice a week, for 12 weeks, to 26 patients assigned to the intervention group, while 29 patients assigned to control group received recommended standard medical care: pharmacological treatment for diabetes and foot care instructions. Both groups were assessed after 12 weeks, and the intervention group at follow-up (24 weeks). Primary outcomes involved foot rollover changes during gait, including peak pressure (PP). Secondary outcomes involved time-to-peak pressure (TPP) and pressure–time integral (PTI) in six foot-areas, mean center of pressure (COP) velocity, ankle kinematics and kinetics in the sagittal plane, intrinsic and extrinsic muscle function, and functional tests of foot and ankle. Results Even though the intervention group primary outcome (PP) showed a not statistically significant change under the six foot areas, intention-to-treat comparisons yielded softening of heel strike (delayed heel TPP, p=.03), better eccentric control of forefoot contact (decrease in ankle extensor moment, p<.01; increase in function of ankle dorsiflexion, p<.05), earlier lateral forefoot contact with respect to medial forefoot (TPP anticipation, p<.01), and increased participation of hallux (increased PP and PTI, p=.03) and toes (increase in PTI, medium effect size). A slower COP mean velocity (p=.05), and an increase in overall foot and ankle function (p<.05) were also observed. In most cases, the values returned to baseline after the follow-up (p<.05). Conclusions Intervention discreetly changed foot rollover towards a more physiological process, supported by improved plantar pressure distribution and better functional condition of the foot ankle complex. Continuous monitoring of the foot status and patient education are necessary, and can contribute to preserving the integrity of foot muscles and joints impaired by polyneuropathy. Trial registration ClinicalTrials.gov Identifier: NCT01207284, registered in 20th September 2010. PMID:24767584

Select injury-related variables are affected by stride length and foot strike style during running.

PubMed

Boyer, Elizabeth R; Derrick, Timothy R

2015-09-01

Some frontal plane and transverse plane variables have been associated with running injury, but it is not known if they differ with foot strike style or as stride length is shortened. To identify if step width, iliotibial band strain and strain rate, positive and negative free moment, pelvic drop, hip adduction, knee internal rotation, and rearfoot eversion differ between habitual rearfoot and habitual mid-/forefoot strikers when running with both a rearfoot strike (RFS) and a mid-/forefoot strike (FFS) at 3 stride lengths. Controlled laboratory study. A total of 42 healthy runners (21 habitual rearfoot, 21 habitual mid-/forefoot) ran overground at 3.35 m/s with both a RFS and a FFS at their preferred stride lengths and 5% and 10% shorter. Variables did not differ between habitual groups. Step width was 1.5 cm narrower for FFS, widening to 0.8 cm as stride length shortened. Iliotibial band strain and strain rate did not differ between foot strikes but decreased as stride length shortened (0.3% and 1.8%/s, respectively). Pelvic drop was reduced 0.7° for FFS compared with RFS, and both pelvic drop and hip adduction decreased as stride length shortened (0.8° and 1.5°, respectively). Peak knee internal rotation was not affected by foot strike or stride length. Peak rearfoot eversion was not different between foot strikes but decreased 0.6° as stride length shortened. Peak positive free moment (normalized to body weight [BW] and height [h]) was not affected by foot strike or stride length. Peak negative free moment was -0.0038 BW·m/h greater for FFS and decreased -0.0004 BW·m/h as stride length shortened. The small decreases in most variables as stride length shortened were likely associated with the concomitant wider step width. RFS had slightly greater pelvic drop, while FFS had slightly narrower step width and greater negative free moment. Shortening one's stride length may decrease or at least not increase propensity for running injuries based on the variables that we measured. One foot strike style does not appear universally better than the other; rather, different foot strike styles may predispose runners to different types of injuries. © 2015 The Author(s).

Effects of strengthening, stretching and functional training on foot function in patients with diabetic neuropathy: results of a randomized controlled trial.

PubMed

Sartor, Cristina D; Hasue, Renata H; Cacciari, Lícia P; Butugan, Marco K; Watari, Ricky; Pássaro, Anice C; Giacomozzi, Claudia; Sacco, Isabel C N

2014-04-27

Foot musculoskeletal deficits are seldom addressed by preventive medicine despite their high prevalence in patients with diabetic polyneuropathy. To investigate the effects of strengthening, stretching, and functional training on foot rollover process during gait. A two-arm parallel-group randomized controlled trial with a blinded assessor was designed. Fifty-five patients diagnosed with diabetic polyneuropathy, 45 to 65 years-old were recruited. Exercises for foot-ankle and gait training were administered twice a week, for 12 weeks, to 26 patients assigned to the intervention group, while 29 patients assigned to control group received recommended standard medical care: pharmacological treatment for diabetes and foot care instructions. Both groups were assessed after 12 weeks, and the intervention group at follow-up (24 weeks). Primary outcomes involved foot rollover changes during gait, including peak pressure (PP). Secondary outcomes involved time-to-peak pressure (TPP) and pressure-time integral (PTI) in six foot-areas, mean center of pressure (COP) velocity, ankle kinematics and kinetics in the sagittal plane, intrinsic and extrinsic muscle function, and functional tests of foot and ankle. Even though the intervention group primary outcome (PP) showed a not statistically significant change under the six foot areas, intention-to-treat comparisons yielded softening of heel strike (delayed heel TPP, p=.03), better eccentric control of forefoot contact (decrease in ankle extensor moment, p<.01; increase in function of ankle dorsiflexion, p<.05), earlier lateral forefoot contact with respect to medial forefoot (TPP anticipation, p<.01), and increased participation of hallux (increased PP and PTI, p=.03) and toes (increase in PTI, medium effect size). A slower COP mean velocity (p=.05), and an increase in overall foot and ankle function (p<.05) were also observed. In most cases, the values returned to baseline after the follow-up (p<.05). Intervention discreetly changed foot rollover towards a more physiological process, supported by improved plantar pressure distribution and better functional condition of the foot ankle complex. Continuous monitoring of the foot status and patient education are necessary, and can contribute to preserving the integrity of foot muscles and joints impaired by polyneuropathy. ClinicalTrials.gov Identifier: NCT01207284, registered in 20th September 2010.

Ship Structure Committee Publications: A Special Bibliography.

DTIC Science & Technology

1983-01-01

structural surfaces, even more so when the surfaces were machined after straining. damage; heavy weather damage to the forefoot and forward weather deck...One of the striking ORDER FROM: NTIS inadequacies of the impact test was the failure to show a difference between AD-72963 steels A and C, a...weldment in the range of 40 deg to 0 deg F. The effects of various types of defects, including arc strikes , Contract NObs-50238 porosity, and partial

Shoe drop reduction influences the lower limb biomechanics of children tennis players during an open stance forehand: A longitudinal study.

PubMed

Herbaut, Alexis; Simoneau-Buessinger, Emilie; Barbier, Franck; Gillet, Christophe; Roux, Maxime; Guéguen, Nils; Chavet, Pascale

2017-11-01

Compared to traditional tennis shoes, using 0-drop shoes was shown to induce an immediate switch from rear- to forefoot strike pattern to perform an open stance tennis forehand for 30% of children tennis players. The purpose of the study was to examine the long-term effects of a gradual reduction in the shoe drop on the biomechanics of children tennis players performing open stance forehands. Thirty children tennis players participated in 2 laboratory biomechanical test sessions (intermediate: +4 months and final: +8 months) after an inclusion visit where they were randomly assigned to control (CON) or experimental (EXP) group. CON received 12-mm-drop shoes twice, whereas EXP received 8 mm then 4-mm-drop shoes. Strike index indicated that all CON were rearfoot strikers in intermediate and final test sessions. All EXP were rearfoot strikers in intermediate test session, but half the group switched towards a forefoot strike pattern in final test session. This switch resulted in a decreased loading rate of the ground reaction force (-73%, p = .005) but increased peak ankle plantarflexors moment (+47%, p = .050) and peak ankle power absorption (+107%, p = .005) for these participants compared with CON. Biomechanical changes associated with the long-term use of partial minimalist shoes suggest a reduction in heel compressive forces but an increase in Achilles tendon tensile forces.

Relationship between foot posture measurements and force platform parameters during two balance tasks in older and younger subjects

PubMed Central

Carvalho, Carlos E.; da Silva, Rubens A.; Gil, André W.; Oliveira, Márcio R.; Nascimento, Juliana A.; Pires-Oliveira, Deise A. A.

2015-01-01

[Purpose] The aim of this study was to compare age-related differences in balance and anthropometric posture measurements of the foot and to determine any relationship between them. [Subjects and Methods] Sixty-eight older and 42 younger adults participated in this study. Foot posture was tested for four domains: 1) hallux flexion and extension range of motion using a goniometer, 2) navicular height and 3) length of the foot using a pachymeter, and 4) footprint (width of forefoot, arch index and hallux valgus). Balance was tested under two conditions on a force platform: bipodal in 60-s trials and unipodal in 30-s trials. The sway area of the center of pressure and velocity in the anteroposterior and mediolateral directions were computed. [Results] Older individuals showed significantly poorer balance compared with younger adults under in the unipodal condition (center of pressure area 9.97 vs. 7.72 cm2). Older people presented a significantly lower hallux mobility and higher values for width of the forefoot and transverse arch index than younger adults. The correlations between all foot posture and center of pressure parameters varied across groups, from weak to moderate (r −0.01 to −0.46). Low hallux mobility was significantly related to higher center of pressure values in older people. [Conclusion] These results have clinical implications for balance and foot posture assessments. PMID:25931713

Relationship between foot posture measurements and force platform parameters during two balance tasks in older and younger subjects.

PubMed

Carvalho, Carlos E; da Silva, Rubens A; Gil, André W; Oliveira, Márcio R; Nascimento, Juliana A; Pires-Oliveira, Deise A A

2015-03-01

[Purpose] The aim of this study was to compare age-related differences in balance and anthropometric posture measurements of the foot and to determine any relationship between them. [Subjects and Methods] Sixty-eight older and 42 younger adults participated in this study. Foot posture was tested for four domains: 1) hallux flexion and extension range of motion using a goniometer, 2) navicular height and 3) length of the foot using a pachymeter, and 4) footprint (width of forefoot, arch index and hallux valgus). Balance was tested under two conditions on a force platform: bipodal in 60-s trials and unipodal in 30-s trials. The sway area of the center of pressure and velocity in the anteroposterior and mediolateral directions were computed. [Results] Older individuals showed significantly poorer balance compared with younger adults under in the unipodal condition (center of pressure area 9.97 vs. 7.72 cm(2)). Older people presented a significantly lower hallux mobility and higher values for width of the forefoot and transverse arch index than younger adults. The correlations between all foot posture and center of pressure parameters varied across groups, from weak to moderate (r -0.01 to -0.46). Low hallux mobility was significantly related to higher center of pressure values in older people. [Conclusion] These results have clinical implications for balance and foot posture assessments.

Effect of Forefoot Strike on Lower Extremity Muscle Activity and Knee Joint Angle During Cutting in Female Team Handball Players.

PubMed

Yoshida, Naruto; Kunugi, Shun; Mashimo, Sonoko; Okuma, Yoshihiro; Masunari, Akihiko; Miyazaki, Shogo; Hisajima, Tatsuya; Miyakawa, Shumpei

2015-06-01

The purpose of this study is to examine the effects of different strike forms, during cutting, on knee joint angle and lower limb muscle activity. Surface electromyography was used to measure muscle activity in individuals performing cutting manoeuvres involving either rearfoot strikes (RFS) or forefoot strikes (FFS). Three-dimensional motion analysis was used to calculate changes in knee angles, during cutting, and to determine the relationship between muscle activity and knee joint angle. Force plates were synchronized with electromyography measurements to compare muscle activity immediately before and after foot strike. The valgus angle tends to be smaller during FFS cutting than during RFS cutting. Just prior to ground contact, biceps femoris, semitendinosus, and lateral head of the gastrocnemius muscle activities were significantly greater during FFS cutting than during RFS cutting; tibialis anterior muscle activity was greater during RFS cutting. Immediately after ground contact, biceps femoris and lateral head of the gastrocnemius muscle activities were significantly greater during FFS cutting than during RFS cutting; tibialis anterior muscle activity was significantly lower during FFS cutting. The results of the present study suggest that the hamstrings demonstrate greater activity, immediately after foot strike, during FFS cutting than during RFS cutting. Thus, FFS cutting may involve a lower risk of anterior cruciate ligament injury than does RFS cutting.

Influence of wound scores and microbiology on the outcome of the diabetic foot syndrome.

PubMed

Bravo-Molina, Alejandra; Linares-Palomino, José Patricio; Lozano-Alonso, Silvia; Asensio-García, Ricardo; Ros-Díe, Eduardo; Hernández-Quero, José

2016-03-01

To establish if the microbiology and the TEXAS, PEDIS and Wagner wound classifications of the diabetic foot syndrome (DFS) predict amputation. Prospective cohort study of 250 patients with DFS from 2009 to 2013. Tissue samples for culture were obtained and wound classification scores were recorded at admission. Infection was monomicrobial in 131 patients (52%). Staphylococcus aureus was the most frequent pathogen (76 patients, 30%); being methicillin-resistant S. aureus in 26% (20/76) Escherichia coli and Enterobacter faecalis were 2nd and 3rd most frequent pathogens. Two hundred nine patients (85%) needed amputation being major in 25 patients (10%). The three wound scales associated minor amputation but did not predict this outcome. Predictors of minor amputation in the multivariate analysis were the presence of osteomyelitis, the location of the wound in the forefoot and of major amputation elevated C reactive proteine (CRP) levels. A low ankle-brachial index (ABI) predicted major amputation in the follow-up. Overall, 74% of gram-positives were sensitive to quinolones and 98% to vancomycin and 90% of gram-negatives to cefotaxime and 95% to carbapenems. The presence of osteomyelitis and the location of the wound in the forefoot predict minor amputation and elevated CRP levels predict major amputation. In the follow-up a low ABI predicts major amputation. Copyright © 2016 Elsevier Inc. All rights reserved.

[Minor foot amputations in diabetic foot syndrome].

PubMed

Biehl, C; Eckhard, M; Szalay, G; Heiss, C

2016-10-01

The treatment strategy for diabetic foot syndrome must take into account protective sensibility of the foot, open wounds, infection status, and the rules of septic bone surgery. Interventions are classified as elective, prophylactic, curative, or emergency. Amputations in the forefoot and midfoot region are performed as ray amputations (including metatarsal), which can often be carried out as "inner" amputations. Gentle tissue treatment mandatory because of greater risk of revision with re-amputation compared to classical amputation. Good demarcation of infection, acute osteomyelitis, osteolytic lesions, neurotropic ulcer, arterial and venous blood flow to the other toes, gangrene of other toes with metatarsal affection. Arterial occlusive disease, infection of neighboring areas, avoidable amputations, poorly healing ulcers on the lower leg. Primary dorsal approach; minimal incisional distance (5 cm) to minimize skin necrosis risk. Atraumatic preparation, minimize hemostasis to not compromise the borderline perfusion situation. In amputations, plantar skin preparation and longer seams placed as dorsal as possible, either disarticulated and maintain cartilage, or round the cortical metatarsal bone after resection. Diabetes control. Braun splint, mobilization in a shoe with forefoot decompression and hindfoot support, physiotherapy. Antibiotics based on resistance testing. If no complications, dressing change on postoperative day 1. Optimal wound drainage by lowering foot several times a day; drainage removal after 12-24 h. Insoles and footwear optimization. Amputations require continued attention and if necessary treatment to avoid sequelae. Insufficient treatment associated with recurrent ulceration and altered anatomy.

Twenty-four hour blood flow in the forefoot after reconstructive vascular surgery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jelnes, R.

Local blood flow in the forefoot (SBF) was measured continuously during 24 hours by 133xenon clearance technique in 10 patients prior to and at least 1 year after successful reconstructive vascular surgery for severe arterial insufficiency (mean: 18 months, range: 12-36). A group of 10 patients with normal peripheral circulation served as a control group. In spite of a considerable increase of the ankle/arm systolic blood pressure index--preoperative: 0.30 +/- 0.12, postoperative: 0.78 +/- 0.28 (mean +/- 1 SD)--the SBF decreased by 50% (p less than 0.001) following reconstructive vascular surgery during day activities. During sleep, however, SBF increased bymore » 80% (p less than 0.001). The relative changes in SBF from day to night at the postoperative examination did not differ from that of the control group, i.e., the normal 24-hour blood flow pattern had been obtained. These changes in SBF are explained by the reappearance of peripheral vasoregulatory mechanisms. Postreconstructive hyperemia was evaluated by the same technique. The changes in SBF following surgery in the positions supine, awake and supine, asleep were found to be insignificant (0.80 less than p less than 0.90). It is concluded that the long-term postreconstructive hyperemia merely is a reflection of the normal 24-hour blood flow pattern.« less

Cutaneous stimulation of discrete regions of the sole during locomotion produces “sensory steering” of the foot

PubMed Central

2014-01-01

Background While the neural and mechanical effects of whole nerve cutaneous stimulation on human locomotion have been previously studied, there is less information about effects evoked by activation of discrete skin regions on the sole of the foot. Electrical stimulation of discrete foot regions evokes position-modulated patterns of cutaneous reflexes in muscles acting at the ankle during standing but data during walking are lacking. Here, non-noxious electrical stimulation was delivered to five discrete locations on the sole of the foot (heel, and medial and lateral sites on the midfoot and forefoot) during treadmill walking. EMG activity from muscles acting at the hip, knee and ankle were recorded along with movement at these three joints. Additionally, 3 force sensing resistors measuring continuous force changes were placed at the heel, and the medial and lateral aspects of the right foot sole. All data were sorted based on stimulus occurrence in twelve step-cycle phases, before being averaged together within a phase for subsequent analysis. Methods Non-noxious electrical stimulation was delivered to five discrete locations on the sole of the foot (heel, and medial and lateral sites on the midfoot and forefoot) during treadmill walking. EMG activity from muscles acting at the hip, knee and ankle were recorded along with movement at these three joints. Additionally, 3 force sensing resistors measuring continuous force changes were placed at the heel, and the medial and lateral aspects of the right foot sole. All data were sorted based on stimulus occurrence in twelve step-cycle phases, before being averaged together within a phase for subsequent analysis. Results The results demonstrate statistically significant dynamic changes in reflex amplitudes, kinematics and foot sole pressures that are site-specific and phase-dependent. The general trends demonstrate responses producing decreased underfoot pressure at the site of stimulation. Conclusions The responses to stimulation of discrete locations on the foot sole evoke a kind of “sensory steering” that may promote balance and maintenance of locomotion through the modulation of limb loading and foot placement. These results have implications for using sensory stimulation as a therapeutic modality during gait retraining (e.g. after stroke) as well as for footwear design and implementation of foot sole contact surfaces during gait. PMID:25202452

Durability of Marine Composites: A Study of the Effects of Fatigue on Fiberglass in the Marine Environment

DTIC Science & Technology

2000-01-01

method assumes a wedge-shaped body striking a horizontal water surface. The 2-D flow yields the pressure equations: 32 2 2 1 )cot( 2 1...vessel’s forefoot is supported by the remaining part of the vessel. Depending on wavelength and forward speed, the impact velocity can vary tremendously...between Figures 9-16 and 9-12 are striking . The accuracy of the linear (with the single-step in-plane effects) was sufficient at the stress levels

Foot loading with an ankle-foot orthosis: the accuracy of an integrated physical strain trainer.

PubMed

Pauser, Johannes; Jendrissek, Andreas; Brem, Matthias; Gelse, Kolja; Swoboda, Bernd; Carl, Hans-Dieter

2012-07-01

To investigate the value of a built-in physical strain trainer for the monitoring of partial weight bearing with an ankle-foot orthosis. 12 healthy volunteers were asked to perform three trials. Plantar peak pressure values from normal gait (trial one) were defined as 100% (baseline). The following trials were performed with the Vacoped® dynamic vacuum ankle orthosis worn in a neutral position with full weight bearing (trial two) and a restriction to 10% body weight (BW) (trial three), as monitored with an integrated physical strain trainer. Peak plantar pressure values were obtained using the pedar® X system. Peak pressure values were statistically significantly reduced wearing the Vacoped® shoe with full weight bearing for the hindfoot to 68% of the baseline (normal gait) and for the midfoot and forefoot to 83% and 60%, respectively. Limited weight bearing with 10% BW as controlled by physical strain trainer further reduced plantar peak pressure values for the hindfoot to 19%, for the midfoot to 43% of the baseline and the forefoot to 22% of the baseline. The Vacoped® vacuum ankle orthosis significantly reduces plantar peak pressure. The integrated physical strain trainer seems unsuitable to monitor a limitation to 10% BW adequately for the total foot. The concept of controlling partial weight bearing with the hindfoot-addressing device within the orthosis seems debatable but may be useful when the hindfoot in particular must be off-loaded.

Flat Feet, Happy Feet? Comparison of the Dynamic Plantar Pressure Distribution and Static Medial Foot Geometry between Malawian and Dutch Adults

PubMed Central

Stolwijk, Niki M.; Duysens, Jacques; Louwerens, Jan Willem K.; van de Ven, Yvonne HM.; Keijsers, Noël LW.

2013-01-01

In contrast to western countries, foot complaints are rare in Africa. This is remarkable, as many African adults walk many hours each day, often barefoot or with worn-out shoes. The reason why Africans can withstand such loading without developing foot complaints might be related to the way the foot is loaded. Therefore, static foot geometry and dynamic plantar pressure distribution of 77 adults from Malawi were compared to 77 adults from the Netherlands. None of the subjects had a history of foot complaints. The plantar pressure pattern as well as the Arch Index (AI) and the trajectory of the center of pressure during the stance phase were calculated and compared between both groups. Standardized pictures were taken from the feet to assess the height of the Medial Longitudinal Arch (MLA). We found that Malawian adults: (1) loaded the midfoot for a longer and the forefoot for a shorter period during roll off, (2) had significantly lower plantar pressures under the heel and a part of the forefoot, and (3) had a larger AI and a lower MLA compared to the Dutch. These findings demonstrate that differences in static foot geometry, foot loading, and roll off technique exist between the two groups. The advantage of the foot loading pattern as shown by the Malawian group is that the plantar pressure is distributed more equally over the foot. This might prevent foot complaints. PMID:23468936

Differences in Muscle Activity between Natural Forefoot and Rearfoot Strikers during Running

PubMed Central

Yong, Jennifer R.; Silder, Amy; Delp, Scott L.

2014-01-01

Running research has focused on reducing injuries by changing running technique. One proposed method is to change from rearfoot striking (RFS) to forefoot striking (FFS) because FFS is thought to be a more natural running pattern that may reduce loading and injury risk. Muscle activity affects loading and influences running patterns; however, the differences in muscle activity between natural FFS runners and natural RFS runners are unknown. The purpose of this study was to measure muscle activity in natural FFS runners and natural RFS runners. We tested the hypotheses that tibialis anterior activity would be significantly lower while activity of the plantarflexors would be significantly greater in FFS runners, compared to RFS runners, during late swing phase and early stance phase. Gait kinematics, ground reaction forces and electromyographic patterns of ten muscles were collected from twelve natural RFS runners and ten natural FFS runners. The root mean square (RMS) of each muscle’s activity was calculated during terminal swing phase and early stance phase. We found significantly lower RMS activity in the tibialis anterior in FFS runners during terminal swing phase, compared to RFS runners. In contrast, the medial and lateral gastrocnemius showed significantly greater RMS activity in terminal swing phase in FFS runners. No significant differences were found during early stance phase for the tibialis anterior or the plantarflexors. Recognizing the differences in muscle activity between FFS and RFS runners is an important step toward understanding how foot strike patterns may contribute to different types of injury. PMID:25458201

12 weeks of simulated barefoot running changes foot-strike patterns in female runners.

PubMed

McCarthy, C; Fleming, N; Donne, B; Blanksby, B

2014-05-01

To investigate the effect of a transition program of simulated barefoot running (SBR) on running kinematics and foot-strike patterns, female recreational athletes (n=9, age 29 ± 3 yrs) without SBR experience gradually increased running distance in Vibram FiveFingers SBR footwear over 12 weeks. Matched controls (n=10, age 30 ± 4 yrs) continued running in standard footwear. A 3-D motion analysis of treadmill running at 12 km/h(-1) was performed by both groups, barefoot and shod, pre- and post-intervention. Post-intervention data indicated a more-forefoot strike pattern in the SBR group compared to controls; both running barefoot (P>0.05), and shod (P<0.001). When assessed barefoot, there were significant kinematic differences across time in the SBR group for ankle flexion angle at toe-off (P<0.01). When assessed shod, significant kinematic changes occurred across time, for ankle flexion angles at foot-strike (P<0.001) and toe-off (P<0.01), and for range of motion (ROM) in the absorptive phase of stance (P<0.01). A knee effect was recorded in the SBR group for flexion ROM in the absorptive phase of stance (P<0.05). No significant changes occurred in controls. Therefore, a 12-week transition program in SBR could assist athletes seeking a more-forefoot strike pattern and "barefoot" kinematics, regardless of preferred footwear. © Georg Thieme Verlag KG Stuttgart · New York.

The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy.

PubMed

Lin, Tung-Liang; Sheen, Huey-Min; Chung, Chin-Teng; Yang, Sai-Wei; Lin, Shih-Yi; Luo, Hong-Ji; Chen, Chung-Yu; Chan, I-Cheng; Shih, Hsu-Sheng; Sheu, Wayne Huey-Herng

2013-07-29

Removable plug insoles appear to be beneficial for patients with diabetic neuropathic feet to offload local plantar pressure. However, quantitative evidence of pressure reduction by means of plug removal is limited. The value of additional insole accessories, such as arch additions, has not been tested. The purpose of this study was to evaluate the effect of removing plugs from foam based insoles, and subsequently adding extra arch support, on plantar pressures. In-shoe plantar pressure measurements were performed on 26 patients with diabetic neuropathic feet at a baseline condition, in order to identify the forefoot region with the highest mean peak pressure (MPP). This was defined as the region of interest (ROI) for plug removal.The primary outcome was measurement of MPP using the pedar® system in the baseline and another three insole conditions (pre-plug removal, post-plug removal, and post-plug removal plus arch support). Among the 26 ROIs, a significant reduction in MPP (32.3%, P<0.001) was found after removing the insole plugs. With an arch support added, the pressure was further reduced (9.5%, P<0.001). There were no significant differences in MPP at non-ROIs between pre- and post-plug removal conditions. These findings suggest that forefoot plantar pressure can be reduced by removing plugs and adding arch support to foam-based insoles. This style of insole may therefore be clinically useful in managing patients with diabetic peripheral neuropathy.

[Footwear according to the "business dress code", and the health condition of women's feet--computer-assisted holistic evaluation].

PubMed

Lorkowski, Jacek; Mrzygłód, Mirosław; Kotela, Ireneusz; Kiełbasiewicz-Lorkowska, Ewa; Teul, Iwona

2013-01-01

According to the verdict of the Supreme Court in 2005, an employer may dismiss an employee if their conduct (including dress) exposes the employer to losses or threatens his interests. The aim of the study was a holistic assessment of the pleiotropic effects of high-heeled pointed shoes on the health condition of women's feet, wearing them at work, in accordance with the existing rules of the "business dress code". A holistic multidisciplinary analysis was performed. It takes into account: 1) women employees of banks and other large corporations (82 persons); 2) 2D FEM computer model developed by the authors of foot deformed by pointed high-heeled shoes; 3) web site found after entering the code "business dress code". Over 60% of women in the office wore high-heeled shoes. The following has been found among people walking to work in high heels: 1) reduction in the quality of life in about 70% of cases, through periodic occurrence of pain and reduction of functional capacity of the feet; 2) increase in the pressure on the plantar side of the forefoot at least twice; 3) the continued effects the forces deforming the forefoot. 1. An evolutionary change of "dress code" shoes is necessary in order to lead to a reduction in non-physiological overload of feet and the consequence of their disability. 2. These changes are particularly urgent in patients with so-called "sensitive foot".

Are in-shoe pressure characteristics in symptomatic idiopathic pes cavus related to the location of foot pain?

PubMed

Crosbie, Jack; Burns, Joshua

2008-01-01

People who have extremely high arched feet may be subject to substantial levels of foot pain, despite the lack of obvious pathology. This study sought to investigate the effect of pes cavus on pain intensity and location and on the magnitude and distribution of foot pressure. Measurements were derived from the more symptomatic foot of 130 participants with painful, idiopathic pes cavus. Data were collected using Pedar in-shoe pressure sensors and averaged over nine randomly selected steps. Participant information, including location and intensity of pain, Foot Posture Index values and anthropometric and "quality of life" variables, were also recorded. Painful idiopathic pes cavus seems to provoke a more cautious gait pattern than normal, with reduced peak and mean pressure values, particularly in the fore- and rear-foot regions. In particular, participants with pain confined to the rear-foot exhibit an antalgic gait pattern, with lower pressure values and a longer period of foot-ground contact in the heel region than those with pain only in the fore-foot. We determined no clear predictors of pain in terms of foot posture or demographics, although people with high body mass index values are more likely to have pain in several regions. The relationship between the posture of the foot and the presentation of pain remains unclear, however we believe that the presence of heel pain in pes cavus may be more restricting than fore-foot pain.

[Risk factors associated with the conformation of the medial longitudinal arch and the symptomatic flat foot in a metropolitan school population in Mexico].

PubMed

Rivera-Saldívar, G; Torres-González, R; Franco-Valencia, M; Ríos-Monroy, R; Martínez-Ramírez, F; Pérez-Hernández, E; Duarte-Dagnino, D

2012-01-01

The investigation on the medial longitudinal arch is aimed at addressing the diagnostic problems of flat foot. The diagnosis is currently based on clinical tests and the appropriate identification of both postural and gait abnormalities. Risk factors are associated with pre-school ages, but there is no adequate analysis of such factors during school ages, when the longitudinal arch reaches its conformational maturity. Probabilistic methods were used to obtain a sample of 476 patients from elementary schools in the Federal District and the state of Puebla. Once the approval of the research committee was obtained, an analytical, prospective, cross-sectional study was conducted. Anthropometric measurements were performed, together with anamnesis, physical exam of the students, and conventional wet footprint analysis in a standardized and duplicate way. Of the 476 patients, 101 had flat foot (21.2%) and 49 of them had pain symptoms in the feet, knees or both (48.5%), accounting for 10.2% of the patients examined. Forefoot pronation and valgus hindfoot resulted in an increased risk of symptomatic flat foot in the school population in the study. In cases of flat or cavus foot, the presence of foot and/or knee pain symptoms in the school population was associated in a statistically significant way with one or more of the factors analyzed (overweight, genu valgus, valgus hindfoot, forefoot pronation and claw toes). Girls with such factors had a 3-7 higher chance of having symptomatic flat foot.

Do rotational shear-cushioning shoes influence horizontal ground reaction forces and perceived comfort during basketball cutting maneuvers?

PubMed

Lam, Wing-Kai; Qu, Yi; Yang, Fan; Cheung, Roy T H

2017-01-01

Court shoe designs predominantly focus on reducing excessive vertical ground reaction force, but shear force cushioning has received little attention in the basketball population. We aimed to examine the effect of a novel shoe-cushioning design on both resultant horizontal ground reaction forces and comfort perception during two basketball-specific cutting movements. Fifteen university team basketball players performed lateral shuffling and 45-degree sidestep cutting at maximum effort in basketball shoes with and without the shear-cushioning system (SCS). Paired t -tests were used to examine the differences in kinetics and comfort perception between two shoes. SCS shoe allowed for larger rotational material deformation compared with control shoes, but no significant shoe differences were found in braking phase kinetics during both cutting movements ( P  = 0.35). Interestingly, a greater horizontal propulsion impulse was found with the SCS during 45-degree cutting ( P  < 0.05), when compared with the control. In addition, players wearing SCS shoes perceived better forefoot comfort ( P  = 0.012). During lateral shuffling, there were no significant differences in horizontal GRF and comfort perception between shoe conditions ( P  > 0.05). The application of a rotational shear-cushioning structure allowed for better forefoot comfort and enhanced propulsion performance in cutting, but did not influence the shear impact. Understanding horizontal ground reaction force information may be useful in designing footwear to prevent shear-related injuries in sport populations.

The influence of foot position on stretching of the plantar fascia.

PubMed

Flanigan, Ryan M; Nawoczenski, Deborah A; Chen, Linlin; Wu, Hulin; DiGiovanni, Benedict F

2007-07-01

A recent study found nonweightbearing stretching exercises specific to the plantar fascia to be superior to the standard program of weightbearing Achilles tendon-stretching exercises in patients with chronic plantar fasciitis. The present study used a cadaver model to demonstrate the influence of foot and ankle position on stretching of the plantar fascia. Twelve fresh-frozen lower-leg specimens were tested in 15 different configurations representing various combinations of ankle and metatarsophalangeal (MTP) joint dorsiflexion, midtarsal transverse plane abduction and adduction, and forefoot varus and valgus. Measurements were recorded by a differential variable reluctance transducer (DVRT) implanted into the medial band of the plantar fascia, and primary measurement was a percent deformation of the plantar fascia (stretch) with respect to a reference position (90 degrees ankle dorsiflexion, 0 degrees midtarsal and forefoot orientation, and 0 degrees MTP dorsiflexion). Ankle and MTP joint dorsiflexion produced a significant increase (14.91%) in stretch compared to the position of either ankle dorsiflexion alone (9.31% increase, p < 0.001) or MTP dorsiflexion alone (7.33% increase, p < 0.01). There was no significant increase in stretch with positions of abduction or varus (2.49%, p = 0.27 and 0.55%, p = 0.79). This study provides a mechanical explanation for enhanced outcomes in recent clinical trials using plantar fascia tissue-specific stretching exercises and lends support to the use of ankle and MTP joint dorsiflexion when employing stretching protocols for nonoperative treatment in patients with chronic proximal plantar fasciitis.

[PERCUTANEOUS CORRECTION OF FOREFOOT DEFORMITIES IN DIABETIC PATIENTS IN ORDER TO PREVENT PRESSURE SORES - TECHNIQUE AND RESULTS IN 20 CONSECUTIVE PATIENTS].

PubMed

Yassin, Mustafa; Garti, Avraham; Heller, Eyal; Weissbrot, Moshe; Robinson, Dror

2017-04-01

Diabetes mellitus is a 21st century pandemic. Due to life-span prolongation combined with the increased rate of diabetes, a growing population of patients is afflicted with neuropathic foot deformities. Traditional operative repair of these deformities is associated with a high complication rate and relatively common infection incidence. In recent years, in order to prevent these complications, percutaneous deformity correction methods were developed. Description of experience accumulated in treating 20 consecutive patients with diabetic neuropathic foot deformities treated in a percutaneous fashion. A consecutive series of patients treated at our institute for neuropathic foot deformity was assessed according to a standard protocol using the AOFAS forefoot score and the LUMT score performed at baseline as well as at 6 months and 12 months. Treatment related complications were monitored. All procedures were performed in an ambulatory setting using local anesthesia. A total of 12 patients had soft tissue corrections, and 8 had a combined soft tissue and bone correction. Baseline AOFAS score was 48±7 and improved to 73±9 at six months and 75±7 at one year. LUMT score in 11 patients with a chronic wound decreased from 22±4 to 2±1 at one year post-op. One patient required hospitalization due to post-op bleeding. Percutaneous techniques allow deformity correction of diabetic feet, including those with open wounds in an ambulatory setting with a low complication rate.

Geometric morphometric footprint analysis of young women

PubMed Central

2013-01-01

Background Most published attempts to quantify footprint shape are based on a small number of measurements. We applied geometric morphometric methods to study shape variation of the complete footprint outline in a sample of 83 adult women. Methods The outline of the footprint, including the toes, was represented by a comprehensive set of 85 landmarks and semilandmarks. Shape coordinates were computed by Generalized Procrustes Analysis. Results The first four principal components represented the major axes of variation in foot morphology: low-arched versus high-arched feet, long and narrow versus short and wide feet, the relative length of the hallux, and the relative length of the forefoot. These shape features varied across the measured individuals without any distinct clusters or discrete types of footprint shape. A high body mass index (BMI) was associated with wide and flat feet, and a high frequency of wearing high-heeled shoes was associated with a larger forefoot area of the footprint and a relatively long hallux. Larger feet had an increased length-to-width ratio of the footprint, a lower-arched foot, and longer toes relative to the remaining foot. Footprint shape differed on average between left and right feet, and the variability of footprint asymmetry increased with BMI. Conclusions Foot shape is affected by lifestyle factors even in a sample of young women (median age 23 years). Geometric morphometrics proved to be a powerful tool for the detailed analysis of footprint shape that is applicable in various scientific disciplines, including forensics, orthopedics, and footwear design. PMID:23886074

[Digital gigantism of the foot: a clinical study of 12 cases].

PubMed

Wang, Hai-hua; Tian, Guang-lei; Zhu, Yin; Zhang, You-le; Zhao, Jun-hui; Tian, Wen

2008-03-15

To summarize the clinical characteristic and outcome of digital gigantism of the foot. Retrospectively analyze the clinical documents of cases of digital gigantism of the foot. Twelve 12 cases with 13 feet in this study included 8 male and 4 female with an average 4.6-years-old. All the deformities were found at birth. Multiple toes involved were more than single toe, and tibial toe involved more than fibular. Forefoot was enlarged. All the phalanges involved and partial metatarsal bones were enlarged. Marked increase in subcutaneous fat was found in all cases in the operation which infiltrated interossei and articular capsules. The appearance of the nerves and its branches in the foot were normal and fat infiltrating was not discovered. The operation types included debulking, epiphyseal arrest, amputation, nerve stripping and anastomosis. Seven cases were followed up with mean periods 25.6 months. Functional evaluation according to a criterion formulated by author revealed a result of 2 excellent, 2 good and 3 fair. Digital gigantism of the foot is an uncommon congenital deformity of the foot characterized by overgrowth of both the soft-tissue and the osseous elements of the enlarged toe and forefoot. Surgical treatment is the unique method, and the goal is to reduce the size of the foot to allow fitting regular shoes and walking readily. There are several types of operations which to be chosen. The indication, the timing of operative intervention and the selection of operation type should be paid more attention.

The Influence of Running on Foot Posture and In-Shoe Plantar Pressures.

PubMed

Bravo-Aguilar, María; Gijón-Noguerón, Gabriel; Luque-Suarez, Alejandro; Abian-Vicen, Javier

2016-03-01

Running can be considered a high-impact practice, and most people practicing continuous running experience lower-limb injuries. The aim of this study was to determine the influence of 45 min of running on foot posture and plantar pressures. The sample comprised 116 healthy adults (92 men and 24 women) with no foot-related injuries. The mean ± SD age of the participants was 28.31 ± 6.01 years; body mass index, 23.45 ± 1.96; and training time, 11.02 ± 4.22 h/wk. Outcome measures were collected before and after 45 min of running at an average speed of 12 km/h, and included the Foot Posture Index (FPI) and a baropodometric analysis. The results show that foot posture can be modified after 45 min of running. The mean ± SD FPI changed from 6.15 ± 2.61 to 4.86 ± 2.65 (P < .001). Significant decreases in mean plantar pressures in the external, internal, rearfoot, and forefoot edges were found after 45 min of running. Peak plantar pressures in the forefoot decreased after running. The pressure-time integral decreased during the heel strike phase in the internal edge of the foot. In addition, a decrease was found in the pressure-time integral during the heel-off phase in the internal and rearfoot edges. The findings suggest that after 45 min of running, a pronated foot tends to change into a more neutral position, and decreased plantar pressures were found after the run.

Characterisation of prosthetic feet used in low-income countries.

PubMed

Sam, M; Hansen, A H; Childress, D S

2004-08-01

Eleven kinds of prosthetic feet that were designed for use in low-income countries were mechanically characterised in this study. Masses of the different kinds of prosthetic feet varied substantially. Dynamic properties, including damping ratios and resonant frequencies, were obtained from step unloading tests of the feet while interacting with masses comparable to the human body. Data showed that for walking, the feet can be appropriately modeled using their quasistatic properties since natural frequencies were high compared to walking frequencies and since damping ratios were small. Roll-over shapes, the effective rocker (cam) geometries that the feet deform to under walking loads, were determined using a quasistatic loading technique and a spatial transformation of the ground reaction force's centre of pressure. The roll-over shapes for most of the prosthetic feet studied were similar to the roll-over shape of the SACH (solid-ankle cushioned heel) prosthetic foot. All roll-over shapes showed a lack of forefoot support, which may cause a "drop-off" experience at the end of single limb stance and shorter step lengths of the contralateral limb. The roll-over shapes of prosthetic feet appear useful in characterization of foot function.

Effect of Relative Marker Movement on the Calculation of the Foot Torsion Axis Using a Combined Cardan Angle and Helical Axis Approach

PubMed Central

Graf, Eveline S.; Wright, Ian C.; Stefanyshyn, Darren J.

2012-01-01

The two main movements occurring between the forefoot and rearfoot segment of a human foot are flexion at the metatarsophalangeal joints and torsion in the midfoot. The location of the torsion axis within the foot is currently unknown. The purpose of this study was to develop a method based on Cardan angles and the finite helical axis approach to calculate the torsion axis without the effect of flexion. As the finite helical axis method is susceptible to error due to noise with small helical rotations, a minimal amount of rotation was defined in order to accurately determine the torsion axis location. Using simulation, the location of the axis based on data containing noise was compared to the axis location of data without noise with a one-sample t-test and Fisher's combined probability score. When using only data with helical rotation of seven degrees or more, the location of the torsion axis based on the data with noise was within 0.2 mm of the reference location. Therefore, the proposed method allowed an accurate calculation of the foot torsion axis location. PMID:22666303

Lower Extremity Disorders among Men and Women in Army Basic Training and Effects of Two Types of Boots

DTIC Science & Technology

1983-01-01

was dropped on the rearfoot or the forefoot regions of the boots. de Moya found that the impact cushioning and energy absorption characteristics of the...appears that women would be more likely than men to display an emphasized heel strike as they execute the relatively long, 30-in. march step. If this...inflexibility may cause the foot to strike the ground in a manner which alters the pattern of forces on the foot relative to that experienced when

Comparison of muscle synergies for running between different foot strike patterns

PubMed Central

Nishida, Koji; Hagio, Shota; Kibushi, Benio; Moritani, Toshio; Kouzaki, Motoki

2017-01-01

It is well known that humans run with a fore-foot strike (FFS), a mid-foot strike (MFS) or a rear-foot strike (RFS). A modular neural control mechanism of human walking and running has been discussed in terms of muscle synergies. However, the neural control mechanisms for different foot strike patterns during running have been overlooked even though kinetic and kinematic differences between different foot strike patterns have been reported. Thus, we examined the differences in the neural control mechanisms of human running between FFS and RFS by comparing the muscle synergies extracted from each foot strike pattern during running. Muscle synergies were extracted using non-negative matrix factorization with electromyogram activity recorded bilaterally from 12 limb and trunk muscles in ten male subjects during FFS and RFS running at different speeds (5–15 km/h). Six muscle synergies were extracted from all conditions, and each synergy had a specific function and a single main peak of activity in a cycle. The six muscle synergies were similar between FFS and RFS as well as across subjects and speeds. However, some muscle weightings showed significant differences between FFS and RFS, especially the weightings of the tibialis anterior of the landing leg in synergies activated just before touchdown. The activation patterns of the synergies were also different for each foot strike pattern in terms of the timing, duration, and magnitude of the main peak of activity. These results suggest that the central nervous system controls running by sending a sequence of signals to six muscle synergies. Furthermore, a change in the foot strike pattern is accomplished by modulating the timing, duration and magnitude of the muscle synergy activity and by selectively activating other muscle synergies or subsets of the muscle synergies. PMID:28158258

Associations of Region-Specific Foot Pain and Foot Biomechanics: The Framingham Foot Study

PubMed Central

Hagedorn, Thomas J.; Dufour, Alyssa B.; Hannan, Marian T.

2015-01-01

Background. Specific regions of the foot are responsible for the gait tasks of weight acceptance, single-limb support, and forward propulsion. With region foot pain, gait abnormalities may arise and affect the plantar pressure and force pattern utilized. Therefore, this study’s purpose was to evaluate plantar pressure and force pattern differences between adults with and without region-specific foot pain. Methods. Plantar pressure and force data were collected on Framingham Foot Study members while walking barefoot at a self-selected pace. Foot pain was evaluated by self-report and grouped by foot region (toe, forefoot, midfoot, or rearfoot) or regions (two or three or more regions) of pain. Unadjusted and adjusted linear regression with generalized estimating equations was used to determine associations between feet with and without foot pain. Results. Individuals with distal foot (forefoot or toes) pain had similar maximum vertical forces under the pain region, while those with proximal foot (rearfoot or midfoot) pain had different maximum vertical forces compared to those without regional foot pain (referent). During walking, there were significant differences in plantar loading and propulsion ranging from 2% to 4% between those with and without regional foot pain. Significant differences in normalized maximum vertical force and plantar pressure ranged from 5.3% to 12.4% and 3.4% to 24.1%, respectively, between those with and without regional foot pain. Conclusions. Associations of regional foot pain with plantar pressure and force were different by regions of pain. Region-specific foot pain was not uniformly associated with an increase or decrease in loading and pressure patterns regions of pain. PMID:25995291

Dimensional differences for evaluating the quality of footwear fit.

PubMed

Witana, Channa P; Feng, Jiejian; Goonetilleke, Ravindra S

2004-10-10

Very few standards exist for fitting products to people. Footwear is a noteworthy example. This study is an attempt to evaluate the quality of footwear fit using two-dimensional foot outlines. Twenty Hong Kong Chinese students participated in an experiment that involved three pairs of dress shoes and one pair of athletic shoes. The participants' feet were scanned using a commercial laser scanner, and each participant wore and rated the fit of each region of each shoe. The shoe lasts were also scanned and were used to match the foot scans with the last scans. The ANOVA showed significant (p < 0.05) differences among the four pairs of shoes for the overall, fore-foot and rear-foot fit ratings. There were no significant differences among shoes for mid-foot fit rating. These perceived differences were further analysed after matching the 2D outlines of both last and feet. The point-wise dimensional difference between foot and shoe outlines were computed and analysed after normalizing with foot perimeter. The dimensional difference (DD) plots along the foot perimeter showed that fore-foot fit was strongly correlated (R(2) > 0.8) with two of the minimums in the DD-plot while mid-foot fit was strongly correlated (R(2) > 0.9) with the dimensional difference around the arch region and a point on the lateral side of the foot. The DD-plots allow the designer to determine the critical locations that may affect footwear fit in addition to quantifying the nature of misfit so that design changes to shape and material may be possible.

Effect of taping on foot kinematics in persons with chronic ankle instability.

PubMed

Deschamps, Kevin; Dingenen, Bart; Pans, Femke; Van Bavel, Isabelle; Matricali, Giovanni Arnoldo; Staes, Filip

2016-07-01

To investigate differences in rigid-foot and multi-segmental foot kinematics between healthy (control) and chronic ankle instability (CAI) participants during running and to evaluate the effect of low-Dye (LD) and high-Dye (HD) taping on foot kinematics of CAI subjects. Cross-sectional, comparative study. Kinematic data of 12 controls and 15 CAI participants were collected by a 3D motion analysis system during running. CAI participants performed barefoot (CAI_BF) running trials as well as trials with taping. A rigid Plug-in gait Model and the Rizzoli 3D Multi-Segment Foot Model were used. Groups were compared using one-dimensional statistical parametric mapping. An increased inversion, a decreased dorsiflexion between the foot and tibia and a decreased external foot progression angle were found during terminal swing and early stance in the CAI_BF group. With respect to the taped conditions, post-hoc SPM{t} calculations highlighted a more dorsiflexed rearfoot (38-46% running cycle) in the CAI_HD compared to the CAI_LD, and a more inverted Mid-Met angle (6-24% running cycle) in the CAI_LD compared to the CAI_BF condition. This study revealed significant differences in rigid foot and multi-segmental foot kinematics between all groups. As high-dye taping embraces shank-rearfoot and forefoot, it seems to have better therapeutic features with respect to low-dye taping as the latter created a more inverted forefoot which may not be recommended in this population. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Does excessive flatfoot deformity affect function? A comparison between symptomatic and asymptomatic flatfeet using the Oxford Foot Model.

PubMed

Hösl, Matthias; Böhm, Harald; Multerer, Christel; Döderlein, Leonhard

2014-01-01

Treatment of asymptomatic flexible flatfeet is a subject of great controversy. The purpose of this study was to examine foot function during walking in symptomatic (SFF) and asymptomatic (ASFF) flexible flatfeet. Thirty-five paediatric and juvenile patients with idiopathic flexible flatfeet were recruited from an orthopaedic outpatient department (14 SFF and 21 ASFF). Eleven age-matched participants with typically developing feet served as controls (TDF). To study foot function, 3D multi-segment foot kinematics and ankle joint kinetics were captured during barefoot gait analysis. Overall, alterations in foot kinematics in flatfeet were pronounced but differences between SFF and ASFF were not observed. Largest discriminatory effects between flatfeet and TDF were noticed in reduced hindfoot dorsiflexion as well as in increased forefoot supination and abduction. Upon clinical examination, restrictions in passive dorsiflexion in ASFF and SFF were significant. During gait, the hindfoot in flatfeet (both ASFF and SFF) was more everted, but less flexible. In sagittal plane, limited hindfoot dorsiflexion of ASFF and SFF was compensated for by increased forefoot mobility and a hypermobile hallux. Concerning ankle kinetics, SFF lacked positive joint energy for propulsion while ASFF needed to absorb more negative ankle joint energy during loading response. This may risk fatigue and overuse syndrome of anterior shank muscles in ASFF. Hence, despite a lack of symptoms flatfoot deformity in ASFF affected function. Yet, contrary to what was expected, SFF did not show greater deviations in 3D foot kinematics than ASFF. Symptoms may rather depend on tissue wear and subjective pain thresholds. Copyright © 2013. Published by Elsevier B.V.

Dynamic foot function and morphology in elite rugby league athletes of different ethnicity.

PubMed

Gurney, Jason K; Kersting, Uwe G; Rosenbaum, Dieter

2009-05-01

It has long been assumed that foot function and morphology differ between ethnicities. However, quantitative research proving or disproving this relationship is sparse. As a starting point, the objective of this study was to investigate the plantar loading characteristics and foot geometry of athletes from three ethnicities, being Caucasian, Maori and Pacific Islanders. Four plantar pressure parameters were compared in 28 male elite rugby league players using an EMED-AT plantar pressure distribution platform [Novel GmbH, Munich, Germany] and the five-step method. Foot geometry measures were also taken, including arch index, coefficient of spreading, hallux angle and sub-arch angle. Five trials were collected per foot at a self-selected speed. It was found that Caucasian and Maori subjects had a relatively wider forefoot than the Pacific Island subjects; however the Pacific Islanders' foot was found to be wider than both these ethnicities in absolute terms. While Caucasian subjects loaded the toes to a much greater extent than the Maori and Pacific Island subjects, the latter demonstrated a greater loading of the mid and forefoot regions. Pacific Island subjects revealed a significantly more pronounced hallux valgus angle as compared to the Caucasian and Maori subjects. The results of this study may be relevant for/should be taken into consideration in footwear design issues, where allowances need to be made during the design process for anatomical differences between ethnicities. However these observations cannot be generalised to whole ethnic populations, and further research is required on non-athletes to build on the current research findings.

Joint dynamics of rear- and fore-foot unplanned sidestepping.

PubMed

Donnelly, Cyril J; Chinnasee, Chamnan; Weir, Gillian; Sasimontonkul, Siriporn; Alderson, Jacqueline

2017-01-01

Compare the lower-limb mechanics and anterior cruciate ligament (ACL) injury risk of athletes using a habitual rear-foot (RF) and fore-foot (FF) fall pattern during unplanned sidestepping (UnSS). Experimental cross-sectional. Nineteen elite female field hockey players attended one biomechanical motion capture testing session, which consisted of a random series of pre-planned and unplanned sidestepping sport tasks. Following data collection, participants were classified as possessing a habitual RF or FF fall pattern during UnSS. Hip, knee and ankle joint angles, moments, instantaneous powers and net joint work were calculated during weight acceptance. Between group differences were evaluated using independent sample t-tests (α=0.05). Athletes using a habitual RF fall pattern during UnSS absorbed significantly more work and power through their knee joint (p<0.001), which was coupled with significantly elevated externally applied peak non-sagittal plane peak ankle moments (p<0.05) as well as peak flexion and abduction knee moments (p<0.005). Athletes using a habitual FF fall pattern during UnSS absorbed more power through their ankle joint (p<0.001). A RF fall pattern during UnSS places a large mechanical demand on the knee joint, which is associated with elevated ACL injury risk. Conversely, a FF fall pattern placed a large mechanical demand on the ankle joint. Modifying an athlete's foot fall pattern during UnSS may be viable technique recommendation when returning from knee or ankle injury. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Joint contact loading in forefoot and rearfoot strike patterns during running.

PubMed

Rooney, Brandon D; Derrick, Timothy R

2013-09-03

Research concerning forefoot strike pattern (FFS) versus rearfoot strike pattern (RFS) running has focused on the ground reaction force even though internal joint contact forces are a more direct measure of the loads responsible for injury. The main purpose of this study was to determine the internal loading of the joints for each strike pattern. A secondary purpose was to determine if converted FFS and RFS runners can adequately represent habitual runners with regards to the internal joint loading. Using inverse dynamics to calculate the net joint moments and reaction forces and optimization techniques to estimate muscle forces, we determined the axial compressive loading at the ankle, knee, and hip. Subjects consisted of 15 habitual FFS and 15 habitual RFS competitive runners. Each subject ran at a preferred running velocity with their habitual strike pattern and then converted to the opposite strike pattern. Plantar flexor muscle forces and net ankle joint moments were greater in the FFS running compared to the RFS running during the first half of the stance phase. The average contact forces during this period increased by 41.7% at the ankle and 14.4% at the knee joint during FFS running. Peak ankle joint contact force was 1.5 body weights greater during FFS running (p<0.05). There was no evidence to support a difference between habitual and converted running for joint contact forces. The increased loading at the ankle joint for FFS is an area of concern for individuals considering altering their foot strike pattern. Copyright © 2013 Elsevier Ltd. All rights reserved.

Differences in muscle activity between natural forefoot and rearfoot strikers during running.

PubMed

Yong, Jennifer R; Silder, Amy; Delp, Scott L

2014-11-28

Running research has focused on reducing injuries by changing running technique. One proposed method is to change from rearfoot striking (RFS) to forefoot striking (FFS) because FFS is thought to be a more natural running pattern that may reduce loading and injury risk. Muscle activity affects loading and influences running patterns; however, the differences in muscle activity between natural FFS runners and natural RFS runners are unknown. The purpose of this study was to measure muscle activity in natural FFS runners and natural RFS runners. We tested the hypotheses that tibialis anterior activity would be significantly lower while activity of the plantarflexors would be significantly greater in FFS runners, compared to RFS runners, during late swing phase and early stance phase. Gait kinematics, ground reaction forces and electromyographic patterns of ten muscles were collected from twelve natural RFS runners and ten natural FFS runners. The root mean square (RMS) of each muscle׳s activity was calculated during terminal swing phase and early stance phase. We found significantly lower RMS activity in the tibialis anterior in FFS runners during terminal swing phase, compared to RFS runners. In contrast, the medial and lateral gastrocnemius showed significantly greater RMS activity in terminal swing phase in FFS runners. No significant differences were found during early stance phase for the tibialis anterior or the plantarflexors. Recognizing the differences in muscle activity between FFS and RFS runners is an important step toward understanding how foot strike patterns may contribute to different types of injury. Copyright © 2014 Elsevier Ltd. All rights reserved.

The influence of shoe drop on the kinematics and kinetics of children tennis players.

PubMed

Herbaut, Alexis; Chavet, Pascale; Roux, Maxime; Guéguen, Nils; Gillet, Christophe; Barbier, Franck; Simoneau-Buessinger, Emilie

2016-11-01

This study investigated the immediate effects of reducing the shoe drop (i.e. the difference between the heel and the forefoot height) on the kinematics and kinetics of the lower extremities of children tennis players performing a tennis-specific movement. Thirteen children tennis players performed a series of simulated open stance forehands wearing 3 pairs of shoes differing only in the drop: 0 (D0), 6 (D6) and the control condition of 12 mm (D12). Two embedded forceplates and a motion capture system were used to analyse the ground reaction forces and ankle and knee joint angles and moments of the leading lower limb. In D6 compared with D12, the peak impact force was reduced by 24% (p = .004) and the ankle was less dorsiflexed at foot strike (p = .037). In D0 compared with D12, the peak impact force was reduced by 17% (p = .049), the ankle was less dorsiflexed at foot strike (p = .045) and the knee was more flexed at foot strike (p = .007). In addition, 4 out of 13 participants (31%) presented a forefoot strike pattern for some of the trials in D0. No difference was observed across shoe conditions for the peak knee extensor moment (p = .658) or the peak ankle plantarflexor moment (p = .071). The results provide preliminary data supporting the hypothesis that for children tennis players, using a 6-mm lower shoe drop might reduce heel impact forces and thus limit potentially impact-related injuries.

Identification and risk estimation of movement strategies during cutting maneuvers.

PubMed

David, Sina; Komnik, Igor; Peters, Markus; Funken, Johannes; Potthast, Wolfgang

2017-12-01

Approximately 70% of anterior cruciate ligament (ACL) injuries occur in non-contact situations during cutting and landing maneuvers. Parameters such as footstrike patterns and trunk orientation were found to influence ACL relevant knee loading, however, the relationship between the whole body movement and injury risk is debated. This study identifies whole body movement strategies that increase injury risk, and provides training recommendations to reduce this risk or enable a save return to sports after injury. Experimental cross-sectional study design. Three dimensional movement analysis was carried out to investigate 50 participants performing anticipated 90° cutting maneuvers. To identify and characterize movement strategies, footstrike pattern, knee valgus moment, knee internal rotation moment, angle of attack, shoulder and pelvis axis were analyzed using statistical parametric mapping. Three different movement strategies were identified. One strategy included rearfoot striking in combination with a relatively upright body position which generated higher knee joint loads than the second strategy, forefoot striking in combination with more backwards leaning and pre-rotation of the trunk towards the new movement direction. A third strategy combined forefoot striking with less preorientation which increased the ACL relevant knee joint load compared to the second strategy. The identified movement strategies clearly pre-determine the injury risk during non-contact situations with the third strategy as the most unfavorable one. Compared to the study of isolated parameters, the analysis of the whole body movement allowed for detailed separation of more risky from less risky cutting strategies. These results give practical recommendations for the prevention of ACL injury. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Finite Element Modeling Used to Study Stress Distribution on the Foot

NASA Technical Reports Server (NTRS)

Morales, Nelson; Davis, Brian; Tajaddini, Azita

2004-01-01

A method to study the stress distribution inside the forefoot during walking was developed at the Cleveland Clinic Foundation by a researcher from the NASA Glenn Research Center. In this method, a semiautomated process was outlined to create a three-dimensional, patient-specific, finite element model (FEM) of the forefoot using magnetic resonance images (MRI). The images were processed in Matlab using the k-nearest neighbor (k-NN) classification algorithm and Sobel edge detection to separate the different tissue types: bone, skin, fat, and muscle. This information was used to create curves and surfaces that were exported to an FEM preprocessor known as Truegrid. In Truegrid, eight-noded or brick elements were created by using surface mapping. The FEM was processed and postprocessed in Abaqus. Material properties of the models were obtained from past experiments such as fat pad confined compression, skin axial and biaxial tests, muscle in vivo compressive tests, and reference literature (bone properties). Nonlinear (hyperelastic) material models were used for the skin (epidermis and dermis), fat, and muscles; and a linear elastic model was used for the bones. Muscle activation during walking yielded uncertainties in the muscle material model since contracted muscles are stiffer than relaxed muscles. These uncertainties were resolved by performing a sensitivity analysis of the muscle material properties. The original properties were multiplied by arbitrary factors of 2, 3, 0.5, and 0.33. The strain and stress distributions, as well as the locations of peak values, were similar in all cases. The peak contact pressure P obtained for each case varied with respect to the applied factor f as follows:

Identification of Clusters of Foot Pain Location in a Community Sample.

PubMed

Gill, Tiffany K; Menz, Hylton B; Landorf, Karl B; Arnold, John B; Taylor, Anne W; Hill, Catherine L

2017-12-01

To identify foot pain clusters according to pain location in a community-based sample of the general population. This study analyzed data from the North West Adelaide Health Study. Data were obtained between 2004 and 2006, using computer-assisted telephone interviewing, clinical assessment, and self-completed questionnaire. The location of foot pain was assessed using a diagram during the clinical assessment. Hierarchical cluster analysis was undertaken to identify foot pain location clusters, which were then compared in relation to demographics, comorbidities, and podiatry services utilization. There were 558 participants with foot pain (mean age 54.4 years, 57.5% female). Five clusters were identified: 1 with predominantly arch and ball pain (26.8%), 1 with rearfoot pain (20.9%), 1 with heel pain (13.3%), and 2 with predominantly forefoot, toe, and nail pain (28.3% and 10.7%). Each cluster was distinct in age, sex, and comorbidity profile. Of the two clusters with predominantly forefoot, toe, and nail pain, one of them had a higher proportion of men and those classified as obese, had diabetes mellitus, and used podiatry services (30%), while the other was comprised of a higher proportion of women who were overweight and reported less use of podiatry services (17.5%). Five clusters of foot pain according to pain location were identified, all with distinct age, sex, and comorbidity profiles. These findings may assist in the identification of individuals at risk for developing foot pain and in the development of targeted preventive strategies and treatments. © 2017, American College of Rheumatology.

Is lower peripheral information weighted differently as a function of step number during step climbing?

PubMed

Graci, Valentina; Rabuffetti, Marco; Frigo, Carlo; Ferrarin, Maurizio

2017-02-01

The importance of peripheral visual information during stair climbing and how peripheral visual information is weighted as a function of step number during step climbing is unclear. Previous authors postulated that the knowledge of predictable characteristics of the steps may decrease reliance on foveal vision and transfer the online visual guidance of stair climbing to peripheral vision. Hence the aim of this study was to investigate if and how the occlusion of the lower peripheral visual field influenced stair climbing and if peripheral visual information was weighted differently between steps. Ten young adult male participants ascended a 5-step staircase under 2 visual conditions: full vision (FV) and lower visual occlusion (LO). Kinematic data (100Hz) were collected. The effect of Vision and Step condition on vertical forefoot clearance was examined with a Repeated Measures 2-way ANOVA. Tukey's HSD test was used for post-hoc comparisons. A significant interaction Vision x Step and main effect of Step were found (p<=0.04): vertical forefoot clearance was greater in LO compared to FV condition only on the 1st and the 2nd steps (p<0.013) and on the last step compared to the other steps (p<0.01). These findings suggest that online peripheral visual information is more relevant when negotiating the first two steps, rather than the end of a staircase and that the steps subsequent the first few ones may require different information likely based on proprioception or working memory of the step height. Copyright © 2016 Elsevier B.V. All rights reserved.

Effectiveness of Total Contact Orthosis for Plantar Pressure Redistribution in Neuropathic Diabetic Patients During Different Walking Activities.

PubMed

Nouman, Muhammad; Leelasamran, Wipawan; Chatpun, Surapong

2017-08-01

Using a total contact orthosis (TCO) is an effective method to offload in diabetic patients with foot neuropathy. However, the redistribution of peak plantar pressure is mostly observed during level walking, which may differ from other walking activities. The aim of this study was to investigate the plantar pressure from 4 regions of the foot during different walking activities (level walking, ramp ascending, ramp descending, stair ascending, and stair descending) in neuropathic diabetic patients with and without a TCO. Sixteen neuropathic diabetic patients aged 40 to 60 years with calluses and hallux valgus were included in this study and were provided with TCOs made up of multifoam, Plastazote, and microcellular rubber. The plantar pressure and contact area with the TCO and without the TCO were recorded using the Pedar X system during different walking activities. A significant reduction of plantar pressure during different walking activities at the toes and forefoot regions was observed while walking with the TCO compared with walking without the TCO (control condition). Plantar pressure increased at the midfoot region when walking with the TCO, and no significant difference was observed at the hindfoot region between the control and TCO conditions. Furthermore, maximum contact area was observed during level walking with the TCO compared with other walking activities. The TCO significantly reduced and redistributed the peak plantar pressure from the sites where the ulceration rate is higher at the toes and forefoot compared with the other regions of the foot. Therapeutic level II, lesser quality randomized controlled trial.

Intrinsic foot muscle volume in experienced runners with and without chronic plantar fasciitis.

PubMed

Cheung, R T H; Sze, L K Y; Mok, N W; Ng, G Y F

2016-09-01

Plantar fasciitis, a common injury in runners, has been speculated to be associated with weakness of the intrinsic foot muscles. A recent study reported that atrophy of the intrinsic forefoot muscles might contribute to plantar fasciitis by destabilizing the medial longitudinal arch. However, intrinsic foot muscle volume difference between individuals with plantar fasciitis and healthy counterparts remains unknown. This study examined the relationship of intrinsic foot muscle volume and incidence of plantar fasciitis. Case-control study. 20 experienced (≥5 years) runners were recruited. Ten of them had bilateral chronic (≥2 years) plantar fasciitis while the others were healthy characteristics-matched runners. Intrinsic muscle volumes of the participants' right foot were scanned with a 1.5T magnetic resonance system and segmented using established methods. Body-mass normalized intrinsic foot muscle volumes were compared between runners with and without chronic plantar fasciitis. There was significant greater rearfoot intrinsic muscle volume in healthy runners than runners with chronic plantar fasciitis (Cohen's d=1.13; p=0.023). A similar trend was also observed in the total intrinsic foot muscle volume but it did not reach a statistical significance (Cohen's d=0.92; p=0.056). Forefoot volume was similar between runners with and without plantar fasciitis. These results suggest that atrophy of intrinsic foot muscles may be associated with symptoms of plantar fasciitis in runners. These findings may provide useful information in rehabilitation strategies of chronic plantar fasciitis. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Surgical treatment strategy for diabetic forefoot osteomyelitis.

PubMed

Fujii, Miki; Terashi, Hiroto; Yokono, Koichi

2016-03-01

The aim of this study was to propose an appropriate surgical treatment for diabetic forefoot osteomyelitis (DFO) involving ischemia or moderate to severe soft tissue infection. The records of 28 patients with osteomyelitis from 2009 to 2015 were retrospectively studied. All patients had undergone surgery based on preoperative magnetic resonance imaging examinations and histopathological or culture analyses confirming the surgical bone margin. The appropriate surgical margin, crucial factors for early healing, and prognosis after complete resection of osteomyelitis were examined. After healing, patients were followed up to assess prognosis (range 32-1,910 days, median 546 days). The healing rate of nonischemic cases of DFO with negative surgical margins was 100% and that of ischemic cases was 84.6%; the ambulatory rates for both types of cases were 100%. No wound (and/or osteomyelitis) recurrence was observed. Nine new cases of DFO developed in six patients (21.4%; eight were due to vascular stenosis, and one was due to biomechanical changes in the foot. After complete resection of osteomyelitis, preoperative and postoperative C-reactive protein levels and the size of the ulcer were significant predictors of early healing (p < 0.05, 0.01, and 0.05, respectively). The appropriate surgical margin should be set in the area of bone marrow edema, based on magnetic resonance imaging examinations after revascularization. In cases with high preoperative or postoperative C-reactive protein levels, long-term antibiotic therapy is recommended, and surgery should be planned after the C-reactive protein levels decrease, except in emergencies. © 2016 by the Wound Healing Society.

Reliability of capturing foot parameters using digital scanning and the neutral suspension casting technique

PubMed Central

2011-01-01

Background A clinical study was conducted to determine the intra and inter-rater reliability of digital scanning and the neutral suspension casting technique to measure six foot parameters. The neutral suspension casting technique is a commonly utilised method for obtaining a negative impression of the foot prior to orthotic fabrication. Digital scanning offers an alternative to the traditional plaster of Paris techniques. Methods Twenty one healthy participants volunteered to take part in the study. Six casts and six digital scans were obtained from each participant by two raters of differing clinical experience. The foot parameters chosen for investigation were cast length (mm), forefoot width (mm), rearfoot width (mm), medial arch height (mm), lateral arch height (mm) and forefoot to rearfoot alignment (degrees). Intraclass correlation coefficients (ICC) with 95% confidence intervals (CI) were calculated to determine the intra and inter-rater reliability. Measurement error was assessed through the calculation of the standard error of the measurement (SEM) and smallest real difference (SRD). Results ICC values for all foot parameters using digital scanning ranged between 0.81-0.99 for both intra and inter-rater reliability. For neutral suspension casting technique inter-rater reliability values ranged from 0.57-0.99 and intra-rater reliability values ranging from 0.36-0.99 for rater 1 and 0.49-0.99 for rater 2. Conclusions The findings of this study indicate that digital scanning is a reliable technique, irrespective of clinical experience, with reduced measurement variability in all foot parameters investigated when compared to neutral suspension casting. PMID:21375757

A comparison of the effects of two volumes of local analgesic solution in the distal interphalangeal joint of horses with lameness caused by solar toe or solar heel pain.

PubMed

Schumacher, J; Schumacher, J; de Graves, F; Steiger, R; Schramme, M; Smith, R; Coker, M

2001-05-01

The response of horses, with solar pain in the dorsal or palmar aspect of the foot, to 6 or 10 ml local analgesic solution administered into the distal interphalangeal (DIP) joint was examined. Lameness was induced in 7 horses by creating solar pain in the dorsal aspect of one forefoot and, at another time, the palmar aspect of the other forefoot with set-screws inserted into a custom-made shoe. Horses were videotaped trotting before and after application of set-screws and, in separate trials, after 6 or 10 ml local analgesic solution was administered into the DIP joint. Lameness scores were assigned by examining videotaped gaits. Scores were significantly lower (P < 0.05) for horses with set-screws applied to the angles of the sole and receiving 10 ml, but not 6 ml, local analgesic solution into the DIP joint. Scores were significantly lower (P < 0.05) for all horses with set-screws in the dorsal margin of the sole receiving either volume of local analgesic solution. Analgesia of the DIP joint was less effective in desensitising the angles of the sole than in desensitising the dorsal margin of the sole, and 10 ml local analgesic solution was more effective than 6 ml in desensitising these regions. The response of horses with solar pain to local analgesic solution in the DIP joint was influenced by the volume administered and the region of sole affected.

Opening wedge and anatomic-specific plates in foot and ankle applications.

PubMed

Kluesner, Andrew J; Morris, Jason B

2011-08-01

As surgeons continually push to improve techniques and outcomes, anatomic-specific and procedure-specific fixation options are becoming increasingly available. The unique size, shape, and function of the foot provide an ideal framework for the use of anatomic-specific plates. These distinctive plate characteristics range from anatomic contouring and screw placements to incorporated step-offs and wedges. By optimizing support, compression, and stabilization, patients may return to weight bearing and activity sooner, improving outcomes. This article discusses anatomic-specific plates and their use in forefoot and rearfoot surgical procedures. Copyright © 2011 Elsevier Inc. All rights reserved.

A Comparison of 2 Current-Issue Army Boots, 5 Prototype Military Boots, and 5 Commercial Hiking Boots: Performance, Efficiency, Biomechanics, Comfort and Injury

DTIC Science & Technology

1999-11-01

Maximum force (N) on the ankle, knee and hip while walking at 3.5 mph 51 23. Maximum heel- strike force (N) while walking at 3.5 mph ^.ർ 24...to first force peak while running at 6.5 mph ’.""."..62 34. Variables relating to force low point between the heel- strike and push-off peak...was lower peak deceleration and lower peak pressure at the heel than at the forefoot . In the second phase of their research, Hamill and Bensel (7, 8

Plantar Pressure Distribution among Older Persons with Different Types of Foot and Its Correlation with Functional Reach Distance

PubMed Central

2016-01-01

Background. Changes in biomechanical structures of human foot are common in the older person, which may lead to alteration of foot type and plantar pressure distribution. We aimed to examine how foot type affects the plantar pressure distribution and to determine the relationship between plantar pressure distribution and functional reach distance in older persons. Methods. Fifty community-dwelling older persons (age: 69.98 ± 5.84) were categorized into three groups based on the Foot Posture Index. The plantar pressure (max⁡P) and contact area were analyzed using Footscan® RSScan platform. The Kruskal-Wallis test was used to compare the plantar pressure between foot types and Spearman's correlation coefficient was used to correlate plantar pressure with the functional reach distance. Results. There were significant differences of max⁡P in the forefoot area across all foot types. The post hoc analysis found significantly lower max⁡P in the pronated foot compared to the supinated foot. A high linear rank correlation was found between functional reach distance and max⁡P of the rearfoot region of the supinated foot. Conclusions. These findings suggested that types of the foot affect the plantar maximal pressure in older persons with functional reach distance showing some associations. PMID:27980874

Percutaneous alcohol injection under sonographic guidance in Morton's neuroma: follow-up in 220 treated lesions.

PubMed

Perini, Luciano; Perini, Claudia; Tagliapietra, Matteo; Varotto, Davide; Valcarenghi, Andrea; Postorino, Andrea; Volpe, Antonio

2016-07-01

To evaluate the efficacy and safety of percutaneous treatment of Civinini-Morton's syndrome due to solitary Morton's neuroma and analyze the effect of clinico-demographic factors on outcome. Alcohol injection was performed under sonographic guidance in 220 consecutive patients. Pain intensity using a numerical rating scale (NRS), pain features, limitation of everyday activities and comorbidity with other forefoot conditions were evaluated at presentation. Patients were reassessed for symptoms and the need of rescue therapy with neurectomy after a mean follow-up of 19.0 months (range 15-24). We treated 220 patients (33 males, mean age 55.8 years). Neuromas were located in the III intermetatarsal space in 85.5 %, with a mean size of 5.4 mm. When considering a reduction of pain intensity of ≥50 % of NRS or a complete disappearance of the neuropathic features as a satisfactory clinical response, a 72.3 % (p < 0.001) responder rate was obtained, and only three patients relapsed (1.2 %). An improvement in limitation of everyday activities was observed in 88.6 % (p < 0.001). No influence of clinico-demographic variables on outcome was found. No major complications occurred. Patients with unsatisfactory response had an overload-related comorbid condition in 20/61 (32.8 %). Surgery was later performed in 14 non-responder patients. Ultrasound-guided alcoholization demonstrated a safe profile, relieved neuropathic symptoms in a majority of patients and improved their quality of life. Rescue therapy with surgery is feasible in patients with unsatisfactory response. However, a thorough evaluation for forefoot comorbidities should be obtained, as they may act as confounding factors.

Effect of lateral wedge length on ambulatory knee kinetics.

PubMed

Fischer, Arielle G; Ulrich, Baptiste; Hoffmann, Laurent; Jolles, Brigitte M; Favre, Julien

2018-04-27

Lateral wedge insoles (LWI) were proposed to treat medial knee osteoarthritis through reductions of the ambulatory knee adduction moment (KAM). Limited attention was however paid to the LWI length, resulting in unclear understanding of its effect on KAM reductions. The knee flexion moment (KFM) was also shown to be important in knee osteoarthritis, but little is known about the effect of LWI length on it. This study aimed to compare the KAM and KFM of healthy subjects walking with four different lengths of LWI, explicitly without LWI and with LWI below the hindfoot (HF), below the hindfoot and forefoot (HF + FF) and below the hindfoot, forefoot and hallux (HF + FF + HX) segments. Nineteen healthy participants (63% male; 24 ± 3 years old) walked in an instrumented gait lab with LWI of four different lengths. Repeated one-way ANOVAs and post-hoc t-tests were used to compare knee kinetics among LWI lengths. The peak value of the KAM during the first half of stance and the KAM impulse differed with respect to the LWI length (p < 0.001). A length of at least HF + FF, but not necessarily longer, was needed to decrease both KAM parameters compared to walking without LWI. The LWI length had no effect on the peak value of the KFM during the first half of stance (p = 0.86). The results in this study could contribute to better selections of LWI for medial knee osteoarthritis and suggested that the length of the LWI could be a critical factor that should be considered in future research. Copyright © 2018 Elsevier B.V. All rights reserved.

Multi-plug insole design to reduce peak plantar pressure on the diabetic foot during walking

PubMed Central

Actis, Ricardo L.; Ventura, Liliana B.; Lott, Donovan J.; Smith, Kirk E.; Commean, Paul K.; Hastings, Mary K.; Mueller, Michael J.

2009-01-01

There is evidence that appropriate footwear is an important factor in the prevention of foot pain in otherwise healthy people or foot ulcers in people with diabetes and peripheral neuropathy. A standard care for reducing forefoot plantar pressure is the utilization of orthotic devices such as total contact inserts (TCI) with therapeutic footwear. Most neuropathic ulcers occur under the metatarsal heads, and foot deformity combined with high localized plantar pressure, appear to be the most significant factors contributing to these ulcers. In this study, patient-specific finite element models of the second ray of the foot were developed to study the influence of TCI design on peak plantar pressure (PPP) under the metatarsal heads. A typical full contact insert was modified based on the results of finite element analyses, by inserting 4 mm diameter cylindrical plugs of softer material in the regions of high pressure. Validation of the numerical model was addressed by comparing the numerical results obtained by the finite element method with measured pressure distribution in the region of the metatarsal heads for a shoe and TCI condition. Two subjects, one with a history of forefoot pain and one with diabetes and peripheral neuropathy, were tested in the laboratory while wearing therapeutic shoes and customized inserts. The study showed that customized inserts with softer plugs distributed throughout the regions of high plantar pressure reduced the PPP over that of the TCI alone. This supports the outcome as predicted by the numerical model, without causing edge effects as reported by other investigators using different plug designs, and provides a greater degree of flexibility for customizing orthotic devices than current practice allows. PMID:18266017

Kinetics and Kinematics after the Bridle Procedure for Treatment of Traumatic Foot Drop

PubMed Central

Hastings, Mary K.; Sinacore, David R.; Woodburn, James; Paxton, E. Scott; Klein, Sandra E.; McCormick, Jeremy J.; Bohnert, Kathryn L.; Beckert, Krista S.; Stein, Michelle L.; Strube, Michael J; Johnson, Jeffrey E.

2014-01-01

Background The Bridle procedure restores active ankle dorsiflexion through a tri-tendon anastamosis of the tibialis posterior, transferred to the dorsum of the foot, with the peroneus longus and tibialis anterior tendon. Inter-segmental foot motion after the Bridle procedure has not been measured. The purpose of this study is to report kinetic and kinematic variables during walking and heel rise in patients after the Bridle procedure. Methods 18 Bridle and 10 control participants were studied. Walking and heel rise kinetic and kinematic variables were collected and compared using an ANOVA. Findings During walking the Bridle group, compared with controls, had reduced ankle power at push off [2.3 (SD 0.7) W/kg, 3.4 (SD 0.6) W/kg, respectively, P<.01], less hallux extension during swing [−13 (SD 7)°, 15 (SD6)°, respectively, P<.01] and slightly less ankle dorsiflexion during swing [6 (SD4)°, 9 (SD 2)°, respectively, P=.03]. During heel rise the Bridle group had 4 (SD 6)° of forefoot on hindfoot dorsiflexion compared to 8 (SD 3)° of plantarflexion in the controls (P<.01). Interpretation This study provides evidence that the Bridle procedure restores the majority of dorsiflexion motion during swing. However, plantarflexor function during push off and hallux extension during swing were reduced during walking in the Bridle group. Abnormal mid-tarsal joint motion, forefoot on hindfoot dorsiflexion instead of plantarflexion, was identified in the Bridle group during the more challenging heel rise task. Intervention after the Bridle procedure must maximize ankle plantarflexor function and midfoot motion should be examined during challenging tasks. PMID:23684087

Multi-plug insole design to reduce peak plantar pressure on the diabetic foot during walking.

PubMed

Actis, Ricardo L; Ventura, Liliana B; Lott, Donovan J; Smith, Kirk E; Commean, Paul K; Hastings, Mary K; Mueller, Michael J

2008-04-01

There is evidence that appropriate footwear is an important factor in the prevention of foot pain in otherwise healthy people or foot ulcers in people with diabetes and peripheral neuropathy. A standard care for reducing forefoot plantar pressure is the utilization of orthotic devices such as total contact inserts (TCI) with therapeutic footwear. Most neuropathic ulcers occur under the metatarsal heads, and foot deformity combined with high localized plantar pressure, appear to be the most significant factors contributing to these ulcers. In this study, patient-specific finite element models of the second ray of the foot were developed to study the influence of TCI design on peak plantar pressure (PPP) under the metatarsal heads. A typical full contact insert was modified based on the results of finite element analyses, by inserting 4 mm diameter cylindrical plugs of softer material in the regions of high pressure. Validation of the numerical model was addressed by comparing the numerical results obtained by the finite element method with measured pressure distribution in the region of the metatarsal heads for a shoe and TCI condition. Two subjects, one with a history of forefoot pain and one with diabetes and peripheral neuropathy, were tested in the laboratory while wearing therapeutic shoes and customized inserts. The study showed that customized inserts with softer plugs distributed throughout the regions of high plantar pressure reduced the PPP over that of the TCI alone. This supports the outcome as predicted by the numerical model, without causing edge effects as reported by other investigators using different plug designs, and provides a greater degree of flexibility for customizing orthotic devices than current practice allows.

Correlation between static radiographic measurements and intersegmental angular measurements during gait using a multisegment foot model.

PubMed

Lee, Dong Yeon; Seo, Sang Gyo; Kim, Eo Jin; Kim, Sung Ju; Lee, Kyoung Min; Farber, Daniel C; Chung, Chin Youb; Choi, In Ho

2015-01-01

Radiographic examination is a widely used evaluation method in the orthopedic clinic. However, conventional radiography alone does not reflect the dynamic changes between foot and ankle segments during gait. Multiple 3-dimensional multisegment foot models (3D MFMs) have been introduced to evaluate intersegmental motion of the foot. In this study, we evaluated the correlation between static radiographic indices and intersegmental foot motion indices. One hundred twenty-five females were tested. Static radiographs of full-leg and anteroposterior (AP) and lateral foot views were performed. For hindfoot evaluation, we measured the AP tibiotalar angle (TiTA), talar tilt (TT), calcaneal pitch, lateral tibiocalcaneal angle, and lateral talcocalcaneal angle. For the midfoot segment, naviculocuboid overlap and talonavicular coverage angle were calculated. AP and lateral talo-first metatarsal angles and metatarsal stacking angle (MSA) were measured to assess the forefoot. Hallux valgus angle (HVA) and hallux interphalangeal angle were measured. In gait analysis by 3D MFM, intersegmental angle (ISA) measurements of each segment (hallux, forefoot, hindfoot, arch) were recorded. ISAs at midstance phase were most highly correlated with radiography. Significant correlations were observed between ISA measurements using MFM and static radiographic measurements in the same segment. In the hindfoot, coronal plane ISA was correlated with AP TiTA (P < .001) and TT (P = .018). In the hallux, HVA was strongly correlated with transverse ISA of the hallux (P < .001). The segmental foot motion indices at midstance phase during gait measured by 3D MFM gait analysis were correlated with the conventional radiographic indices. The observed correlation between MFM measurements at midstance phase during gait and static radiographic measurements supports the fundamental basis for the use of MFM in analysis of dynamic motion of foot segment during gait. © The Author(s) 2014.

A multi-segment foot model based on anatomically registered technical coordinate systems: method repeatability in pediatric feet.

PubMed

Saraswat, Prabhav; MacWilliams, Bruce A; Davis, Roy B

2012-04-01

Several multi-segment foot models to measure the motion of intrinsic joints of the foot have been reported. Use of these models in clinical decision making is limited due to lack of rigorous validation including inter-clinician, and inter-lab variability measures. A model with thoroughly quantified variability may significantly improve the confidence in the results of such foot models. This study proposes a new clinical foot model with the underlying strategy of using separate anatomic and technical marker configurations and coordinate systems. Anatomical landmark and coordinate system identification is determined during a static subject calibration. Technical markers are located at optimal sites for dynamic motion tracking. The model is comprised of the tibia and three foot segments (hindfoot, forefoot and hallux) and inter-segmental joint angles are computed in three planes. Data collection was carried out on pediatric subjects at two sites (Site 1: n=10 subjects by two clinicians and Site 2: five subjects by one clinician). A plaster mold method was used to quantify static intra-clinician and inter-clinician marker placement variability by allowing direct comparisons of marker data between sessions for each subject. Intra-clinician and inter-clinician joint angle variability were less than 4°. For dynamic walking kinematics, intra-clinician, inter-clinician and inter-laboratory variability were less than 6° for the ankle and forefoot, but slightly higher for the hallux. Inter-trial variability accounted for 2-4° of the total dynamic variability. Results indicate the proposed foot model reduces the effects of marker placement variability on computed foot kinematics during walking compared to similar measures in previous models. Copyright © 2011 Elsevier B.V. All rights reserved.

Repeatability of the Oxford Foot Model in children with foot deformity.

PubMed

McCahill, Jennifer; Stebbins, Julie; Koning, Bart; Harlaar, Jaap; Theologis, Tim

2018-03-01

The Oxford Foot Model (OFM) is a multi-segment, kinematic model developed to assess foot motion. It has previously been assessed for repeatability in healthy populations. To determine the OFM's reliability for detecting foot deformity, it is important to know repeatability in pathological conditions. The aim of the study was to assess the repeatability of the OFM in children with foot deformity. Intra-tester repeatability was assessed for 45 children (15 typically developing, 15 hemiplegic, 15 clubfoot). Inter-tester repeatability was assessed in the clubfoot population. The mean absolute differences between testers (clubfoot) and sessions (clubfoot and hemiplegic) were calculated for each of 15 clinically relevant, kinematic variables and compared to typically developing children. Children with clubfoot showed a mean difference between visits of 2.9° and a mean difference between raters of 3.6° Mean absolute differences were within one degree for the intra and inter-rater reliability in 12/15 variables. Hindfoot rotation, forefoot/tibia abduction and forefoot supination were the most variable between testers. Overall the clubfoot data were less variable than the typically developing population. Children with hemiplegia demonstrated slightly higher differences between sessions (mean 4.1°), with the most reliable data in the sagittal plane, and largest differences in the transverse plane. The OFM was designed to measure different types of foot deformity. The results of this study show that it provides repeatable results in children with foot deformity. To be distinguished from measurement artifact, changes in foot kinematics as a result of intervention or natural progression over time must be greater than the repeatability reported here. Copyright © 2018 Elsevier B.V. All rights reserved.

Comparison of foot muscle morphology and foot kinematics between recreational runners with normal feet and with asymptomatic over-pronated feet.

PubMed

Zhang, Xianyi; Aeles, Jeroen; Vanwanseele, Benedicte

2017-05-01

Over-pronated feet are common in adults and are associated with lower limb injuries. Studying the foot muscle morphology and foot kinematic patterns is important for understanding the mechanism of over-pronation related injuries. The aim of this study is to compare the foot muscle morphology and foot inter-segmental kinematics between recreational runners with normal feet and those with asymptomatic over-pronated feet. A total of 26 recreational runners (17 had normal feet and 9 had over-pronated feet) participated in this study and their foot type was assessed using the 6-item Foot Posture Index. Selected foot muscles were scanned using an ultrasound device and the scanned images were processed to measure the thickness and cross-sectional area of the muscles. Muscles of interest include abductor hallucis, abductor digiti minimi, flexor digitorum brevis and longus, tibialis anterior and peroneus muscles. Foot kinematic data during walking was collected using a 3D motion capture system incorporating the Oxford Foot Model. The results show that individuals with over-pronated feet have larger size of abductor hallucis, flexor digitorum brevis and longus and smaller abductor digiti minimi than controls. Higher rearfoot peak eversion and forefoot peak supination during walking were observed in individuals with over-pronated feet. However, during gait the forefoot peak abduction was comparable. These findings indicate that in active asymptomatic individuals with over-pronated feet, the foot muscle morphology is adapted to increase control of the foot motion. The morphological characteristics of the foot muscles in asymptomatic individuals with over-pronated feet may affect their foot kinematics and benefit prevention from injuries. Copyright © 2017 Elsevier B.V. All rights reserved.

Inter-segmental motions of the foot: differences between younger and older healthy adult females.

PubMed

Lee, Dong Yeon; Seo, Sang Gyo; Kim, Eo Jin; Lee, Doo Jae; Bae, Kee Jeong; Lee, Kyoung Min; Choi, In Ho

2017-01-01

Although accumulative evidence exists that support the applicability of multi-segmental foot models (MFMs) in evaluating foot motion in various pathologic conditions, little is known of the effect of aging on inter-segmental foot motion. The objective of this study was to evaluate differences in inter-segmental motion of the foot between older and younger adult healthy females during gait using a MFM with 15-marker set. One hundred symptom-free females, who had no radiographic evidence of osteoarthritis, were evaluated using MFM with 15-marker set. They were divided into young ( n  = 50, 20-35 years old) and old ( n  = 50, 60-69 years old) groups. Coefficients of multiple correlations were evaluated to assess the similarity of kinematic curve. Inter-segmental angles (hindfoot, forefoot, and hallux) were calculated at each gait phase. To evaluate the effect of gait speed on intersegmental foot motion, subgroup analysis was performed according to the similar speed of walking. Kinematic curves showed good or excellent similarity in most parameters. Range of motion in the sagittal ( p  < 0.001) and transverse ( p  = 0.001) plane of the hallux, and sagittal ( p  = 0.023) plane of the forefoot was lower in older females. The dorsiflexion ( p  = 0.001) of the hallux at terminal stance and pre-swing phases was significantly lower in older females. When we compared young and older females with similar speed, these differences remained. Although the overall kinematic pattern was similar between young and older females, reduced range of inter-segmental motion was observed in the older group. Our results suggest that age-related changes need to be considered in studies evaluating inter-segmental motion of the foot.

Foot posture is associated with kinematics of the foot during gait: A comparison of normal, planus and cavus feet.

PubMed

Buldt, Andrew K; Levinger, Pazit; Murley, George S; Menz, Hylton B; Nester, Christopher J; Landorf, Karl B

2015-06-01

Variations in foot posture are associated with the development of some lower limb injuries. However, the mechanisms underlying this relationship are unclear. The objective of this study was to compare foot kinematics between normal, pes cavus and pes planus foot posture groups using a multi-segment foot model. Ninety-seven healthy adults, aged 18-47 were classified as either normal (n=37), pes cavus (n=30) or pes planus (n=30) based on normative data for the Foot Posture Index, Arch Index and normalised navicular height. A five segment foot model was used to measure tri-planar motion of the rearfoot, midfoot, medial forefoot, lateral forefoot and hallux during barefoot walking at a self-selected speed. Angle at heel contact, peak angle, time to peak angle and range of motion was measured for each segment. One way ANOVAs with post-hoc analyses of mean differences were used to compare foot posture groups. The pes cavus group demonstrated a distinctive pattern of motion compared to the normal and pes planus foot posture groups. Effect sizes of significant mean differences were large and comparable to similar studies. Three key differences in overall foot function were observed between the groups: (i) altered frontal and transverse plane angles of the rearfoot in the pes cavus foot; (ii) Less midfoot motion in the pes cavus foot during initial contact and midstance; and (iii) reduced midfoot frontal plane ROM in the pes planus foot during pre-swing. These findings indicate that foot posture does influence motion of the foot. Copyright © 2015 Elsevier B.V. All rights reserved.

Custom therapeutic insoles based on both foot shape and plantar pressure measurement provide enhanced pressure relief.

PubMed

Owings, Tammy M; Woerner, Julie L; Frampton, Jason D; Cavanagh, Peter R; Botek, Georgeanne

2008-05-01

The purpose of this study was to determine whether custom insoles tailored to contours of the barefoot pressure distribution and shape of a patient's foot can reduce plantar pressures in the metatarsal head (MTH) region to a greater extent than conventional custom insoles. Seventy regions of elevated barefoot pressures (mean peak 834 kPa under MTHs) were identified in 20 subjects with diabetes. Foam box impressions of their feet were sent to three different orthotic supply companies for fabrication of custom insoles. One company was also given plantar pressure data, which were incorporated into the insole design. Measurements of in-shoe plantar pressures were recorded during gait for the three custom insoles in a flexible and a rocker-bottom shoe. Peak pressure and force-time integral were extracted for analysis. In 64 of 70 regions, the shape-plus-pressure-based insole in the flexible shoe achieved superior unloading compared with the two shape-based insoles. On average, peak pressure was reduced by 32 and 21% (both P

Plantar pressure with and without custom insoles in patients with common foot complaints.

PubMed

Stolwijk, Niki M; Louwerens, Jan Willem K; Nienhuis, Bart; Duysens, Jacques; Keijsers, Noël L W

2011-01-01

Although many patients with foot complaints receive customized insoles, the choice for an insole design can vary largely among foot experts. To investigate the variety of insole designs used in daily practice, the insole design and its effect on plantar pressure distribution were investigated in a large group of patients. Mean, peak, and pressure-time-integral per sensor for 204 subjects with common foot complaints for walking with and without insoles was measured with the footscan® insole system (RSscan International). Each insole was scanned twice (precision3D), after which the insole height along the longitudinal and transversal cross section was calculated. Subjects were assigned to subgroups based on complaint and medial arch height. Data were analyzed for the total group and for the separate subgroups (forefoot or heel pain group and flat, normal or high medial arch group). The mean pressure significantly decreased under the metatarsal heads II-V and the calcaneus and significantly increased under the metatarsal bones and the lateral foot (p<0.0045) due to the insoles. However, similar redistribution patterns were found for the different foot complaints and arch heights. There was a slight difference in insole design between the subgroups; the heel cup was significantly higher and the midfoot support lower for the heel pain group compared to the forefoot pain group. The midfoot support was lowest in the flat arch group compared to the high and normal arch group (p<0.05). Although the insole shape was specific for the kind of foot complaint and arch height, the differences in shape were very small and the plantar pressure redistribution was similar for all groups. This study indicates that it might be sufficient to create basic insoles for particular patient groups.

Pressure-relieving properties of various shoe inserts in older people with plantar heel pain.

PubMed

Bonanno, Daniel R; Landorf, Karl B; Menz, Hylton B

2011-03-01

Plantar heel pain is one of the most common musculoskeletal conditions affecting the foot and it is commonly experienced by older adults. Contoured foot orthoses and some heel inserts have been found to be effective for plantar heel pain, however the mechanism by which they achieve their effects is largely unknown. The aim of this study was to investigate the effects of foot orthoses and heel inserts on plantar pressures in older adults with plantar heel pain. Thirty-six adults aged over 65 years with plantar heel pain participated in the study. Using the in-shoe Pedar(®) system, plantar pressure data were recorded while participants walked along an 8 m walkway wearing a standardised shoe and 4 different shoe inserts. The shoe inserts consisted of a silicon heel cup, a soft foam heel pad, a heel lift and a prefabricated foot orthosis. Data were collected for the heel, midfoot and forefoot. Statistically significant attenuation of heel peak plantar pressure was provided by 3 of the 4 shoe inserts. The greatest reduction was achieved by the prefabricated foot orthosis, which provided a fivefold reduction compared to the next most effective insert. The contoured nature of the prefabricated foot orthosis allowed for an increase in midfoot contact area, resulting in a greater redistribution of force. The prefabricated foot orthosis was also the only shoe insert that did not increase forefoot pressure. The findings from this study indicate that of the shoe inserts tested, the contoured prefabricated foot orthosis is the most effective at reducing pressure under the heel in older people with heel pain. Copyright © 2010 Elsevier B.V. All rights reserved.

Foot and ankle problems in Muay Thai kickboxers.

PubMed

Vaseenon, Tanawat; Intharasompan, Piyapong; Wattanarojanapom, Thongaek; Theeraamphon, Nipon; Auephanviriyakul, Sansanee; Phisitkul, Phinit

2015-01-01

Muay Thai kickboxing is a common sport that uses the foot and ankle in fighting. Muay Thai kickboxing trainees usually receive training in Thailand Foot and ankle problems in this group ofpeople who usually train barefoot remain unexplored To evaluate the prevalence of common foot and ankle problems in Muay Thai kick boxers. The present study is a cross-sectional survey of Muay Thai kick boxers practicing in northern Thailand. Interviews were conducted and foot and ankle examinations were evaluated Foot morphology was examined using a Harris mat footprint. One hundred and twenty-three Muay Thai kickbox ersinnine training gyms were included in this study. Common foot and ankle problems found in the Muay Thai kick boxers were callosity (59%), gastrocnemius contracture (57%), toe deformities (49.3%), wounds (10%) and heel pain (9%). Callosity was most commonly found on the forefoot (77.5%), on the plantar first metatarsal (55.3%) and on the big toe (33.3%). An association was found between a tight heel cord and a history of foot injury with prolonged periods of weekly training. Toe deformities such as hallux rigidus (37.6%) were also associated with prolonged periods of training (p = 0.001). No correlation was found between type of foot arch and foot and ankle problems. Plantar forefoot callosities and wounds as well as toe deformities including tight heel cords are some of the foot and ankle problems commonly found in Muay Thai kick boxers. They are associated with prolonged periods of barefoot training. The unique pattern of training and of the kicks in Muay Thai might be a path mechanism, leading to the development of foot and ankle problems.

Foot strike patterns after obstacle clearance during running.

PubMed

Scholten, Shane D; Stergiou, Nicholas; Hreljac, Alan; Houser, Jeremy; Blanke, Daniel; Alberts, L Russell

2002-01-01

Running over obstacles of sufficient height requires heel strike (HS) runners to make a transition in landing strategy to a forefoot (FF) strike, resulting in similar ground reaction force patterns to those observed while landing from a jump. Identification of the biomechanical variables that distinguish between the landing strategies may offer some insight into the reasons that the transition occurs. The purpose of this study was to investigate the difference in foot strike patterns and kinetic parameters of heel strike runners between level running and running over obstacles of various heights. Ten heel strike subjects ran at their self-selected pace under seven different conditions: unperturbed running (no obstacle) and over obstacles of six different heights (10%, 12.5%, 15%, 17.5%, 20%, and 22.5% of their standing height). The obstacle was placed directly before a Kistler force platform. Repeated measures ANOVAs were performed on the subject means of selected kinetic parameters. The statistical analysis revealed significant differences (P < 0.004) for all of the parameters analyzed. The evaluation of the center of pressure and the ground reaction forces indicated that the foot strike patterns were affected by the increased obstacle height. Between the 12.5% and 15% obstacle conditions, the group response changed from a heel strike to a forefoot strike pattern. At height > 15%, the pattern was more closely related to the foot strike patterns found in jumping activities. This strategy change may represent a gait transition effected as a mechanism to protect against increased impact forces. Greater involvement of the ankle and the calf muscles could have assisted in attenuating the increased impact forces while maintaining speed after clearing the obstacle.

Modulation of plantar pressure and gastrocnemius activity during gait using electrical stimulation of the tibialis anterior in healthy adults

PubMed Central

Ueno, Mizuki; Yoshikawa, Yoshiyuki; Terashi, Hiroto; Fujino, Hidemi

2018-01-01

High plantar flexor moment during the stance phase is known to cause high plantar pressure under the forefoot; however, the effects on plantar pressure due to a change of gastrocnemius medialis (GM) activity during gait, have not been investigated to date. Reciprocal inhibition is one of the effects of electrical stimulation (ES), and is the automatic antagonist alpha motor neuron inhibition which is evoked by excitation of the agonist muscle. The aim of this study was to investigate the influences of ES of the tibialis anterior (TA) on plantar pressure and the GM activity during gait in healthy adults. ES was applied to the TAs of twenty healthy male adults for 30 minutes at the level of intensity that causes a full range of dorsiflexion in the ankle (frequency; 50 Hz, on-time; 10 sec, off-time; 10 sec). Subjects walked 10 meters before and after ES, and we measured the peak plantar pressure (PP), pressure time integral (PTI), and gait parameters by using an F-scan system. The percentage of integrated electromyogram (%IEMG), active time, onset time, peak time, and cessation time of TA and GM were calculated. PP and PTI under the forefoot, rear foot, and total plantar surface significantly decreased after the application of ES. Meanwhile, changes of gait parameters were not observed. %IEMG and the active time of both muscles did not change; however, onset time and peak time of GM became significantly delayed. ES application to the TA delayed the timing of onset and peak in the GM, and caused the decrease of plantar pressure during gait. The present results suggest that ES to the TA could become a new method for the control of plantar pressure via modulation of GM activity during gait. PMID:29746498

Economy and rate of carbohydrate oxidation during running with rearfoot and forefoot strike patterns.

PubMed

Gruber, Allison H; Umberger, Brian R; Braun, Barry; Hamill, Joseph

2013-07-15

It continues to be argued that a forefoot (FF) strike pattern during running is more economical than a rearfoot (RF) pattern; however, previous studies using one habitual footstrike group have found no difference in running economy between footstrike patterns. We aimed to conduct a more extensive study by including both habitual RF and FF runners. The purposes of this study were to determine whether there were differences in running economy between these groups and whether running economy would change when they ran with the alternative footstrike pattern. Nineteen habitual RF and 18 habitual FF runners performed the RF and FF patterns on a treadmill at 3.0, 3.5, and 4.0 m/s. Steady-state rates of oxygen consumption (Vo2, ml·kg(-1)·min(-1)) and carbohydrate contribution to total energy expenditure (%CHO) were determined by indirect calorimetry for each footstrike pattern and speed condition. A mixed-model ANOVA was used to assess the differences in each variable between groups and footstrike patterns (α = 0.05). No differences in Vo2 or %CHO were detected between groups when running with their habitual footstrike pattern. The RF pattern resulted in lower Vo2 and %CHO compared with the FF pattern at the slow and medium speeds in the RF group (P < 0.05) but not in the FF group (P > 0.05). At the fast speed, a significant footstrike pattern main effect indicated that Vo2 was greater with the FF pattern than with the RF pattern (P < 0.05), but %CHO was not different (P > 0.05). The results suggest that the FF pattern is not more economical than the RF pattern.

Angular position of the cleat according to torsional parameters of the cyclist's lower limb.

PubMed

Ramos-Ortega, Javier; Domínguez, Gabriel; Castillo, José Manuel; Fernández-Seguín, Lourdes; Munuera, Pedro V

2014-05-01

The aim of this work was to study the relationship of torsional and rotational parameters of the lower limb with a specific angular position of the cleat to establish whether these variables affect the adjustment of the cleat. Correlational study. Motion analysis laboratory. Thirty-seven male cyclists of high performance. The variables studied of the cyclist's lower limb were hip rotation (internal and external), tibial torsion angle, Q angle, and forefoot adductus angle. The cleat angle was measured through a photograph of the sole and with an Rx of this using the software AutoCAD 2008. The variables were photograph angle (photograph), the variable denominated cleat-tarsus minor angle, and a variable denominated cleat-second metatarsal angle (Rx). Analysis included the intraclass correlation coefficient for the reliability of the measurements, Student's t test performed on the dependent variables to compare side, and the multiple linear regression models were calculated using the software SPSS 15.0 for Windows. The Student's t test performed on the dependent variables to compare side showed no significant differences (P = 0.209 for the photograph angle, P = 0.735 for the cleat-tarsus minor angle, and P = 0.801 for the cleat-second metatarsal angle). Values of R and R2 for the photograph angle model were 0.303 and 0.092 (P = 0.08), the cleat/tarsus minor angle model were 0.683 and 0.466 (P < 0.001), and the cleat/second metatarsal angle model were 0.618 and 0.382, respectively (P < 0.001). The equation given by the model was cleat-tarsus minor angle = 75.094 - (0.521 × forefoot adductus angle) + (0.116 × outward rotation of the hips) + (0.220 × Q angle).

Gait kinematics of subjects with ankle instability using a multisegmented foot model.

PubMed

De Ridder, Roel; Willems, Tine; Vanrenterghem, Jos; Robinson, Mark; Pataky, Todd; Roosen, Philip

2013-11-01

Many patients who sustain an acute lateral ankle sprain develop chronic ankle instability (CAI). Altered ankle kinematics have been reported to play a role in the underlying mechanisms of CAI. In previous studies, however, the foot was modeled as one rigid segment, ignoring the complexity of the ankle and foot anatomy and kinematics. The purpose of this study was to evaluate stance phase kinematics of subjects with CAI, copers, and controls during walking and running using both a rigid and a multisegmented foot model. Foot and ankle kinematics of 77 subjects (29 subjects with self-reported CAI, 24 copers, and 24 controls) were measured during barefoot walking and running using a rigid foot model and a six-segment Ghent Foot Model. Data were collected on a 20-m-long instrumented runway embedded with a force plate and a six-camera optoelectronic system. Groups were compared using statistical parametric mapping. Both the CAI and the coper group showed similar differences during midstance and late stance compared with the control group (P < 0.05). The rigid foot segment showed a more everted position during walking compared with the control group. Based on the Ghent Foot Model, the rear foot also showed a more everted position during running. The medial forefoot showed a more inverted position for both running and walking compared with the control group. Our study revealed significant midstance and late stance differences in rigid foot, rear foot, and medial forefoot kinematics The multisegmented foot model demonstrated intricate behavior of the foot that is not detectable with rigid foot modeling. Further research using these models is necessary to expand knowledge of foot kinematics in subjects with CAI.

Decreasing an Offloading Device's Size and Offsetting Its Imposed Limb Length Discrepancy Lead to Improved Comfort and Gait.

PubMed

Crews, Ryan T; Candela, Joseph

2018-04-17

Patient adherence is a challenge in offloading diabetic foot ulcers (DFUs) with removable cast walkers (RCWs). The size and weight of an RCW, changes to gait, and imposed limb length discrepancies may all discourage adherence. This study sought to determine whether RCW size and provision of a contralateral limb lift affected users' comfort and gait. Twenty-five individuals at risk for DFUs completed several 20-m walking trials under five footwear conditions: bilateral standardized shoes, a knee-high RCW with shoe with or without an external shoe lift contralaterally, and an ankle-high RCW with shoe with or without an external shoe lift contralaterally. Perceived comfort ratings were assessed through the use of visual analog scales. Spatial and temporal parameters of gait were captured by an instrumented walkway, and plantar pressure was measured and recorded using pedobarographic insoles. The bilateral shoes condition was reported to be most comfortable; both RCW conditions without the lift were significantly less comfortable ( P < 0.01). In contrast to the ankle-high RCW, the knee-high RCW resulted in significantly slower walking (5.6%; P < 0.01) but greater offloading in multiple forefoot regions of the offloaded foot (6.8-8.1%; P < 0.01). Use of the contralateral shoe lift resulted in significantly less variability in walking velocity (52.8%; P < 0.01) and reduced stance time for the offloaded foot (2.6%; P = 0.01), but it also reduced offloading in multiple forefoot regions of the offloaded foot (3.7-6.0%; P < 0.01). Improved comfort and gait were associated with the ankle-high RCW and contralateral limb lift. Providing this combination to patients with active DFUs may increase offloading adherence and subsequently improve healing. © 2018 by the American Diabetes Association.

Foot function is well preserved in children and adolescents with juvenile idiopathic arthritis who are optimally managed

PubMed Central

Hendry, Gordon J.; Rafferty, Danny; Barn, Ruth; Gardner-Medwin, Janet; Turner, Debbie E.; Woodburn, James

2013-01-01

Purpose The objective of this study was to compare disease activity, impairments, disability, foot function and gait characteristics between a well described cohort of juvenile idiopathic arthritis (JIA) patients and normal healthy controls using a 7-segment foot model and three-dimensional gait analysis. Methods Fourteen patients with JIA (mean (standard deviation) age of 12.4 years (3.2)) and a history of foot disease and 10 healthy children (mean (standard deviation) age of 12.5 years (3.4)) underwent three-dimensional gait analysis and plantar pressure analysis to measure biomechanical foot function. Localised disease impact and foot-specific disease activity were determined using the juvenile arthritis foot disability index, rear- and forefoot deformity scores, and clinical and musculoskeletal ultrasound examinations respectively. Mean differences between groups with associated 95% confidence intervals were calculated using the t distribution. Results Mild-to-moderate foot impairments and disability but low levels of disease activity were detected in the JIA group. In comparison with healthy subjects, minor trends towards increased midfoot dorsiflexion and reduced lateral forefoot abduction within a 3–5° range were observed in patients with JIA. The magnitude and timing of remaining kinematic, kinetic and plantar pressure distribution variables during the stance phase were similar for both groups. Conclusion In children and adolescents with JIA, foot function as determined by a multi-segment foot model did not differ from that of normal age- and gender-matched subjects despite moderate foot impairments and disability scores. These findings may indicate that tight control of active foot disease may prevent joint destruction and associated structural and functional impairments. PMID:23142184

Foot and ankle kinematics in patients with posterior tibial tendon dysfunction.

PubMed

Ness, Mary Ellen; Long, Jason; Marks, Richard; Harris, Gerald

2008-02-01

The purpose of this study is to provide a quantitative characterization of gait in patients with posterior tibial tendon dysfunction (PTTD), including temporal-spatial and kinematic parameters, and to compare these results to those of a Normal population. Our hypothesis was that segmental foot kinematics were significantly different in multiple segments across multiple planes. A 15 camera motion analysis system and weight-bearing radiographs were employed to evaluate 3D foot and ankle motion in a population of 34 patients with PTTD (30 females, 4 males) and 25 normal subjects (12 females, 13 males). The four-segment Milwaukee Foot Model (MFM) with radiographic indexing was used to analyze foot and ankle motion and provided kinematic data in the sagittal, coronal and transverse planes as well as temporal-spatial information. The temporal-spatial parameters revealed statistically significant deviations in all four metrics for the PTTD population. Stride length, cadence and walking speed were all significantly diminished, while stance duration was significantly prolonged (p<0.0125). Significant kinematic differences were noted between the groups (p<0.002), including: (1) diminished dorsiflexion and increased eversion of the hindfoot; (2) decreased plantarflexion of the forefoot, as well as abduction shift and loss of the varus thrust in the forefoot; and (3) decreased range of motion (ROM) with diminished dorsiflexion of the hallux. The study provides an impetus for improved orthotic and bracing designs to aid in the care of distal foot segments during the treatment of PTTD. It also provides the basis for future evaluation of surgical efficacy. The course of this investigation may ultimately lead to improved treatment planning methods, including orthotic and operative interventions.

In-shoe plantar pressure measurements for the evaluation and adaptation of foot orthoses in patients with rheumatoid arthritis: A proof of concept study.

PubMed

Tenten-Diepenmaat, Marloes; Dekker, Joost; Steenbergen, Menno; Huybrechts, Elleke; Roorda, Leo D; van Schaardenburg, Dirkjan; Bus, Sicco A; van der Leeden, Marike

2016-03-01

Improving foot orthoses (FOs) in patients with rheumatoid arthritis (RA) by using in-shoe plantar pressure measurements seems promising. The objectives of this study were to evaluate (1) the outcome on plantar pressure distribution of FOs that were adapted using in-shoe plantar pressure measurements according to a protocol and (2) the protocol feasibility. Forty-five RA patients with foot problems were included in this observational proof-of concept study. FOs were custom-made by a podiatrist according to usual care. Regions of Interest (ROIs) for plantar pressure reduction were selected. According to a protocol, usual care FOs were evaluated using in-shoe plantar pressure measurements and, if necessary, adapted. Plantar pressure-time integrals at the ROIs were compared between the following conditions: (1) no-FO versus usual care FO and (2) usual care FO versus adapted FO. Semi-structured interviews were held with patients and podiatrists to evaluate the feasibility of the protocol. Adapted FOs were developed in 70% of the patients. In these patients, usual care FOs showed a mean 9% reduction in pressure-time integral at forefoot ROIs compared to no-FOs (p=0.01). FO adaptation led to an additional mean 3% reduction in pressure-time integral (p=0.05). The protocol was considered feasible by patients. Podiatrists considered the protocol more useful to achieve individual rather than general treatment goals. A final protocol was proposed. Using in-shoe plantar pressure measurements for adapting foot orthoses for patients with RA leads to a small additional plantar pressure reduction in the forefoot. Further research on the clinical relevance of this outcome is required. Copyright © 2016. Published by Elsevier B.V.

Novel dynamic peak and distribution plantar pressure measures on diabetic patients during walking.

PubMed

Al-Angari, Haitham M; Khandoker, Ahsan H; Lee, Sungmun; Almahmeed, Wael; Al Safar, Habiba S; Jelinek, Herbert F; Khalaf, Kinda

2017-01-01

Diabetic peripheral neuropathy (DPN) is a common complication leading to foot ulceration and amputation. Several kinematic, kinetic and plantar pressure measures have been proposed for DPN detection, however findings have been inconsistent. In this work, we present new shape features that capture variations in the plantar pressure using shape and entropy measures to the study of patients with retinopathy, DPN and nephropathy, and a control diabetic group with no complications. The change in the peak plantar pressure (PPP) position with each step for both feet was represented as a convex polygon, asymmetry index, area of the convex polygon, 2nd wavelet moment (WM2) and sample entropy (SamEn). WM2 and the SamEn were more sensitive in capturing variations due to presence of complications than the area and asymmetry measures. WM2 of the left heel (median: 1st IQ, 3rd IQ): 8.27 (4.6,14.8) and left forefoot: 9.2 (2.4,16) were significantly lower for the DPN group compared to the control (CONT) group (heel 11.9 (5.0,16.4); forefoot: 10.3 (4.4,21.3), p < 0.05). SamEn for the DPN group was significantly lower in the right foot compared to the left foot (1.3 (1.26, 1.37) and 1.33 (1.26,1.4), p < 0.01) compared to CONT (right foot: 1.37 (1.24,1.45) and left foot: 1.34 (1.25,1.42), P < 0.05). These new shape and regularity features have shown promising results in detecting diabetic peripheral neuropathy and warrant further investigation. Copyright © 2016 Elsevier B.V. All rights reserved.

[Tibiotalocalcaneal arthrodesis using a distally introduced femur nail (DFN)].

PubMed

Grass, René

2005-10-01

Simultaneous arthrodesis of ankle and subtalar joints and, at the same sitting, correction of axial malalignment of hindfoot, treatment of bony defects and of sequelae of circulatory disturbances after multiple previous interventions. Internal stabilization with a short distal femur nail. Restitution of a pain-free weight bearing. Failure of arthrodesis of ankle and subtalar joint causing pain in patients with severely altered bone structures particularly at the level of the talar dome. Malalignment of hind- and/or forefoot after previous arthrodesis of ankle and subtalar joint. Failure of conservative therapy in both above-enumerated conditions. Poor skin or soft-tissue conditions. Reflex sympathetic dystrophy. Acute osteitis/osteomyelitis. Posterolateral approach. Resection of the articular cartilage and the areas of sclerosis of the ankle and of the posterior facet of the subtalar joint. Interposition of bone grafts harvested from the iliac crest. Correction of malalignment of hind- and forefoot. Locked nailing with a short distal femur nail. Fitting of a flexible custom-made arthrodesis boot; weight bearing in boot not exceeding half of body weight until the 8th week. Gait training. After 12 weeks wearing of normal shoes. Radiographs after 6 and 12 weeks. Between February 1, 2002 and September 1, 2003 this technique was performed on 18 feet in 17 patients (three women, 14 men, average age 53 years [38.9-73.7 years]). Average duration of follow-up: 1.2 years (0.6-2.1 years). The goal of surgery was reached in all patients. Subjective assessment: 14 times good, three times satisfactory. Four complications: one loss of nail purchase, one dislocation of locking screw, one breakage of locking bolt, one prolonged bone healing.

Prevention of Recurrent Foot Ulcers With Plantar Pressure–Based In-Shoe Orthoses: The CareFUL Prevention Multicenter Randomized Controlled Trial

PubMed Central

Ulbrecht, Jan S.; Hurley, Timothy; Mauger, David T.

2014-01-01

OBJECTIVE To assess the efficacy of in-shoe orthoses that were designed based on shape and barefoot plantar pressure in reducing the incidence of submetatarsal head plantar ulcers in people with diabetes, peripheral neuropathy, and a history of similar prior ulceration. RESEARCH DESIGN AND METHODS Single-blinded multicenter randomized controlled trial with subjects randomized to wear shape- and pressure-based orthoses (experimental, n = 66) or standard-of-care A5513 orthoses (control, n = 64). Patients were followed for 15 months, until a study end point (forefoot plantar ulcer or nonulcerative plantar forefoot lesion) or to study termination. Proportional hazards regression was used for analysis. RESULTS There was a trend in the composite primary end point (both ulcers and nonulcerative lesions) across the full follow-up period (P = 0.13) in favor of the experimental orthoses. This trend was due to a marked difference in ulcer occurrence (P = 0.007) but no difference in the rate of nonulcerative lesions (P = 0.76). At 180 days, the ulcer prevention effect of the experimental orthoses was already significant (P = 0.003) when compared with control, and the benefit of the experimental orthoses with respect to the composite end point was also significant (P = 0.042). The hazard ratio was 3.4 (95% CI 1.3–8.7) for the occurrence of a submetatarsal head plantar ulcer in the control compared with experimental arm over the duration of the study. CONCLUSIONS We conclude that shape- and barefoot plantar pressure–based orthoses were more effective in reducing submetatarsal head plantar ulcer recurrence than current standard-of-care orthoses, but they did not significantly reduce nonulcerative lesions. PMID:24760263

Prevention of recurrent foot ulcers with plantar pressure-based in-shoe orthoses: the CareFUL prevention multicenter randomized controlled trial.

PubMed

Ulbrecht, Jan S; Hurley, Timothy; Mauger, David T; Cavanagh, Peter R

2014-07-01

To assess the efficacy of in-shoe orthoses that were designed based on shape and barefoot plantar pressure in reducing the incidence of submetatarsal head plantar ulcers in people with diabetes, peripheral neuropathy, and a history of similar prior ulceration. Single-blinded multicenter randomized controlled trial with subjects randomized to wear shape- and pressure-based orthoses (experimental, n = 66) or standard-of-care A5513 orthoses (control, n = 64). Patients were followed for 15 months, until a study end point (forefoot plantar ulcer or nonulcerative plantar forefoot lesion) or to study termination. Proportional hazards regression was used for analysis. There was a trend in the composite primary end point (both ulcers and nonulcerative lesions) across the full follow-up period (P = 0.13) in favor of the experimental orthoses. This trend was due to a marked difference in ulcer occurrence (P = 0.007) but no difference in the rate of nonulcerative lesions (P = 0.76). At 180 days, the ulcer prevention effect of the experimental orthoses was already significant (P = 0.003) when compared with control, and the benefit of the experimental orthoses with respect to the composite end point was also significant (P = 0.042). The hazard ratio was 3.4 (95% CI 1.3-8.7) for the occurrence of a submetatarsal head plantar ulcer in the control compared with experimental arm over the duration of the study. We conclude that shape- and barefoot plantar pressure-based orthoses were more effective in reducing submetatarsal head plantar ulcer recurrence than current standard-of-care orthoses, but they did not significantly reduce nonulcerative lesions. © 2014 by the American Diabetes Association.

Comparison of plantar pressures and contact area between normal and cavus foot.

PubMed

Fernández-Seguín, Lourdes M; Diaz Mancha, Juan Antonio; Sánchez Rodríguez, Raquel; Escamilla Martínez, Elena; Gómez Martín, Beatriz; Ramos Ortega, Javier

2014-02-01

In pes cavus, the medial longitudinal arch elevation reduces the contact surface area and consequently increases the corresponding plantar pressure measurements. This poor distribution of loads may produce associated pathology and pain in this or other areas of the body. Normal reference values need to be established in order to determine which patterns are prone to pathology. To compare the plantar pressures and weight-bearing surface in a population with pes cavus to a population with neutral feet. The sample comprised 68 adults, 34 with pes cavus and 34 with neutral feet. The Footscan USB Gait Clinical System(®) was used as a platform to measure the total contact area and plantar pressure under the forefoot, midfoot, hindfoot, each metatarsal head, and the overall metatarsal area. A statistical analysis of the data was performed using Student's t-test for independent samples. The pes cavus subjects showed a significant reduction in their weight-bearing area [neutral feet: 165.04 ( ± 20.68) cm(2); pes cavus: 118.26 ( ± 30.31) cm(2); p < 0.001] and significantly increased pressures under all zones of the forefoot except the fifth metatarsal [metatarsal pressure: in neutral feet 503,797 ( ± 9.32) kPa; in pes cavus 656.12 ( ± 22.39) kPa; p < 0.001]. Compared to neutral feet, pes cavus feet show a reduction in total contact surface and the load under the first toe. A significant increase is present in the load under the metatarsal areas, but the relative distribution of this load is similar in both groups. Copyright © 2013 Elsevier B.V. All rights reserved.

Use of MRI for volume estimation of tibialis posterior and plantar intrinsic foot muscles in healthy and chronic plantar fasciitis limbs.

PubMed

Chang, Ryan; Kent-Braun, Jane A; Hamill, Joseph

2012-06-01

Due to complexity of the plantar intrinsic foot muscles, little is known about their muscle architecture in vivo. Chronic plantar fasciitis may be accompanied by muscle atrophy of plantar intrinsic foot muscles and tibialis posterior compromising the dynamic support of the foot prolonging the injury. Magnetic resonance images of the foot may be digitized to quantify muscle architecture. The first purpose of this study was to estimate in vivo the volume and distribution of healthy plantar intrinsic foot muscles. The second purpose was to determine whether chronic plantar fasciitis is accompanied by atrophy of plantar intrinsic foot muscles and tibialis posterior. Magnetic resonance images were taken bilaterally in eight subjects with unilateral plantar fasciitis. Muscle perimeters were digitally outlined and muscle signal intensity thresholds were determined for each image for volume computation. The mean volume of contractile tissue in healthy plantar intrinsic foot muscles was 113.3 cm(3). Forefoot volumes of plantar fasciitis plantar intrinsic foot muscles were 5.2% smaller than healthy feet (P=0.03, ES=0.26), but rearfoot (P=0.26, ES=0.08) and total foot volumes (P=0.07) were similar. No differences were observed in tibialis posterior size. While the total volume of plantar intrinsic foot muscles was similar in healthy and plantar fasciitis feet, atrophy of the forefoot plantar intrinsic foot muscles may contribute to plantar fasciitis by destabilizing the medial longitudinal arch. These results suggest that magnetic resonance imaging measures may be useful in understanding the etiology and rehabilitation of chronic plantar fasciitis. Copyright © 2011 Elsevier Ltd. All rights reserved.

A comparison of subtalar joint motion during anticipated medial cutting turns and level walking using a multi-segment foot model.

PubMed

Jenkyn, T R; Shultz, R; Giffin, J R; Birmingham, T B

2010-02-01

The weight-bearing in-vivo kinematics and kinetics of the talocrural joint, subtalar joint and joints of the foot were quantified using optical motion analysis. Twelve healthy subjects were studied during level walking and anticipated medial turns at self-selected pace. A multi-segment model of the foot using skin-mounted marker triads tracked four foot segments: the hindfoot, midfoot, lateral and medial forefoot. The lower leg and thigh were also tracked. Motion between each of the segments could occur in three degrees of rotational freedom, but only six inter-segmental motions were reported in this study: (1) talocrural dorsi-plantar-flexion, (2) subtalar inversion-eversion, (3) frontal plane hindfoot motion, (4) transverse plane hindfoot motion, (5) forefoot supination-pronation twisting and (6) the height-to-length ratio of the medial longitudinal arch. The motion at the subtalar joint during stance phase of walking (eversion then inversion) was reversed during a turning task (inversion then eversion). The external subtalar joint moment was also changed from a moderate eversion moment during walking to a larger inversion moment during the turn. The kinematics of the talocrural joint and the joints of the foot were similar between these two tasks. During a medial turn, the subtalar joint may act to maintain the motions in the foot and talocrural joint that occur during level walking. This is occurring despite the conspicuously different trajectory of the centre of mass of the body. This may allow the foot complex to maintain its function of energy absorption followed by energy return during stance phase that is best suited to level walking. Copyright 2009 Elsevier B.V. All rights reserved.

Propionyl-L-carnitine improves endothelial function, microcirculation and pain management in critical limb ischemia.

PubMed

De Marchi, S; Zecchetto, S; Rigoni, A; Prior, M; Fondrieschi, L; Scuro, A; Rulfo, F; Arosio, E

2012-10-01

Chronic critical limb ischemia (CLI) is a severe condition of hypo-perfusion of lower limbs, which is associated with inflammation and a pro-coagulative state. It is a disease at high risk of amputation and cardiovascular death. Propionyl-L-carnitine (PLC) is efficacious in improving pain free walking distance in peripheral arterial disease with claudication; it also exerts favorable effects on the arterial wall and on endothelial function. The purpose of this study was to evaluate the effects of PLC on microcirculation, endothelial function and pain relief in patients affected by CLI not suitable for surgical intervention. We enrolled 48 patients with CLI. Patients were randomized into two groups: the first group was treated with PLC, the second was treated with saline solution. All of them underwent the following tests: laser Doppler flowmetry at the forefoot at rest and after ischemia, trans cutaneous oxygen partial pressure and carbon dioxide partial pressure at the forefoot at rest and after ischemia, endothelium dependent dilation of the brachial artery. All tests were repeated after treatments. Pain was assessed by visual analog pain scale. Endothelium dependent dilation increased after PLC (9.5 ± 3.2 vs 4.9 ± 1.4 %; p < 0.05). Post-ischemic peak flow with laser-Doppler flow increased after PLC. TcPO2 increased, while TcPCO2 decreased after PLC; CO2 production decreased after PLC. VAS showed a significant reduction in pain perception after active treatment. In CLI patients, PLC can improve microcirculation (post ischemic hyperemia, TcPO2 and TcPCO2 production). PLC also enhances endothelium dependent dilation and reduces analgesic consumption and pain perception.

Effects of unweighting and speed on in-shoe regional loading during running on a lower body positive pressure treadmill.

PubMed

Smoliga, James M; Wirfel, Leah Anne; Paul, Danielle; Doarnberger, Mary; Ford, Kevin R

2015-07-16

The purpose of this study was to determine how unweighted running on a lower body positive pressure treadmill (LBPPT) modifies in-shoe regional loading. Ten experienced runners were fit with pressure distribution measurement insoles and ran at 100%, 120%, and 140% of self-reported easy training pace on a LBPPT at 20%, 40%, 60%, 80%, and 100% body weight percentage settings (BWSet). Speeds and BWSet were in random order. A linear mixed effect model (p<0.05 significance level) was used to compare differences in whole foot and regional maximum in-shoe plantar force (FMAX), impulse, and relative load distribution across speeds and BWSet. There were significant main effects (p<0.001) for running speed and BWSet for whole foot Fmax and impulse. The model revealed 1.4% and 0.24% increases in whole foot FMAX (times body weight) and impulse, respectively, for every unit increase in body weight percentage. There was a significant main effect for BWSet on Fmax and relative load (p<0.05) for each of the nine foot regions examined, though four regions were not different between 80% and 100% BWSet. There was a significant (p<0.001) main effect for BWSet on forefoot to rear foot relative load. Linear relationships were found between increases in BWSet and increases in-shoe Fmax and impulse, resulting from regional changes in foot pressure which represent a shift towards forefoot loading, most evident <80% BWSet. Estimating in-shoe regional loading parameters may be useful during rehabilitation and training to appropriately prescribe specific speed and body weight levels, without exceeding certain critical peak force levels while running. Copyright © 2015 Elsevier Ltd. All rights reserved.

Lower limb sympathectomy assessed by laser Doppler blood flow and transcutaneous oxygen measurements.

PubMed

Lantsberg, L; Goldman, M

1990-01-01

In a retrospective study of critical ischaemia of the lower limb, sympathectomy appeared to be of value in the majority of patients. We therefore assessed sympathectomy by measuring skin blood flow before and after the procedure using laser Doppler flowmetry (LDF) and transcutaneous oxygen tension (TCpO2) techniques. Twenty patients underwent chemical sympathectomy and there was one surgical procedure. Measurements were performed before and 1 week after sympathectomy below the knee and on the forefoot. Symptomatic improvement occurred in 20 of 21 patients. This study demonstrates that skin blood flow in the leg and foot is improved by sympathectomy and confirms objectively our clinical impression.

Gigantism of the foot: our experience in seven cases.

PubMed

Turra, S; Santini, S; Cagnoni, G; Jacopetti, T

1998-01-01

We report our experience in seven patients with congenital gigantism of the foot with the following diagnoses: neurofibromatosis (two), fibrolipomatosis (two), Proteus syndrome (two), and idiopathic localized gigantism (one). Our purpose is to introduce a new classification of foot gigantism, based on the concept of "neuroinduction." In our experience, intraoperative examination and subsequent histologic examination show consistently pathologic findings in the plantar nerve and its terminal branches in the foot affected by gigantism. Limited surgical treatment was used in five patients. To prevent forefoot enlargement and recurrence of deformity, we suggest complete ray resection. We evaluated our results using radiographs, functional status, and cosmetic considerations.

Dance medicine of the foot and ankle: a review.

PubMed

Werber, Bruce

2011-01-01

All forms of dance are highly demanding activities, with a lifetime injury incidence of up to 90%. Most dance types are stressful, particularly on the dancer's forefoot, but certainly there is no area of the foot or ankle that is exempt from potential injury. Dancers often have unusual difficulties related to the dynamic biomechanical forces required by their individual dance form. A thorough understanding of these movements guides the physician to the cause of the injury, particularly in understanding specific overuse injuries. This article discusses biomechanics of the foot and the imaging and treatment of dance-related injuries. Copyright © 2011 Elsevier Inc. All rights reserved.

Barefoot Plantar Pressure Indicates Progressive Neurological Damage in Patients with Human T-Cell Lymphotropic Virus Type 1 Infection.

PubMed

Vasconcelos, Beatriz Helena B; Souza, Givago S; Barroso, Tatiana G C P; Silveira, Luiz Carlos L; Sousa, Rita Catarina M; Callegari, Bianca; Xavier, Marília B

2016-01-01

The human T-Cell Lymphotropic Virus Type 1 (HTLV-1) is a retrovirus associated with neurological alterations; individuals with HTLV-1 infection may develop HTLV-1 associated myelopathy / tropical spastic paraparesis (HAM/TSP). Frequent neurological complaints include foot numbness and leg weakness. In this study, we compared the distribution of the body weight on different areas of the foot in HTLV-1 patients with HAM/TSP, asymptomatic HTLV-1 patients, and healthy individuals. We studied 36 HTLV-1 infected patients, who were divided in two groups of 18 patients each based on whether or not they had been diagnosed with HAM/TSP, and 17 control subjects. The evaluation included an interview on the patient's clinical history and examinations of the patient's reflexes, foot skin tactile sensitivity, and risk of falling. The pressure distribution on different areas of the foot was measured with baropodometry, using a pressure platform, while the patients had their eyes open or closed. The prevalence of neurological disturbances-altered reflexes and skin tactile sensitivity and increased risk of falling-was higher in HTLV-1 HAM/TSP patients than in HTLV-1 asymptomatic patients. The medium and maximum pressure values were higher in the forefoot than in the midfoot and hindfoot in both HTLV-1 groups. In addition, the pressure on the hindfoot was lower in HAM/TSP patients compared to control subjects. The neurological disturbances associated with HTLV-1 infection gradually worsened from HTLV-1 asymptomatic patients to HAM/TSP patients. Baropodometry is a valuable tool to establish the extent of neurological damage in patients suffering from HTLV-1 infection.

Development of a patient-specific anatomical foot model from structured light scan data.

PubMed

Lochner, Samuel J; Huissoon, Jan P; Bedi, Sanjeev S

2014-01-01

The use of anatomically accurate finite element (FE) models of the human foot in research studies has increased rapidly in recent years. Uses for FE foot models include advancing knowledge of orthotic design, shoe design, ankle-foot orthoses, pathomechanics, locomotion, plantar pressure, tissue mechanics, plantar fasciitis, joint stress and surgical interventions. Similar applications but for clinical use on a per-patient basis would also be on the rise if it were not for the high costs associated with developing patient-specific anatomical foot models. High costs arise primarily from the expense and challenges of acquiring anatomical data via magnetic resonance imaging (MRI) or computed tomography (CT) and reconstructing the three-dimensional models. The proposed solution morphs detailed anatomy from skin surface geometry and anatomical landmarks of a generic foot model (developed from CT or MRI) to surface geometry and anatomical landmarks acquired from an inexpensive structured light scan of a foot. The method yields a patient-specific anatomical foot model at a fraction of the cost of standard methods. Average error for bone surfaces was 2.53 mm for the six experiments completed. Highest accuracy occurred in the mid-foot and lowest in the forefoot due to the small, irregular bones of the toes. The method must be validated in the intended application to determine if the resulting errors are acceptable.

Evaluation of multidensity orthotic materials used in footwear for patients with diabetes.

PubMed

Foto, J G; Birke, J A

1998-12-01

Selected combinations of multidensity orthotic materials were tested under simulated walking conditions found in the forefoot of diabetic patients. Materials were compared for therapeutic effectiveness by their stress/strain properties and dynamic compression set. Results showed that all of the multidensity materials experienced losses in performance throughout the testing period of 100,000 cycles, with the greatest losses occurring within the first 10,000 cycles. Of the materials tested, Poron + Plastazote #2 and Spenco + Microcel Puff Lite had the highest dynamic material strain and the lowest dynamic compression set over 100,000 cycles. In comparison, these are better multidensity combinations than the others tested to use as therapeutic orthoses in footwear for diabetic patients.

A Two-Stage Foot Repair in a 55-Year-Old Man with Poliomyelitis.

PubMed

Pollack, Daniel

2018-01-01

A 55-year-old man with poliomyelitis presented with a plantarflexed foot and painful ulceration of the sub-first metatarsophalangeal joint present for many years. A two-stage procedure was performed to bring the foot to 90°, perpendicular to the leg, and resolve the ulceration. The first stage corrected only soft-tissue components. It involved using a hydrosurgery system to debride and prepare the ulcer, a unilobed rotational skin plasty to close the ulcer, and a tendo Achillis lengthening to decrease forefoot pressure. The second stage corrected the osseous deformity with a dorsiflexory wedge osteotomy of the first metatarsal. The ulceration has remained closed since the procedures, with complete resolution of pain.

Determining the maximum diameter for holes in the shoe without compromising shoe integrity when using a multi-segment foot model.

PubMed

Shultz, Rebecca; Jenkyn, Thomas

2012-01-01

Measuring individual foot joint motions requires a multi-segment foot model, even when the subject is wearing a shoe. Each foot segment must be tracked with at least three skin-mounted markers, but for these markers to be visible to an optical motion capture system holes or 'windows' must be cut into the structure of the shoe. The holes must be sufficiently large avoiding interfering with the markers, but small enough that they do not compromise the shoe's structural integrity. The objective of this study was to determine the maximum size of hole that could be cut into a running shoe upper without significantly compromising its structural integrity or changing the kinematics of the foot within the shoe. Three shoe designs were tested: (1) neutral cushioning, (2) motion control and (3) stability shoes. Holes were cut progressively larger, with four sizes tested in all. Foot joint motions were measured: (1) hindfoot with respect to midfoot in the frontal plane, (2) forefoot twist with respect to midfoot in the frontal plane, (3) the height-to-length ratio of the medial longitudinal arch and (4) the hallux angle with respect to first metatarsal in the sagittal plane. A single subject performed level walking at her preferred pace in each of the three shoes with ten repetitions for each hole size. The largest hole that did not disrupt shoe integrity was an oval of 1.7cm×2.5cm. The smallest shoe deformations were seen with the motion control shoe. The least change in foot joint motion was forefoot twist in both the neutral shoe and stability shoe for any size hole. This study demonstrates that for a hole smaller than this size, optical motion capture with a cluster-based multi-segment foot model is feasible for measure foot in shoe kinematics in vivo. Copyright © 2011. Published by Elsevier Ltd.

Foot segmental motion and coupling in stage II and III tibialis posterior tendon dysfunction.

PubMed

Van de Velde, Maarten; Matricali, Giovanni Arnoldo; Wuite, Sander; Roels, Charlotte; Staes, Filip; Deschamps, Kevin

2017-06-01

Classification systems developed in the field of posterior tibialis tendon dysfunction omit to include dynamic measurements. Since this may negatively affect the selection of the most appropriate treatment modality, studies on foot kinematics are highly recommended. Previous research characterised the foot kinematics in patients with posterior tibialis tendon dysfunction. However, none of the studies analysed foot segmental motion synchrony during stance phase, nor compared the kinematic behaviour of the foot in presence of different posterior tibialis tendon dysfunction stages. Therefore, we aimed at comparing foot segmental motion and coupling in patients with posterior tibialis tendon dysfunction grade 2 and 3 to those of asymptomatic subjects. Foot segmental motion of 11 patients suffering from posterior tibialis tendon dysfunction stage 2, 4 patients with posterior tibialis tendon dysfunction stage 3 and 15 asymptomatic subjects was objectively quantified with the Rizzoli foot model using an instrumented walkway and a 3D passive motion capture system. Dependent variables were the range of motion occurring at the different inter-segment angles during subphases of stance and swing phase as well as the cross-correlation coefficient between a number of segments. Significant differences in range of motion were predominantly found during the forefoot push off phase and swing phase. In general, both patient cohorts demonstrated a reduced range of motion compared to the control group. This hypomobility occurred predominantly in the rearfoot and midfoot (p<0.01). Significant differences between both posterior tibialis tendon dysfunction patient cohorts were not revealed. Cross-correlation coefficients highlighted a loss of joint coupling between rearfoot and tibia as well as between rearfoot and forefoot in both posterior tibialis tendon dysfunction groups. The current evidence reveals considerable mechanical alterations in the foot which should be considered in the decision making process since it may help explaining the success and failure of certain conservative and surgical interventions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Changes in lower extremity movement and power absorption during forefoot striking and barefoot running.

PubMed

Williams, D S Blaise; Green, Douglas H; Wurzinger, Brian

2012-10-01

Both forefoot strike shod (FFS) and barefoot (BF) running styles result in different mechanics when compared to rearfoot strike (RFS) shod running. Additionally, running mechanics of FFS and BF running are similar to one another. Comparing the mechanical changes occurring in each of these patterns is necessary to understand potential benefits and risks of these running styles. The authors hypothesized that FFS and BF conditions would result in increased sagittal plane joint angles at initial contact and that FFS and BF conditions would demonstrate a shift in sagittal plane joint power from the knee to the ankle when compared to the RFS condition. Finally, total lower extremity power absorption will be least in BF and greatest in the RFS shod condition. The study included 10 male and 10 female RFS runners who completed 3-dimensional running analysis in 3 conditions: shod with RFS, shod with FFS, and BF. Variables were the angles of plantarflexion, knee flexion, and hip flexion at initial contact and peak sagittal plane joint power at the hip, knee, and ankle during stance phase. Running with a FFS pattern and BF resulted in significantly greater plantarflexion and significantly less negative knee power (absorption) when compared to shod RFS condition. FFS condition runners landed in the most plantarflexion and demonstrated the most peak ankle power absorption and lowest knee power absorption between the 3 conditions. BF and FFS conditions demonstrated decreased total lower extremity power absorption compared to the shod RFS condition but did not differ from one another. BF and FFS running result in reduced total lower extremity power, hip power and knee power and a shift of power absorption from the knee to the ankle. Alterations associated with BF running patterns are present in a FFS pattern when wearing shoes. Additionally, both patterns result in increased demand at the foot and ankle as compared to the knee.

CHANGES IN LOWER EXTREMITY MOVEMENT AND POWER ABSORPTION DURING FOREFOOT STRIKING AND BAREFOOT RUNNING

PubMed Central

Green, Douglas H.; Wurzinger, Brian

2012-01-01

Purpose/Background: Both forefoot strike shod (FFS) and barefoot (BF) running styles result in different mechanics when compared to rearfoot strike (RFS) shod running. Additionally, running mechanics of FFS and BF running are similar to one another. Comparing the mechanical changes occurring in each of these patterns is necessary to understand potential benefits and risks of these running styles. The authors hypothesized that FFS and BF conditions would result in increased sagittal plane joint angles at initial contact and that FFS and BF conditions would demonstrate a shift in sagittal plane joint power from the knee to the ankle when compared to the RFS condition. Finally, total lower extremity power absorption will be least in BF and greatest in the RFS shod condition. Methods: The study included 10 male and 10 female RFS runners who completed 3‐dimensional running analysis in 3 conditions: shod with RFS, shod with FFS, and BF. Variables were the angles of plantarflexion, knee flexion, and hip flexion at initial contact and peak sagittal plane joint power at the hip, knee, and ankle during stance phase. Results: Running with a FFS pattern and BF resulted in significantly greater plantarflexion and significantly less negative knee power (absorption) when compared to shod RFS condition. FFS condition runners landed in the most plantarflexion and demonstrated the most peak ankle power absorption and lowest knee power absorption between the 3 conditions. BF and FFS conditions demonstrated decreased total lower extremity power absorption compared to the shod RFS condition but did not differ from one another. Conclusions: BF and FFS running result in reduced total lower extremity power, hip power and knee power and a shift of power absorption from the knee to the ankle. Clinical Relevance: Alterations associated with BF running patterns are present in a FFS pattern when wearing shoes. Additionally, both patterns result in increased demand at the foot and ankle as compared to the knee. PMID:23091785

Foot Kinematics Differ Between Runners With and Without a History of Navicular Stress Fractures

PubMed Central

Becker, James; James, Stanley; Osternig, Louis; Chou, Li-Shan

2018-01-01

Background: A navicular stress fracture (NSF) is a common and high-risk injury in distance runners. It is not clear whether there are differences in foot structure and function between runners who have and those who have not sustained an NSF. Purpose/Hypothesis: This study compared foot structure, range of motion, and biomechanics between runners with a history of unilateral NSFs and runners who had never sustained this injury. The hypothesis was that runners with a history of NSFs will have less dorsiflexion and subtalar range of motion in a clinical examination and greater rearfoot eversion and higher eversion velocity while running than either the noninvolved feet or healthy controls. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Seven runners who sustained an NSF were matched with 7 controls without this injury history. Participants underwent a clinical orthopaedic examination, followed by a 3-dimensional running gait analysis. Clinical examination variables, foot kinematics, and ground-reaction forces were compared between injured and noninjured feet within the NSF group and between the NSF group and control group. Results: The NSF group demonstrated less plantar flexion on the clinical examination than the control group (P = .034, effect size [ES] = 0.69). The involved feet of the NSF group demonstrated greater rearfoot eversion excursion, greater eversion velocity, and reduced forefoot abduction excursion than either the noninvolved feet of the NSF group (P = .015, ES = 1.73; P = .015, ES = 1.86; and P = .015, ES = 0.96, respectively) or the control group (P = .012, ES = 1.40; P = .016, ES = 0.49; and P = .005, ES = 1.60, respectively). Conclusion: There are differences in foot kinematics but not ground-reaction forces, foot structure, or passive range of motion between runners who have and those who have not sustained an NSF. Runners who demonstrate increased rearfoot eversion and reduced forefoot abduction during stance may be more at risk for developing NSFs. PMID:29780837

Relationships between static foot alignment and dynamic plantar loads in runners with acute and chronic stages of plantar fasciitis: a cross-sectional study

PubMed Central

Ribeiro, Ana P.; Sacco, Isabel C. N.; Dinato, Roberto C.; João, Silvia M. A.

2016-01-01

BACKGROUND: The risk factors for the development of plantar fasciitis (PF) have been associated with the medial longitudinal arch (MLA), rearfoot alignment and calcaneal overload. However, the relationships between the biomechanical variables have yet to be determined. OBJECTIVE: The goal of this study was to investigate the relationships between the MLA, rearfoot alignment, and dynamic plantar loads in runners with unilateral PF in acute and chronic phases. METHOD: Cross-sectional study which thirty-five runners with unilateral PF were evaluated: 20 in the acute phase (with pain) and 15 with previous chronic PF (without pain). The MLA index and rearfoot alignment were calculated using digital images. The contact area, maximum force, peak pressure, and force-time integral over three plantar areas were acquired with Pedar X insoles while running at 12 km/h, and the loading rates were calculated from the vertical forces. RESULTS: The multiple regression analyses indicated that both the force-time integral (R 2=0.15 for acute phase PF; R 2=0.17 for chronic PF) and maximum force (R 2=0.35 for chronic PF) over the forefoot were predicted by an elevated MLA index. The rearfoot valgus alignment predicted the maximum force over the rearfoot in both PF groups: acute (R 2=0.18) and chronic (R 2=0.45). The rearfoot valgus alignment also predicted higher loading rates in the PF groups: acute (R 2=0.19) and chronic (R 2=0.40). CONCLUSION: The MLA index and the rearfoot alignment were good predictors of plantar loads over the forefoot and rearfoot areas in runners with PF. However, rearfoot valgus was demonstrated to be an important clinical measure, since it was able to predict the maximum force and both loading rates over the rearfoot. PMID:26786073

Differences in neutral foot positions when measured barefoot compared to in shoes with varying stiffnesses.

PubMed

Shultz, R; Birmingham, T B; Jenkyn, T R

2011-12-01

This study examined the absolute differences in neutral positions of the joints of the foot with different footwear. This addresses the question of whether separate static trials should be collected for each footwear condition to establish neutral positions. A multi-segment kinematic foot model and optical motion analysis system measured four inter-segmental joints of the foot: (1) hindfoot-to-midfoot in the frontal plane, (2) forefoot-to-midfoot in the frontal plane, (3) hallux-to-forefoot in the sagittal plane, and (4) the height-to-length ratio of the medial longitudinal arch. Barefoot was compared to three shoe condition using Nike Free trainers of varying longitudinal torsional stiffness in ten male volunteers. There was high variability both within subjects and shoe conditions. Shoes in general tended to raise the medial longitudinal arch and dorsiflex the hallux compared to barefoot condition. For the hallux, a minimum important difference of 5° or more was found between shoe conditions and the barefoot condition for majority of the subjects in all three shoe conditions (90% for control, 60% for least stiff, 50% for most stiff). This was less for the frontal plane inter-segmental joints of the foot where 50% of the subjects experience a change above 5° for at least one of the conditions. The choice of using condition-specific neutral trials versus a single common neutral trials should be considered carefully. A single common trial allows for differences in absolute joint angles to be compared between footwear conditions. This can be important clinically to determine whether a joint is approaching its end-of-range and therefore at risk of injury. Several condition-specific neutral trials allows for subtleties in kinematic waveforms to be better compared between conditions, since absolute shifts in joint angles due to changing neutral position are removed and the waveforms are better aligned. Copyright © 2011. Published by Elsevier Ltd.

Six-week transition to minimalist shoes improves running economy and time-trial performance.

PubMed

Fuller, Joel T; Thewlis, Dominic; Tsiros, Margarita D; Brown, Nicholas A T; Buckley, Jonathan D

2017-12-01

This study investigated if gradually introducing runners to minimalist shoes during training improved running economy and time-trial performance compared to training in conventional shoes. Changes in stride rate, stride length, footfall pattern and ankle plantar-flexor strength were also investigated. Randomised parallel intervention trial. 61 trained runners gradually increased the amount of running performed in either minimalist (n=31) or conventional (n=30) shoes during a six-week standardised training program. 5-km time-trial performance, running economy, ankle plantar-flexor strength, footfall pattern, stride rate and length were assessed in the allocated shoes at baseline and after training. Footfall pattern was determined from the time differential between rearfoot and forefoot (TD R-F ) pressure sensors. The minimalist shoe group improved time-trial performance (effect size (ES): 0.24; 95% confidence interval (CI): 0.01, 0.48; p=0.046) and running economy (ES 0.48; 95%CI: 0.22, 0.74; p<0.001) more than the conventional shoe group. There were no minimalist shoe training effects on ankle plantar-flexor concentric (ES: 0.11; 95%CI: -0.18, 0.41; p=0.45), isometric (ES: 0.23; 95%CI: -0.17, 0.64; p=0.25), or eccentric strength (ES: 0.24; 95%CI: -0.17, 0.65; p=0.24). Minimalist shoes caused large reductions in TD R-F (ES: 1.03; 95%CI: 0.65, 1.40; p<0.001) but only two runners changed to a forefoot footfall. Minimalist shoes had no effect on stride rate (ES: 0.04; 95%CI: -0.08, 0.16; p=0.53) or length (ES: 0.06; 95%CI: -0.06, 0.18; p=0.35). Gradually introducing minimalist shoes over a six-week training block is an effective method for improving running economy and performance in trained runners. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Effect of Acute Alterations in Foot Strike Patterns during Running on Sagittal Plane Lower Limb Kinematics and Kinetics

PubMed Central

Valenzuela, Kevin A.; Lynn, Scott K.; Mikelson, Lisa R.; Noffal, Guillermo J.; Judelson, Daniel A.

2015-01-01

The purpose of this study was to determine the effect of foot strike patterns and converted foot strike patterns on lower limb kinematics and kinetics at the hip, knee, and ankle during a shod condition. Subjects were videotaped with a high speed camera while running a 5km at self-selected pace on a treadmill to determine natural foot strike pattern on day one. Preferred forefoot group (PFFG, n = 10) and preferred rear foot group (PRFG, n = 11) subjects were identified through slow motion video playback (n = 21, age = 22.8±2.2 years, mass = 73.1±14.5 kg, height 1.75 ± 0.10 m). On day two, subjects performed five overground run trials in both their natural and unnatural strike patterns while motion and force data were collected. Data were collected over two days so that foot strike videos could be analyzed for group placement purposes. Several 2 (Foot Strike Pattern –forefoot strike [FFS], rearfoot strike [RFS]) x 2 (Group – PFFG, PRFG) mixed model ANOVAs (p < 0.05) were run on speed, active peak vertical ground reaction force (VGRF), peak early stance and mid stance sagittal ankle moments, sagittal plane hip and knee moments, ankle dorsiflexion ROM, and sagittal plane hip and knee ROM. There were no significant interactions or between group differences for any of the measured variables. Within subject effects demonstrated that the RFS condition had significantly lower (VGRF) (RFS = 2.58 ± .21 BW, FFS = 2.71 ± 0.23 BW), dorsiflexion moment (RFS = -2.6 1± 0.61 Nm·kg-1, FFS = -3.09 ± 0.32 Nm·kg-1), and dorsiflexion range of motion (RFS = 17.63 ± 3.76°, FFS = 22.10 ± 5.08°). There was also a significantly higher peak plantarflexion moment (RFS = 0.23 ± 0.11 Nm·kg-1, FFS = 0.01 ± 0.01 Nm·kg-1), peak knee moment (RFS = 2.61 ± 0.54 Nm·kg-1, FFS = 2.39 ± 0.61 Nm·kg-1), knee ROM (RFS = 31.72 ± 2.79°, FFS = 29.58 ± 2.97°), and hip ROM (RFS = 42.72 ± 4.03°, FFS = 41.38 ± 3.32°) as compared with the FFS condition. This research suggests that acute changes in foot strike patterns during shod running can create alterations in certain lower limb kinematic and kinetic measures that are not dependent on the preferred foot strike pattern of the individual. This research also challenges the contention that the impact transient spike in the vertical ground reaction force curve is only present during a rear foot strike type of running gait. Key points Footstrike pattern changes should be individually considered and implemented based on individual histories/abilities Forefoot strike patterns increase external dorsiflexion moments Rearfoot strike patterns increase external knee flexion moments Recreational shod runners are able to mimic habitual mechanics of different foot strike patterns PMID:25729311

Effect of Acute Alterations in Foot Strike Patterns during Running on Sagittal Plane Lower Limb Kinematics and Kinetics.

PubMed

Valenzuela, Kevin A; Lynn, Scott K; Mikelson, Lisa R; Noffal, Guillermo J; Judelson, Daniel A

2015-03-01

The purpose of this study was to determine the effect of foot strike patterns and converted foot strike patterns on lower limb kinematics and kinetics at the hip, knee, and ankle during a shod condition. Subjects were videotaped with a high speed camera while running a 5km at self-selected pace on a treadmill to determine natural foot strike pattern on day one. Preferred forefoot group (PFFG, n = 10) and preferred rear foot group (PRFG, n = 11) subjects were identified through slow motion video playback (n = 21, age = 22.8±2.2 years, mass = 73.1±14.5 kg, height 1.75 ± 0.10 m). On day two, subjects performed five overground run trials in both their natural and unnatural strike patterns while motion and force data were collected. Data were collected over two days so that foot strike videos could be analyzed for group placement purposes. Several 2 (Foot Strike Pattern -forefoot strike [FFS], rearfoot strike [RFS]) x 2 (Group - PFFG, PRFG) mixed model ANOVAs (p < 0.05) were run on speed, active peak vertical ground reaction force (VGRF), peak early stance and mid stance sagittal ankle moments, sagittal plane hip and knee moments, ankle dorsiflexion ROM, and sagittal plane hip and knee ROM. There were no significant interactions or between group differences for any of the measured variables. Within subject effects demonstrated that the RFS condition had significantly lower (VGRF) (RFS = 2.58 ± .21 BW, FFS = 2.71 ± 0.23 BW), dorsiflexion moment (RFS = -2.6 1± 0.61 Nm·kg(-1), FFS = -3.09 ± 0.32 Nm·kg(-1)), and dorsiflexion range of motion (RFS = 17.63 ± 3.76°, FFS = 22.10 ± 5.08°). There was also a significantly higher peak plantarflexion moment (RFS = 0.23 ± 0.11 Nm·kg(-1), FFS = 0.01 ± 0.01 Nm·kg(-1)), peak knee moment (RFS = 2.61 ± 0.54 Nm·kg(-1), FFS = 2.39 ± 0.61 Nm·kg(-1)), knee ROM (RFS = 31.72 ± 2.79°, FFS = 29.58 ± 2.97°), and hip ROM (RFS = 42.72 ± 4.03°, FFS = 41.38 ± 3.32°) as compared with the FFS condition. This research suggests that acute changes in foot strike patterns during shod running can create alterations in certain lower limb kinematic and kinetic measures that are not dependent on the preferred foot strike pattern of the individual. This research also challenges the contention that the impact transient spike in the vertical ground reaction force curve is only present during a rear foot strike type of running gait. Key pointsFootstrike pattern changes should be individually considered and implemented based on individual histories/abilitiesForefoot strike patterns increase external dorsiflexion momentsRearfoot strike patterns increase external knee flexion momentsRecreational shod runners are able to mimic habitual mechanics of different foot strike patterns.

Case series of 17 modified Weil's osteotomies for Freiberg's and Köhler's II AVN, with AOFAS scoring pre- and post-operatively.

PubMed

Edmondson, M C; Sherry, K R; Afolayan, J; Armitage, A R; Skyrme, A D

2011-03-01

Treatment for metatarsal head avascular necrosis is largely conservative. For severe or refractory cases there are various surgical options. We have performed a 'modified Weil's osteotomy' of the distal metatarsal in order to manage this problem. We present the largest case series, to our knowledge, with 17 such cases. The patients were scored pre- and post-operatively using the AOFAS Forefoot scoring system. We found that this procedure provided a mean score improvement of 36 points, with a complication rate of 5.9%. We would advocate this modified osteotomy as an effective, reliable and safe treatment option. Copyright © 2009 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

The barefoot debate: can minimalist shoes reduce running-related injuries?

PubMed

Rixe, Jeffrey A; Gallo, Robert A; Silvis, Matthew L

2012-01-01

Running has evolved throughout history from a necessary form of locomotion to an athletic and recreational pursuit. During this transition, our barefoot ancestors developed footwear. By the late 1970s, running popularity surged, and footwear manufacturers developed the running shoe. Despite new shoe technology and expert advice, runners still face high injury rates, which have yet to decline. Recently, "minimalist" running, marked by a soft forefoot strike and shorter, quicker strides, has become increasingly popular within the running community. Biomechanical studies have suggested that these features of barefoot-style running may lead to a reduction in injury rates. After conducting more outcomes-based research, minimalist footwear and gait retraining may serve as new methods to reduce injuries within the running population.

Severity of spine malalignment on center of pressure progression during level walking in subjects with adolescent idiopathic scoliosis.

PubMed

Chern, Jen-Suh; Kao, Chia-Chi; Lai, Po-Lian; Lung, Chi-Wen; Chen, Wen-Jer

2014-01-01

Center of pressure (CoP) progression during level walking in subjects with Adolescents Idiopathic Scoliosis (AIS) was measured. Participants were divided into three groups according to scoliosis severity. CoP progression among groups was compared quantitatively and qualitatively. The results showed that scoliosis severity affects CoP progression significantly in the hind-foot and forefoot areas. This result indicated that spine alignment might affect the control of heel, ankle and toe rockers in the ankle-foot complex. The effects of scoliosis severity is mainly on the CoP of right foot plantar surface, indicating asymmetrical influence of IS on bilateral lower limb coordination during walking. These results might contribute to musculoskeletal complains over the apparatus within trunk-foot in the later lives of this population.

[Lateral column lengthening osteotomy of calcaneus].

PubMed

Hintermann, B

2015-08-01

Lengthening of the lateral column for adduction of forefoot and restoration of the medial arch. Stabilization of the ankle joint complex. Supple flatfoot deformity (posterior tibial tendon dysfunction stage II). Instability of the medial ankle joint complex (superficial deltoid and spring ligament). Posttraumatic valgus and pronation deformity of the foot. Rigid flatfoot deformity (posterior tibial tendon dysfunction stage III and IV). Talocalcaneal and naviculocalcaneal coalition. Osteoarthritis of calcaneocuboid joint. Exposition of calcaneus at sinus tarsi. Osteotomy through sinus tarsi and widening until desired correction of the foot is achieved. Insertion of bone graft. Screw fixation. Immobilization in a cast for 6 weeks. Weight-bearing as tolerated from the beginning. In the majority of cases, part of hindfoot reconstruction. Reliable and stable correction. Safe procedure with few complications.

Effect of Achilles tendon loading on plantar fascia tension in the standing foot.

PubMed

Cheung, Jason Tak-Man; Zhang, Ming; An, Kai-Nan

2006-02-01

The plantar fascia, which is one of the major arch-supporting structures of the human foot, sustains high tensions during weight-bearing. A positive correlation between Achilles tendon loading and plantar fascia tension has been reported. Excessive stretching and tightness of the Achilles tendon are thought to be the risk factors of plantar fasciitis but their biomechanical effects on the plantar fascia have not been fully addressed. A three-dimensional finite element model of the human foot and ankle, incorporating geometrical and material nonlinearity, was employed to investigate the loading response of the plantar fascia in the standing foot with different magnitudes of Achilles tendon loading. With the total ground reaction forces of one foot maintained at 350 N to represent half body weight, an increase in Achilles tendon load from (0-700 N) resulted in a general increase in total force and peak plantar pressure at the forefoot of up to about 250%. There was a lateral and anterior shift of the centre of pressure and a reduction in the arch height with an increasing Achilles tendon load as a result of the plantar flexion moment on the calcaneus. From the finite element predictions of simulated balanced standing, Achilles tendon forces of 75% of the total weight on the foot (350 N) were found to provide the closest match of the measured centre of pressure of the subject during balanced standing. Both the weight on the foot and Achilles tendon loading resulted in an increase in tension of the plantar fascia with the latter showing a two-times larger straining effect. Increasing tension on the Achilles tendon is coupled with an increasing strain on the plantar fascia. Overstretching of the Achilles tendon resulting from intense muscle contraction and passive stretching of tight Achilles tendon are plausible mechanical factors for overstraining of the plantar fascia.

[Reconstruction of ankle and foot with combination of free perforator flaps and skin graft].

PubMed

Yin, Lu; Gong, Ketong; Yin, Zhonggang; Zhang, Bo; Xu, Jianhua

2017-03-01

To evaluate the clinical outcomes of free perforator flaps combined with skin graft for reconstruction of ankle and foot soft tissue defects. Between June 2014 and October 2015, 20 cases of ankle and foot soft tissue defects were treated. There were 16 males and 4 females, aged from 19 to 61 years (mean, 43.3 years). Injury was caused by traffic accident in 7 cases, by crashing in 9 cases, and machine twist in 4 cases. The locations were the ankle in 6 cases, the heel in 3 cases, the dorsum pedis in 4 cases, and the plantar forefoot in 7 cases of avulsion injury after toes amputation. The size of wound ranged from 15 cm×10 cm to 27 cm×18 cm. The time from injury to treatment was from 11 to 52 days (mean, 27 days). The anterolateral thigh perforator flap was used in 11 cases, thoracodorsal antery perforator flap in 3 cases, medial sural artery perforator flap in 4 cases, deep inferior epigastric perforator flap in 1 case, and anteromedial thigh perforator flap in 1 case, including 5 chimeric perforator flaps, 5 polyfoliate perforator flaps, 3 flow-through perforator flaps, and 3 conjoined perforator flaps. The size of the perforator flap ranged from 10.0 cm×6.5 cm to 36.0 cm×8.0 cm, the size of skin graft from 5 cm×3 cm to 18 cm×12 cm. Venous crisis occurred in 2 flaps which survived after symptomatic treatment; 18 flaps survived successfully and skin grafting healed well. The follow-up time ranged 4-18 months (mean, 8.3 months). The flaps had good appearance, texture and color, without infection. The patients could walk normally and do daily activities. Only linear scars were observed at the donor sites. Free perforator flap can be used to reconstruct defects in the ankle and foot, especially in the weight-bearing area of the plantar forefoot. A combination of free perforator flap and skin graft is ideal in reconstruction of great soft tissue defects in the ankle and foot.

Effect of step-synchronized vibration stimulation of soles on gait in Parkinson's disease: a pilot study.

PubMed

Novak, Peter; Novak, Vera

2006-05-04

Previous studies have suggested that impaired proprioceptive processing in the striatum may contribute to abnormal gait in Parkinson's disease (PD). This pilot study assessed the effects of enhanced proprioceptive feedback using step-synchronized vibration stimulation of the soles (S-VS) on gait in PD. S-VS was used in 8 PD subjects (3 women and 5 men, age range 44-79 years, on medication) and 8 age-matched healthy subjects (5 women and 3 men). PD subjects had mild or moderate gait impairment associated with abnormal balance, but they did not have gait freezing. Three vibratory devices (VDs) were embedded in elastic insoles (one below the heel and two below the forefoot areas) inserted into the shoes. Each VD operates independently and has a pressure switch that activates the underlying vibratory actuator. The VD delivered the 70-Hz suprathreshold vibration pulse upon touch by the heel or forefoot, and the vibration pulse was deactivated upon respective push-offs. Six-minute hallway walking was studied with and without S-VS. Gait characteristics were measured using the force-sensitive foot switches. The primary outcome was the stride variability expressed as a coefficient of variation (CV), a measure of gait steadiness. Secondary outcome measures were walking distance and speed, stride length and duration, cadence, stance, swing and double support duration, and respective CVs (if applicable). The walking speed (p < 0.04) and the CV of the stride interval (p < 0.02) differed between the groups and S-VS conditions. In the PD group, S-VS decreased stride variability (p < 0.002), increased walking speed (p < 0.0001), stride duration (p < 0.01), stride length (p < 0.0002), and cadence (p < 0.03). In the control group, S-VS decreased stride variability (p < 0.006) and increased gait speed (p < 0.03), but other locomotion parameters were not significantly altered. Augmented sensory feedback improves parkinsonian gait steadiness in the short-term setting. Because the suprathreshold stimulation prevented blinding of subjects, the learning effect and increased attention can be a confounding factor underlying results. Long-term studies are needed to establish the clinical value of the S-VS.

The Effectiveness of a 6-Week Intervention Program Aimed at Modifying Running Style in Patients With Chronic Exertional Compartment Syndrome: Results From a Series of Case Studies.

PubMed

Helmhout, Pieter H; Diebal, Angela R; van der Kaaden, Lisanne; Harts, Chris C; Beutler, Anthony; Zimmermann, Wes O

2015-03-01

Previous studies have reported on the promising effects of changing running style in patients with chronic exertional compartment syndrome (CECS) using a 6-week training program aimed at adopting a forefoot strike technique. This study expands that work by comparing a 6-week in-house, center-based run training program with a less extensive, supervised, home-based run training program (50% home training). An alteration in running technique will lead to improvements in CECS complaints and running performance, with the less supervised program producing less dramatic results. Cohort study; Level of evidence, 3. Nineteen patients with CECS were prospectively enrolled. Postrunning intracompartmental pressure (ICP), run performance, and self-reported questionnaires were taken for all patients at baseline and after 6 weeks of running intervention. Questionnaires were also taken from 14 patients (7 center-based, 6 home-based) 4 months posttreatment. Significant improvement between preintervention and postintervention rates was found for running distance (43%), ICP values (36%), and scores on the questionnaires Single Assessment Numeric Evaluation (SANE; 36%), Lower Leg Outcome Survey (LLOS; 18%), and Patient Specific Complaints (PSC; 60%). The mean posttreatment score on the Global Rating of Change (GROC) was between +4 and +5 ("somewhat better" to "moderately better"). In 14 participants (74%), no elevation of pain was reported posttreatment, compared with 3 participants (16%) at baseline; in all these cases, the running test was aborted because of a lack of cardiorespiratory fitness. Self-reported scores continued to improve 4 months after the end of the intervention program, with mean improvement rates of 48% (SANE), 26% (LLOS), and 81% (PSC). The mean GROC score improved to +6 points ("a great deal better"). In 19 patients diagnosed with CECS, a 6-week forefoot running intervention performed in both a center-based and home-based training setting led to decreased postrunning lower leg ICP values, improved running performances, and self-assessed leg condition. The influence of training group was not statistically significant. Overall, this is a promising finding, taking into consideration the significantly reduced investments in time and resources needed for the home-based program.

Plantar pressure relief under the metatarsal heads: therapeutic insole design using three-dimensional finite element model of the foot.

PubMed

Chen, Wen-Ming; Lee, Sung-Jae; Lee, Peter Vee Sin

2015-02-26

Therapeutic footwear with specially-made insoles is often used in people with diabetes and rheumatoid arthritis to relieve ulcer risks and pain due to high pressures from areas beneath bony prominences of the foot, in particular to the metatarsal heads (MTHs). In a three-dimensional finite element study of the foot and footwear with sensitivity analysis, effects of geometrical variations of a therapeutic insole, in terms of insole thicknesses and metatarsal pad (MP) placements, on local peak plantar pressure under MTHs and stress/strain states within various forefoot tissues, were determined. A validated musculoskeletal finite element model of the human foot was employed. Analyses were performed in a simulated muscle-demanding instant in gait. For many design combinations, increasing insole thicknesses consistently reduce peak pressures and internal tissue strain under MTHs, but the effects reach a plateau when insole becomes very thick (e.g., a value of 12.7mm or greater). Altering MP placements, however, showed a proximally- and a distally-placed MP could result in reverse effects on MTH pressure-relief. The unsuccessful outcome due to a distally-placed MP may attribute to the way it interacts with plantar tissue (e.g., plantar fascia) adjacent to the MTH. A uniform pattern of tissue compression under metatarsal shaft is necessary for a most favorable pressure-relief under MTHs. The designated functions of an insole design can best be achieved when the insole is very thick, and when the MP can achieve a uniform tissue compression pattern adjacent to the MTH. Copyright © 2015 Elsevier Ltd. All rights reserved.

An Approach to Transmetatarsal Amputation to Encourage Immediate Weightbearing in Diabetic Patients.

PubMed

Canales, Michael B; Heurich, Maureen E; Mandela, Ashley M; Razzante, Mark C

Transmetatarsal amputation remains the standard treatment for the unsalvageable diabetic forefoot; however, this operation is often complicated by wound dehiscence, ulceration, and the need for additional surgery and tendon balancing. The technique described in the present report provides an uncomplicated suturing method for closure of a standard transmetatarsal amputation. A drill hole is created through the first, second, and fourth metatarsals, which facilitates added stability to the plantar flap of the residual metatarsals. The patients are encouraged to begin protected weightbearing as early as the first postoperative day. The security of the flap promotes immediate weightbearing, which could result in fewer postoperative complications of transmetatarsal amputations. Early weightbearing will not only encourage tendon rebalancing, but also could improve angiogenesis through capillary ingrowth. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Serial casting for neuromuscular flatfoot and vertical talus in an adolescent with hereditary spastic paraplegia.

PubMed

Sweet, Laurene A; OʼNeill, Lindsey M; Dobbs, Matthew B

2014-01-01

The purpose of this report is to explore assessment and serial casting intervention for painful rigid flatfoot deformities with vertical talus in an adolescent girl with hereditary spastic paraplegia who was nonambulatory. The participant's right foot underwent 2 phases of casting with correction first toward hindfoot inversion and then dorsiflexion. Because of a vertical talus, her left foot required an intermediate casting toward plantar flexion, inversion, and forefoot adduction prior to casting toward dorsiflexion. The patient improved despite the underlying progressive neuromuscular disorder. Pain ameliorated and she returned to supported standing and transfers. Spasticity decreased bilaterally and the flexibility of her foot deformities improved to allow orthotic fabrication in subtalar neutral. Results were maintained at 12 and 16 months. Individualized multiphase serial casting requires further investigation with patients such as those with hereditary spastic paraplegia.

Foot care for the aging.

PubMed

Edelstein, J E

1988-12-01

Age-related changes in the feet include alterations in the skin, which becomes dry, inelastic, and cool and often exhibits hyperkeratoses. Thickened and brittle toenails complicate pedicure. The contour of the foot widens with age and may have increased forefoot height in the presence of toe deformities. Sensory acuity diminishes, as does joint mobility, muscle-force production, and ability to withstand stress. The elderly person's gait is slower and less forceful, with shorter strides. Visual loss affects footwear donning and toenail trimming. Older individuals on a limited income are less likely to have appropriate shoes and hose. Preventive care begins with good hygiene and continues with selection of suitable hosiery and shoes. Conservative management of the podiatric conditions most often seen in geriatric patients (eg, metatarsalgia and hallux valgus) should be based on relating the pathomechanics of the disorder to the options available in shoe selection, modification, and insert design.

Diagnostic considerations of lateral column foot pain in athletes.

PubMed

Traister, Eric; Simons, Stephen

2014-01-01

Foot maladies are often classified descriptively by general foot locations, i.e., forefoot, midfoot, and rearfoot. However, common vernacular verbiage, implicating a common biomechanical purpose, also applies pathology to the medial or lateral foot column. Although imprecisely defined, lateral column injuries to the foot encompass conditions that affect any of the lateral side of the foot from the calcaneus to the toes. The lateral column of the foot includes the calcaneus, the cuboid, the fourth and fifth metatarsals as well as the calcaneocuboid, cuboido-metatarsal, and intermetatarsal joints. It may be helpful to think in a "lateral column" fashion when evaluating and treating certain lateral foot injuries, load patterns, and biomechanical or anatomical faults. Misdiagnosed injuries in this area of the foot can be a source of great morbidity to the athlete. It is important for the clinician to be aware of common conditions presenting as pain to the lateral side of the foot.

Clinical and radiological assessment of a family with mild brachydactyly type A1: the usefulness of metacarpophalangeal profiles.

PubMed

Armour, C M; Bulman, D E; Hunter, A G

2000-04-01

The brachydactylies are a group of conditions in which various subtypes have been defined based upon the specific pattern of digital bones involved. Type A1 brachydactyly is principally characterised by maximal involvement of the middle phalanges. We report an extended family with a mild brachydactyly A1 which was, except for some short stature, not associated with any of the additional clinical findings reported in several published families. While all the hand bones tended to be small, the principal features of the affected members were shortened middle and distal phalanges, proximal 1st phalanges, and 5th metacarpals. The feet were similarly involved and tended to have a broad, slightly adducted forefoot. The two affected children showed multiple coned epiphyses. This paper provides a detailed description of the family including the radiographic signs and metacarpophalangeal profiles, which proved to be useful in distinguishing the mildly affected persons.

Idiopathic toe walking.

PubMed

Oetgen, Matthew E; Peden, Sean

2012-05-01

Toe walking is a bilateral gait abnormality in which a normal heel strike is absent and most weight bearing occurs through the forefoot. This abnormality may not be pathologic in patients aged <2 years, but it is a common reason for referral to an orthopaedic surgeon. Toe walking can be caused by several neurologic and developmental abnormalities and may be the first sign of a global developmental problem. Cases that lack a definitive etiology are categorized as idiopathic. A detailed history, with careful documentation of the developmental history, and a thorough physical examination are required in the child with a primary report of toe walking. Treatment is based on age and the severity of the abnormality. Management includes observation, stretching, casting, bracing, chemodenervation, and surgical lengthening of the gastrocnemius-soleus complex and/or Achilles tendon. An understanding of idiopathic toe walking as well as treatment options and their outcomes can help the physician individualize treatment to achieve optimal results.

Effect of revised high-heeled shoes on foot pressure and static balance during standing.

PubMed

Bae, Young-Hyeon; Ko, Mansoo; Park, Young-Soul; Lee, Suk-Min

2015-04-01

[Purpose] The purpose of this study was to investigate the effects of revised high-heeled shoes on the foot pressure ratio and static balance during standing. [Subjects and Methods] A single-subject design was used, 15 healthy women wearing revised high-heeled shoes and general high-heeled shoes in a random order. The foot pressure ratio and static balance scores during standing were measured using a SpaceBalance 3D system. [Results] Forefoot and rearfoot pressures were significantly different between the 2 types of high-heeled shoes. Under the 3 conditions tested, the static balance score was higher for the revised high-heeled shoes than for the general high-heeled shoes, but this difference was not statistically significant. [Conclusion] Revised high-heeled shoes are preferable to general high-heeled shoes, as they result in normalization of normalized foot pressure and a positive effect on static balance.

Does foot pitch at ground contact affect parachute landing technique?

PubMed

Whitting, John W; Steele, Julie R; Jaffrey, Mark; Munro, Bridget J

2009-08-01

The Australian Defence Force Parachute Training School instructs trainees to make initial ground contact using a flat foot whereas United States paratroopers are taught to contact the ground with the ball of the foot first. This study aimed to determine whether differences in foot pitch affected parachute landing technique. Kinematic, ground reaction force and electromyographic data were analyzed for 28 parachutists who performed parachute landings (vertical descent velocity = 3.4 m x s(-1)) from a monorail apparatus. Independent t-tests were used to determine significant (p < 0.05) differences between variables characterizing foot pitch. Subjects who landed flat-footed displayed less knee and ankle flexion, sustained higher peak ground reaction forces, and took less time to reach peak force than those who landed on the balls of their feet. Although forefoot landings lowered ground reaction forces compared to landing flat-footed, further research is required to confirm whether this is a safer parachute landing strategy.

Compact and portable digitally controlled device for testing footwear materials: technical note.

PubMed

Foto, James G

2008-01-01

Little or no practical decision-making data are available to the foot-care provider regarding the selection of orthotic materials used in therapeutic footwear. A device for simulating in-shoe forefoot conditions for the testing of orthosis materials is described. Materials are tested for their effectiveness by evaluating and comparing stress-strain and dynamic compression fatigue characteristics. The device, called the Cyclical Compression Tester (CCT), has been optimized for size, simplicity of construction, and cost. Application of the device ranges from the clinician deciding the useful life of single- and multidensity orthosis materials to the researcher characterizing materials for finite-element analysis modeling. This real-time CCT device and custom user interface combine to make an evaluation tool useful for testing how the pressure distribution of in-shoe materials changes over time in therapeutic footwear for those with peripheral neuropathy at risk for foot injury.

Effect of revised high-heeled shoes on foot pressure and static balance during standing

PubMed Central

Bae, Young-Hyeon; Ko, Mansoo; Park, Young-Soul; Lee, Suk-Min

2015-01-01

[Purpose] The purpose of this study was to investigate the effects of revised high-heeled shoes on the foot pressure ratio and static balance during standing. [Subjects and Methods] A single-subject design was used, 15 healthy women wearing revised high-heeled shoes and general high-heeled shoes in a random order. The foot pressure ratio and static balance scores during standing were measured using a SpaceBalance 3D system. [Results] Forefoot and rearfoot pressures were significantly different between the 2 types of high-heeled shoes. Under the 3 conditions tested, the static balance score was higher for the revised high-heeled shoes than for the general high-heeled shoes, but this difference was not statistically significant. [Conclusion] Revised high-heeled shoes are preferable to general high-heeled shoes, as they result in normalization of normalized foot pressure and a positive effect on static balance. PMID:25995572

Assessing the long-term outcomes of minor lower limb amputations: a 5-year study.

PubMed

Uzzaman, Mohammed Mohsin; Jukaku, Saud; Kambal, Amir; Hussain, Syed Tahir

2011-07-01

Our aim was to assess the long-term outcome for minor forefoot amputations. A retrospective study of 126 patients who had such amputations between 1999 and 2004 was performed. Patients were divided into 2 groups, diabetic (group A: 79 patients) and nondiabetic (group B: 47 patients). Angiograms were requested in 45 patients in group A compared with 31 patients in group B (P = ·77). In group A, 11 patients underwent further ipsilateral amputations compared with 30 patients in group B (P = ·02.). The 2 groups were equally likely to have vascular reconstruction (35% vs 37%). The overall 5-year mortality was 27%, with 58% of deaths occurring within the first year. This study shows that foot amputees have high mortality and reintervention rates. Adequate utilization of vascular services, extra vigilance in the prevention of complications, and risk factor modifications are required to improve postoperative outcomes.

Orthopaedic Perspective on Barefoot and Minimalist Running.

PubMed

Roth, Jonathan; Neumann, Julie; Tao, Matthew

2016-03-01

In recent years, there has been a movement toward barefoot and minimalist running. Advocates assert that a lack of cushion and support promotes a forefoot or midfoot strike rather than a rearfoot strike, decreasing the impact transient and stress on the hip and knee. Although the change in gait is theorized to decrease injury risk, this concept has not yet been fully elucidated. However, research has shown diminished symptoms of chronic exertional compartment syndrome and anterior knee pain after a transition to minimalist running. Skeptics are concerned that, because of the effects of the natural environment and the lack of a standardized transition program, barefoot running could lead to additional, unforeseen injuries. Studies have shown that, with the transition to minimalist running, there is increased stress on the foot and ankle and risk of repetitive stress injuries. Nonetheless, despite the large gap of evidence-based knowledge on minimalist running, the potential benefits warrant further research and consideration.

Posterior approach for arthroscopic treatment of posterolateral impingement syndrome of the ankle in a top-level field hockey player.

PubMed

Lohrer, Heinz; Arentz, Sabine

2004-04-01

A case history of a 25-year-old field hockey player, a member of the German National Field Hockey Team, is presented. The patient could not remember any specific ankle injury, but since the World Indoor Championship in February 2003, he experienced significant but diffuse pain around the posterior ankle, especially while loading the forefoot in hockey training and competition. For 2 months, the patient was unable to run. Conservative treatment failed, and surgery was performed. Posterior ankle arthroscopy revealed a frayed posterior intermalleolar ligament and meniscoid-like scar tissue at the posterolateral ankle, indicating a posterolateral soft tissue ankle impingement syndrome. A concomitant inflammation of the posterolateral ankle and subtalar synovium was present. After arthroscopic resection and early functional aftertreatment, the patient returned to full high-level sports ability within 2 months.

The Influence of Footwear on the Modular Organization of Running.

PubMed

Santuz, Alessandro; Ekizos, Antonis; Janshen, Lars; Baltzopoulos, Vasilios; Arampatzis, Adamantios

2017-01-01

For most of our history, we predominantly ran barefoot or in minimalist shoes. The advent of modern footwear, however, might have introduced alterations in the motor control of running. The present study investigated shod and barefoot running under the perspective of the modular organization of muscle activation, in order to help addressing the neurophysiological factors underlying human locomotion. On a treadmill, 20 young and healthy inexperienced barefoot runners ran shod and barefoot at preferred speed (2.8 ± 0.4 m/s). Fundamental synergies, containing the time-dependent activation coefficients (motor primitives) and the time-invariant muscle weightings (motor modules), were extracted from 24 ipsilateral electromyographic activities using non-negative matrix factorization. In shod running, the average foot strike pattern was a rearfoot strike, while in barefoot running it was a mid-forefoot strike. In both conditions, five fundamental synergies were enough to describe as many gait cycle phases: weight acceptance, propulsion, arm swing, early swing and late swing. We found the motor primitives to be generally shifted earlier in time during the stance-related phases and later in the swing-related ones in barefoot running. The motor primitive describing the propulsion phase was significantly of shorter duration (peculiarity confirmed by the analysis of the spinal motor output). The arm swing primitive, instead, was significantly wider in the barefoot condition. The motor modules demonstrated analogous organization with some significant differences in the propulsion, arm swing and late swing synergies. Other than to the trivial absence of shoes, the differences might be deputed to the lower ankle gear ratio (and the consequent increased system instability) and to the higher recoil capabilities of the longitudinal foot arch during barefoot compared to shod running.

The Influence of Footwear on the Modular Organization of Running

PubMed Central

Santuz, Alessandro; Ekizos, Antonis; Janshen, Lars; Baltzopoulos, Vasilios; Arampatzis, Adamantios

2017-01-01

For most of our history, we predominantly ran barefoot or in minimalist shoes. The advent of modern footwear, however, might have introduced alterations in the motor control of running. The present study investigated shod and barefoot running under the perspective of the modular organization of muscle activation, in order to help addressing the neurophysiological factors underlying human locomotion. On a treadmill, 20 young and healthy inexperienced barefoot runners ran shod and barefoot at preferred speed (2.8 ± 0.4 m/s). Fundamental synergies, containing the time-dependent activation coefficients (motor primitives) and the time-invariant muscle weightings (motor modules), were extracted from 24 ipsilateral electromyographic activities using non-negative matrix factorization. In shod running, the average foot strike pattern was a rearfoot strike, while in barefoot running it was a mid-forefoot strike. In both conditions, five fundamental synergies were enough to describe as many gait cycle phases: weight acceptance, propulsion, arm swing, early swing and late swing. We found the motor primitives to be generally shifted earlier in time during the stance-related phases and later in the swing-related ones in barefoot running. The motor primitive describing the propulsion phase was significantly of shorter duration (peculiarity confirmed by the analysis of the spinal motor output). The arm swing primitive, instead, was significantly wider in the barefoot condition. The motor modules demonstrated analogous organization with some significant differences in the propulsion, arm swing and late swing synergies. Other than to the trivial absence of shoes, the differences might be deputed to the lower ankle gear ratio (and the consequent increased system instability) and to the higher recoil capabilities of the longitudinal foot arch during barefoot compared to shod running. PMID:29213246

Effect of step-synchronized vibration stimulation of soles on gait in Parkinson's disease: a pilot study

PubMed Central

Novak, Peter; Novak, Vera

2006-01-01

Background Previous studies have suggested that impaired proprioceptive processing in the striatum may contribute to abnormal gait in Parkinson's disease (PD). Methods This pilot study assessed the effects of enhanced proprioceptive feedback using step-synchronized vibration stimulation of the soles (S-VS) on gait in PD. S-VS was used in 8 PD subjects (3 women and 5 men, age range 44–79 years, on medication) and 8 age-matched healthy subjects (5 women and 3 men). PD subjects had mild or moderate gait impairment associated with abnormal balance, but they did not have gait freezing. Three vibratory devices (VDs) were embedded in elastic insoles (one below the heel and two below the forefoot areas) inserted into the shoes. Each VD operates independently and has a pressure switch that activates the underlying vibratory actuator. The VD delivered the 70-Hz suprathreshold vibration pulse upon touch by the heel or forefoot, and the vibration pulse was deactivated upon respective push-offs. Six-minute hallway walking was studied with and without S-VS. Gait characteristics were measured using the force-sensitive foot switches. The primary outcome was the stride variability expressed as a coefficient of variation (CV), a measure of gait steadiness. Secondary outcome measures were walking distance and speed, stride length and duration, cadence, stance, swing and double support duration, and respective CVs (if applicable). Results The walking speed (p < 0.04) and the CV of the stride interval (p < 0.02) differed between the groups and S-VS conditions. In the PD group, S-VS decreased stride variability (p < 0.002), increased walking speed (p < 0.0001), stride duration (p < 0.01), stride length (p < 0.0002), and cadence (p < 0.03). In the control group, S-VS decreased stride variability (p < 0.006) and increased gait speed (p < 0.03), but other locomotion parameters were not significantly altered. Conclusion Augmented sensory feedback improves parkinsonian gait steadiness in the short-term setting. Because the suprathreshold stimulation prevented blinding of subjects, the learning effect and increased attention can be a confounding factor underlying results. Long-term studies are needed to establish the clinical value of the S-VS. PMID:16674823

Comparison of the effects of forefoot joint-preserving arthroplasty and resection-replacement arthroplasty on walking plantar pressure distribution and patient-based outcomes in patients with rheumatoid arthritis.

PubMed

Ebina, Kosuke; Hirao, Makoto; Takagi, Keishi; Ueno, Sachi; Morimoto, Tokimitsu; Matsuoka, Hozo; Kitaguchi, Kazuma; Iwahashi, Toru; Hashimoto, Jun; Yoshikawa, Hideki

2017-01-01

The purpose of this retrospective study is to clarify the difference in plantar pressure distribution during walking and related patient-based outcomes between forefoot joint-preserving arthroplasty and resection-replacement arthroplasty in patients with rheumatoid arthritis (RA). Four groups of patients were recruited. Group1 included 22 feet of 11 healthy controls (age 48.6 years), Group2 included 36 feet of 28 RA patients with deformed non-operated feet (age 64.8 years, Disease activity score assessing 28 joints with CRP [DAS28-CRP] 2.3), Group3 included 27 feet of 20 RA patients with metatarsal head resection-replacement arthroplasty (age 60.7 years, post-operative duration 5.6 years, DAS28-CRP 2.4), and Group4 included 34 feet of 29 RA patients with metatarsophalangeal (MTP) joint-preserving arthroplasty (age 64.6 years, post-operative duration 3.2 years, DAS28-CRP 2.3). Patients were cross-sectionally examined by F-SCAN II to evaluate walking plantar pressure, and the self-administered foot evaluation questionnaire (SAFE-Q). Twenty joint-preserving arthroplasty feet were longitudinally examined at both pre- and post-operation. In the 1st MTP joint, Group4 showed higher pressure distribution (13.7%) than Group2 (8.0%) and Group3 (6.7%) (P<0.001). In the 2nd-3rd MTP joint, Group4 showed lower pressure distribution (9.0%) than Group2 (14.5%) (P<0.001) and Group3 (11.5%) (P<0.05). On longitudinal analysis, Group4 showed increased 1st MTP joint pressure (8.5% vs. 14.7%; P<0.001) and decreased 2nd-3rd MTP joint pressure (15.2% vs. 10.7%; P<0.01) distribution. In the SAFE-Q subscale scores, Group4 showed higher scores than Group3 in pain and pain-related scores (84.1 vs. 71.7; P<0.01) and in shoe-related scores (62.5 vs. 43.1; P<0.01). Joint-preserving arthroplasty resulted in higher 1st MTP joint and lower 2nd-3rd MTP joint pressures than resection-replacement arthroplasty, which were associated with better patient-based outcomes.

An Elaborate Data Set Characterizing the Mechanical Response of the Foot

PubMed Central

Erdemir, Ahmet; Sirimamilla, Pavana A.; Halloran, Jason P.; van den Bogert, Antonie J.

2010-01-01

Background Mechanical properties of the foot are responsible for its normal function and play a role in various clinical problems. Specifically, we are interested in quantification of foot mechanical properties to assist the development of computational models for movement analysis and detailed simulations of tissue deformation. Current available data are specific to a foot region and the loading scenarios are limited to a single direction. A data set that incorporates regional response, to quantify individual function of foot components, as well as overall response, to illustrate their combined operation, does not exist. Furthermore, combined three-dimensional loading scenarios while measuring the complete three-dimensional deformation response are lacking. When combined with an anatomical image data set, development of anatomically realistic and mechanically validated models becomes possible. Therefore, the goal of this study was to record and disseminate the mechanical response of a foot specimen, supported by imaging data. Method of Approach Robotic testing was conducted at the rear foot, forefoot, metatarsal heads, and the foot as a whole. Complex foot deformations were induced by single mode loading, e.g. compression, and combined loading, e.g. compression and shear. Small and large indenters were used for heel and metatarsal head loading; an elevated platform was utilized to isolate the rear foot and forefoot; and a full platform compressed the whole foot. Three-dimensional tool movements and reaction loads were recorded simultaneously. Computed tomography scans of the same specimen were collected for anatomical reconstruction a-priori. Results Three-dimensional mechanical response of the specimen was nonlinear and viscoelastic. A low stiffness region was observed starting with contact between the tool and foot regions, increasing with loading. Loading and unloading response portrayed hysteresis. Loading range ensured capturing the toe and linear regions of the load deformation curves for the dominant loading direction, with the rates approximating those of walking. Conclusion A large data set was successfully obtained to characterize the overall as well as regional mechanical response of an intact foot specimen under single and combined loads. Medical imaging complemented the mechanical testing data to establish the potential relationship between the anatomical architecture and mechanical response, and for further development of foot models that are mechanically realistic and anatomically consistent. This combined data set has been documented and disseminated in the public domain to promote future development in foot biomechanics. PMID:19725699

Evaluation of an Innovative Fixation System for Chevron Bunionectomy.

PubMed

Bennett, Gordon L; Sabetta, James A

2016-02-01

Distal chevron metatarsal osteotomy bunionectomy is a commonly performed procedure for the treatment of mild to moderate hallux valgus deformity. There are several different methods to stabilize this osteotomy. We evaluated a new intramedullary plate system. We prospectively evaluated 57 consecutive patients who underwent distal chevron metatarsal osteotomy bunionectomy utilizing the intramedullary plate system. All operative procedures were performed by the senior author. Patients were evaluated preoperatively, postoperatively, and at a final follow-up utilizing the American Orthopaedic Foot & Ankle Society (AOFAS) forefoot scoring system. Sixty-three surgically corrected feet went on to heal the osteotomy site. There were no hardware failures. We had one patient that expressed mild discomfort over the plate. All patients significantly improved their AOFAS scores compared with preoperative values. We concluded that the distal chevron metatarsal osteotomy bunionectomy resulted in excellent function and pain relief. The new plate system was a reliable and stable implant with a low profile, good strength, and ease of use. Level IV, retrospective case series. © The Author(s) 2015.

Effects of surface characteristics on the plantar shape of feet and subjects' perceived sensations.

PubMed

Witana, Channa P; Goonetilleke, Ravindra S; Xiong, Shuping; Au, Emily Y L

2009-03-01

Orthotics and other types of shoe inserts are primarily designed to reduce injury and improve comfort. The interaction between the plantar surface of the foot and the load-bearing surface contributes to foot and surface deformations and hence to perceived comfort, discomfort or pain. The plantar shapes of 16 participants' feet were captured when standing on three support surfaces that had different cushioning properties in the mid-foot region. Foot shape deformations were quantified using 3D laser scans. A questionnaire was used to evaluate the participant's perceptions of perceived shape and perceived feeling. The results showed that the structure in the mid-foot could change shape, independent of the rear-foot and forefoot regions. Participants were capable of identifying the shape changes with distinct preferences towards certain shapes. The cushioning properties of the mid-foot materials also have a direct influence on perceived feelings. This research has strong implications for the design and material selection of orthotics, insoles and footwear.

Foot Loading Characteristics of Chinese Bound Feet Women: A Comparative Analysis

PubMed Central

Gu, Yaodong; Mei, Qichang; Fernandez, Justin; Li, Jianshe; Ren, Xuejun; Feng, Neng

2015-01-01

The custom of bound feet among Chinese women has existed for almost a century. This practice has influenced the daily life of Chinese women, especially during everyday locomotion. The primary aim of this study is to analyze the loading patterns of bound feet. Specifically, the plantar pressure and center of pressure were analyzed for peak pressure, contact area, force time integral, center of pressure displacement velocity and trajectory in the anterior-posterior direction via a comparison with normal feet. The key outcomes from this work were that the forefoot and rearfoot of bound feet bear the whole loading during stance phase. The center of pressure displacement velocity of bound feet was also greatly reduced with the shortening of trajectories. This suggests that the proprioceptive system adjusts motor function to adapt to new loading patterns while maintaining locomotive stability. A biomechanical understanding of bound feet may assist with prevention, treatment and rehabilitation of bound feet disorders. PMID:25884982

Foot deformation during walking: differences between static and dynamic 3D foot morphology in developing feet.

PubMed

Barisch-Fritz, Bettina; Schmeltzpfenning, Timo; Plank, Clemens; Grau, Stefan

2014-01-01

The complex functions of feet require a specific composition, which is progressively achieved by developmental processes. This development should take place without being affected by footwear. The aim of this study is to evaluate differences between static and dynamic foot morphology in developing feet. Feet of 2554 participants (6-16 years) were recorded using a new scanner system (DynaScan4D). Each foot was recorded in static half and full weight-bearing and during walking. Several foot measures corresponding to those used in last construction were calculated. The differences were identified by one-way ANOVA and paired Student's t-test. Static and dynamic values of each foot measure must be considered to improve the fit of footwear. In particular, footwear must account for the increase of forefoot width and the decrease of midfoot girth. Furthermore, the toe box should have a more rounded shape. The findings are important for the construction of footwear for developing feet.

COMPARING 3D FOOT SHAPE MODELS BETWEEN TAIWANESE AND JAPANESE FEMALES.

PubMed

Lee, Yu-Chi; Kouchi, Makiko; Mochimaru, Masaaki; Wang, Mao-Jiun

2015-06-01

This study compares foot shape and foot dimensions between Taiwanese and Japanese females. One hundred Taiwanese and 100 Japanese female 3D foot scanning data were used for comparison. To avoid the allometry effect, data from 23 Taiwanese and 19 Japanese with foot length between 233 to 237 mm were used for shape comparison. Homologous models created for the right feet of the 42 subjects were analyzed by Multidimensional Scaling. The results showed that there were significant differences in the forefoot shape between the two groups, and Taiwanese females had slightly wider feet with straighter big toe than Japanese females. The results of body and foot dimension comparison indicated that Taiwanese females were taller, heavier and had larger feet than Japanese females, while Japanese females had significantly larger toe 1 angle. Since some Taiwanese shoemakers adopt the Japanese shoe sizing system for making shoes, appropriateness of the shoe sizing system was also discussed. The present results provide very useful information for improving shoe last design and footwear fit for Taiwanese females.

Morton's metatarsalgia: sonographic findings and correlated histopathology.

PubMed

Read, J W; Noakes, J B; Kerr, D; Crichton, K J; Slater, H K; Bonar, F

1999-03-01

The results of 79 high resolution ultrasound examinations of the forefoot that were performed for suspected Morton's metatarsalgia were retrospectively assessed. Scans were only obtained if the pain was poorly localized or if there were atypical features that made the clinical diagnosis uncertain. Ultrasound detected 92 hypoechoic intermetatarsal web space masses in 63 patients. Surgery was performed on 23 web spaces in 22 patients where the response to nonsurgical management had been poor. The surgical specimens were retrieved and reviewed by a pathologist in 21 cases. The histopathology in 20 of 21 operated cases was that of Morton's neuroma; however, prominent mucoid degeneration was also found to involve the adjacent loose fibroadipose tissues in 19 of 20 neuroma specimens. Ultrasound was sensitive in the detection of web space abnormality (sensitivity, 0.95), but could not clearly separate Morton's neuroma from associated mass-like mucoid degeneration in the adjacent loose connective tissues. The implications of these observations for both diagnosis and treatment are discussed.

Resection of the metatarsal head for diabetic foot ulcers.

PubMed

Wieman, T J; Mercke, Y K; Cerrito, P B; Taber, S W

1998-11-01

Diabetic foot ulceration is a worldwide health problem. Approximately 15% of the 10 million diabetic patients in the United States will develop a foot ulceration at some time in their lives. The presence of a foot ulcer in this population is extremely debilitating and dramatically increases the risk of lower extremity amputation, accounting for approximately 67,000 lost limbs each year. Additionally, the costs associated with treating foot ulcers in diabetic patients is a major expense in the overall care of this patient group. An 11-year retrospective study was conducted to evaluate 101 consecutive patients with diabetic ulcers of the forefoot who were treated using resection of the metatarsal head as the primary means of obtaining wound closure. The results indicate that 88% of the ulcers were healed by using this technique, and relatively more rapidly than would be expected when compared with historical norms. Resection of the metatarsal head is a safe and relatively inexpensive procedure that facilitates closure of the lesion, helps to control infection, and prevents countless and costly amputations.

Effects of Combined Foot/Ankle Electromyostimulation and Resistance Training on the In-Shoe Plantar Pressure Patterns during Sprint in Young Athletes.

PubMed

Fourchet, François; Kuitunen, Sami; Girard, Olivier; Beard, Adam J; Millet, Grégoire P

2011-01-01

Several studies have already reported that specific foot/ankle muscle reinforcement strategies induced strength and joint position sense performance enhancement. Nevertheless the effects of such protocols on sprint performance and plantar loading distribution have not been addressed yet. The objective of the study is to investigate the influence of a 5-wk foot/ankle strength training program on plantar loading characteristics during sprinting in adolescent males. Sixteen adolescent male athletes of a national training academy were randomly assigned to either a combined foot/ankle electromyostimulation and resistance training (FAST) or a control (C) group. FAST consisted of foot medial arch and extrinsic ankle muscles reinforcement exercises, whereas C maintained their usual training routine. Before and after training, in-shoe loading patterns were measured during 30-m running sprints using pressure sensitive insoles (right foot) and divided into nine regions for analysis. Although sprint times remained unchanged in both groups from pre- to post- training (3.90 ± 0.32 vs. 3.98 ± 0.46 s in FAST and 3.83 ± 0.42 vs. 3.81 ± 0.44 s in C), changes in force and pressure appeared from heel to forefoot between FAST and C. In FAST, mean pressure and force increased in the lateral heel area from pre- to post- training (67.1 ± 44.1 vs. 82.9 ± 28.6 kPa [p = 0.06]; 25.5 ± 17.8 vs. 34.1 ± 14.3 N [p = 0.05]) and did not change in the medial forefoot (151.0 ± 23.2 vs. 146.1 ± 30.0 kPa; 142.1 ± 29.4 vs. 136.0 ± 33.8; NS). Mean area increased in FAST under the lateral heel from pre- to post- (4.5 ± 1.3 vs. 5.7 ± 1.6 cm(2) [p < 0.05]) and remained unchanged in C (5.5 ± 2.8 vs. 5.0 ± 3.0 cm(2)). FAST program induced significant promising lateral and unwanted posterior transfer of the plantar loads without affecting significantly sprinting performance. Key pointsWe have evaluated the effects of a foot/ankle strength training program on sprint performance and on related plantar loading characteristics in teenage athletes, and this have not been examined previously.Our results showed no significant pre- to post- changes in sprint performance.This study revealed initially a lateral transfer and secondly a posterior transfer of the plantar loads after the foot/ankle strength training program.

Effects of Combined Foot/Ankle Electromyostimulation and Resistance Training on the In-Shoe Plantar Pressure Patterns during Sprint in Young Athletes

PubMed Central

Fourchet, François; Kuitunen, Sami; Girard, Olivier; Beard, Adam J.; Millet, Grégoire P.

2011-01-01

Several studies have already reported that specific foot/ankle muscle reinforcement strategies induced strength and joint position sense performance enhancement. Nevertheless the effects of such protocols on sprint performance and plantar loading distribution have not been addressed yet. The objective of the study is to investigate the influence of a 5-wk foot/ankle strength training program on plantar loading characteristics during sprinting in adolescent males. Sixteen adolescent male athletes of a national training academy were randomly assigned to either a combined foot/ankle electromyostimulation and resistance training (FAST) or a control (C) group. FAST consisted of foot medial arch and extrinsic ankle muscles reinforcement exercises, whereas C maintained their usual training routine. Before and after training, in-shoe loading patterns were measured during 30-m running sprints using pressure sensitive insoles (right foot) and divided into nine regions for analysis. Although sprint times remained unchanged in both groups from pre- to post- training (3.90 ± 0.32 vs. 3.98 ± 0.46 s in FAST and 3.83 ± 0.42 vs. 3.81 ± 0.44 s in C), changes in force and pressure appeared from heel to forefoot between FAST and C. In FAST, mean pressure and force increased in the lateral heel area from pre- to post- training (67.1 ± 44.1 vs. 82.9 ± 28.6 kPa [p = 0.06]; 25.5 ± 17.8 vs. 34.1 ± 14.3 N [p = 0.05]) and did not change in the medial forefoot (151.0 ± 23.2 vs. 146.1 ± 30.0 kPa; 142.1 ± 29.4 vs. 136.0 ± 33.8; NS). Mean area increased in FAST under the lateral heel from pre- to post- (4.5 ± 1.3 vs. 5.7 ± 1.6 cm2 [p < 0.05]) and remained unchanged in C (5.5 ± 2.8 vs. 5.0 ± 3.0 cm2). FAST program induced significant promising lateral and unwanted posterior transfer of the plantar loads without affecting significantly sprinting performance. Key points We have evaluated the effects of a foot/ankle strength training program on sprint performance and on related plantar loading characteristics in teenage athletes, and this have not been examined previously. Our results showed no significant pre- to post- changes in sprint performance. This study revealed initially a lateral transfer and secondly a posterior transfer of the plantar loads after the foot/ankle strength training program. PMID:24149874

Biomechanical podiatric evaluation in an Italian cohort of patients with systemic sclerosis: A pilot study.

PubMed

Bongi, Susanna Maddali; Ravenni, Giovanni; Ciampi, Benedetta; Del Rosso, Angela; El Aoufy, Khadija

2016-12-01

Foot problems are often present in Systemic Sclerosis (SSc) patients, however studies regarding podiatric problems related to SSc are lacking and there are no data evaluating the foot biomechanical changes. The aim of the present pilot study was to evaluate podiatric problems in an Italian cohort of SSc patients by assessing received podiatric services, foot pain and disability and biomechanical foot deformity. 25 consecutive SSc patients were enrolled from the Division of Rheumatology, University of Florence. All SSc patients were assessed by: Standards of Care for People with Foot Musculoskeletal Health problems: Audit Tool, Foot Function Index (FFI), Weight and non-weight bearing foot joint assessment, (Foot Posture Index (FPI) and Gait Cycle), Health Assessment Questionnaire (HAQ) and Medical Outcomes Survey Short Form 36 (SF-36). Audit Tool - Only 7 (28%) out of the 25 patients with SSc had a specific podiatric assessment and treatment: no patient received a foot health assessment within the first 6 months of disease diagnosis and no patient received information about foot involvement. 1 patient (4%) received foot assessment every year; 1 patient (4%) received specific information about the disease and 5 patients (20%) received information about the benefits of using adapted footwear and insoles. FFI - Values of pain, disability and activity limitations, reported in FFI, are 4.7±5.1, 5.1±3.2 and 3.2±3.1 (M±DS), respectively. Non-weight bearing foot joint assessment shows a rearfoot varus deformity in 64% of patients, forefoot varus deformity in 42% and 6% forefoot valgus deformity. Weight bearing foot joint assessment, through FPI shows a pronated foot 20% of patients with and 34% with highly pronated overall foot posture. Gait analysis shows that 64% of patients has a contact of the calcaneus in invertion while 36% in eversion. In the midstance, 78% have the foot in pronation and 22% in supination, while in propulsion 12% presents a takeoff of the foot in supination and 88% in the pronation. HAQ result is 1.13±0.80, SFI and SMI scales of SF-36 have scores of 32.38±10.65 and 38.67±11.40, respectively. Our results shows that podiatric problems in SSc patients are common, serious but foot assessment and health care are inadequate. Thus, foot health information should be improved in order to better empower patients to self-manage low risk problems and help identify high-risk problems, which require specialist care.

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

PubMed

Bus, S A; van Deursen, R W; Armstrong, D G; Lewis, J E A; Caravaggi, C F; Cavanagh, P R

2016-01-01

Footwear and offloading techniques are commonly used in clinical practice for preventing and healing of foot ulcers in persons with diabetes. The goal of this systematic review is to assess the medical scientific literature on this topic to better inform clinical practice about effective treatment. We searched the medical scientific literature indexed in PubMed, EMBASE, CINAHL, and the Cochrane database for original research studies published since 1 May 2006 related to four groups of interventions: (1) casting; (2) footwear; (3) surgical offloading; and (4) other offloading interventions. Primary outcomes were ulcer prevention, ulcer healing, and pressure reduction. We reviewed both controlled and non-controlled studies. Controlled studies were assessed for methodological quality, and extracted key data was presented in evidence and risk of bias tables. Uncontrolled studies were assessed and summarized on a narrative basis. Outcomes are presented and discussed in conjunction with data from our previous systematic review covering the literature from before 1 May 2006. We included two systematic reviews and meta-analyses, 32 randomized controlled trials, 15 other controlled studies, and another 127 non-controlled studies. Several randomized controlled trials with low risk of bias show the efficacy of therapeutic footwear that demonstrates to relief plantar pressure and is worn by the patient, in the prevention of plantar foot ulcer recurrence. Two meta-analyses show non-removable offloading to be more effective than removable offloading for healing plantar neuropathic forefoot ulcers. Due to the limited number of controlled studies, clear evidence on the efficacy of surgical offloading and felted foam is not yet available. Interestingly, surgical offloading seems more effective in preventing than in healing ulcers. A number of controlled and uncontrolled studies show that plantar pressure can be reduced by several conservative and surgical approaches. Sufficient evidence of good quality supports the use of non-removable offloading to heal plantar neuropathic forefoot ulcers and therapeutic footwear with demonstrated pressure relief that is worn by the patient to prevent plantar foot ulcer recurrence. The evidence base to support the use of other offloading interventions is still limited and of variable quality. The evidence for the use of interventions to prevent a first foot ulcer or heal ischemic, infected, non-plantar, or proximal foot ulcers is practically non-existent. High-quality controlled studies are needed in these areas. Copyright © 2015 John Wiley & Sons, Ltd.

Comparison of peripheral nerve blockade characteristics between non-diabetic patients and patients suffering from diabetic neuropathy: a prospective cohort study.

PubMed

Baeriswyl, M; Taffé, P; Kirkham, K R; Bathory, I; Rancati, V; Crevoisier, X; Cherix, S; Albrecht, E

2018-06-02

Animal data have demonstrated increased block duration after local anaesthetic injections in diabetic rat models. Whether the same is true in humans is currently undefined. We, therefore, undertook this prospective cohort study to test the hypothesis that type-2 diabetic patients suffering from diabetic peripheral neuropathy would have increased block duration after ultrasound-guided popliteal sciatic nerve block when compared with patients without neuropathy. Thirty-three type-2 diabetic patients with neuropathy and 23 non-diabetic control patients, scheduled for fore-foot surgery, were included prospectively. All patients received an ultrasound-guided popliteal sciatic nerve block with a 30 ml 1:1 mixture of lidocaine 1% and bupivacaine 0.5%. The primary outcome was time to first opioid request after block procedure. Secondary outcomes included the time to onset of sensory blockade, and pain score at rest on postoperative day 1 (numeric rating scale 0-10). These outcomes were analysed using an accelerated failure time regression model. Patients in the diabetic peripheral neuropathy group had significantly prolonged median (IQR [range]) time to first opioid request (diabetic peripheral neuropathy group 1440 (IQR 1140-1440 [180-1440]) min vs. control group 710 (IQR 420-1200 [150-1440] min, p = 0.0004). Diabetic peripheral neuropathy patients had a time ratio of 1.57 (95%CI 1.10-2.23, p < 0.01), experienced a 59% shorter time to onset of sensory blockade (median time ratio 0.41 (95%CI 0.28-0.59), p < 0.0001) and had lower median (IQR [range]) pain scores at rest on postoperative day 1 (diabetic peripheral neuropathy group 0 (IQR 0-1 [0-5]) vs. control group 3 (IQR 0-5 [0-9]), p = 0.001). In conclusion, after an ultrasound-guided popliteal sciatic nerve block, patients with diabetic peripheral neuropathy demonstrated reduced time to onset of sensory blockade, with increased time to first opioid request when compared with patients without neuropathy. © 2018 The Association of Anaesthetists.

The 'ABC' of examining foot radiographs.

PubMed

Pearse, Eyiyemi O; Klass, Benjamin; Bendall, Stephen P

2005-11-01

We report a simple systematic method of assessing foot radiographs that improves diagnostic accuracy and can reduce the incidence of inappropriate management of serious forefoot and midfoot injuries, particularly the Lisfranc-type injury. Five recently appointed senior house officers (SHOs), with no casualty or Orthopaedic experience prior to their appointment, were shown a set of 10 foot radiographs and told the history and examination findings recorded in the casualty notes of each patient within 6 weeks of taking up their posts. They were informed that the radiographs might or might not demonstrate an abnormality. They were asked to make a diagnosis and decide on a management plan. The test was repeated after they were taught the 'ABC' method of evaluating foot radiographs. Diagnostic accuracy improved after SHOs were taught a systematic method of assessing foot radiographs. The proportion of correct diagnoses increased from 0.64 to 0.78 and the probability of recognising Lisfranc injuries increased from 0 to 0.6. The use of this simple method of assessing foot radiographs can reduce the incidence of inappropriate management of serious foot injuries by casualty SHOs, in particular the Lisfranc type injury.

A Prospective Study of Distal Metatarsal Chevron Osteotomies with K-Wire Fixations to Treat Hallux Valgus Deformities.

PubMed

Baig, M N; Baig, Usman; Tariq, Ali; Din, Robert

2017-09-20

Introduction Hallux valgus is one of the most common forefoot deformities worldwide. Females are affected more often than males. The three most common clinical symptoms are the painful bunion, transfer metatarsalgia, and hammer or claw toes. Methods This case series consisted of 20 patients who had chevron osteotomy from January 2015 to January 2016. The clinical assessment was measured by The American Orthopedic Foot and Ankle Score (AOFAS), and radiologic assessment was determined by preoperative and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA). Results The patients' mean age was 56 years. Out of 20 patients, 19 were female, and one was male. The mean AOFAS improved from 51 preoperatively to 82 postoperatively. The HVA improved from 26° preoperatively to 14°. There were five complications including four Kirschner (K)-wire complications. Conclusion Distal chevron osteotomy is a reliable and time-tested procedure. The K-wire fixation has a relatively high complication rate. We planned to use other methods of fixation and then compared them with K-wires fixation results for future studies.

A Prospective Study of Distal Metatarsal Chevron Osteotomies with K-Wire Fixations to Treat Hallux Valgus Deformities

PubMed Central

Baig, Usman; Tariq, Ali; Din, Robert

2017-01-01

Introduction Hallux valgus is one of the most common forefoot deformities worldwide. Females are affected more often than males. The three most common clinical symptoms are the painful bunion, transfer metatarsalgia, and hammer or claw toes. Methods This case series consisted of 20 patients who had chevron osteotomy from January 2015 to January 2016. The clinical assessment was measured by The American Orthopedic Foot and Ankle Score (AOFAS), and radiologic assessment was determined by preoperative and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA). Results The patients’ mean age was 56 years. Out of 20 patients, 19 were female, and one was male. The mean AOFAS improved from 51 preoperatively to 82 postoperatively. The HVA improved from 26° preoperatively to 14°. There were five complications including four Kirschner (K)-wire complications. Conclusion Distal chevron osteotomy is a reliable and time-tested procedure. The K-wire fixation has a relatively high complication rate. We planned to use other methods of fixation and then compared them with K-wires fixation results for future studies. PMID:29167752

The effect of racetrack design on gait symmetry of the pacer.

PubMed Central

Crawford, W H; Leach, D H

1984-01-01

A survey of a western Canadian racetrack determined the superelevation and transition curves to be less than the cited design standards. High-speed cinematography was used to film seven Standardbred pacers as they proceeded around one curve of the track at racing speed and for each horse 19 temporal stride parameters were obtained from these films using a film analyzer system. Average velocities were calculated and the mean stride length was found to vary from 5.08 m to 5.77 m. In all frames analyzed the hind foot was observed to contact the track surface prior to the ipsilateral forefoot and all horses displayed significant (p less than 0.05) contralateral asymmetry of some temporal stride parameters. Fifteen temporal stride parameters were significantly different (p less than 0.05) when compared between horses but only three temporal stride parameters were significantly different (p less than 0.05) when their values were compared between segments of the curved portions of the track. It is suggested that temporal gait asymmetry should not be used to judge the standards of racetrack design. PMID:6509365

Do the feet of German and Australian children differ in structure? Implications for children's shoe design.

PubMed

Mauch, Marlene; Mickle, Karen J; Munro, Bridget J; Dowling, Annaliese M; Grau, Stefan; Steele, Julie R

2008-04-01

The purpose of this study was to determine whether there were any significant differences in the morphology of the feet of children living on two different continents. The shape and dimensions of the feet of 86 preschool and 419 primary school children from Australia, matched to the same number of German children for age, gender, height and BMI, were compared. The German children display significantly longer and flatter feet relative to their Australian counterparts, whereas the Australian children reveal a significantly smaller ball angle, implying that the forefoot of the Australian children is squarer in shape. These findings imply that footwear must be designed to cater to the unique foot dimensions of children in different continents to ensure that shoe shape matches foot shape. Most footwear companies do not vary the dimensions of their shoe lasts to accommodate intercontinental differences in foot morphology based on racial and/or environmental factors. The results of this study will have immediate implications for the design of comfortable footwear suitable for the developing feet of children.

Is the rearfoot pattern the most frequently foot strike pattern among recreational shod distance runners?

PubMed

de Almeida, Matheus Oliveira; Saragiotto, Bruno Tirotti; Yamato, Tiê Parma; Lopes, Alexandre Dias

2015-02-01

To determine the distribution of the foot strike patterns among recreational shod runners and to compare the personal and training characteristics between runners with different foot strike patterns. Cross-sectional study. Areas of running practice in São Paulo, Brazil. 514 recreational shod runners older than 18 years and free of injury. Foot strike patterns were evaluated with a high-speed camera (250 Hz) and photocells to assess the running speed of participants. Personal and training characteristics were collected through a questionnaire. The inter-rater reliability of the visual foot strike pattern classification method was 96.7% and intra-rater reliability was 98.9%. 95.1% (n = 489) of the participants were rearfoot strikers, 4.1% (n = 21) were midfoot strikers, and four runners (0.8%) were forefoot strikers. There were no significant differences between strike patterns for personal and training characteristics. This is the first study to demonstrate that almost all recreational shod runners were rearfoot strikers. The visual method of evaluation seems to be a reliable and feasible option to classify foot strike pattern. Copyright © 2014 Elsevier Ltd. All rights reserved.

Field hospital treatment of blast wounds of the musculoskeletal system during the Yugoslav civil war.

PubMed

Covey, D C; Lurate, R B; Hatton, C T

2000-05-01

The spectrum of wounding and treatment of forty-one patients with musculoskeletal blast injuries at a U.S. military field hospital in the former Yugoslavia was reviewed. Patients underwent wound exploration, irrigation, debridement, broad-spectrum antibiotic therapy, early fracture stabilization, and appropriate reconstructive surgery. Four patients developed wound infections. Two patients died as a result of their injuries (overall mortality 5 percent). There were three below-knee amputations and five other amputations (above-knee, ankle, midtarsal, partial forefoot, and finger). Three patients sustained lumbar burst fractures from mines that exploded under their vehicles, resulting in paraplegia in one case. Our patients underwent 112 surgical procedures, an average of 2.1 per patient. Twenty-two patients (54 percent) had other injuries or conditions in addition to their orthopaedic wounds. There were wide variations in the bone and soft tissue injuries caused by detonating ordnance, and the tissue damage was qualitatively different from that caused by gunshot wounds. Early debridement, leaving wounds open, and treatment with broad-spectrum antibiotics were important factors in wound healing to allow subsequent successful reconstructive surgery in an austere field setting.

The effect of racetrack design on gait symmetry of the pacer.

PubMed

Crawford, W H; Leach, D H

1984-10-01

A survey of a western Canadian racetrack determined the superelevation and transition curves to be less than the cited design standards. High-speed cinematography was used to film seven Standardbred pacers as they proceeded around one curve of the track at racing speed and for each horse 19 temporal stride parameters were obtained from these films using a film analyzer system. Average velocities were calculated and the mean stride length was found to vary from 5.08 m to 5.77 m. In all frames analyzed the hind foot was observed to contact the track surface prior to the ipsilateral forefoot and all horses displayed significant (p less than 0.05) contralateral asymmetry of some temporal stride parameters. Fifteen temporal stride parameters were significantly different (p less than 0.05) when compared between horses but only three temporal stride parameters were significantly different (p less than 0.05) when their values were compared between segments of the curved portions of the track. It is suggested that temporal gait asymmetry should not be used to judge the standards of racetrack design.

Foot loading characteristics during three fencing-specific movements.

PubMed

Trautmann, Caroline; Martinelli, Nicolo; Rosenbaum, Dieter

2011-12-01

Plantar pressure characteristics during fencing movements may provide more specific information about the influence of foot loading on overload injury patterns. Twenty-nine experienced fencers participated in the study. Three fencing-specific movements (lunge, advance, retreat) and normal running were performed with three different shoe models: Ballestra (Nike, USA), Adistar Fencing Lo (Adidas, Germany), and the fencers' own shoes. The Pedar system (Novel, Munich, Germany) was used to collect plantar pressures at 50 Hz. Peak pressures, force-time integrals and contact times for five foot regions were compared between four athletic tasks in the lunge leg and supporting leg. Plantar pressure analysis revealed characteristic pressure distribution patterns for the fencing movements. For the lunge leg, during the lunge and advance movements the heel is predominantly loaded; during retreat, it is the hallux. For the supporting leg, during the lunge and advance movements the forefoot is predominantly loaded; during retreat, it is the hallux. Fencing-specific movements load the plantar surface in a distinct way compared with running. An effective cushioning in the heel and hallux region would help to minimize foot loading during fencing-specific movements.

Analysis of foot load during ballet dancers' gait.

PubMed

Prochazkova, Marketa; Tepla, Lucie; Svoboda, Zdenek; Janura, Miroslav; Cieslarová, Miloslava

2014-01-01

Ballet is an art that puts extreme demands on the dancer's musculoskeletal system and therefore significantly affects motor behavior of the dancers. The aim of our research was to compare plantar pressure distribution during stance phase of gait between a group of professional ballet dancers and non-dancers. Thirteen professional dancers (5 men, 8 women; mean age of 24.1 ± 3.8 years) and 13 nondancers (5 men, 8 women; mean age of 26.1 ± 5.3 years) participated in this study. Foot pressure analysis during gait was collected using a 2 m pressure plate. The participants were instructed to walk across the platform at a self-selected pace barefoot. Three gait cycles were necessary for the data analysis. The results revealed higher (p < 0.05) pressure peaks in medial edge of forefoot during gait for dancers in comparison with nondancers. Furthermore, differences in total foot loading and foot loading duration of rearfoot was higher (p < 0.05) in dancers as well. We can attribute these differences to long-term and intensive dancing exercises that can change the dancer's gait stereotype.

The influence of a small insert, in the footbed of a shoe, upon plantar pressure distribution.

PubMed

Burgess, S; Jordan, C; Bartlett, RM

1997-04-01

INTRODUCTION:: A recent development in plantar pressure distribution research, has been the study of the effects of sensory input on pressure distribution. It has been suggested that proprioceptive and exteroceptive information received from the plantar surface of the foot plays an important role in adapting to high pressures in shoes. Robbins and Gouw (1991) suggested that surface irregularities should be added to the insoles of running shoes to gain correct sensory input. Hayda et al. (1994) found that placing a pad proximal to the metatarsal heads produced significant reductions in forefoot plantar pressures around the first and second metatarsal heads. A development by Villeneuve (1993), 'La Posteropodle', utilized a small insert to maintain postural equilibrium, by stimulating the mechanoreceptors in the plantar surface of the foot. The aim of this study was to measure changes in plantar pressure distribution using a small circular insert. METHODS:: Ten non-pathological male subjects were tested whilst walking, after one day of wearing a pair of oxfords (hard) and running shoes (soft), containing an insert of 4 mm in height placed on a 0.8 mm EVA insole. The foot was split into five sections: (1) midfoot, (2) first metatarsal head, (3) 2nd and 3rd metatarsal heads, (4) 4th and 5th metatarsal heads, (5) the phalanges. A PEDAR system (Novel GmbH) was used to collect in-shoe plantar pressure data, with data collections at the beginning and end of a working day. Subjects were tested under two conditions: (1) the insert 5 mm proximal to the metatarsal heads, between the 2nd and 3rd heads, (2) a control, with no insert. RESULTS:: Preliminary results indicate that whilst wearing a hard shoe the insert had the effect of shifting peak pressures from the first metatarsal head, to the area of the second and third metatarsal heads. Peak pressures were found to be lower with the insert present. This has not yet been tested for significance. With the running shoe there appeared to be no significant differences between conditions with and without the insert. There were also no differences between the beginning and end of the day, for both shoe types. DISCUSSION:: From the results it appears that the insert is successful in both shifting peak pressures from the medial to the lateral forefoot, whilst reducing peak pressures simultaneously. This was only evident in the hard shoe condition however, suggesting that the footbed of the running shoe was perhaps too soft to allow the insert to influence sensory input sufficiently. These findings indicate that there may be implications for the use of small orthotics. Further study is required, however, to fully substantiate this hypothesis.

THE EFFECT OF STEP RATE MANIPULATION ON FOOT STRIKE PATTERN OF LONG DISTANCE RUNNERS.

PubMed

Allen, Darrell J; Heisler, Hollie; Mooney, Jennifer; Kring, Richard

2016-02-01

Running gait retraining to change foot strike pattern in runners from a heel strike pattern to a non heel- strike pattern has been shown to reduce impact forces and may help to reduce running related injuries. Step rate manipulation above preferred is known to help decrease step length, foot inclination angle, and vertical mass excursion, but has not yet been evaluated as a method to change foot strike pattern. The purpose of this study was to investigate the effect of step rate manipulation on foot strike pattern in shod recreational runners who run with a heel strike pattern. A secondary purpose was to describe the effect of step rate manipulation at specific percentages above preferred on foot inclination angle at initial contact. Forty volunteer runners, who were self-reported heel strikers and had a weekly running mileage of at least 10 miles, were recruited. Runners were confirmed to be heel strikers during the warm up period on the treadmill. The subject's step rate was determined at their preferred running pace. A metronome was used to increase step rate above the preferred step rate by 5%, 10% and 15%. 2D video motion analysis was utilized to determine foot strike pattern and to measure foot inclination angle at initial contact for each step rate condition. There was a statistically significant change in foot strike pattern from a heel strike pattern to a mid-foot or forefoot strike pattern at both 10% and 15% step rates above preferred. Seven of the 40 subjects (17.5%) changed from a heel- strike pattern to a non- heel strike pattern at +10% and 12 of the 40 subjects (30%) changed to a non-heel strike pattern at +15%. Mean foot inclination angle at initial contact showed a statistically significant change (reduction) as step rate increased. Step rate manipulation of 10% or greater may be enough to change foot strike pattern from a heel strike to a mid-foot or forefoot strike pattern in a small percentage of recreational runners who run in traditional running shoes. If changing the foot strike pattern is the main goal, other gait re-training methods may be needed to make a change from a heel strike to a non-heel strike pattern. Step rate manipulation shows a progressive reduction of foot inclination angle at 5%, 10%, and 15% above preferred step rate which reduces the severity of the heel strike at initial contact. Step rate manipulation of at least +10% above preferred may be an effective running gait retraining method for clinicians to decrease the severity of heel strike and possibly assist a runner to change to a non-heel strike pattern. 3.

[Factors affecting the pressure distribution underneath the foot sole in ski boots].

PubMed

Schaff, P; Kulot, M; Hauser, W; Rosemeyer, B

1988-12-01

The determination of pressure patterns underneath the footsole inside skiboots, may reveal reasons for footpain and injury risk. In our study, a new developed 72 point measuring mat was used in 5 different skiboots. Data were collected in 10 subjects in different forward flexion positions. In addition a determination of the pressure distribution over the instep was done by means of single measuring points. The results proof, that a proper adapting along the dorsum of the foot does lower the forefoot load during flexion. A tightly closed and well adapted boot will lead to a significant reduction of the total load on the footsole. High shaft models show similar pressure patterns even at earlier forward flexion angles. A pressure related discrimination between rear entry and traditional boots, that was found along the tibia, was not the case underneath the footsole. The force transmission is mainly performed along the shaft of the boot. The effect of orthotics designed mainly to support steerability of the ski, is therefore doubtful. The results may help to improve our knowledge of the interaction between boot and skier and lead, together with future field research, to a reduction of equipment related injuries.

A case of penetration of the intestinal wall by a soft-shelled turtle bone successfully removed with double-balloon endoscopy.

PubMed

Sawada, Mizuho; Sekigawa, Kenichiro; Mitsui, Hiroshi; Kobayashi, Katsuya; Okubo, Masao; Yamaguchi, Hajime; Hashimoto, Naoaki

2015-10-01

A 62-year-old male was admitted to our hospital due to left lower abdominal pain. Three days before admission, he ate seafood in a Japanese restaurant. Two days before admission, he suffered from intermittent left lower abdominal pain. One day before admission, he developed a high fever and subsequently visited our hospital the following day. Localized tenderness and rebound pain were observed in the left lower abdomen, and C-reactive protein was elevated. Computed tomography revealed a linear high-density object in the distal portion of the small intestine accompanied by edema of the wall, suggesting penetration by something like a fishbone. On the ninth hospital day, double-balloon endoscopy was performed via the transanal route. Yellow foreign material was found in the ileum and was then successfully removed with biopsy forceps. The removed material measured 3 mm in width, 3 cm in length and was slightly curved. It proved to be a bone of the forefoot of a soft-shelled turtle, which had been included on the menu of the restaurant. The patient was completely cured and discharged on the 14th hospital day.

A new approach to children's footwear based on foot type classification.

PubMed

Mauch, M; Grau, S; Krauss, I; Maiwald, C; Horstmann, T

2009-08-01

Current shoe designs do not allow for the comprehensive 3-D foot shape, which means they are unable to reproduce the wide variability in foot morphology. Therefore, the purpose of this study was to capture these variations of children's feet by classifying them into groups (types) and thereby provide a basis for their implementation in the design of children's shoes. The feet of 2867 German children were measured using a 3-D foot scanner. Cluster analysis was then applied to classify the feet into three different foot types. The characteristics of these foot types differ regarding their volume and forefoot shape both within and between shoe sizes. This new approach is in clear contrast to previous systems, since it captures the variability of foot morphology in a more comprehensive way by using a foot typing system and therefore paves the way for the unimpaired development of children's feet. Previous shoe systems do not allow for the wide variations in foot morphology. A new approach was developed regarding different morphological foot types based on 3-D measurements relevant in shoe construction. This can be directly applied to create specific designs for children's shoes.

Measurement agreement between a newly developed sensing insole and traditional laboratory-based method for footstrike pattern detection in runners

PubMed Central

Cheung, Roy T. H.; An, Winko W.; Au, Ivan P. H.; Zhang, Janet H.; Chan, Zoe Y. S.; Man, Alfred; Lau, Fannie O. Y.; Lam, Melody K. Y.; Lau, K. K.; Leung, C. Y.; Tsang, N. W.; Sze, Louis K. Y.; Lam, Gilbert W. K.

2017-01-01

This study introduced a novel but simple method to continuously measure footstrike patterns in runners using inexpensive force sensors. Two force sensing resistors were firmly affixed at the heel and second toe of both insoles to collect the time signal of foot contact. A total of 109 healthy young adults (42 males and 67 females) were recruited in this study. They ran on an instrumented treadmill at 0°, +10°, and -10° inclinations and attempted rearfoot, midfoot, and forefoot landings using real time visual biofeedback. Intra-step strike index and onset time difference between two force sensors were measured and analyzed with univariate linear regression. We analyzed 25,655 footfalls and found that onset time difference between two sensors explained 80–84% of variation in the prediction model of strike index (R-squared = 0.799–0.836, p<0.001). However, the time windows to detect footstrike patterns on different surface inclinations were not consistent. These findings may allow laboratory-based gait retraining to be implemented in natural running environments to aid in both injury prevention and performance enhancement. PMID:28599003

Predicting ground contact events for a continuum of gait types: An application of targeted machine learning using principal component analysis.

PubMed

Osis, Sean T; Hettinga, Blayne A; Ferber, Reed

2016-05-01

An ongoing challenge in the application of gait analysis to clinical settings is the standardized detection of temporal events, with unobtrusive and cost-effective equipment, for a wide range of gait types. The purpose of the current study was to investigate a targeted machine learning approach for the prediction of timing for foot strike (or initial contact) and toe-off, using only kinematics for walking, forefoot running, and heel-toe running. Data were categorized by gait type and split into a training set (∼30%) and a validation set (∼70%). A principal component analysis was performed, and separate linear models were trained and validated for foot strike and toe-off, using ground reaction force data as a gold-standard for event timing. Results indicate the model predicted both foot strike and toe-off timing to within 20ms of the gold-standard for more than 95% of cases in walking and running gaits. The machine learning approach continues to provide robust timing predictions for clinical use, and may offer a flexible methodology to handle new events and gait types. Copyright © 2016 Elsevier B.V. All rights reserved.

Ankle and Midfoot Power During Walking and Stair Ascent in Healthy Adults.

PubMed

DiLiberto, Frank E; Nawoczenski, Deborah A; Houck, Jeff

2018-02-27

Ankle power dominates forward propulsion of gait, but midfoot power generation is also important for successful push off. However, it is unclear if midfoot power generation increases or stays the same in response to propulsive activities that induce larger external loads and require greater ankle power. The purpose of this study was to examine ankle and midfoot power in healthy adults during progressively more demanding functional tasks. Multi-segment foot motion (tibia, calcaneus, forefoot) and ground reaction forces were recorded as participants (N=12) walked, ascended a standard step, and ascended a high step. Ankle and midfoot positive peak power and total power, and the proportion of midfoot to ankle total power were calculated. One-way repeated measures ANOVAs were conducted to evaluate differences across tasks. Main effects were found for ankle and midfoot peak and total powers (all p < .001), but not for the proportion of midfoot to ankle total power (p = .331). Ankle and midfoot power significantly increased across each task. Midfoot power increased in proportion to ankle power and in congruence to the external load of a task. Study findings may serve to inform multi-segment foot modeling applications and internal mechanistic theories of normal and pathological foot function.

Implantable electrical bone stimulation for arthrodeses of the foot and ankle in high-risk patients: a multicenter study.

PubMed

Saxena, Amol; DiDomenico, Lawrence A; Widtfeldt, Arthur; Adams, Todd; Kim, Will

2005-01-01

This study assessed arthrodesis procedures performed in the foot and ankle of high-risk patients following implantation of an internal electrical bone stimulator. Criteria defining patients as "high risk" included diabetes, obesity, habitual tobacco and/or alcohol use, immunosuppressive therapy, and previous history of nonunion. Standard arthrodesis protocol of bone graft and internal fixation was supplemented with the implantable electrical bone stimulator. A retrospective, multicenter review was conducted of 26 patients (28 cases) who underwent 28 forefoot and hindfoot arthrodeses from 1998 to 2002. Complete fusion was defined as bony trabeculation across the joint, lack of motion across the joint, maintenance of hardware/fixation, and absence of radiographic signs of nonunion or pseudoarthrosis. Radiographic consolidation was achieved in 24 of the 28 cases at an average 10.3+/-4.0 weeks. Followup averaged 27.2 months. Complications included 2 patients who sustained breakage of the cables to the bone stimulator. Five patients underwent additional surgery. Four of the 5 patients had additional surgery in order to achieve arthrodesis. All 4 went on to subsequent arthrodesis. This study demonstrates how arthrodesis of the foot and ankle may be enhanced by the use of implantable electrical bone stimulation.

[A 65-year-old man with history of claudication, palpable purpura and livedo reticularis].

PubMed

Braun, N; Kimmel, M; Grabner, A; Ott, G; Alscher, M D

2010-04-01

A 65-year-old man was admitted with history of claudication symptoms and painful skin lesions of the lower legs. Physical examination showed palpable purpura of the lower legs and livedo reticularis, most marked at the forefoot and toes. Computed tomography (CT) showed an aortic mass 2 cm above the bifurcation. This was treated after angiography with a covered stent. Biopsy of the skin lesions showed no sign of vasculitis and no cholesterol crystals. The patient was discharged and remained symptom-free for 9 months. He was readmitted at that time with recurrent complaints. CT revealed a subtotal stenosis of the aortic stent. A skin biopsy showed CD31-positive tumor cells in small arteries. Biopsy of a new osteolytic lesion in the ileum confirmed the diagnosis of angiosarcoma of the aorta. The patient decided in favor of palliative care and was discharged from the hospital. Primary tumors of the aorta, although they are rare, should be considered in the presence of an intravascular mass with stenosis to blood flow. A skin biopsy is easy to conduct and often leads to the final diagnosis. Georg Thieme Verlag KG Stuttgart. New York.

Semiclosed transfemoral iliac endarterectomy with an oscillating ring stripper.

PubMed

Stevick, C A; Bloom, R J

1989-10-01

The technique of endarterectomy for the removal of occlusive atherosclerotic lesions of the aorta and iliac arteries has been utilized successfully in the revascularization of ischemic limbs since its introduction in 1951. The oscillating loop endarterectomy device (Amsco-Hall arterial oscillator) has proven to be useful for endarterectomy of segmental occlusive disease as a substitute for bypass with prosthetic graft. For our elderly debilitated patients, we have adopted a new technique of semiclosed transfemoral iliac endarterectomy for management of occlusive external iliac disease with a patent common iliac artery. We report seven patients treated during May 1987 through May 1988 for external iliac artery occlusion by transfemoral oscillating loop endarterectomy. At 12 months for follow-up review, the cumulative limb salvage rate was 80% with no perioperative mortality. One patient required above-knee amputation eight months following endarterectomy to control forefoot sepsis. Two patients required subsequent leg bypass procedures to achieve full healing of foot level amputation. One patient required dilatation of residual stenosis at the iliac bifurcation by percutaneous balloon angioplasty. Semiclosed transfemoral endarterectomy with the Amsco-Hall oscillating loop device remains an attractive option to the vascular surgeon for recanalization of the iliac artery without the need for an extensive retroperitoneal dissection.

Factors Influencing Running-Related Musculoskeletal Injury Risk Among U.S. Military Recruits.

PubMed

Molloy, Joseph M

2016-06-01

Running-related musculoskeletal injuries among U.S. military recruits negatively impact military readiness. Low aerobic fitness, prior injury, and weekly running distance are known risk factors. Physical fitness screening and remedial physical training (or discharging the most poorly fit recruits) before entry-level military training have tended to reduce injury rates while decreasing attrition, training, and medical costs. Incorporating anaerobic running sessions into training programs can offset decreased weekly running distance and decrease injury risk. Varying lower extremity loading patterns, stride length or cadence manipulation, and hip stability/strengthening programming may further decrease injury risk. No footstrike pattern is ideal for all runners; transitioning to forefoot striking may reduce risk for hip, knee, or tibial injuries, but increase risk for calf, Achilles, foot or ankle injuries. Minimal evidence associates running surfaces with injury risk. Footwear interventions should focus on proper fit and comfort; the evidence does not support running shoe prescription per foot type to reduce injury risk among recruits. Primary injury mitigation efforts should focus on physical fitness screening, remedial physical training (or discharge for unfit recruits), and continued inclusion of anaerobic running sessions to offset decreased weekly running distance. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Ultrasound elasticity imaging of human posterior tibial tendon

NASA Astrophysics Data System (ADS)

Gao, Liang

Posterior tibial tendon dysfunction (PTTD) is a common degenerative condition leading to a severe impairment of gait. There is currently no effective method to determine whether a patient with advanced PTTD would benefit from several months of bracing and physical therapy or ultimately require surgery. Tendon degeneration is closely associated with irreversible degradation of its collagen structure, leading to changes to its mechanical properties. If these properties could be monitored in vivo, it could be used to quantify the severity of tendonosis and help determine the appropriate treatment. Ultrasound elasticity imaging (UEI) is a real-time, noninvasive technique to objectively measure mechanical properties in soft tissue. It consists of acquiring a sequence of ultrasound frames and applying speckle tracking to estimate displacement and strain at each pixel. The goals of my dissertation were to 1) use acoustic simulations to investigate the performance of UEI during tendon deformation with different geometries; 2) develop and validate UEI as a potentially noninvasive technique for quantifying tendon mechanical properties in human cadaver experiments; 3) design a platform for UEI to measure mechanical properties of the PTT in vivo and determine whether there are detectable and quantifiable differences between healthy and diseased tendons. First, ultrasound simulations of tendon deformation were performed using an acoustic modeling program. The effects of different tendon geometries (cylinder and curved cylinder) on the performance of UEI were investigated. Modeling results indicated that UEI accurately estimated the strain in the cylinder geometry, but underestimated in the curved cylinder. The simulation also predicted that the out-of-the-plane motion of the PTT would cause a non-uniform strain pattern within incompressible homogeneous isotropic material. However, to average within a small region of interest determined by principal component analysis (PCA) would improve the estimation. Next, UEI was performed on five human cadaver feet mounted in a materials testing system (MTS) while the PTT was attached to a force actuator. A portable ultrasound scanner collected 2D data during loading cycles. Young's modulus was calculated from the strain, loading force and cross sectional area of the PTT. Average Young's modulus for the five tendons was (0.45+/-0.16GPa) using UEI. This was consistent with simultaneous measurements made by the MTS across the whole tendon (0.52+/-0.18GPa). We also calculated the scaling factor (0.12+/-0.01) between the load on the PTT and the inversion force at the forefoot, a measurable quantity in vivo. This study suggests that UEI could be a reliable in vivo technique for estimating the mechanical properties of the human PTT. Finally, we built a custom ankle inversion platform for in vivo imaging of human subjects (eight healthy volunteers and nine advanced PTTD patients). We found non-linear elastic properties of the PTTD, which could be quantified by the slope between the elastic modulus (E) and the inversion force (F). This slope (DeltaE/DeltaF), or Non-linear Elasticity Parameter (NEP), was significantly different for the two groups: 0.16+/-0.20 MPa/N for healthy tendons and 0.45+/-0.43 MPa/N for PTTD tendons. A receiver operating characteristic (ROC) curve revealed an area under the curve (AUC) of 0.83+/-0.07, which indicated that the classifier system is valid. In summary, the acoustic modeling, cadaveric studies, and in vivo experiments together demonstrated that UEI accurately quantifies tendon mechanical properties. As a valuable clinical tool, UEI also has the potential to help guide treatment decisions for advanced PTTD and other tendinopathies.

Effect of six types of footwear on peak plantar pressures in patients with diabetes and transmetatarsal amputation.

PubMed

Mueller, MJ; Strube, MJ; Allen, BT

1997-04-01

INTRODUCTION:: Patients with diabetes (DM) and transmetatarsal amputation (TMA) are at high risk for skin breakdown from excessive peak plantar pressures (PPP). The primary purpose of this study was to determine how footwear (full length shoe or short shoe), a total contact insert, a rigid-rocker bottom (RRB) sole, and an ankle-foot-orthosis (AFO) affect PPP on the distal residuum and contralateral extremity of patients with DM and TMA. A secondary purpose was to monitor various functional measures during use of the footwear. METHODS:: Thirty patients with DM and TMA participated (mean age 62+/-4 years). The mean duration of DM was 19.9+/-10.1 years, and the mean time since TMA was 27.4+/-28.1 months. The following footwear was provided after a check-out from an orthotist and physical therapist (PT); 1) Full length shoe (ie shoe length prior to surgery), with a toe filler, 2) full length shoe, total contact insert, and an AFO, 2) full length shoe, total contact insert, and an AFO, 3) full length shoe, total contact insert, and a RRB sole, 4) full length shoe, total contact insert, RRB sole, and an AFO, 5) short shoe (ie length of residuum), total contact insert, and RRB, 6) short shoe, total contact insert, AFO, and RRB sole. In-shoe PPP during walking at the distal residuum and forefoot of the contralateral extremity were measured using the F-Scan System with established reliability under similar conditions (Generilizability coefficient =.75). Each measurement occurred after a one month adjustment period. Data were analyzed using a univariate repeated measuresANOVA. Individual contrasts were used for post-hoc analysis on those variables showing a significant overall F value (p<.05). RESULTS:: Compared to a regular shoe with a toe-filler, all conditions except the short shoe (#5), resulted in lower PPP on the distal residuum (p<.05). Condition 3, the full length shoe, total contact insert, and RRB resulted in lower pressures on the distal residuum and forefoot of the contralateral extremity compared to a regular shoe and toe-filler, and had few functional complaints as identified by the patient, orthotist or PT (3/27). Footwear using an AFO (Conditions 2,4,6) showed reduced PPP on the residuum, but most patients (16/29) had functional complaints. The short shoe (condition 5) had the fewest[Table: see text] functional complaints (2/26), but did not significantly reduce PPP and had the highest cosmetic refusal rate (5/26). DISCUSSION AND CONCLUSIONS:: Although there are individual patient characteristics which warrant other prescriptions, based on the results of this study, we recommend the full length shoe, total contact insert, and RRB sole for most patients with DM and TMA to reduce PPP. A reduction in PPP should help to lower the high risk of skin breakdown in this patient population.

Training of support afferentation in postmenopausal women.

PubMed

Bazanova, O M; Kholodina, N V; Nikolenko, E D; Payet, J

2017-12-01

We have recently shown a diminishing of the Menopause Index in old-aged women who underwent special training directed at the enhancement of support afferentation by increasing the plantar forefoot sensitivity (Bazanova et al., 2015). Based on these results we hypothesized, that purposeful training of support afferentation through stimulation of plantar graviceptors by Aikido practice will decrease excessive postural and psychoemotional tension not only in rest condition, but during cognitive and manual task performance too. Fluency of cognitive and motor task performance, EEG alpha power as an index of neuronal efficiency of cognitive control, amount of alpha power suppression as a visual activation measure and EMG power of forehead muscles as a sign of psychoemotional tension were compared in three groups of post-menopausal women: i) 8years training with forefeet support afferentation with Aikido practice (A), ii) 8years fitness training (F) and iii) no dedicated fitness training for past 8years (N). Simultaneous stabilometry, EEG, and frontal EMG recording were performed in sitting and standing up position in eyes closed and eyes open condition. Recording done at rest and while performing cognitive and finger motor tasks. We compared studied parameters between groups with one- and two-way analyses of variance (ANOVAs) with Bonferroni correction for multiple comparisons, followed by post hoc two-tailed unpaired t-tests. The fluency of tasks performance, EMG and alpha-EEG-activity displayed similar values in all groups in a sitting position. Center of pressure (CoP) sway length, velocity and energy demands for saving balance increased when standing up, more in group N than in groups F and A (all contrasts p values<0.002, η 2 >0.89). Post hoc t-tests showed increased fluency in standing in both Aikido (p<0.01) and Fitness (p<0.05) subjects in relation to untrained subjects. Increasing fluency in motor task performance was in parallel with enhancing the EEG alpha-2-power and decreasing EMG power only in A group (η 2 >0.77). Fluency in motor task and alpha EEG power decreased, but frontal EMG power increased in response to standing in untrained women (group N) and did not change in F group. Post hoc t-tests showed that EEG amount of alpha-2 power suppression in response to visual activation and frontal EMG power was lower in A than F and N groups (p<0.004) during motor task performance in the standing position. These results were interpreted as showing that training of forefoot plantar surface sensitivity in postmenopausal women decreases levels of psychoemotional tension and increases cognitive control caused by the psychomotor and postural challenges. Thus, Aikido training aimed at learning coordination between manual task performance and balance control by increasing the plantar support zones sensation decreases the cost of maintained vertical position and dependence of motor coordination on visual contribution. Copyright © 2017 Elsevier B.V. All rights reserved.

The Kinematics of Treadmill Locomotion in Space

NASA Technical Reports Server (NTRS)

Thornton, W. E.; Cavanagh, P. R.; Buczek, F. L.; Burgess-Milliron, M. J.; Davis, B. L.

1997-01-01

Locomotion on a treadmill in 0 G will probably remain a centerpiece of NASA's exercise countermeasures programme. This form of physical activity has the potential to cause large bone and muscle forces as well as loading during a period of continuous treadmill exercise. A critical concern is the provision of a treadmill which can approximate 1 G performance in space. At this point, no adequate objective measurements of in-flight treadmill kinetics or of the human response to this activity have been made. Interpretation of the results obtained in the present study is limited by the following: (1) bungee tensions were not measured; (2) ground reaction forces were not measured in parallel with the kinematic measurements; and (3) the instrumentation used to film the astronauts could itself have been affected by microgravity. Despite these shortcomings, what is apparent is that exercise during NASA missions STS 7 and STS 8 resulted in leg motions that were similar to those found during 1 G locomotion on an inclined passive treadmill and on an active treadmill at an even steeper grade. In addition, it was apparent that the majority of the loads were transmitted through the forefoot, and one can surmise that this style of running would result in physiologically significant tensions in the calf musculature and resultant ankle compressive loading. Further speculation regarding limb loading is complicated by the fact that varying amounts of force are transmitted through (1) the treadmill handle and (2) bungee cords that act as a tether. New generations of treadmills are being manufactured that could provide I important information for planners of long-duration space missions. If these types of treadmill are flown on future missions, it will be possible to control bungee tensions more precisely, control for grade and speed, and, most importantly, provide data on the rates and magnitudes of limb loading. These data could then be incorporated into biomechanical models of the lower limb to more fully understand mechanisms of load transmission from distal to proximal structures and to optimize in-flight exercise protocols in such a way that muscle and bone loss could be reduced.

A comparison of the spatiotemporal parameters, kinematics, and biomechanics between shod, unshod, and minimally supported running as compared to walking.

PubMed

Lohman, Everett B; Balan Sackiriyas, Kanikkai Steni; Swen, R Wesley

2011-11-01

Recreational running has many proven benefits which include increased cardiovascular, physical and mental health. It is no surprise that Running USA reported over 10 million individuals completed running road races in 2009 not to mention recreational joggers who do not wish to compete in organized events. Unfortunately there are numerous risks associated with running, the most common being musculoskeletal injuries attributed to incorrect shoe choice, training errors and excessive shoe wear or other biomechanical factors associated with ground reaction forces. Approximately 65% of chronic injuries in distance runners are related to routine high mileage, rapid increases in mileage, increased intensity, hills or irregular surface running, and surface firmness. Humans have been running barefooted or wearing minimally supportive footwear such as moccasins or sandals since the beginning of time while modernized running shoes were not invented until the 1970s. However, the current trend is that many runners are moving back to barefoot running or running in "minimal" shoes. The goal of this masterclass article is to examine the similarities and differences between shod and unshod (barefoot or minimally supportive running shoes) runners by examining spatiotemporal parameters, energetics, and biomechanics. These running parameters will be compared and contrasted with walking. The most obvious difference between the walking and running gait cycle is the elimination of the double limb support phase of walking gait in exchange for a float (no limb support) phase. The biggest difference between barefoot and shod runners is at the initial contact phase of gait where the barefoot and minimally supported runner initiates contact with their forefoot or midfoot instead of the rearfoot. As movement science experts, physical therapists are often called upon to assess the gait of a running athlete, their choice of footwear, and training regime. With a clearer understanding of running and its complexities, the physical therapist will be able to better identify faults and create informed treatment plans while rehabilitating patients who are experiencing musculoskeletal injuries due to running. Copyright © 2011 Elsevier Ltd. All rights reserved.

Prospective Analysis of Surgical Bone Margins After Partial Foot Amputation in Diabetic Patients Admitted With Moderate to Severe Foot Infections.

PubMed

Schmidt, Brian M; McHugh, Jonathan B; Patel, Rajiv M; Wrobel, James S

2018-04-01

Osteomyelitis is common in diabetic foot infections and medical management can lead to poor outcomes. Surgical management involves sending histopathologic and microbiologic specimens which guides future intervention. We examined the effect of obtainment of surgical margins in patients undergoing forefoot amputations to identify patient characteristics associated with outcomes. Secondary aims included evaluating interobserver reliability of histopathologic data at both the distal-to and proximal-to surgical bone margin. Data were prospectively collected on 72 individuals and was pooled for analysis. Standardized method to retrieve intraoperative bone margins was established. A univariate analysis was performed. Negative outcomes, including major lower extremity amputation, wound dehiscence, reulceration, reamputation, or death were recorded. Viable proximal margins were obtained in 63 out of 72 cases (87.5%). Strong interobserver reliability of histopathology was recorded. Univariate analysis demonstrated preoperative platelets, albumin, probe-to-bone testing, absolute toe pressures, smaller wound surface area were associated with obtaining viable margins. Residual osteomyelitis resulted in readmission 2.6 times more often and more postoperative complications. Certain patients were significantly different in the viable margin group versus dirty margin group. High interobserver reliability was demonstrated. Obtainment of viable margins resulted in reduced rates of readmission and negative outcomes. Prognostic, Level I: Prospective.

Does footprint depth correlate with foot motion and pressure?

PubMed Central

Bates, K. T.; Savage, R.; Pataky, T. C.; Morse, S. A.; Webster, E.; Falkingham, P. L.; Ren, L.; Qian, Z.; Collins, D.; Bennett, M. R.; McClymont, J.; Crompton, R. H.

2013-01-01

Footprints are the most direct source of evidence about locomotor biomechanics in extinct vertebrates. One of the principal suppositions underpinning biomechanical inferences is that footprint geometry correlates with dynamic foot pressure, which, in turn, is linked with overall limb motion of the trackmaker. In this study, we perform the first quantitative test of this long-standing assumption, using topological statistical analysis of plantar pressures and experimental and computer-simulated footprints. In computer-simulated footprints, the relative distribution of depth differed from the distribution of both peak and pressure impulse in all simulations. Analysis of footprint samples with common loading inputs and similar depths reveals that only shallow footprints lack significant topological differences between depth and pressure distributions. Topological comparison of plantar pressures and experimental beach footprints demonstrates that geometry is highly dependent on overall print depth; deeper footprints are characterized by greater relative forefoot, and particularly toe, depth than shallow footprints. The highlighted difference between ‘shallow’ and ‘deep’ footprints clearly emphasizes the need to understand variation in foot mechanics across different degrees of substrate compliance. Overall, our results indicate that extreme caution is required when applying the ‘depth equals pressure’ paradigm to hominin footprints, and by extension, those of other extant and extinct tetrapods. PMID:23516064

Studies of experimental hosiery in diabetic neuropathic patients with high foot pressures.

PubMed

Veves, A; Masson, E A; Fernando, D J; Boulton, A J

1990-05-01

High plantar pressures and painless trauma are associated with the development of foot ulcers in diabetic patients. Padded hosiery has been reported to reduce plantar pressures in patients at risk of ulceration. Using the optical pedobarograph we have studied 10 patients who regularly wore experimental padded hosiery for 6 months. The hosiery continued to provide substantial and significant reduction in peak forefoot pressures at 3 months (mean reduction 15.5%, p less than 0.01) and 6 months (17.6%, p less than 0.01), although the level of reduction was less than that seen at baseline (31.3%, p less than 0.05). In addition, commercially available hosiery designed as sportswear has been tested, and compared with experimental hosiery. Although these socks (with high or medium density padding) provided significant pressure reduction versus barefoot (mean 17.4% and 10.4%, p less than 0.01), this was not as great as that seen with experimental hosiery (27%, p less than 0.05). Thus the use of socks designed to reduce pressure stress on diabetic neuropathic feet is effective, and continues to be so for a considerable period of time. Commercially available sports socks may also have a place in the management of the diabetic insensitive foot.

Experimental and model-based analysis of differences in perception of cutaneous electrical stimulation across the sole of the foot.

PubMed

Frahm, Ken Steffen; Mørch, Carsten Dahl; Grill, Warren M; Andersen, Ole Kæseler

2013-09-01

During electrocutaneous stimulations, variation in skin properties across locations can lead to differences in neural activation. However, little focus has been given to the effect of different skin thicknesses on neural activation. Electrical stimulation was applied to six sites across the sole of the foot. The intensities used were two and four times perception threshold. The subjects (n = 8) rated the perception quality and intensity using the McGill Pain Questionnaire and a visual analog scale (VAS). A finite element model was developed and combined with the activation function (AF) to estimate neural activation. Electrical stimulation was perceived as significantly less sharp at the heel compared to all other sites, except one site in the forefoot (logistic regression, p < 0.05). The VAS scores were significantly higher in the arch than at the heel (RM ANOVA, p < 0.05). The model showed that the AF was between 91 and 231 % higher at the five other sites than at the heel. The differences in perception across the sole of the foot indicated that the CNS received different inputs depending on the stimulus site. The lower AF at the heel indicated that the skin thicknesses could contribute to the perceived differences.

Age-related differences in women's foot shape.

PubMed

Ansuategui Echeita, Jone; Hijmans, Juha M; Smits, Sharon; Van der Woude, Lucas H V; Postema, Klaas

2016-12-01

Describe age-related differences in women's foot shape using a wide range of measurements and ages. Cross-sectional, observational study. Six foot-shape measurements of each foot: foot lengths, ball widths, ball circumferences, low instep circumferences, high instep circumferences, and heel instep circumference. 168 women from 20 to over 80 years of age, divided into seven age categories, were included. Older women had significantly greater foot-shape measurements, even after adjusting for Body Mass Index. Ball widths increased 3.1-4.0mm per decade, ball circumferences 5.6-7.4mm per decade, high instep circumferences 0.4-4.8mm per decade, and heel instep circumferences 1.8-1.9mm per decade. Ball widths, ball circumferences, and left high instep circumference plateaued in the 70-75 years-of-age category, and decreased in the oldest age category. For low instep circumference, age did not prevail significantly over Body Mass Index. Foot length was not associated with age. This study described women's progressive foot-shape changes with age. The findings provide a better understanding of foot-shape changes, mainly found in the forefoot. It demonstrates that for a good fit, shoe design for older adults and for younger adults should differ. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Development of a finite element model of female foot for high-heeled shoe design.

PubMed

Yu, Jia; Cheung, Jason Tak-Man; Fan, Yubo; Zhang, Yan; Leung, Aaron Kam-Lun; Zhang, Ming

2008-01-01

Wearing high-heeled shoes may produce deleterious effects on the musculoskeletal system while elevation of the shoe heel with arch insole insert is used as a treatment strategy for plantar fasciitis. Due to limitations of the experimental approaches, direct measurements of internal stress/strain of the foot are impossible or invasive. This study aims at developing a finite element model for evaluating the biomechanical effects of high-heeled support on the ankle-foot complex. A 3D anatomically detailed FE model of the female foot and ankle together with a high-heeled support was developed and used to investigate the plantar contact pressure and internal loading responses of the bony and soft tissue structures of the foot with varying heel heights during simulated balanced standing. In the balanced standing position with high-heeled support, a pronounced increase in von Mises stress at the first metatarsophalangeal (MTP) joint was predicted. The strain on plantar fascia decreased compared to the flat horizontal support and valgus deformity of the hallux was not significant. The increased stress in forefoot especially at the first MTP segment during prolonged high-heeled standing may contribute to progressive hallux valgus (HV) deformity. However, the reduced tensile strain in the plantar fascia with heel elevation may help relieve plantar fasciitis related pain and inflammation.

Effect of using poles on foot-ground kinetics during stance phase in trail running.

PubMed

Daviaux, Yannick; Hintzy, Frédérique; Samozino, Pierre; Horvais, Nicolas

2013-01-01

The aim of this study was to investigate the effect of using poles on foot-ground interaction during trail running with slopes of varying incline. Ten runners ran on a loop track representative of a trail running field situation with uphill (+9°), level and downhill (-6°) sections at fixed speed (3.2 m.s(-1)). Experimental conditions included running with (WP) and without (NP) the use of poles for each of the three slopes. Several quantitative and temporal foot-ground interaction parameters were calculated from plantar pressure data measured with a portable device. Using poles induced a decrease in plantar pressure intensity even when the running velocity stayed constant. However, the localisation and the magnitude of this decrease depended on the slope situations. During WP level running, regional analysis of the foot highlighted a decrease of the force time integral (FTI) for absolute (FTIabs; -12.6%; P<0.05) and relative values (FTIrel; -14.3%; P<0.05) in the medial forefoot region. FTIabs (-14.2%; P<0.05) and duration of force application (Δt; -13.5%; P<0.05) also decreased in the medial heel region when WP downhill running. These results support a facilitating effect of pole use for propulsion during level running and for the absorption phase during downhill running.

Frontal plane multi-segment foot kinematics in high- and low-arched females during dynamic loading tasks.

PubMed

Powell, Douglas W; Long, Benjamin; Milner, Clare E; Zhang, Songning

2011-02-01

The functions of the medial longitudinal arch have been the focus of much research in recent years. Several studies have shown kinematic differences between high- and low-arched runners. No literature currently compares the inter-segmental foot motion of high- and low-arched recreational athletes. The purpose of this study was to examine inter-segmental foot motion in the frontal plane during dynamic loading activities in high- and low-arched female athletes. Inter-segmental foot motions were examined in 10 high- and 10 low-arched female recreational athletes. Subjects performed five barefooted trials in each of the following randomized movements: walking, running, downward stepping and landing. Three-dimensional kinematic data were recorded. High-arched athletes had smaller peak ankle eversion angles in walking, running and downward stepping than low-arched athletes. At the rear-midfoot joint high-arched athletes reached peak eversion later in walking and downward stepping than the low-arched athletes. The high-arched athletes had smaller peak mid-forefoot eversion angles in walking, running and downward stepping than the low-arched athletes. The current findings show that differences in foot kinematics between the high- and low-arched athletes were in position and not range of motion within the foot. Copyright © 2010 Elsevier B.V. All rights reserved.

A mechanical model of metatarsal stress fracture during distance running.

PubMed

Gross, T S; Bunch, R P

1989-01-01

A model of metatarsal mechanics has been proposed as a link between the high incidence of second and third metatarsal stress fractures and the large stresses measured beneath the second and third metatarsal heads during distance running. Eight discrete piezoelectric vertical stress transducers were used to record the forefoot stresses of 21 male distance runners. Based upon load bearing area estimates derived from footprints, plantar forces were estimated. Highest force was estimated beneath the second and first metatarsal head (341.1 N and 279.1 N, respectively). Considering the toe as a hinged cantilever and the metatarsal as a proximally attached rigid cantilever allowed estimation of metatarsal midshaft bending strain, shear, and axial forces. Bending strain was estimated to be greatest in the second metatarsal (6662 mu epsilon), a value 6.9 times greater than estimated first metatarsal strain. Predicted third, fourth, and fifth metatarsal strains ranged between 4832 and 5241 mu epsilon. Shear force estimates were also greatest in the second metatarsal (203.0 N). Axial forces were highest in the first metatarsal (593.2 N) due to large hallux forces in relationship to the remaining toes. Although a first order model, these data highlight the structural demands placed upon the second metatarsal, a location of high metatarsal stress fracture incidence during distance running.

Foot-strike pattern and performance in a marathon.

PubMed

Kasmer, Mark E; Liu, Xue-Cheng; Roberts, Kyle G; Valadao, Jason M

2013-05-01

To determine prevalence of heel strike in a midsize city marathon, if there is an association between foot-strike classification and race performance, and if there is an association between foot-strike classification and gender. Foot-strike classification (forefoot, midfoot, heel, or split strike), gender, and rank (position in race) were recorded at the 8.1-km mark for 2112 runners at the 2011 Milwaukee Lakefront Marathon. 1991 runners were classified by foot-strike pattern, revealing a heel-strike prevalence of 93.67% (n = 1865). A significant difference between foot-strike classification and performance was found using a Kruskal-Wallis test (P < .0001), with more elite performers being less likely to heel strike. No significant difference between foot-strike classification and gender was found using a Fisher exact test. In addition, subgroup analysis of the 126 non-heel strikers found no significant difference between shoe wear and performance using a Kruskal-Wallis test. The high prevalence of heel striking observed in this study reflects the foot-strike pattern of most mid-distance to long-distance runners and, more important, may predict their injury profile based on the biomechanics of a heel-strike running pattern. This knowledge can help clinicians appropriately diagnose, manage, and train modifications of injured runners.

Fatigue testing of energy storing prosthetic feet.

PubMed

Toh, S L; Goh, J C; Tan, P H; Tay, T E

1993-12-01

This paper describes a simple approach to the fatigue testing of prosthetic feet. A fatigue testing machine for prosthetic feet was designed as part of the programme to develop an energy storing prosthetic foot (ESPF). The fatigue tester does not simulate the loading pattern on the foot during normal walking. However, cyclic vertical loads are applied to the heel and forefoot during heel-strike and toe-off respectively, for 500,000 cycles. The maximum load applied was chosen to be 1.5 times that applied by the bodyweight of the amputee and the test frequency was chosen to be 2 Hz to shorten the test duration. Four prosthetic feet were tested: two Lambda feet (a newly developed ESPF), a Kingsley SACH foot and a Proteor SACH foot. It was found that the Lambda feet have very good fatigue properties. The Kingsley SACH foot performed better than the Proteor model, with no signs of wear at the heel. The results obtained using the simple approach was found to be comparable to the results from more complex fatigue machines which simulate the load pattern during normal walking. This suggests that simple load simulating machines, which are less costly and require less maintenance, are useful substitutes in studying the fatigue properties of prosthetic feet.

Foot pressure analysis of gait pattern in older Japanese females requiring different personal care support levels.

PubMed

Takayanagi, Naoto; Sudo, Motoki; Fujii, Masahiko; Sakai, Hirokazu; Morimoto, Keiko; Tomisaki, Masumi; Niki, Yoshifumi; Tokimitsu, Ichiro

2018-03-01

[Purpose] This study evaluated gait parameters and foot pressure in two regions of the feet among older females with different personal care support needs to analyze factors that contribute to higher support requirements. [Subjects and Methods] Thirty-two older females were divided into support-need and care-need level groups. Gait parameters (speed, cadence, step length, step width, gait angle, toe angle, double support phase, swing phase, and stance phase) and foot pressure during a 5-m walk were measured and analyzed in the two groups. [Results] The percentage of the double support phase on both feet and the right stance phase were significantly higher in the care-need level group, while that of the right swing phase was significantly lower than that of the support-need level group. Additionally, the phase showing peak pressure on the left rear foot was significantly delayed and the left forefoot pressure in the terminal stance was significantly lower in the care-need level group than in the support-need level group. [Conclusion] These findings show that the temporal duration parameters and foot pressure on a particular side were significantly different between the two groups and suggest that these differences were associated with a higher care level.

Prediction of wound healing after minor amputations of the diabetic foot.

PubMed

Caruana, Luana; Formosa, Cynthia; Cassar, Kevin

2015-08-01

To identify any significant differences in physiological test results between healing and non healing amputation sites. A single center prospective non-experimental study design was conducted on fifty subjects living with type 2 diabetes and requiring a forefoot or toe amputation. Subjects underwent non-invasive physiological testing preoperatively. These included assessment of pedal pulses, preoperative arterial spectral waveforms at the ankle, absolute toe pressures, toe-brachial pressure index and ankle-brachial pressure index. After 6 weeks, patients were examined to assess whether the amputation site was completely healed, was healing, had developed complications, or did not heal. There was no significant difference in ABPI between the healed/healing and the non-healing groups. Mean TBI (p=0.031) and toe pressure readings (p=0.014) were significantly higher in the healed/healing group compared to the non healing group. A significant difference was also found in ankle spectral waveforms between the two groups (p=0.028). TBIs, toe pressures and spectral waveforms at the ankle are better predictors of likelihood of healing and non-healing after minor amputation than ABPIs. ABPI alone is a poor indicator of the likelihood of healing of minor amputations and should not be relied on to determine need for revascularization procedures before minor amputation. Copyright © 2015 Elsevier Inc. All rights reserved.

Foot strike pattern in preschool children during running: sex and shod-unshod differences.

PubMed

Latorre-Román, Pedro Á; Párraga-Montilla, Juan A; Guardia-Monteagudo, Ignacio; García-Pinillos, Felipe

2018-04-01

This study aims to determine the foot strike patterns (FSPs) and neutral support (no inversion [INV]/eversion [EVE] and no foot rotation) in preschool children, as well as to determine the influence of shod/unshod conditions and sex. A total of 1356 children aged 3-6 years (673 boys and 683 girls) participated in this study. A sagittal and frontal-plane video (240 Hz) was recorded using a high-speed camcorder to record the following variables: rearfoot strike (RFS), midfoot strike (MFS), forefoot strike (FFS), inversion/ eversion (INV/EVE) and foot rotation on initial contact. There were no between-sex significant differences in both shod and unshod conditions in RFS. In the unshod condition, there was a significant reduction (p < 0.001) of RFS prevalence in both boys (shod condition = 44.2% vs. 34.7% unshod condition) and girls (shod condition = 48.5% vs. 36.1% unshod condition). As for neutral support, there were no between-sex differences in both shod and unshod conditions or in the shod-unshod comparison. In preschool children, no between-sex differences were found in relation to prevalence of RFS and neutral support (no INV/EVE). Shod running alters FSP of running barefoot, producing a significant increase of RFS prevalence.

Joint torques and joint reaction forces during squatting with a forward or backward inclined Smith machine.

PubMed

Biscarini, Andrea; Botti, Fabio M; Pettorossi, Vito E

2013-02-01

We developed a biomechanical model to determine the joint torques and loadings during squatting with a backward/forward-inclined Smith machine. The Smith squat allows a large variety of body positioning (trunk tilt, foot placement, combinations of joint angles) and easy control of weight distribution between forefoot and heel. These distinctive aspects of the exercise can be managed concurrently with the equipment inclination selected to unload specific joint structures while activating specific muscle groups. A backward (forward) equipment inclination decreases (increases) knee torque, and compressive tibiofemoral and patellofemoral forces, while enhances (depresses) hip and lumbosacral torques. For small knee flexion angles, the strain-force on the posterior cruciate ligament increases (decreases) with a backward (forward) equipment inclination, whereas for large knee flexion angles, this behavior is reversed. In the 0 to 60 degree range of knee flexion angles, loads on both cruciate ligaments may be simultaneously suppressed by a 30 degree backward equipment inclination and selecting, for each value of the knee angle, specific pairs of ankle and hip angles. The anterior cruciate ligament is safely maintained unloaded by squatting with backward equipment inclination and uniform/forward foot weight distribution. The conditions for the development of anterior cruciate ligament strain forces are clearly explained.

Biomechanical evaluation of heel elevation on load transfer — experimental measurement and finite element analysis

NASA Astrophysics Data System (ADS)

Luximon, Yan; Luximon, Ameersing; Yu, Jia; Zhang, Ming

2012-02-01

In spite of ill-effects of high heel shoes, they are widely used for women. Hence, it is essential to understand the load transfer biomechanics in order to design better fit and comfortable shoes. In this study, both experimental measurement and finite element analysis were used to evaluate the biomechanical effects of heel height on foot load transfer. A controlled experiment was conducted using custom-designed platforms. Under different weight-bearing conditions, peak plantar pressure, contact area and center of pressure were analyzed. A three-dimensional finite element foot model was used to simulate the high-heel support and to predict the internal stress distributions and deformations for different heel heights. Results from both experiment and model indicated that heel elevations had significant effects on all variables. When heel elevation increased, the center of pressure shifted from the midfoot region to the forefoot region, the contact area was reduced by 26% from 0 to 10.2 cm heel and the internal stress of foot bones increased. Prediction results also showed that the strain and total tension force of plantar fascia was minimum at 5.1 cm heel condition. This study helps to better understand the biomechanical behavior of foot, and to provide better suggestions for design parameters of high heeled shoes.

First metatarsophalangeal joint arthrodesis: an evaluation of hardware failure.

PubMed

Bennett, Gordon L; Kay, David B; Sabatta, James

2005-08-01

First metatarsophalangeal joint (MTPJ) arthrodesis is commonly used for the treatment of a variety of conditions affecting the hallux. We used a method incorporating a ball-and-cup preparation of the first metatarsal and proximal phalanx, followed by fixation of the arthrodesis with a lag screw and a dorsal plate (Synthes Modular Hand Set). Ninety-five consecutive patients had first MTPJ arthrodesis using fixation with the Synthes Modular Hand Set. All patients were evaluated preoperatively, at regular intervals postoperatively, and at final followup. The American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scoring system was used preoperatively and at final followup. Solid fusion occurred in 93 of 107 feet (86.9%). In the 14 that did not fuse, either the screws or plate, or both, broke. Ten of the 14 feet were symptomatic, but only three required further operative treatment. There were no hardware problems or failures in patients who had solid fusions. Preoperative AOFAS scores were improved after surgery in all patients. A solid first MTPJ fusion results in excellent function and pain relief, but the Synthes Modular Hand Set implants do not appear to be strong enough in all patients for this application; nonunion at the arthrodesis site and failure of hardware occurred in 13% of arthrodeses. We no longer recommend this implant for this application.

The influence of muscle fatigue on electromyogram and plantar pressure patterns as an explanation for the incidence of metatarsal stress fractures.

PubMed

Weist, Roger; Eils, Eric; Rosenbaum, Dieter

2004-12-01

Stress fractures are common overuse injuries in runners and appear most frequently in the metatarsals. To investigate fatigue-related changes in surface electromyographic activity patterns and plantar pressure patterns during treadmill running as potential causative factors for metatarsal stress fractures. Prospective cohort study with repeated measurements. Thirty experienced runners volunteered to participate in a maximally exhaustive run above the anaerobic threshold. Surface electromyographic activity was monitored for 14 muscles, and plantar pressures were measured using an in-shoe monitoring system. Fatigue was documented with blood lactate measurements. The results demonstrated an increased maximal force (5%, P < .01), peak pressure (12%, P < .001), and impulse (9%, P < .01) under the second and third metatarsal head and under the medial midfoot (force = 7%, P < .05; pressure = 6%, P < .05; impulse = 17%, P < .01) toward the end of the fatiguing run. Contact area and contact time were only slightly affected. The mean electromyographic activity was significantly reduced in the medial gastrocnemius (-9%, P < .01), lateral gastrocnemius (-12%, P < .01), and soleus (-9%, P < .001) muscles. The demonstrated alteration of the rollover process with an increased forefoot loading may help to explain the incidence of stress fractures of the metatarsals under fatiguing loading conditions.

Plantar Pressures During Long Distance Running: An Investigation of 10 Marathon Runners

PubMed Central

Hohmann, Erik; Reaburn, Peter; Tetsworth, Kevin; Imhoff, Andreas

2016-01-01

The objective of this study was to record plantar pressures using an in-shoe measuring system before, during, and after a marathon run in ten experienced long-distance runners with a mean age of 37.7 ± 11.5 years. Peak and mean plantar pressures were recorded before, after, and every three km during a marathon race. There were no significant changes over time in peak and mean plantar pressures for either the dominant or non-dominant foot. There were significant between foot peak and mean plantar pressure differences for the total foot (p = 0.0001), forefoot (p = 0.0001), midfoot (p = 0.02 resp. p = 0.006), hindfoot (p = 0.0001), first ray (p = 0.01 resp. p = 0.0001) and MTP (p = 0.05 resp. p = 0.0001). Long-distance runners do not demonstrate significant changes in mean or peak plantar foot pressures over the distance of a marathon race. However, athletes consistently favoured their dominant extremity, applying significantly higher plantar pressures through their dominant foot over the entire marathon distance. Key points Fatigue does not increase foot pressures Every runner has a dominant foot where pressures are higher and that he/she favours Foot pressures do not increase over the distance of a marathon run PMID:27274662

Management of idiopathic and nonidiopathic flatfoot.

PubMed

Frances, Jenny M; Feldman, David S

2015-01-01

Flatfoot in a child may be normal before development of the arch, but the prevalence decreases with age. Treatment is indicated only in the presence of pain and should begin with nonsurgical management options such as stretching of the Achilles tendon and the use of soft shoe orthotics. If pain persists, a modified Evans procedure, together with additional procedures to address forefoot supination, can be successful in correcting deformity and addressing pain. A thorough understanding of the pathology and correction desired will help minimize complications and recurrence. If neuromuscular pathology is present, treatment principles are altered and greatly depend on the severity of the deformity, the association of tibialis posterior spasticity, and ambulatory status. In mild to moderate pathology in walking patients with cerebral palsy, osteotomies can be successful. Various forms of arthrodesis can decrease recurrence when the deformity is severe in a nonambulatory patient with cerebral palsy and a symptomatic valgus foot deformity. In cases of collagen disorders, where soft-tissue laxity complicates management, deformity correction may be of higher importance. Overall alignment always should be evaluated and corrected when necessary to optimize the outcome in patients with valgus foot deformities. The successful treatment of flexible or rigid flatfoot deformity must take into account underlying pathology to optimize outcomes.

The effect of age and speed on foot and ankle kinematics assessed using a 4-segment foot model.

PubMed

van Hoeve, Sander; Leenstra, Bernard; Willems, Paul; Poeze, Martijn; Meijer, Kenneth

2017-09-01

The effects of age and speed on foot and ankle kinematics in gait studies using foot models are not fully understood, whereas this can have significant influence. We analyzed these variables with the 4-segment Oxford foot model. Twenty-one healthy subjects (aged 20-65 years) were recruited for gait analysis. The effect of speed on foot and ankle kinematics was assessed by comparing results during slow walking and fast walking. To assess the effect of age, a group of 13 healthy young adults (aged 20-24 years) were compared with a group of 8 older adults (aged 53-65 years). Also, the interaction between age and speed was analyzed. Regarding speed, there was a significant difference between forefoot/hindfoot motion in the sagittal plane (flexion/extension) during both loading- and push-off phase (P = .004, P < .001). Between hindfoot/tibia, there was a significant difference for all parameters except for motion in the sagittal plane (flexion/extension) during push-off phase (P = .5). Age did not significantly influence kinematics. There was no interaction between age and speed. Our analysis found that speed significantly influenced the kinematic outcome parameters. This was more pronounced in the ankle joint. In contrast, no significant differences were found between younger and older healthy subjects.

Transfer of the second to the first metatarsal ray in a case of lawn mower injury: a case report.

PubMed

Sassu, Paolo; Tsai, Tsu Min

2009-01-01

The medial longitudinal arch of the foot plays a major role for a physiologic transfer of the load from the heel to the forefoot during walking and running. Traumatic amputation that involve either the great toe or the whole first metatarsal bone can lead to collapse of the medial longitudinal arch, overload of the metatarsal heads, and painful callus formation. If replant of the amputated part is not possible or has failed, it is advisable to reconstruct the medial longitudinal arch in order to re-establish a functional transfer of the load in the foot. We present a case of a young lady who suffered from traumatic amputation at the distal third of the first metatarsal. Replantation failed due to the severity of the initial injury. Despite a good coverage of the defect with a lateral arm flap, the patient developed a painful plantar callus underneath the amputated stump. The adjacent second metatarsal ray was then raised as a pedicled flap including bone and soft tissues and transferred to the first ray in order to reconstruct a physiologic medial longitudinal arch. The patient had excellent functional results with no recurrence of the callus. (c) 2008 Wiley-Liss, Inc.

A novel magnet based 3D printed marker wand as basis for repeated in-shoe multi segment foot analysis: a proof of concept.

PubMed

Eerdekens, Maarten; Staes, Filip; Pilkington, Thomas; Deschamps, Kevin

2017-01-01

Application of in-shoe multi-segment foot kinematic analyses currently faces a number of challenges, including: (i) the difficulty to apply regular markers onto the skin, (ii) the necessity for an adequate shoe which fits various foot morphologies and (iii) the need for adequate repeatability throughout a repeated measure condition. The aim of this study therefore was to design novel magnet based 3D printed markers for repeated in-shoe measurements while using accordingly adapted modified shoes for a specific multi-segment foot model. Multi-segment foot kinematics of ten participants were recorded and kinematics of hindfoot, midfoot and forefoot were calculated. Dynamic trials were conducted to check for intra and inter-session repeatability when combining novel markers and modified shoes in a repeated measures design. Intraclass correlation coefficients were calculated to determine reliability. Both repeatability and reliability were proven to be good to excellent with maximum joint angle deviations of 1.11° for intra-session variability and 1.29° for same-day inter-session variability respectively and ICC values of >0.91. The novel markers can be reliably used in future research settings using in-shoe multi-segment foot kinematic analyses with multiple shod conditions.

Acute effect of different minimalist shoes on foot strike pattern and kinematics in rearfoot strikers during running.

PubMed

Squadrone, Roberto; Rodano, Renato; Hamill, Joseph; Preatoni, Ezio

2015-01-01

Despite the growing interest in minimalist shoes, no studies have compared the efficacy of different types of minimalist shoe models in reproducing barefoot running patterns and in eliciting biomechanical changes that make them differ from standard cushioned running shoes. The aim of this study was to investigate the acute effects of different footwear models, marketed as "minimalist" by their manufacturer, on running biomechanics. Six running shoes marketed as barefoot/minimalist models, a standard cushioned shoe and the barefoot condition were tested. Foot-/shoe-ground pressure and three-dimensional lower limb kinematics were measured in experienced rearfoot strike runners while they were running at 3.33 m · s⁻¹ on an instrumented treadmill. Physical and mechanical characteristics of shoes (mass, heel and forefoot sole thickness, shock absorption and flexibility) were measured with laboratory tests. There were significant changes in foot strike pattern (described by the strike index and foot contact angle) and spatio-temporal stride characteristics, whereas only some among the other selected kinematic parameters (i.e. knee angles and hip vertical displacement) changed accordingly. Different types of minimalist footwear models induced different changes. It appears that minimalist footwear with lower heel heights and minimal shock absorption is more effective in replicating barefoot running.

Modifying landing mat material properties may decrease peak contact forces but increase forefoot forces in gymnastics landings.

PubMed

Mills, Chris; Yeadon, Maurice R; Pain, Matthew T G

2010-09-01

This study investigated how changes in the material properties of a landing mat could minimise ground reaction forces (GRF) and internal loading on a gymnast during landing. A multi-layer model of a gymnastics competition landing mat and a subject-specific seven-link wobbling mass model of a gymnast were developed to address this aim. Landing mat properties (stiffness and damping) were optimised using a Simplex algorithm to minimise GRF and internal loading. The optimisation of the landing mat parameters was characterised by minimal changes to the mat's stiffness (<0.5%) but increased damping (272%) compared to the competition landing mat. Changes to the landing mat resulted in reduced peak vertical and horizontal GRF and reduced bone bending moments in the shank and thigh compared to a matching simulation. Peak bone bending moments within the thigh and shank were reduced by 6% from 321.5 Nm to 302.5Nm and GRF by 12% from 8626 N to 7552 N when compared to a matching simulation. The reduction in these forces may help to reduce the risk of bone fracture injury associated with a single landing and reduce the risk of a chronic injury such as a stress fracture.

Clinical Usage of an Extracellular, Collagen-rich Matrix: A Case Series.

PubMed

AbouIssa, Abdelfatah; Mari, Walid; Simman, Richard

2015-11-01

OASIS Ultra (Smith and Nephew, St. Petersburg, FL) is an extracellular, collagen-rich matrix derived from submucosa of porcine intestine. It is composed of collagen type I, glycosaminoglycan, and proteoglycans. This extracellular matrix (ECM) differs from the single layer in thickness and offers ease of handling and application. It also stimulates cell migration and structural support, provides moisture environment, decreases inflammation, and induces cell proliferation and cellular attachments. In this case series, the authors present their experience with this product in various clinical scenarios. The authors used the product in a variety of wounds with different etiologies to test the clinical outcome of the ECM. This was an observational case series with prospective review of 6 different patients with different types of wounds who received treatment with the ECM during their treatment. The product was applied on the following types of wounds: chronic venous ulcer, nonhealing Achilles tendon vasculitic wound, Marjolin's ulcer, posttraumatic wound, stage IV sacral-coccygeal pressure wound, and complicated transmetatarsal amputation of gangrenous left forefoot diabetic wound. All of these wounds healed within the expected time periods and without complications. In general, healing was achieved in 4-16 weeks using 1-12 applications of the ECM. Wounds with different etiologies were successfully treated with an extracellular, collagen-rich matrix. By replacing the lost ECM to guide cellular growth and migration, this product did ultimately hasten the healing process.

Changes in muscle cross-sectional area, muscle force, and jump performance during 6 weeks of progressive whole-body vibration combined with progressive, high intensity resistance training

PubMed Central

Rosenberger, A.; Beijer, Å.; Johannes, B.; Schoenau, E.; Mester, J.; Rittweger, J.; Zange, J.

2017-01-01

Objectives: We hypothesized that progressive whole-body vibration (WBV) superimposed to progressive high intensity resistance training has greater effects on muscle cross-sectional area (CSA), muscle force of leg muscles, and jump performance than progressive high intensity resistance training alone. Methods: Two groups of healthy male subjects performed either 6 weeks of Resistive Vibration Exercise (RVE, squats and heel raises with WBV, n=13) or Resistive Exercise (RE, squats and heel raises without WBV, n=13). Squats under RVE required indispensable weight loading on the forefoot to damp harmful vibrations to the head. Time, intervention, and interaction effects were analyzed. Results: After 6 weeks of training, knee extensor CSA, isometric knee extension force, and counter movement jump height increased equally in both groups (time effect, P<0.001, P≤0.02, and P≤0.03, respectively), whereas only in RVE ankle plantar flexor CSA and isometric ankle plantar flexion force reached significance or a tendency, respectively, (time effect, P=0.015 and P=0.069, respectively; intervention effect also for the latter, P=0.006). Drop jump contact time did significantly more improve in RVE (interaction effect, P=0.042). Conclusions: RVE showed better training effects than RE only in plantar flexor muscles. RVE seems to be suitable in professional sports with a special focus on calf muscles. PMID:28574410

Basketball lay-up - foot loading characteristics and the number of trials necessary to obtain stable plantar pressure variables.

PubMed

Chua, YaoHui K; Quek, Raymond K K; Kong, Pui W

2017-03-01

This study aimed (1) to profile the plantar loading characteristics when performing the basketball lay-up in a realistic setting and (2) to determine the number of trials necessary to establish a stable mean for plantar loading variables during the lay-up. Thirteen university male basketball players [age: 23.0 (1.4) years, height: 1.75 (0.05) m, mass: 68.4 (8.6) kg] performed ten successful basketball lay-ups from a stationary position. Plantar loading variables were recorded using the Novel Pedar-X in-shoe system. Loading variables including peak force, peak pressure, and pressure-time integral were extracted from eight foot regions. Performance stability of plantar loading variables during the take-off and landing steps were assessed using the sequential averaging technique and intra-class correlation coefficient (ICC). High plantar loadings were experienced at the heel during the take-off steps, and both the heel and forefoot regions upon landing. The sequential estimation technique revealed a five-eight trial range to achieve a stable mean across all plantar loading variables, whereas ICC analysis was insensitive to inter-trial differences of repeated lay-up performances. Future studies and performance evaluation protocols on plantar loading during basketball lay-ups should include at least eight trials to ensure that the measurements obtained are sufficiently stable.

Kinematic and kinetic analyses of the toes in dance movements.

PubMed

Jarvis, Danielle N; Kulig, Kornelia

2016-09-01

Due to the significant amount of time dancers spend on the forefoot, loads on the metatarsophalangeal joints are likely high, yet vary between dance movements. The purpose of this study was to compare joint motion and net joint moments at the metatarsophalangeal joints during three different dance movements ranging in demands at the foot and ankle joints. Ten healthy, female dancers (27.6 ± 3.2 years; 56.3 ± 6.9 kg; 1.6 ± 0.1 m) with an average 21.7 ± 4.9 years of dance training performed relevés (rising up onto the toes), sautés (vertical bipedal jumps), and saut de chat leaps (split jumps involving both vertical and horizontal components). Metatarsophalangeal joint kinematics and kinetics in the sagittal plane were calculated. Total excursion and peak net joint moments during rising or push-off were compared between the three dance movements. Greater extension of the metatarsophalangeal joints was seen during relevés compared to sautés or saut de chat leaps, and the largest metatarsophalangeal net joint moments were seen during saut de chat leaps. The metatarsophalangeal joints frequently and repetitively manage external loads and substantial metatarsophalangeal extension during these three dance movements, which may contribute to the high rate of foot and ankle injuries in dancers.

The effect of age and speed on foot and ankle kinematics assessed using a 4-segment foot model

PubMed Central

van Hoeve, Sander; Leenstra, Bernard; Willems, Paul; Poeze, Martijn; Meijer, Kenneth

2017-01-01

Abstract Background: The effects of age and speed on foot and ankle kinematics in gait studies using foot models are not fully understood, whereas this can have significant influence. We analyzed these variables with the 4-segment Oxford foot model. Methods: Twenty-one healthy subjects (aged 20–65 years) were recruited for gait analysis. The effect of speed on foot and ankle kinematics was assessed by comparing results during slow walking and fast walking. To assess the effect of age, a group of 13 healthy young adults (aged 20–24 years) were compared with a group of 8 older adults (aged 53–65 years). Also, the interaction between age and speed was analyzed. Results: Regarding speed, there was a significant difference between forefoot/hindfoot motion in the sagittal plane (flexion/extension) during both loading- and push-off phase (P = .004, P < .001). Between hindfoot/tibia, there was a significant difference for all parameters except for motion in the sagittal plane (flexion/extension) during push-off phase (P = .5). Age did not significantly influence kinematics. There was no interaction between age and speed. Conclusion: Our analysis found that speed significantly influenced the kinematic outcome parameters. This was more pronounced in the ankle joint. In contrast, no significant differences were found between younger and older healthy subjects. PMID:28858109

An on-ice measurement approach to analyse the biomechanics of ice hockey skating.

PubMed

Buckeridge, Erica; LeVangie, Marc C; Stetter, Bernd; Nigg, Sandro R; Nigg, Benno M

2015-01-01

Skating is a fundamental movement in ice hockey; however little research has been conducted within the field of hockey skating biomechanics due to the difficulties of on-ice data collection. In this study a novel on-ice measurement approach was tested for reliability, and subsequently implemented to investigate the forward skating technique, as well as technique differences across skill levels. Nine high caliber (High) and nine low caliber (Low) hockey players performed 30 m forward skating trials. A 3D accelerometer was mounted to the right skate for the purpose of stride detection, with the 2nd and 6th strides defined as acceleration and steady-state, respectively. The activity of five lower extremity muscles was recorded using surface electromyography. Biaxial electro-goniometers were used to quantify hip and knee angles, and in-skate plantar force was measured using instrumented insoles. Reliability was assessed with the coefficient of multiple correlation, which demonstrated moderate (r>0.65) to excellent (r>0.95) scores across selected measured variables. Greater plantar-flexor muscle activity and hip extension were evident during acceleration strides, while steady state strides exhibited greater knee extensor activity and hip abduction range of motion (p<0.05). High caliber exhibited greater hip range of motion and forefoot force application (p<0.05). The successful implementation of this on-ice mobile measurement approach offers potential for athlete monitoring, biofeedback and training advice.

Immediate effects of modified landing pattern on a probabilistic tibial stress fracture model in runners.

PubMed

Chen, T L; An, W W; Chan, Z Y S; Au, I P H; Zhang, Z H; Cheung, R T H

2016-03-01

Tibial stress fracture is a common injury in runners. This condition has been associated with increased impact loading. Since vertical loading rates are related to the landing pattern, many heelstrike runners attempt to modify their footfalls for a lower risk of tibial stress fracture. Such effect of modified landing pattern remains unknown. This study examined the immediate effects of landing pattern modification on the probability of tibial stress fracture. Fourteen experienced heelstrike runners ran on an instrumented treadmill and they were given augmented feedback for landing pattern switch. We measured their running kinematics and kinetics during different landing patterns. Ankle joint contact force and peak tibial strains were estimated using computational models. We used an established mathematical model to determine the effect of landing pattern on stress fracture probability. Heelstrike runners experienced greater impact loading immediately after landing pattern switch (P<0.004). There was an increase in the longitudinal ankle joint contact force when they landed with forefoot (P=0.003). However, there was no significant difference in both peak tibial strains and the risk of tibial stress fracture in runners with different landing patterns (P>0.986). Immediate transitioning of the landing pattern in heelstrike runners may not offer timely protection against tibial stress fracture, despite a reduction of impact loading. Long-term effects of landing pattern switch remains unknown. Copyright © 2016 Elsevier Ltd. All rights reserved.

Kinematic repeatability of a multi-segment foot model for dance.

PubMed

Carter, Sarah L; Sato, Nahoko; Hopper, Luke S

2018-03-01

The purpose of this study was to determine the intra and inter-assessor repeatability of a modified Rizzoli Foot Model for analysing the foot kinematics of ballet dancers. Six university-level ballet dancers performed the movements; parallel stance, turnout plié, turnout stance, turnout rise and flex-point-flex. The three-dimensional (3D) position of individual reflective markers and marker triads was used to model the movement of the dancers' tibia, entire foot, hindfoot, midfoot, forefoot and hallux. Intra and inter-assessor reliability demonstrated excellent (ICC ≥ 0.75) repeatability for the first metatarsophalangeal joint in the sagittal plane. Intra-assessor reliability demonstrated excellent (ICC ≥ 0.75) repeatability during flex-point-flex across all inter-segmental angles except for the tibia-hindfoot and hindfoot-midfoot frontal planes. Inter-assessor repeatability ranged from poor to excellent (0.5 > ICC ≥ 0.75) for the 3D segment rotations. The most repeatable measure was the tibia-foot dorsiflexion/plantar flexion articulation whereas the least repeatable measure was the hindfoot-midfoot adduction/abduction articulation. The variation found in the inter-assessor results is likely due to inconsistencies in marker placement. This 3D dance specific multi-segment foot model provides insight into which kinematic measures can be reliably used to ascertain in vivo technical errors and/or biomechanical abnormalities in a dancer's foot motion.

Therapeutic footwear can reduce plantar pressures in patients with diabetes and transmetatarsal amputation.

PubMed

Mueller, M J; Strube, M J; Allen, B T

1997-04-01

To compare how footwear (full-length shoe or short shoe), a total contact insert, a rigid rocker-bottom (RRB) sole, and an ankle-foot orthosis (AFO) affect peak plantar pressure (PPP) on the distal residuum and contralateral extremity of patients with diabetes and transmetatarsal amputation (TMA). Thirty patients with diabetes and TMA participated (mean age 62 +/- 4 years). In-shoe plantar pressures during walking were measured in six types of footwear. Each measurement occurred after a 1-month adjustment period. Repeated measure analysis of variance (ANOVA) was used to compare treatments. All five types of therapeutic footwear reduced plantar pressures compared with regular shoes with a toe-filler (P < 0.05). A full-length shoe, total contact insert, and RRB sole resulted in lower pressures on the distal residuum (222 vs. 284 kPa) and forefoot of the contralateral extremity (197 vs. 239 kPa), compared with a regular shoe and toe-filler. Footwear with an AFO showed reduced PPP on the residuum, but most patients complained of reduced ankle motion during walking. A short shoe reduced pressures on the residuum, but not on the contralateral extremity, and many patients had complaints regarding cosmesis of the shoe. The full-length shoe, total contact insert, and an RRB sole provided the best pressure reduction for the residuum and contralateral foot, with the optimal compromise for cosmetic acceptance and function.

Analysis of foot structure in athletes sustaining proximal fifth metatarsal stress fracture.

PubMed

Hetsroni, Iftach; Nyska, Meir; Ben-Sira, David; Mann, Gideon; Segal, Ofer; Maoz, Guy; Ayalon, Moshe

2010-03-01

In the past, several studies provided anecdotal descriptions of high-arched feet in individuals sustaining proximal fifth metatarsal stress fractures. This relationship has never been supported by scientific evidence. Our objective was to examine whether athletes who sustained this injury had an exceptional static foot structure or dynamic loading pattern. Ten injured professional soccer players who regained full professional activity following a unilateral proximal fifth metatarsal stress fracture and ten control soccer players were examined. Independent variables included static evaluation of foot and arch structure, followed by dynamic plantar foot pressure evaluation. Each variable was compared between injured, contra-lateral uninjured, and control feet. Static measurements of foot and arch structure did not reveal differences among the groups. However, plantar pressure evaluation revealed relative unloading of the fourth metatarsal in injured and uninjured limbs of injured athletes compared with control, while the fifth metatarsal revealed pressure reduction only in the injured limbs of injured athletes. Athletes who sustained proximal fifth metatarsal stress fracture were not characterized by an exceptional static foot structure. Dynamically, lateral metatarsal unloading during stance may either play a role in the pathogenesis of the injury, or alternately represent an adaptive process. Footwear fabrication for previously injured athletes should not categorically address cushioning properties designed for high-arch feet, but rather focus on individual dynamic evaluation of forefoot loading, with less attention applied to static foot and arch characteristics.

Plantar loading changes with alterations in foot strike patterns during a single session in habitual rear foot strike female runners.

PubMed

Kernozek, Thomas W; Vannatta, Charles N; Gheidi, Naghmeh; Kraus, Sydnie; Aminaka, Naoko

2016-03-01

Characterize plantar loading parameters when habitually rear foot strike (RFS) runners change their pattern to a non-rear foot strike (NRFS). Experimental. University biomechanics laboratory. Twenty three healthy female runners (Age: 22.17 ± 1.64 yrs; Height: 168.91 ± 5.46 cm; Mass: 64.29 ± 7.11 kg). Plantar loading was measured using an in-sole pressure sensor while running down a 20-m runway restricted to a range of 3.52-3.89 m/s under two conditions, using the runner's typical RFS, and an adapted NRFS pattern. Repeated measures multivariate analysis of variance was performed to detect differences in loading between these two conditions. Force and pressure variables were greater in the forefoot and phalanx in NRFS and greater in the heel and mid foot in RFS pattern, but the total force imposed upon the whole foot and contact time remained similar between conditions. Total peak pressure was higher and contact area was lower during NRFS running. The primary finding of this investigation is that there are distinctly different plantar loads when changing from a RFS to NRFS during running. So, during a transition from RFS to a NRFS pattern; a period of acclimation should be considered to allow for adaptations to these novel loads incurred on plantar regions of the foot. Copyright © 2015 Elsevier Ltd. All rights reserved.

Characterization of Foot-Strike Patterns: Lack of an Association With Injuries or Performance in Soldiers.

PubMed

Warr, Bradley J; Fellin, Rebecca E; Sauer, Shane G; Goss, Donald L; Frykman, Peter N; Seay, Joseph F

2015-07-01

Characterize the distribution of foot-strike (FS) patterns in U.S. Army Soldiers and determine if FS patterns are related to self-reported running injuries and performance. 341 male Soldiers from a U.S. Army Combined Arms Battalion ran at their training pace for 100 meters, and FSs were recorded in the sagittal plane. Participants also completed a survey related to training habits, injury history, and run times. Two researchers classified FS patterns as heel strike (HS) or nonheel strike (NHS, combination of midfoot strike and forefoot strike patterns). Two clinicians classified the musculoskeletal injuries as acute or overuse. The relationship of FS type with two-mile run time and running-related injury was analyzed (p ≤ 0.05). The Soldiers predominately landed with an HS (87%) and only 13% were characterized as NHS. Running-related injury was similar between HS (50.3%) and NHS (55.6%) patterns (p = 0.51). There was no difference (p = 0.14) between overuse injury rates between an HS pattern (31.8%) and an NHS pattern (31.0%). Two-mile run times were also similar, with both groups averaging 14:48 minutes. Soldiers were mostly heel strikers (87%) in this U.S. Army Combined Arms Battalion. Neither FS pattern was advantageous for increased performance or decreased incidence of running-related injury. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

Foot-strike pattern and performance in a marathon

PubMed Central

Kasmer, Mark E.; Liu, Xue-cheng; Roberts, Kyle G.; Valadao, Jason M.

2016-01-01

Purpose To: 1) determine prevalence of heel-strike in a mid-size city marathon, 2) determine if there is an association between foot-strike classification and race performance, and 3) determine if there is an association between foot-strike classification and gender. Methods Foot-strike classification (fore-foot strike, mid-foot strike, heel strike, or split-strike), gender, and rank (position in race) were recorded at the 8.1 kilometer (km) mark for 2,112 runners at the 2011 Milwaukee Lakefront Marathon. Results 1,991 runners were classified by foot-strike pattern, revealing a heel-strike prevalence of 93.67% (n=1,865). A significant difference between foot-strike classification and performance was found using a Kruskal-Wallis test (p < 0.0001), with more elite performers being less likely to heel-strike. No significant difference between foot-strike classification and gender was found using a Fisher’s exact test. Additionally, subgroup analysis of the 126 non-heel strikers found no significant difference between shoe wear and performance using a Kruskal-Wallis test. Conclusions The high prevalence of heel-striking observed in this study reflects the foot-strike pattern of the majority of mid- to long-distance runners and more importantly, may predict their injury profile based on the biomechanics of a heel strike running pattern. This knowledge can aid the clinician in the appropriate diagnosis, management, and training modifications of the injured runner. PMID:23006790

Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement

PubMed Central

Renstrom, P; Ljungqvist, A; Arendt, E; Beynnon, B; Fukubayashi, T; Garrett, W; Georgoulis, T; Hewett, T E; Johnson, R; Krosshaug, T; Mandelbaum, B; Micheli, L; Myklebust, G; Roos, E; Roos, H; Schamasch, P; Shultz, S; Werner, S; Wojtys, E; Engebretsen, L

2014-01-01

The incidence of anterior cruciate ligament (ACL) injury remains high in young athletes. Because female athletes have a much higher incidence of ACL injuries in sports such as basketball and team handball than male athletes, the IOC Medical Commission invited a multidisciplinary group of ACL expert clinicians and scientists to (1) review current evidence including data from the new Scandinavian ACL registries; (2) critically evaluate high-quality studies of injury mechanics; (3) consider the key elements of successful prevention programmes; (4) summarise clinical management including surgery and conservative management; and (5) identify areas for further research. Risk factors for female athletes suffering ACL injury include: (1) being in the preovulatory phase of the menstrual cycle compared with the postovulatory phase; (2) having decreased intercondylar notch width on plain radiography; and (3) developing increased knee abduction moment (a valgus intersegmental torque) during impact on landing. Well-designed injury prevention programmes reduce the risk of ACL for athletes, particularly women. These programmes attempt to alter dynamic loading of the tibiofemoral joint through neuromuscular and proprioceptive training. They emphasise proper landing and cutting techniques. This includes landing softly on the forefoot and rolling back to the rearfoot, engaging knee and hip flexion and, where possible, landing on two feet. Players are trained to avoid excessive dynamic valgus of the knee and to focus on the “knee over toe position” when cutting. PMID:18539658

The influence of arthritis on the anthropometric parameters of the feet of older women.

PubMed

Castro, Alessandra Paiva; Rebelatto, José Rubens; Aurichio, Thaís Rabiatti; Greve, Patrícia

2010-01-01

Age-related and arthritis-related foot modifications have been described in literature, but there is a lack of references that allow shoes to be designed on the basis of specific anthropometric measurements of older women. The aim of this study was to identify the anthropometric characteristics of the feet of elderly women with and without arthritis. This is an observational transversal study. The right and left feet of 227 older women aged between 60 and 90 years (69.6 + or - 6.8 years) were evaluated, of whom 45 reported a diagnosis of arthritis (non-osteoarthritis). The anthropometric evaluation of the feet comprised the variables of width, perimeter, height, foot length, first and fifth metatarsophalangeal angles, the arch-index and the foot posture index (FPI). The data were analyzed using the analysis of probability to compare the groups (arthritic and non-arthritic women). The differences between the means were significant in the case of the FPI and some of its criteria, such as the calcaneal frontal plane position, the bulge in the region of the talo-navicular joint and the forefoot alignment. The width of the right foot was also significantly greater in the women with arthritis. These results are preliminary findings that may help direct larger studies of foot characteristics among older adults with arthritis. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

The management of the neglected congenital foot deformity in the older child with the Taylor spatial frame.

PubMed

Hassan, Atef; Letts, Merv

2012-01-01

Neglected or inadequately treated rigid congenitally deformed feet in older children are a nightmarish challenge for the child, the parents, and the orthopaedic surgeon. Because of the multiplicity of spatial deformities exhibited by these feet and legs, it was hypothesized that correction using the Taylor spatial frame (TSF) would decrease morbidity, facilitate correction, and minimize treatment time in children from remote regions with extremely rigid deformed feet. Recent experience with the management of 11 such feet (Dimeglio type IV) in 9 children with an average age of 9.2 years using the TSF has been gratifying. Six children had associated leg length discrepancy, which was corrected by concomitant tibial lengthening. All feet underwent soft tissue releases, whereas forefoot and/or hindfoot osteotomies were performed in 7 feet. All children attained plantigrade, functional feet, and were fully ambulatory and capable of wearing normal footwear. Complications were minor consisting of pin tract infections, residual metatarsus varus in 3, and wound dehiscence in 1. There were no neurovascular events. This was attributed to the slower 3 plane correction using the TSF technique as well as the elimination of the need for plaster immobilization thus allowing direct monitoring of the foot and limb. The rigid foot deformity in the older child can be safely and effectively corrected with the aid of the TSF, which facilitates a 3 plane correction and concomitant limb lengthening.

ACQUIRED PES CAVUS IN CHARCOT-MARIE-TOOTH DISEASE.

PubMed

Maranho, Daniel Augusto; Volpon, José Batista

2009-01-01

Hereditary motor and sensory neuropathies, especially Charcot-Marie-Tooth disease, are frequently expressed with an acquired cavusvarus foot which is characterized by a fixed increase of the plantar arch and hindfoot inversion. Diagnosis of the underlying condition achieved through careful patient assessment and local evaluations is the keystone for decision-making about the adequate treatment. The cavus may present as an isolated deformity of the forefoot, hindfoot or it may be a combination of both locations. Related deformities, mainly the varus and toe clawing require appropriate evaluation; clinical characteristics such as severity of the deformity, impairment of the muscular power, flexibility and patient's age are important characteristics in the treatment decision. Conservative treatment of the cavusvarus foot with physiotherapy, insoles and shoe modifications are reserved to young patients and mild deformities. However, there is a tendency of the deformity to become more severe over time because of the progressive feature of the underlying neurological condition. So, the surgical treatment by using classical techniques is performed in early stages. Most importantly is the identification of the primary and main components of each deformity to properly correct them, if possible. Muscular transfers are used to treat the dynamic unbalance, retracted structures should be either divided or lengthened and localized osteotomies should be preferred over arthrodeses, which are reserved for stiff and severely deformed feet in adults.

An On-Ice Measurement Approach to Analyse the Biomechanics of Ice Hockey Skating

PubMed Central

Buckeridge, Erica; LeVangie, Marc C.; Stetter, Bernd; Nigg, Sandro R.; Nigg, Benno M.

2015-01-01

Skating is a fundamental movement in ice hockey; however little research has been conducted within the field of hockey skating biomechanics due to the difficulties of on-ice data collection. In this study a novel on-ice measurement approach was tested for reliability, and subsequently implemented to investigate the forward skating technique, as well as technique differences across skill levels. Nine high caliber (High) and nine low caliber (Low) hockey players performed 30m forward skating trials. A 3D accelerometer was mounted to the right skate for the purpose of stride detection, with the 2nd and 6th strides defined as acceleration and steady-state, respectively. The activity of five lower extremity muscles was recorded using surface electromyography. Biaxial electro-goniometers were used to quantify hip and knee angles, and in-skate plantar force was measured using instrumented insoles. Reliability was assessed with the coefficient of multiple correlation, which demonstrated moderate (r>0.65) to excellent (r>0.95) scores across selected measured variables. Greater plantar-flexor muscle activity and hip extension were evident during acceleration strides, while steady state strides exhibited greater knee extensor activity and hip abduction range of motion (p<0.05). High caliber exhibited greater hip range of motion and forefoot force application (p<0.05). The successful implementation of this on-ice mobile measurement approach offers potential for athlete monitoring, biofeedback and training advice. PMID:25973775

The influence of tennis court surfaces on player perceptions and biomechanical response.

PubMed

Starbuck, Chelsea; Damm, Loïc; Clarke, James; Carré, Matt; Capel-Davis, Jamie; Miller, Stuart; Stiles, Victoria; Dixon, Sharon

2016-09-01

This study aimed to examine player perceptions and biomechanical responses to tennis surfaces and to evaluate the influence of prior clay court experience. Two groups with different clay experiences (experience group, n = 5 and low-experience group, n = 5) performed a 180° turning movement. Three-dimensional ankle and knee movements (50 Hz), plantar pressure of the turning step (100 Hz) and perception data (visual analogue scale questionnaire) were collected for two tennis courts (acrylic and clay). Greater initial knee flexion (acrylic 20. 8 ± 11.2° and clay 32.5 ± 9.4°) and a more upright position were reported on the clay compared to the acrylic court (P < 0.05). This suggests adaptations to increase player stability on clay. Greater hallux pressures and lower midfoot pressures were observed on the clay court, allowing for sliding whilst providing grip at the forefoot. Players with prior clay court experience exhibited later peak knee flexion compared to those with low experience. All participants perceived the differences in surface properties between courts and thus responded appropriately to these differences. The level of previous clay court experience did not influence players' perceptions of the surfaces; however, those with greater clay court experience may reduce injury risk as a result of reduced loading through later peak knee flexion.

Investigating the role of backward walking therapy in alleviating plantar pressure of patients with diabetic peripheral neuropathy.

PubMed

Zhang, Xingguang; Zhang, Yanqi; Gao, Xiaoxiao; Wu, Jinxiao; Jiao, Xiumin; Zhao, Jing; Lv, Xiaofeng

2014-05-01

To investigate the effect of combination therapy of backward walking training and alpha-lipoic acid (ALA) treatment on the distribution of plantar pressure in patients with diabetic peripheral neuropathy (DPN). This study is a double-blinded, randomized controlled trial. The test group was treated with combination therapy of backward walking exercise and ALA (ALA for 2wk, backward walking exercise for 12wk), and the control group only received ALA treatment. Clinical and laboratory setting. Patients with DPN (N=60) were divided into the test group (n=30) or control group (n=30). Backward walking exercise with ALA treatment for the test group; lipoic acid treatment for the control group. Plantar pressure before and after treatment was tested and analyzed with the flatbed plantar pressure measurement system. After treatment, peak plantar pressure in the forefoot dropped for both the test and control groups; peak plantar pressure for the test group dropped significantly. Peak plantar pressure in the medial foot slightly increased for the test group, suggesting a more even distribution of plantar pressure in the test group after treatment. The combination therapy of ALA and backward walking proved to be more effective than ALA monotherapy. Backward walking also proved to have an ameliorating effect on balance ability and muscle strength of patients with DPN. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Retrocalcaneal bursitis but not Achilles tendinopathy is characterized by increased pressure in the retrocalcaneal bursa.

PubMed

Lohrer, Heinz; Nauck, Tanja

2014-03-01

We questioned whether different forms of Achilles tendon overuse injuries can be differentiated by retrocalcaneal bursa pressure measurement. Retrocalcaneal bursa pressure was determined by using invasive pressure measurement in patients suffering from retrocalcaneal bursitis (n=13) or Achilles tendinopathy (n=15), respectively. Standardized measurements were taken with the subject lying prone. Initially, the foot and ankle was in a spontaneous, unsupported position. Then passive dorsiflexion was induced by an increasing pressure which was applied in five defined steps against the plantar forefoot. Mean pressures found in unloaded position were 30.5 (SD 28.9) mmHg in retrocalcaneal bursitis and -9.9 (SD 17.2) mmHg in Achilles tendinopathy (p<0.001). A stepwise increase in passive ankle dorsiflexion was associated with increasing pressure values in both groups. The differences were p=0.009 to 0.035 when dorsiflexion was initiated with 10, 20, 30, and 40N, respectively. Dorsiflexion induced by 50N load resulted in a mean pressure of 113.7 (SD 124.9) mmHg for retrocalcaneal bursitis and 32.5 (SD 48.9) mmHg for Achilles tendinopathy (p=0,051). Higher retrocalcaneal bursa pressure values were found in patients suffering from chronic retrocalcaneal bursitis. This result supports the hypothesis that retrocalcaneal bursa hypertension leads to an impingement lesion of the corresponding anterior Achilles tendon. Copyright © 2013 Elsevier Ltd. All rights reserved.

Radiographic Outcomes Following Lateral Column Lengthening With a Porous Titanium Wedge.

PubMed

Gross, Christopher E; Huh, Jeannie; Gray, Joni; Demetracopoulos, Constantine; Nunley, James A

2015-08-01

Lateral column lengthening (LCL) is commonly utilized in treating stage II posterior tibialis tendon dysfunction. This study aimed to analyze the outcomes of LCL with porous titanium wedges compared to historic controls of iliac crest autograft and allograft. We hypothesized that the use of a porous titanium wedge would have radiographic improvement and union rates similar to those with the use of autograft and allograft in LCL. Between May 2009 and May 2014, 28 feet in 26 patients were treated with LCL using a porous titanium wedge. Of the 26 patients, 9 were males (34.6%). The average age for males was 43 years (range, 17.9-58.7), 48.7 years (range, 21-72.3) for females. Mean follow-up was 14.6 months. Radiographs were examined for correction of the flatfoot deformity and forefoot abduction. All complications were noted. Radiographically, the patients had a significant deformity correction in the anteroposterior talo-first metatarsal angle, talonavicular coverage angle, lateral talo-first metatarsal angle, and calcaneal pitch. All but 1 patient (96%) had bony incorporation of the porous titanium wedge. The average preoperative visual analog scale pain score was 5; all patients but 3 (12%) had improvements in their pain score, with a mean change of 3.4. LCL with porous titanium had low nonunion rates, improved radiographic correction, and pain relief. Level IV, case series. © The Author(s) 2015.

All-cause and cardiovascular mortality in a consecutive series of patients with diabetic foot osteomyelitis.

PubMed

Ricci, Lucia; Scatena, Alessia; Tacconi, Danilo; Ventoruzzo, Giorgio; Liistro, Francesco; Bolognese, Leonardo; Monami, Matteo; Mannucci, Edoardo

2017-09-01

Mortality in patients with type 2 diabetes and diabetic foot osteomyelitis (DFO) have been explored in few small studies with a short follow-up. Aim of the present study is to assess all-cause and cardiovascular mortality and predictors of mortality in a consecutive series of patients with DFO. Patients with a diagnosis of DFO, attending the Diabetic Foot Unit of San Donato Hospital in Arezzo between January 1st, 2012 and December 31st, 2013, were included in this retrospective study. Information on all-cause mortality up to December 1st, 2016, was obtained from the registry of the Local Health Unit of Arezzo, which contains updated records of all persons living in Tuscany. One hundred ninety-four patients were included in the study. During a mean period of observation of 2.8±1.4years, 73 (37.6%) died, with a yearly rate of 13.2%. Of the 73 deaths, 59 were attributable to cardiovascular causes. After adjusting for possible confounders in a Cox analysis, site of osteomyelitis (hindfoot vs mid/forefoot) was associated with a higher mortality, and surgical treatment with a lower mortality. Mortality in patients with DFO appears to be much higher than that reported in clinical series of patients with diabetic foot ulcers, particularly when hindfoot is affected. Copyright © 2017. Published by Elsevier B.V.

Modelling the joint torques and loadings during squatting at the Smith machine.

PubMed

Biscarini, Andrea; Benvenuti, Paolo; Botti, Fabio; Mastrandrea, Francesco; Zanuso, Silvano

2011-03-01

An analytical biomechanical model was developed to establish the relevant properties of the Smith squat exercise, and the main differences from the free barbell squat. The Smith squat may be largely patterned to modulate the distributions of muscle activities and joint loadings. For a given value of the included knee angle (θ(knee)), bending the trunk forward, moving the feet forward in front of the knees, and displacing the weight distribution towards the forefoot emphasizes hip and lumbosacral torques, while also reducing knee torque and compressive tibiofemoral and patellofemoral forces (and vice versa). The tibiofemoral shear force φ(t) displays more complex trends that strongly depend on θ(knee). Notably, for 180° ≥ θ(knee) ≥ 130°, φ(t) and cruciate ligament strain forces can be suppressed by selecting proper pairs of ankle and hip angles. Loading of the posterior cruciate ligament increases (decreases) in the range 180° ≥ θ(knee) ≥ 150° (θ(knee) ≤ 130°) with knee extension, bending the trunk forward, and moving the feet forward in front of the knees. In the range 150° > θ(knee) > 130°, the behaviour changes depending on the foot weight distribution. The conditions for the development of anterior cruciate ligament strain forces are explained. This work enables careful use of the Smith squat in strengthening and rehabilitation programmes.

Biomechanical Analysis of Cuboid Osteotomy Lateral Column Lengthening for Stage II B Adult-Acquired Flatfoot Deformity: A Cadaveric Study.

PubMed

Zhou, Haichao; Ren, Haoyang; Li, Chunguang; Xia, Jiang; Yu, Guangrong; Yang, Yunfeng

2017-01-01

Purpose . To investigate the effect of cuboid osteotomy lateral column lengthening (LCL) for the correction of stage II B adult-acquired flatfoot deformity in cadaver. Methods . Six cadaver specimens were loaded to 350 N. Flatfoot models were established and each was evaluated radiographically and pedobarographically in the following conditions: (1) intact foot, (2) flatfoot, and (3) cuboid osteotomy LCL (2, 3, 4, and 5 mm). Results . Compared with the flatfoot model, the LCLs showed significant correction of talonavicular coverage on anteroposterior radiographs and talus-first metatarsal angle on both anteroposterior and lateral radiographs ( p < .05). Compared with the intact foot, the above angles of the LCLs showed no significant difference except the 2 mm LCL. In terms of forefoot pressure, medial pressure of the 2 mm LCL ( p = .044) and lateral pressure of the 3, 4, and 5 mm LCLs showed statistical differences ( p < .05), but lateral pressure of the 3 mm LCL was not more than the intact foot as compared to the 4 and 5 mm LCLs, which was less than medial pressure. Conclusion . Cuboid osteotomy LCL procedure avoids damage to subtalar joint and has a good effect on correction of stage II B adult-acquired flatfoot deformity with a 3 mm lengthening in cadavers.

Biomechanical Analysis of Cuboid Osteotomy Lateral Column Lengthening for Stage II B Adult-Acquired Flatfoot Deformity: A Cadaveric Study

PubMed Central

Zhou, Haichao; Ren, Haoyang; Li, Chunguang; Xia, Jiang; Yu, Guangrong

2017-01-01

Purpose. To investigate the effect of cuboid osteotomy lateral column lengthening (LCL) for the correction of stage II B adult-acquired flatfoot deformity in cadaver. Methods. Six cadaver specimens were loaded to 350 N. Flatfoot models were established and each was evaluated radiographically and pedobarographically in the following conditions: (1) intact foot, (2) flatfoot, and (3) cuboid osteotomy LCL (2, 3, 4, and 5 mm). Results. Compared with the flatfoot model, the LCLs showed significant correction of talonavicular coverage on anteroposterior radiographs and talus-first metatarsal angle on both anteroposterior and lateral radiographs (p < .05). Compared with the intact foot, the above angles of the LCLs showed no significant difference except the 2 mm LCL. In terms of forefoot pressure, medial pressure of the 2 mm LCL (p = .044) and lateral pressure of the 3, 4, and 5 mm LCLs showed statistical differences (p < .05), but lateral pressure of the 3 mm LCL was not more than the intact foot as compared to the 4 and 5 mm LCLs, which was less than medial pressure. Conclusion. Cuboid osteotomy LCL procedure avoids damage to subtalar joint and has a good effect on correction of stage II B adult-acquired flatfoot deformity with a 3 mm lengthening in cadavers. PMID:28497049

Development of a high resolution plantar pressure monitoring pad based on fiber Bragg grating (FBG) sensors.

PubMed

Suresh, R; Bhalla, S; Hao, J; Singh, C

2015-01-01

High importance is given to plantar pressure monitoring in the field of biomedical engineering for the diagnosis of posture related ailments associated with diseases such as diabetes and gonarthrosis. This paper presents the proof-of-concept development of a new high resolution plantar pressure monitoring pad based on fiber Bragg grating (FBG) sensors. In the proposed configuration, the FBG sensors are embedded within layers of carbon composite material (CCM) in turn conforming to an arc shape. A total of four such arc shaped sensors are instrumented in the pad at the locations of the forefoot and the hind foot. As a test of the pad, static plantar pressure is monitored on normal subjects under various posture conditions. The pad is evaluated both as a standalone platform as well as a pad inserted inside a standard shoe. An average pressure sensitivity of 1.2 pm/kPa and a resolution of approximately 0.8 kPa is obtained in this special configuration. The pad is found to be suitable in both configurations- stand-alone pad as well as an insert inside a standard shoe. The proposed set up offers a cost-effective high resolution and accurate plantar pressure measurement system suitable for clinical deployment. The novelty of the developed pressure pad lies in its ability to be used both as platform type as well as inserted in-sole type sensor system.

Z-plasty of the flexor hallucis longus tendon at tarsal tunnel for checkrein deformity.

PubMed

Lee, Jae Hoon; Kim, Young Jun; Baek, Jong Hun; Kim, Dong Hee

2016-12-01

To review the outcome of Z-plasty of the flexor hallucis longus (FHL) tendon at the tarsal tunnel for checkrein deformity in 8 patients. Records of 6 males and 2 females aged 14 to 67 (mean, 39.5) years who underwent Z-plasty (lengthening) of the FHL tendon at the tarsal tunnel for checkrein deformity in the first and second toes by a single surgeon were reviewed. All patients had undergone 3 months of conservative treatment. The mean time from injury to surgical treatment was 8.4 (range, 5-12) months. All patients had associated injuries including distal tibiofibular fracture (n=6), distal fibular fracture (n=1), and crush injury aroundthe ankle (n=1); they were treated with intramedullary nailing (n=6), long leg splinting (n=1), and short leg splinting (n=1). After a mean follow-up of 3.4 (range, 1-7) years, the FHL tendon was lengthened by a mean of 1.7 (range, 1.6-1.8) cm, and the mean American Orthopedic Foot and Ankle Society hallux score increased from 59 (range, 52-67) to 89 (range, 80-90). No patient had recurrence, nerve injury, or tarsal tunnel syndrome, although one patient had sensory disturbance of the posterior tibial nerve in the forefoot, which resolved spontaneously at week 2. Z-plasty of the FHL tendon at the tarsal tunnel is a viable option for correction of checkrein deformity.

Custom-made foot orthoses: an analysis of prescription characteristics from an Australian commercial orthotic laboratory.

PubMed

Menz, Hylton B; Allan, Jamie J; Bonanno, Daniel R; Landorf, Karl B; Murley, George S

2017-01-01

Foot orthoses are widely used in the prevention and treatment of foot disorders. The aim of this study was to describe characteristics of custom-made foot orthosis prescriptions from a Australian podiatric orthotic laboratory. One thousand consecutive foot orthosis prescription forms were obtained from a commercial prescription foot orthosis laboratory located in Melbourne, Victoria, Australia (Footwork Podiatric Laboratory). Each item from the prescription form was documented in relation to orthosis type, cast correction, arch fill technique, cast modifications, shell material, shell modifications and cover material. Cluster analysis and discriminant function analysis were applied to identify patterns in the prescription data. Prescriptions were obtained from 178 clinical practices across Australia and Hong Kong, with patients ranging in age from 5 to 92 years. Three broad categories ('clusters') were observed that were indicative of increasing 'control' of rearfoot pronation. A combination of five variables (rearfoot cast correction, cover shape, orthosis type, forefoot cast correction and plantar fascial accommodation) was able to identify these clusters with an accuracy of 70%. Significant differences between clusters were observed in relation to age and sex of the patient and the geographic location of the prescribing clinician. Foot orthosis prescriptions are complex, but can be broadly classified into three categories. Selection of these prescription subtypes appears to be influenced by both patient factors (age and sex) and clinician factors (clinic location).

[Congenital club foot: treatment in childhood, outcome and problems in adulthood].

PubMed

Besse, J L; Leemrijse, T; Thémar-Noël, C; Tourné, Y

2006-04-01

PURPOSE OF THE SYMPOSIUM: Treatment of idiopathic talipes varus, or congenital clubfoot, is designed to re-align the foot to alleviate pain and allow plantigrade weight bearing with adequate joint motion despite the subnormal radiographic presentation. This symposium was held to review current management practices for congenital clubfoot in children and to analyze outcome in adults in order to propose the most appropriate therapeutic solutions. Idiopathic talipes varus can be suspected from the fetal ultrasound. Parents should be given precise information concerning proposed treatment after birth. Deviations must be assessed in the newborn then revised regularly using objective scales during and after the end of treatment. This enables a better apprehension of the evolution in comparison with the severity of the initial deformation. Conservative treatment is proposed by many teams: a functional approach (rehabilitation and minimal use of orthetic material) or the Ponseti method (progressive correction using casts associated with percutaneous tenotomy of the calcaneal tendon) are currently preferred. If such methods are insufficient or unsuccessful, surgery may be performed as needed at about 8 to 11 months to achieve posteromedial release. Good results are obtained in 80% of patients who generally present minimal residual deformations (adduction of the forefoot, minimal calcaneal varus, residual medial rotation, limitation of dorsal flexion), which must be followed regularly through growth. The difficulty is to distinguish acceptable from non-acceptable deformation. At the end of the growth phase, severe articular sequelae are rare (stiff joint, recurrence of initial deformation, overcorrection) but difficult to correct surgically: osteotomy, tendon transfer, double arthrodesis, Ilizarov fixator. Gait analysis is essential to quantify function and obtain an objective assessment of the impact on higher joints, providing valuable guidance for surgical correction. There have been very few studies evaluating the long-term functional outcome after treatment during childhood. According to two studies presented at this symposium (Brussels, Lausanne), results have been generally good but with subnormal radiographs irrespective of the type of treatment or how early treatment started in childhood. Hypoplasia of the talar dome is a constant finding and is correlated with limitation of dorsal flexion of the ankle joint. A small degree under-correction is often observed but well tolerated while overcorrection is generally less well tolerated. Functional outcome depends highly on preservation of subtalar joint motion. There have been no reports on the results of treatment of sequelae in adults. Most problems (pain, stiffness, osteoarthritis) are observed in the mid or rear foot. Indications for conservative surgery (osteotomy) of the mid or rear foot are rare compared with indications for combined arthrodesis. Talocrural decompensation is a turning point observed in the adult. Management at this point is difficult: fusion of the ankle worsens the situation by increasing the stress on the forefoot and aggravating the disability; implantation of an ankle prosthesis is technically difficult and remains to be fully developed. Treatment of the dorsal bunion of the great toe may require tendon transfer and/or fusion. A child born with clubfoot will never have a normal foot in adulthood. Sequelae present at the end of growth will intensify during adult life; under-correction is easier to treat in adulthood than overcorrection. The most difficult problems in adulthood are: neglected clubfoot, over correction, and degradation of the talocrural joint.

Ultrasound-guided Interdigital Neuroma Injections: Short-term Clinical Outcomes after a Single Percutaneous Injection—Preliminary Results

PubMed Central

Adler, Ronald S.; Ciavarra, Gina A.; Pavlov, Helene

2006-01-01

Purpose To describe the procedure of ultrasound-guided Morton’s neuroma and recurrent stump neuroma injections and early clinical outcomes after a single injection. Materials and Methods Retrospective review of 44 percutaneous ultrasound-guided neuroma injections in 24 patients who had completed clinical outcomes questionnaires. A 10-point pain scale [scale of 1 (no pain) to 10 (severe pain)] in a 7-day pain log format was distributed to patients at the time percutaneous neuroma injection was performed. Results Neuromas were clearly visualized with sonography as hypoechoic nodules and were distinguishable from other causes of forefoot pain, such as metatarsophalangeal joint synovitis and intermetatarsal bursae. The sizes of the neuromas injected ranged between 4 and 19 mm. Postinjection, all neuromas displayed increased echogenicity and/or the appearance of fluid surrounding it, confirming localization of the therapeutic mixture. We arbitrarily subdivided the pain ratings into symptomatic (greater than 4) and asymptomatic (less than or equal to 4) for statistical analysis. Average pain level pre injection was 5.2 and average pain level was 3.7 at 7 days post single injection, with 62% of the initially symptomatic patients asymptomatic on day 7 (p < 0.000001). Overall, 76% of the total number of neuromas injected once were asymptomatic on day 7. Conclusion Ultrasound can be used to accurately target Morton’s neuromas and, therefore, appropriately direct therapeutic interventions, with good short-term clinical results. PMID:18751769

Effects of a dynamic balance training protocol on podalic support in older women. Pilot Study.

PubMed

Battaglia, Giuseppe; Bellafiore, Marianna; Bianco, Antonino; Paoli, Antonio; Palma, Antonio

2010-01-01

The foot provides the only direct contact with supporting surfaces and therefore plays an important role in all postural tasks. Changes in the musculoskeletal and neurological characteristics of the foot with advancing age can alter plantar loading patterns and postural balance. Several studies have reported that exercise training improves postural performance in elderly individuals. The aim of our study was to investigate the effectiveness of a dynamic balance training protocol performed for 5 weeks on the support surface, percentage distribution of load in both feet, and body balance performance in healthy elderly women. Ten subjects (68.67±5.50 yrs old; 28.17±3.35 BMI) were evaluated with a monopodalic performance test and baropodometric analyses before and after the training period. We found a significant improvement in balance unipedal performance times on left and right foot by 20.18% and 26.23% respectively (p<0.05). The support surface of the right foot significantly increased in response to the training protocol and, in particular, in both forefoot and rearfoot regions (p<0.05). In addition, before the training period, load distribution on the left foot was greater than on the right one; equal load redistribution was measured on both feet in response to exercise (p>0.05). The increased support surface and equal redistribution of body weight on both feet obtained in response to our training protocol may be postural adaptations sufficient to improve static balance in elderly women.

The effect of gait training with shoe inserts on the improvement of pain and gait in sacroiliac joint patients.

PubMed

Cho, Byung-Yun; Yoon, Jung-Gyu

2015-08-01

[Purpose] The purpose of the current research was to identify how gait training with shoe inserts affects the pain and gait of sacroiliac joint dysfunction patients. [Subjects and Methods] Thirty subjects were randomly selected and assigned to be either the experimental group (gait training with shoe insert group) or control group. Each group consisted of 15 patients. Pain was measured by Visual Analogue Scale, and foot pressure in a standing position and during gait was measured with a Gateview AFA-50 system (Alpus, Seoul, Republic of Korea). A paired sample t-test was used to compare the pain and gait of the sacroiliac joint before and after the intervention. Correlation between pain and walking after gait training with shoe inserts was examined by Pearson test. The level of significance was set at α=0.05. [Results] It was found that application of the intervention to the experimental group resulted in a significant decrease in sacroiliac joint pain. It was also found that there was a significant correlation between Visual Analogue Scale score and dynamic asymmetric index (r= 0.796) and that there was a negative correlation between Visual Analogue Scale score and forefoot/rear foot peak pressure ratio (r=-0.728). [Conclusion] The results of our analysis lead us to conclude that the intervention with shoe inserts had a significant influence on the pain and gait of sacroiliac joint patients.

[The retrocapital osteotomy ("chevron") for correction of splayfoot with hallux valgus].

PubMed

Gabel, Michael

2008-12-01

Surgical treatment of hallux valgus deformity with a distal osteotomy of the first metatarsal to address an increased intermetatarsal angle (IMA) I-II. This procedure is combined with a soft-tissue procedure at the first metatarsophalangeal joint: realignment of the first ray, lateral displacement of the first metatarsal head above the sesamoids, rebalancing of the soft tissues at the metatarsophalangeal joint. Pain and soft-tissue inflammation at the bunion, impaired function of the metatarsophalangeal joint, and lateral deviation of the hallux. IMA I-II 10 degrees. Symptomatic osteoarthritis of the first metatarsophalangeal joint, assessed clinically or radiographically. Acute inflammation of the forefoot, osteoporosis of the first metatarsal. Vascular disturbance. Cosmetic indication only. Relative: hypermobility of the first ray, valgus malalignment of the hindfoot, previous retrocapital osteotomy. Lateral soft-tissue release. Resection of the medial pseudoexostosis. V-shaped osteotomy of the distal metatarsal I. Exostosectomy. Lateral displacement of the first metatarsal head. Screw fixation. Realignment of the metatarsophalangeal joint by tightening of the medial soft tissues. Postoperative shoe with full weight bearing. Active exercises of the foot and hallux. Physiotherapy. Prophylaxis of deep vein thrombosis depending on the degree of mobility. Radiographic control after 6 weeks. Bandage or orthosis to maintain toe alignment. IMA I-II was reduced from 13.6 degrees preoperatively to 6.6 degrees postoperatively. HVA decreased from 29.8 degrees to 8.2 degrees postoperatively.

Change-of-Direction Biomechanics: Is What's Best for Anterior Cruciate Ligament Injury Prevention Also Best for Performance?

PubMed

Fox, Aaron S

2018-05-02

Change-of-direction maneuvers (e.g., side-step cutting) are an important aspect of performance in multi-directional sports, but these maneuvers are also associated with anterior cruciate ligament (ACL) injury. Despite this, the impact of biomechanics on ACL injury risk and performance is often examined in isolation. The purpose of this review was to examine the alignment between biomechanical recommendations for ACL injury prevention and performance with regard to change-of-direction maneuvers. Several studies linking change-of-direction biomechanics to both ACL injury risk and performance were examined. A degree of overlap was identified between biomechanical strategies that could both reduce ACL injury risk and enhance performance during change-of-direction maneuvers. A fore-foot footfall pattern along with trunk rotation and lateral flexion in the intended cutting direction were identified as biomechanical strategies that could both reduce potentially hazardous knee joint moments and enhance change-of-direction speed. Minimizing knee valgus during change-of-direction maneuvers may also reduce ACL injury risk, with this biomechanical strategy found to have no impact on performance. Certain biomechanical strategies proposed to reduce ACL injury risk were linked to reduced change-of-direction performance. A narrow foot placement and "soft" landings with greater knee flexion were identified as ACL injury prevention strategies that could have a negative impact on performance. The findings of this review emphasize the need to consider both ACL injury risk and performance when examining the biomechanics of change-of-direction maneuvers.

Is midsole thickness a key parameter for the running pattern?

PubMed

Chambon, Nicolas; Delattre, Nicolas; Guéguen, Nils; Berton, Eric; Rao, Guillaume

2014-01-01

Many studies have highlighted differences in foot strike pattern comparing habitually shod runners who ran barefoot and with running shoes. Barefoot running results in a flatter foot landing and in a decreased vertical ground reaction force compared to shod running. The aim of this study was to investigate one possible parameter influencing running pattern: the midsole thickness. Fifteen participants ran overground at 3.3 ms(-1) barefoot and with five shoes of different midsole thickness (0 mm, 2 mm, 4 mm, 8 mm, 16 mm) with no difference of height between rearfoot and forefoot. Impact magnitude was evaluated using transient peak of vertical ground reaction force, loading rate, tibial acceleration peak and rate. Hip, knee and ankle flexion angles were computed at touch-down and during stance phase (range of motion and maximum values). External net joint moments and stiffness for hip, knee and ankle joints were also observed as well as global leg stiffness. No significant effect of midsole thickness was observed on ground reaction force and tibial acceleration. However, the contact time increased with midsole thickness. Barefoot running compared to shod running induced ankle in plantar flexion at touch-down, higher ankle dorsiflexion and lower knee flexion during stance phase. These adjustments are suspected to explain the absence of difference on ground reaction force and tibial acceleration. This study showed that the presence of very thin footwear upper and sole was sufficient to significantly influence the running pattern. Copyright © 2014 Elsevier B.V. All rights reserved.

The effect of gait training with shoe inserts on the improvement of pain and gait in sacroiliac joint patients

PubMed Central

Cho, Byung-Yun; Yoon, Jung-Gyu

2015-01-01

[Purpose] The purpose of the current research was to identify how gait training with shoe inserts affects the pain and gait of sacroiliac joint dysfunction patients. [Subjects and Methods] Thirty subjects were randomly selected and assigned to be either the experimental group (gait training with shoe insert group) or control group. Each group consisted of 15 patients. Pain was measured by Visual Analogue Scale, and foot pressure in a standing position and during gait was measured with a Gateview AFA-50 system (Alpus, Seoul, Republic of Korea). A paired sample t-test was used to compare the pain and gait of the sacroiliac joint before and after the intervention. Correlation between pain and walking after gait training with shoe inserts was examined by Pearson test. The level of significance was set at α=0.05. [Results] It was found that application of the intervention to the experimental group resulted in a significant decrease in sacroiliac joint pain. It was also found that there was a significant correlation between Visual Analogue Scale score and dynamic asymmetric index (r= 0.796) and that there was a negative correlation between Visual Analogue Scale score and forefoot/rear foot peak pressure ratio (r=-0.728). [Conclusion] The results of our analysis lead us to conclude that the intervention with shoe inserts had a significant influence on the pain and gait of sacroiliac joint patients. PMID:26357428

Subtalar neutral position as an offset for a kinematic model of the foot during walking.

PubMed

Houck, Jeff R; Tome, Josh M; Nawoczenski, Deborah A

2008-07-01

The lack of a common reference position when defining foot postures may underestimate the ability to differentiate foot function in subjects with pathology. The effect of using the subtalar neutral (STN) position as an offset for both rearfoot and forefoot through comparison of the kinematic walking patterns of subjects classified as normal (n=7) and abnormally pronated (n=14) foot postures was completed. An Optotrak Motion Analysis System (Northern Digital, Inc.) integrated with Motion Monitor Software (Innovative Sports, Inc.) was used to track three-dimensional movement of the leg, rearfoot and first metatarsal segments. Intrarater reliability of positioning the foot into STN using clinical guidelines was determined for a single rater for 21 subjects. Walking data were subsequently compared before and after an offset was applied to the rearfoot and first metatarsal segments. Repeated measures of foot positioning found the STN position to be highly repeatable (intraclass correlation coefficients>0.9), with peak errors ranging from 1.9 degrees to 4.3 degrees . Utilizing STN as the offset resulted in a significant increase in rearfoot eversion (p=0.019) during early stance, and greater first metatarsal dorsiflexion (p<0.007) across stance in the pronated foot groups that was not observed prior to applying the offset. When applied to subjects with differing foot postures, the selection of a common reference position that is both clinically appropriate and reliable may distinguish kinematic patterns during walking that are consistent with theories of abnormal pronation.

The Influence of a Bout of Exertion on Novice Barefoot Running Dynamics

PubMed Central

Hashish, Rami; Samarawickrame, Sachithra D.; Baker, Lucinda; Salem, George J.

2016-01-01

Barefoot, forefoot strike (FFS) running has recently risen in popularity. Relative to shod, rear-foot strike (RFS) running, employing a FFS is associated with heightened triceps surae muscle activation and ankle mechanical demand. Novice to this pattern, it is plausible that habitually shod RFS runners exhibit fatigue to the triceps surae when acutely transitioning to barefoot running, thereby limiting their ability to attenuate impact. Therefore, the purpose was to determine how habitually shod RFS runners respond to an exertion bout of barefoot running, operationally defined as a barefoot run 20% of mean daily running distance. Twenty-one RFS runners performed novice barefoot running, before and after exertion. Ankle peak torque, triceps surae EMG median frequency, foot-strike patterns, joint energy absorption, and loading rates were evaluated. Of the 21 runners, 6 maintained a RFS, 10 adopted a mid-foot strike (MFS), and 5 adopted a FFS during novice barefoot running. In-response to exertion, MFS and FFS runners demonstrated reductions in peak torque, median frequency, and ankle energy absorption, and an increase in loading rate. RFS runners demonstrated reductions in peak torque and loading rate. These results indicate that a short bout of running may elicit fatigue to novice barefoot runners, limiting their ability to attenuate impact. Key points In response to exertion, novice barefoot runners demonstrate fatigue to their soleus. In response to exertion, novice barefoot runners demonstrate a reduction in ankle energy absorption In response to exertion, novice barefoot runners demonstrate an increase in loading rate PMID:27274672

The Influence of a Bout of Exertion on Novice Barefoot Running Dynamics.

PubMed

Hashish, Rami; Samarawickrame, Sachithra D; Baker, Lucinda; Salem, George J

2016-06-01

Barefoot, forefoot strike (FFS) running has recently risen in popularity. Relative to shod, rear-foot strike (RFS) running, employing a FFS is associated with heightened triceps surae muscle activation and ankle mechanical demand. Novice to this pattern, it is plausible that habitually shod RFS runners exhibit fatigue to the triceps surae when acutely transitioning to barefoot running, thereby limiting their ability to attenuate impact. Therefore, the purpose was to determine how habitually shod RFS runners respond to an exertion bout of barefoot running, operationally defined as a barefoot run 20% of mean daily running distance. Twenty-one RFS runners performed novice barefoot running, before and after exertion. Ankle peak torque, triceps surae EMG median frequency, foot-strike patterns, joint energy absorption, and loading rates were evaluated. Of the 21 runners, 6 maintained a RFS, 10 adopted a mid-foot strike (MFS), and 5 adopted a FFS during novice barefoot running. In-response to exertion, MFS and FFS runners demonstrated reductions in peak torque, median frequency, and ankle energy absorption, and an increase in loading rate. RFS runners demonstrated reductions in peak torque and loading rate. These results indicate that a short bout of running may elicit fatigue to novice barefoot runners, limiting their ability to attenuate impact. Key pointsIn response to exertion, novice barefoot runners demonstrate fatigue to their soleus.In response to exertion, novice barefoot runners demonstrate a reduction in ankle energy absorptionIn response to exertion, novice barefoot runners demonstrate an increase in loading rate.

Initial foot contact and related kinematics affect impact loading rate in running.

PubMed

Breine, Bastiaan; Malcolm, Philippe; Van Caekenberghe, Ine; Fiers, Pieter; Frederick, Edward C; De Clercq, Dirk

2017-08-01

This study assessed kinematic differences between different foot strike patterns and their relationship with peak vertical instantaneous loading rate (VILR) of the ground reaction force (GRF). Fifty-two runners ran at 3.2 m · s -1 while we recorded GRF and lower limb kinematics and determined foot strike pattern: Typical or Atypical rearfoot strike (RFS), midfoot strike (MFS) of forefoot strike (FFS). Typical RFS had longer contact times and a lower leg stiffness than Atypical RFS and MFS. Typical RFS showed a dorsiflexed ankle (7.2 ± 3.5°) and positive foot angle (20.4 ± 4.8°) at initial contact while MFS showed a plantar flexed ankle (-10.4 ± 6.3°) and more horizontal foot (1.6 ± 3.1°). Atypical RFS showed a plantar flexed ankle (-3.1 ± 4.4°) and a small foot angle (7.0 ± 5.1°) at initial contact and had the highest VILR. For the RFS (Typical and Atypical RFS), foot angle at initial contact showed the highest correlation with VILR (r = -0.68). The observed higher VILR in Atypical RFS could be related to both ankle and foot kinematics and global running style that indicate a limited use of known kinematic impact absorbing "strategies" such as initial ankle dorsiflexion in MFS or initial ankle plantar flexion in Typical RFS.

Initiating running barefoot: Effects on muscle activation and impact accelerations in habitually rearfoot shod runners.

PubMed

Lucas-Cuevas, Angel Gabriel; Priego Quesada, José Ignacio; Giménez, José Vicente; Aparicio, Inma; Jimenez-Perez, Irene; Pérez-Soriano, Pedro

2016-11-01

Runners tend to shift from a rearfoot to a forefoot strike pattern when running barefoot. However, it is unclear how the first attempts at running barefoot affect habitually rearfoot shod runners. Due to the inconsistency of their recently adopted barefoot technique, a number of new barefoot-related running injuries are emerging among novice barefoot runners. The aim of this study was therefore to analyse the influence of three running conditions (natural barefoot [BF], barefoot with a forced rearfoot strike [BRS], and shod [SH]) on muscle activity and impact accelerations in habitually rearfoot shod runners. Twenty-two participants ran at 60% of their maximal aerobic speed while foot strike, tibial and head impact accelerations, and tibialis anterior (TA), peroneus longus (PL), gastrocnemius medialis (GM) and gastrocnemius lateralis (GL) muscle activity were registered. Only 68% of the runners adopted a non-rearfoot strike pattern during BF. Running BF led to a reduction of TA activity as well as to an increase of GL and GM activity compared to BRS and SH. Furthermore, BRS increased tibial peak acceleration, tibial magnitude and tibial acceleration rate compared to SH and BF. In conclusion, 32% of our runners showed a rearfoot strike pattern at the first attempts at running barefoot, which corresponds to a running style (BRS) that led to increased muscle activation and impact accelerations and thereby to a potentially higher risk of injury compared to running shod.

Comparison of plantar pressure distribution between three different shoes and three common movements in futsal.

PubMed

Teymouri, Meghdad; Halabchi, Farzin; Mirshahi, Maryam; Mansournia, Mohammad Ali; Mousavi Ahranjani, Ali; Sadeghi, Amir

2017-01-01

Analysis of in-shoe pressure distribution during sport-specific movements may provide a clue to improve shoe design and prevent injuries. This study compared the mean and the peak pressures over the whole foot and ten separate areas of the foot, wearing different shoes during specific movements. Nine male adult recreational futsal players performed three trials of three sport-specific movements (shuffle, sprint and penalty kick), while they were wearing three brands of futsal shoes (Adidas, Lotto and Tiger). Plantar pressures on dominant feet were collected using the F-SCAN system. Peak and mean pressures for whole foot and each separate area were extracted. For statistical analysis, the mean differences in outcome variables between different shoes and movements were estimated using random-effects regression model using STATA ver.10. In the average calculation of the three movements, the peak pressure on the whole foot in Adidas shoe was less than Lotto [8.8% (CI95%: 4.1-13.6%)] and Tiger shoes [11.8% (CI95%:7-16.7%)], (P<0.001). Also, the recorded peak pressure on the whole foot in penalty kick was 61.1% (CI95%: 56.3-65.9%) and 57.6% (CI95%: 52.8-62.3%) less than Shuffle and Sprint tests, respectively (P<0.001). Areas with the highest peak pressure during all 3 movements were not different between all shoes. This area was medial forefoot in cases of shuffle and sprint movements and medial heel in case of penalty kick.

Nociception at the diabetic foot, an uncharted territory

PubMed Central

Chantelau, Ernst A

2015-01-01

The diabetic foot is characterised by painless foot ulceration and/or arthropathy; it is a typical complication of painless diabetic neuropathy. Neuropathy depletes the foot skin of intraepidermal nerve fibre endings of the afferent A-delta and C-fibres, which are mostly nociceptors and excitable by noxious stimuli only. However, some of them are cold or warm receptors whose functions in diabetic neuropathy have frequently been reported. Hence, it is well established by quantitative sensory testing that thermal detection thresholds at the foot skin increase during the course of painless diabetic neuropathy. Pain perception (nociception), by contrast, has rarely been studied. Recent pilot studies of pinprick pain at plantar digital skinfolds showed that the perception threshold was always above the upper limit of measurement of 512 mN (equivalent to 51.2 g) at the diabetic foot. However, deep pressure pain perception threshold at musculus abductor hallucis was beyond 1400 kPa (equivalent to 14 kg; limit of measurement) only in every fifth case. These discrepancies of pain perception between forefoot and hindfoot, and between skin and muscle, demand further study. Measuring nociception at the feet in diabetes opens promising clinical perspectives. A critical nociception threshold may be quantified (probably corresponding to a critical number of intraepidermal nerve fibre endings), beyond which the individual risk of a diabetic foot rises appreciably. Staging of diabetic neuropathy according to nociception thresholds at the feet is highly desirable as guidance to an individualised injury prevention strategy. PMID:25897350

Loading rate increases during barefoot running in habitually shod runners: Individual responses to an unfamiliar condition.

PubMed

Tam, Nicholas; Astephen Wilson, Janie L; Coetzee, Devon R; van Pletsen, Leanri; Tucker, Ross

2016-05-01

The purpose of this study was to examine the effect of barefoot running on initial loading rate (LR), lower extremity joint kinematics and kinetics, and neuromuscular control in habitually shod runners with an emphasis on the individual response to this unfamiliar condition. Kinematics and ground reaction force data were collected from 51 habitually shod runners during overground running in a barefoot and shod condition. Joint kinetics and stiffness were calculated with inverse dynamics. Inter-individual initial LR variability was explored by separating individuals by a barefoot/shod ratio to determine acute responders/non-responders. Mean initial LR was 54.1% greater in the barefoot when compared to the shod condition. Differences between acute responders/non-responders were found at peak and initial contact sagittal ankle angle and at initial ground contact. Correlations were found between barefoot sagittal ankle angle at initial ground contact and barefoot initial LR. A large variability in biomechanical responses to an acute exposure to barefoot running was found. A large intra-individual variability was found in initial LR but not ankle plantar-dorsiflexion between footwear conditions. A majority of habitually shod runners do not exhibit previously reported benefits in terms of reduced initial LRs when barefoot. Lastly, runners who increased LR when barefoot reduced LRs when wearing shoes to levels similar seen in habitually barefoot runners who do adopt a forefoot-landing pattern, despite increased dorsiflexion. Copyright © 2016 Elsevier B.V. All rights reserved.

Role of Surgery in Management of Osteo-Articular Tuberculosis of the Foot and Ankle

PubMed Central

Dhillon, Mandeep Singh; Agashe, Vikas; Patil, Sampat Dumbre

2017-01-01

Background: Tuberculosis of the foot and ankle still remains to be a significant problem, especially in the developing countries, and with an increase in incidence in immunosuppressed patients. Treatment is mainly medical using multidrug chemotherapy; surgical interventions range from biopsy, synovectomy and debridement, to joint preserving procedures like distraction in early cases, and arthrodesis of hindfoot joints and the ankle in advanced disease with joint destruction. Surgical Options: All procedures should be done after initiating appropriate medical management. The ankle is the commonest joint needing intervention, followed by the subtalar and talo-navicular joint. Forefoot TB limited to the bone rarely needs surgical intervention except when the infective focus is threatening to invade a joint. Articular disease can spread rapidly, so early diagnosis and treatment can influence the outcome. Surgical interventions may need to be modified in the presence of sinuses and active disease; fusions need compression, and implants have to be chosen wisely. External fixators are the commonest devices used for compression in active disease, but intramedullary nails better stabilize pantalar arthrodesis. Arthroscopy has become a valuable tool for visualizing the ankle and hindfoot joints, and is an excellent adjunct for arthrodesis by minimally invasive methods. Conclusion: Although Osteoarticular Tb involving the foot and ankle is largely managed with chemotherapy, specific indications for surgical intervention exist. Timely done procedures could limit joint destruction, or prevent spread to adjacent joints. Fusions are the commonest procedure for sequelae of disease or for correcting residual deformity. PMID:29081861

Spatiotemporal and plantar pressure patterns of 1000 healthy individuals aged 3-101 years.

PubMed

McKay, Marnee J; Baldwin, Jennifer N; Ferreira, Paulo; Simic, Milena; Vanicek, Natalie; Wojciechowski, Elizabeth; Mudge, Anita; Burns, Joshua

2017-10-01

The purpose of this study was to establish normative reference values for spatiotemporal and plantar pressure parameters, and to investigate the influence of demographic, anthropometric and physical characteristics. In 1000 healthy males and females aged 3-101 years, spatiotemporal and plantar pressure data were collected barefoot with the Zeno™ walkway and Emed ® platform. Correlograms were developed to visualise the relationships between widely reported spatiotemporal and pressure variables with demographic (age, gender), anthropometric (height, mass, waist circumference) and physical characteristics (ankle strength, ankle range of motion, vibration perception) in children aged 3-9 years, adolescents aged 10-19 years, adults aged 20-59 years and older adults aged over 60 years. A comprehensive catalogue of 31 spatiotemporal and pressure variables were generated from 1000 healthy individuals. The key findings were that gait velocity was stable during adolescence and adulthood, while children and older adults walked at a comparable slower speed. Peak pressures increased during childhood to older adulthood. Children demonstrated highest peak pressures beneath the rearfoot whilst adolescents, adults and older adults demonstrated highest pressures at the forefoot. Main factors influencing spatiotemporal and pressure parameters were: increased age, height, body mass and waist circumference, as well as ankle dorsiflexion and plantarflexion strength. This study has established whole of life normative reference values of widely used spatiotemporal and plantar pressure parameters, and revealed changes to be expected across the lifespan. Copyright © 2017 Elsevier B.V. All rights reserved.

First metatarsalphalangeal joint arthrodesis: evaluation of plate and screw fixation.

PubMed

Bennett, Gordon L; Sabetta, James

2009-08-01

First metatarsalphalangeal joint (MTPJ) arthrodesis is a commonly performed procedure for the treatment of a variety of conditions affecting the hallux. There are several different methods to accomplish the fusion. We utilized a method incorporating a ball and cup preparation of the joint, followed by stabilization of the arthrodesis site utilizing the Accutrak congruent first MTPJ fusion set. We prospectively evaluated two hundred consecutive patients who underwent first MTPJ arthrodeses utilizing the Accutrak congruent first MTPJ fusion set. Patients were evaluated preoperatively, postoperatively, and at a final followup, utilizing the AOFAS forefoot scoring system. Two hundred consecutive patients underwent first MTPJ arthrodeses by the same surgeon. All but three feet (230/233) (98.7%) went on to solidly fuse. Three of the patients did not fuse solidly. One patient broke two of the screws, and the other two patients did not have hardware failure. All patients dramatically improved their AOFAS scores compared with pre-surgical values. There were three minor hardware problems in the group of patients who solidly fused their joint. We concluded that a solid first MTPJ fusion results in excellent function and pain relief. The Accutrak first MTPJ fusion system would appear to be an ideal implant system to accomplish a fusion because of its low profile, strength, and ease of use. Compared to other methods we have used, this procedure results in a very high rate of fusion, with minimal complications and excellent patient satisfaction.

The role of foot morphology on foot function in diabetic subjects with or without neuropathy.

PubMed

Guiotto, Annamaria; Sawacha, Zimi; Guarneri, Gabriella; Cristoferi, Giuseppe; Avogaro, Angelo; Cobelli, Claudio

2013-04-01

The aim of this study was to investigate the role of foot morphology, related with respect to diabetes and peripheral neuropathy in altering foot kinematics and plantar pressure during gait. Healthy and diabetic subjects with or without neuropathy with different foot types were analyzed. Three dimensional multisegment foot kinematics and plantar pressures were assessed on 120 feet: 40 feet (24 cavus, 20 with valgus heel and 11 with hallux valgus) in the control group, 80 feet in the diabetic (25 cavus 13 with valgus heel and 13 with hallux valgus) and the neuropathic groups (28 cavus, 24 with valgus heel and 18 with hallux valgus). Subjects were classified according to their foot morphology allowing further comparisons among the subgroups with the same foot morphology. When comparing neuropathic subjects with cavus foot, valgus heel with controls with the same foot morphology, important differences were noticed: increased dorsiflexion and peak plantar pressure on the forefoot (P<0.05), decreased contact surface on the hindfoot (P<0.03). While results indicated the important role of foot morphology in altering both kinematics and plantar pressure in diabetic subjects, diabetes appeared to further contribute in altering foot biomechanics. Surprisingly, all the diabetic subjects with normal foot arch or with valgus hallux were no more likely to display significant differences in biomechanics parameters than controls. This data could be considered a valuable support for future research on diabetic foot function, and in planning preventive interventions. Copyright © 2012 Elsevier B.V. All rights reserved.

The Role of Pressure Offloading on Diabetic Foot Ulcer Healing and Prevention of Recurrence.

PubMed

Bus, Sicco A

2016-09-01

An increased plantar pressure is a causative factor in the development of plantar foot ulcers in people with diabetes mellitus, and ulcers are a precursor of lower extremity amputation. In this article, the evidence is reviewed that relieving areas of increased plantar pressure (ie, offloading) can heal plantar foot ulcers and prevent their recurrence. Noninfected, nonischemic neuropathic plantar forefoot ulcers should heal in 6 to 8 weeks with adequate offloading. Recent meta-analyses and systematic reviews show that nonremovable knee-high devices are most effective. This is probably because they eliminate the problem of nonadherence with the use of a removable device. Studies show a large discrepancy between evidence-based recommendations on offloading and what is used in clinical practice. Many clinics continue to use methods that are less effective or have not been proven to be effective, while ignoring evidence-based methods. Strategies are proposed to address this issue, notably the adoption and implementation of recent international guidelines by professional societies and a stronger focus of clinicians on expedited healing. For the prevention of plantar foot ulcer recurrence in high-risk patients, 2 recent trials have shown that the incidence of recurrence can be significantly reduced with custom-made footwear that has a demonstrated pressure-relieving effect through guidance by plantar pressure measurements, under the condition that the footwear is worn. This review helps to inform clinicians about effective offloading treatment for healing plantar foot ulcers and preventing their recurrence.

STAPP: Spatiotemporal analysis of plantar pressure measurements using statistical parametric mapping.

PubMed

Booth, Brian G; Keijsers, Noël L W; Sijbers, Jan; Huysmans, Toon

2018-05-03

Pedobarography produces large sets of plantar pressure samples that are routinely subsampled (e.g. using regions of interest) or aggregated (e.g. center of pressure trajectories, peak pressure images) in order to simplify statistical analysis and provide intuitive clinical measures. We hypothesize that these data reductions discard gait information that can be used to differentiate between groups or conditions. To test the hypothesis of null information loss, we created an implementation of statistical parametric mapping (SPM) for dynamic plantar pressure datasets (i.e. plantar pressure videos). Our SPM software framework brings all plantar pressure videos into anatomical and temporal correspondence, then performs statistical tests at each sampling location in space and time. Novelly, we introduce non-linear temporal registration into the framework in order to normalize for timing differences within the stance phase. We refer to our software framework as STAPP: spatiotemporal analysis of plantar pressure measurements. Using STAPP, we tested our hypothesis on plantar pressure videos from 33 healthy subjects walking at different speeds. As walking speed increased, STAPP was able to identify significant decreases in plantar pressure at mid-stance from the heel through the lateral forefoot. The extent of these plantar pressure decreases has not previously been observed using existing plantar pressure analysis techniques. We therefore conclude that the subsampling of plantar pressure videos - a task which led to the discarding of gait information in our study - can be avoided using STAPP. Copyright © 2018 Elsevier B.V. All rights reserved.

Global body posture and plantar pressure distribution in individuals with and without temporomandibular disorder: a preliminary study.

PubMed

Souza, Juliana A; Pasinato, Fernanda; Corrêa, Eliane C R; da Silva, Ana Maria T

2014-01-01

The aim of this study was to evaluate body posture and the distribution of plantar pressure at physiologic rest of the mandible and during maximal intercuspal positions in subjects with and without temporomandibular disorder (TMD). Fifty-one subjects were assessed by the Diagnostic Criteria for Research on Temporomandibular Disorders and divided into a symptomatic group (21) and an asymptomatic group (30). Postural analysis for both groups was conducted using photogrammetry (SAPo version 0.68; University of São Paulo, São Paulo, Brazil). The distribution of plantar pressures was evaluated by means of baropodometry (Footwork software), at physiologic rest and maximal intercuspal positions. Of 18 angular measurements, 3 (17%) were statistically different between the groups in photogrammetric evaluation. The symptomatic group showed more pronounced cervical distance (P = .0002), valgus of the right calcaneus (P = .0122), and lower pelvic tilt (P = .0124). The baropodometry results showed the TMD subjects presented significantly higher rearfoot and lower forefoot distribution than those in the asymptomatic group. No differences were verified in maximal intercuspal position in the between-group analysis and between the 2 mandibular positions in the within-group analysis. Subjects with and without TMD presented with global body posture misalignment. Postural changes were more pronounced in the subjects with TMD. In addition, symptomatic subjects presented with abnormal plantar pressure distribution, suggesting that TMD may have an influence on the postural system. Copyright © 2014 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion.

PubMed

Barton, C J; Bonanno, D R; Carr, J; Neal, B S; Malliaras, P; Franklyn-Miller, A; Menz, H B

2016-05-01

Running-related injuries are highly prevalent. Synthesise published evidence with international expert opinion on the use of running retraining when treating lower limb injuries. Mixed methods. A systematic review of clinical and biomechanical findings related to running retraining interventions were synthesised and combined with semistructured interviews with 16 international experts covering clinical reasoning related to the implementation of running retraining. Limited evidence supports the effectiveness of transition from rearfoot to forefoot or midfoot strike and increase step rate or altering proximal mechanics in individuals with anterior exertional lower leg pain; and visual and verbal feedback to reduce hip adduction in females with patellofemoral pain. Despite the paucity of clinical evidence, experts recommended running retraining for: iliotibial band syndrome; plantar fasciopathy (fasciitis); Achilles, patellar, proximal hamstring and gluteal tendinopathy; calf pain; and medial tibial stress syndrome. Tailoring approaches to each injury and individual was recommended to optimise outcomes. Substantial evidence exists for the immediate biomechanical effects of running retraining interventions (46 studies), including evaluation of step rate and strike pattern manipulation, strategies to alter proximal kinematics and cues to reduce impact loading variables. Our synthesis of published evidence related to clinical outcomes and biomechanical effects with expert opinion indicates running retraining warrants consideration in the treatment of lower limb injuries in clinical practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Injuries And Footwear (Part 2): Minimalist Running Shoes.

PubMed

Knapik, Joseph J; Orr, Robin; Pope, Rodney; Grier, Tyson

2016-01-01

This article defines minimalist running shoes and examines physiological, biomechanical, and injury rate differences when running in conventional versus minimalist running shoes. A minimalist shoe is one that provides "minimal interference with the natural movement of the foot, because of its high flexibility, low heel to toe drop, weight and stack height, and the absence of motion control and stability devices." Most studies indicate that running in minimalist shoes results in a lower physiological energy cost than running in conventional shoes, likely because of the lower weight of the minimalist shoe. Most individuals running in conventional shoes impact the ground heel first (rearfoot strike pattern), whereas most people running in minimalist shoes tend to strike with the front of the foot (forefoot strike pattern). The rate at which force is developed on ground impact (i.e., the loading rate) is generally higher when running in conventional versus minimalist shoes. Findings from studies that have looked at associations between injuries and foot strike patterns or injuries and loading rates are conflicting, so it is not clear if these factors influence injury rates; more research is needed. Better-designed prospective studies indicate that bone stress injuries and the overall injury incidence are higher in minimalist shoes during the early weeks (10-12 weeks) of transition to this type of footwear. Longer-term studies are needed to define injury rates once runners are fully transitioned to minimalist shoes. At least one longer-term minimalist-shoe investigation is ongoing and, hopefully, will be published soon. 2016.

Clinical photographic observation of plantar corns and callus associated with a nominal scale classification and inter- observer reliability study in a student population.

PubMed

Tollafield, David R

2017-01-01

The management of plantar corns and callus has a low cost-benefit with reduced prioritisation in healthcare. The distinction between types of keratin lesions that forms corns and callus has attracted limited interest. Observation is imperative to improving diagnostic predictions and a number of studies point to some confusion as to how best to achieve this. The use of photographic observation has been proposed to improve our understanding of intractable keratin lesions. Students from a podiatry school reviewed photographs where plantar keratin lesions were divided into four nominal groups; light callus (Grade 1), heavy defined callus (Grade 2), concentric keratin plugs (Grade 3) and callus with deeper density changes under the forefoot (Grade 4). A group of 'experts' assigned from qualified podiatrists validated the observer rated responses by the students. Cohen's weighted statistic (k) was used to measure inter-observer reliability. First year students (unskilled) performed less well when viewing photographs ( k  = 0.33) compared to third year students (semi-skilled, k  = 0.62). The experts performed better than students ( k  = 0.88) providing consistency with wound care models in other studies. Improved clinical annotation of clinical features, supported by classification of keratin- based lesions, combined with patient outcome tools, could improve the scientific rationale to prioritise patient care. Problems associated with photographic assessment involves trying to differentiate similar lesions without the benefit of direct palpation. Direct observation of callus with and without debridement requires further investigation alongside the model proposed in this paper.

Effects of different heel-raise-lower exercise interventions on the strength of plantarflexion, balance, and gait parameters in stroke survivors.

PubMed

Lee, Seung-Mi; Cynn, Heon-Seock; Yoon, Tae-Lim; Lee, Ji-Hyun

2017-09-01

The objective of this study was to investigate the effects of Heel-Raise-Lower Exercise (HRLE) interventions on the strength of plantarflexion, balance, and gait parameters in people with stroke. Specifically, this study compared the two different HRLEs to identify whether heels raise-lower with forefoot on a block (HRB) is more effective or ineffective to enhance strength and functional capacities than heels raise-lower on a level floor (HRL) exercise in people with stroke. Repetitive heel raise-lower is a common exercise for improving the strength and power of ankle plantarflexors. It is a simple movement, requires no equipment, and can be performed at home. Each group of 10 people with stroke was given either HRB training or HRL training. The subjects performed the exercise 100 times per day, 5 days per week for 6 weeks. The strength of plantarflexors, static/dynamic balance, and gait parameters were measured using the manual muscle test (MMT), a Biodex Balance System (BBS) SD, and the GAITRite system. After 6 weeks of treatment, there were significant increases in the plantarflexors strength in both groups: by 34% in the HRB group and by 21% in the HRL group. Static and dynamic balance and gait speed also increased significantly in both groups. However, cadence, the paretic side single limb support period (SLSP), paretic side step length, and paretic side stride length significantly increased only in the HRB group. The HRB improved significantly the plantar flexor strength of the paretic side, gait speed, and cadence compared to the HRL.

Relationship between footwear comfort of shoe inserts and anthropometric and sensory factors.

PubMed

Mündermann, A; Stefanyshyn, D J; Nigg, B M

2001-11-01

The purposes of this study were (a) to determine lower extremity anthropometric and sensory factors that are related to differences in comfort perception of shoe inserts with varying shape and material and (b) to investigate whether shoe inserts that improve comfort decrease injury frequency in a military population. 206 military personnel volunteered for this study. The shoe inserts varied in arch and heel cup shape, hardness, and elasticity in the heel and forefoot regions. A no insert condition was included as the control condition. Measured subject characteristics included foot shape, foot and leg alignment, and tactile and vibration sensitivity of the plantar surface of the foot. Footwear comfort was assessed using a visual analog scale. Injury frequency was evaluated with a questionnaire. The statistical analyses included Student's t-tests for repeated measures, ANOVA (within subjects), MANOVA (within insert combinations), and chi-square tests. The average comfort ratings for all shoe inserts were significantly higher than the average comfort rating for the control condition. The incidence of stress fractures and pain at different locations was reduced by 1.5-13.4% for the insert compared with the control group. Foot arch height, foot and leg alignment, and foot sensitivity were significantly related to differences in comfort ratings for the hard/soft, the viscous/elastic, and the high arch/low arch insert combinations. Shoe inserts of different shape and material that are comfortable are able to decrease injury frequency. The results of this study showed that subject specific characteristics influence comfort perception of shoe inserts.

Challenging the foundations of the clinical model of foot function: further evidence that the root model assessments fail to appropriately classify foot function.

PubMed

Jarvis, Hannah L; Nester, Christopher J; Bowden, Peter D; Jones, Richard K

2017-01-01

The Root model of normal and abnormal foot function remains the basis for clinical foot orthotic practice globally. Our aim was to investigate the relationship between foot deformities and kinematic compensations that are the foundations of the model. A convenience sample of 140 were screened and 100 symptom free participants aged 18-45 years were invited to participate. The static biomechanical assessment described by the Root model was used to identify five foot deformities. A 6 segment foot model was used to measure foot kinematics during gait. Statistical tests compared foot kinematics between feet with and without foot deformities and correlated the degree of deformity with any compensatory motions. None of the deformities proposed by the Root model were associated with distinct differences in foot kinematics during gait when compared to those without deformities or each other. Static and dynamic parameters were not correlated. Taken as part of a wider body of evidence, the results of this study have profound implications for clinical foot health practice. We believe that the assessment protocol advocated by the Root model is no longer a suitable basis for professional practice. We recommend that clinicians stop using sub-talar neutral position during clinical assessments and stop assessing the non-weight bearing range of ankle dorsiflexion, first ray position and forefoot alignments and movement as a means of defining the associated foot deformities. The results question the relevance of the Root assessments in the prescription of foot orthoses.

Foot Type Biomechanics Part 1: Structure and Function of the Asymptomatic Foot

PubMed Central

Hillstrom, Howard J.; Song, Jinsup; Kraszewski, Andrew P.; Hafer, Jocelyn F.; Mootanah, Rajshree; Dufour, Alyssa B.; PT, Betty (Shingpui) Chow; Deland, Jonathan T.

2012-01-01

Background Differences in foot structure are thought to be associated with differences in foot function during movement. Many foot pathologies are of a biomechanical nature and often associated with foot type. Fundamental to the understanding of foot pathomechanics is the question: do different foot types have distinctly different structure and function? Aim To determine if objective measures of foot structure and function differ between planus, rectus and cavus foot types in asymptomatic individuals. Methods Sixty-one asymptomatic healthy adults between 18 and 77 years old, that had the same foot type bilaterally (44 planus feet, 54 rectus feet, and 24 cavus feet), were recruited. Structural and functional measurements were taken using custom equipment, an emed-x plantar pressure measuring device, a GaitMatII gait pattern measurement system, and a goniometer. Generalized Estimation Equation modeling was employed to determine if each dependent variable of foot structure and function was significantly different across foot type while accounting for potential dependencies between sides. Post hoc testing was performed to assess pairwise comparisons. Results Several measures of foot structure (malleolar valgus index and arch height index) were significantly different between foot types. Gait pattern parameters were invariant across foot types. Peak pressure, maximum force, pressure-time-integral, force-time-integral and contact area were significantly different in several medial forefoot and arch locations between foot types. Planus feet exhibited significantly different center of pressure excursion indices compared to rectus and cavus feet. Conclusions Planus, rectus and cavus feet exhibited significantly different measures of foot structure and function. PMID:23107625

The feasibility of a modified shoe for multi-segment foot motion analysis: a preliminary study.

PubMed

Halstead, J; Keenan, A M; Chapman, G J; Redmond, A C

2016-01-01

The majority of multi-segment kinematic foot studies have been limited to barefoot conditions, because shod conditions have the potential for confounding surface-mounted markers. The aim of this study was to investigate whether a shoe modified with a webbed upper can accommodate multi-segment foot marker sets without compromising kinematic measurements under barefoot and shod conditions. Thirty participants (15 controls and 15 participants with midfoot pain) underwent gait analysis in two conditions; barefoot and wearing a shoe (shod) in a random order. The shod condition employed a modified shoe (rubber plimsoll) with a webbed upper, allowing skin mounted reflective markers to be visualised through slits in the webbed material. Three dimensional foot kinematics were captured using the Oxford multi-segment foot model whilst participants walked at a self-selected speed. The foot pain group showed greater hindfoot eversion and less hindfoot dorsiflexion than controls in the barefoot condition and these differences were maintained when measured in the shod condition. Differences between the foot pain and control participants were also observed for walking speed in the barefoot and in the shod conditions. No significant differences between foot pain and control groups were demonstrated at the forefoot in either condition. Subtle differences between pain and control groups, which were found during barefoot walking are retained when wearing the modified shoe. The novel properties of the modified shoe offers a potential solution for the use of passive infrared based motion analysis for shod applications, for instance to investigate the kinematic effect of foot orthoses.

A multi-segment foot model based on anatomically registered technical coordinate systems: method repeatability and sensitivity in pediatric planovalgus feet.

PubMed

Saraswat, Prabhav; MacWilliams, Bruce A; Davis, Roy B; D'Astous, Jacques L

2013-01-01

Several multisegment foot models have been proposed and some have been used to study foot pathologies. These models have been tested and validated on typically developed populations; however application of such models to feet with significant deformities presents an additional set of challenges. For the first time, in this study, a multisegment foot model is tested for repeatability in a population of children with symptomatic abnormal feet. The results from this population are compared to the same metrics collected from an age matched (8-14 years) typically developing population. The modified Shriners Hospitals for Children, Greenville (mSHCG) foot model was applied to ten typically developing children and eleven children with planovalgus feet by two clinicians. Five subjects in each group were retested by both clinicians after 4-6 weeks. Both intra-clinician and inter-clinician repeatability were evaluated using static and dynamic measures. A plaster mold method was used to quantify variability arising from marker placement error. Dynamic variability was measured by examining trial differences from the same subjects when multiple clinicians carried out the data collection multiple times. For hindfoot and forefoot angles, static and dynamic variability in both groups was found to be less than 4° and 6° respectively. The mSHCG model strategy of minimal reliance on anatomical markers for dynamic measures and inherent flexibility enabled by separate anatomical and technical coordinate systems resulted in a model equally repeatable in typically developing and planovalgus populations. Copyright © 2012 Elsevier B.V. All rights reserved.

Kinematic foot types in youth with equinovarus secondary to hemiplegia.

PubMed

Krzak, Joseph J; Corcos, Daniel M; Damiano, Diane L; Graf, Adam; Hedeker, Donald; Smith, Peter A; Harris, Gerald F

2015-02-01

Elevated kinematic variability of the foot and ankle segments exists during gait among individuals with equinovarus secondary to hemiplegic cerebral palsy (CP). Clinicians have previously addressed such variability by developing classification schemes to identify subgroups of individuals based on their kinematics. To identify kinematic subgroups among youth with equinovarus secondary to CP using 3-dimensional multi-segment foot and ankle kinematics during locomotion as inputs for principal component analysis (PCA), and K-means cluster analysis. In a single assessment session, multi-segment foot and ankle kinematics using the Milwaukee Foot Model (MFM) were collected in 24 children/adolescents with equinovarus and 20 typically developing children/adolescents. PCA was used as a data reduction technique on 40 variables. K-means cluster analysis was performed on the first six principal components (PCs) which accounted for 92% of the variance of the dataset. The PCs described the location and plane of involvement in the foot and ankle. Five distinct kinematic subgroups were identified using K-means clustering. Participants with equinovarus presented with variable involvement ranging from primary hindfoot or forefoot deviations to deformtiy that included both segments in multiple planes. This study provides further evidence of the variability in foot characteristics associated with equinovarus secondary to hemiplegic CP. These findings would not have been detected using a single segment foot model. The identification of multiple kinematic subgroups with unique foot and ankle characteristics has the potential to improve treatment since similar patients within a subgroup are likely to benefit from the same intervention(s). Copyright © 2014 Elsevier B.V. All rights reserved.

Multi-segment foot landing kinematics in subjects with chronic ankle instability.

PubMed

De Ridder, Roel; Willems, Tine; Vanrenterghem, Jos; Robinson, Mark A; Palmans, Tanneke; Roosen, Philip

2015-07-01

Chronic ankle instability has been associated with altered joint kinematics at the ankle, knee and hip. However, no studies have investigated possible kinematic deviations at more distal segments of the foot. The purpose of this study was to evaluate if subjects with ankle instability and copers show altered foot and ankle kinematics and altered kinetics during a landing task when compared to controls. Ninety-six subjects (38 subjects with chronic ankle instability, 28 copers and 30 controls) performed a vertical drop and side jump task. Foot kinematics were obtained using the Ghent Foot Model and a single-segment foot model. Group differences were evaluated using statistical parametric mapping and analysis of variance. Subjects with ankle instability had a more inverted midfoot position in relation to the rearfoot when compared to controls during the side jump. They also had a greater midfoot inversion/eversion range of motion than copers during the vertical drop. Copers exhibited less plantar flexion/dorsiflexion range of motion in the lateral and medial forefoot. Furthermore, the ankle instability and coper group exhibited less ankle plantar flexion at touchdown. Additionally, the ankle instability group demonstrated a decreased plantar flexion/dorsiflexion range of motion at the ankle compared to the control group. Analysis of ground reaction forces showed a higher vertical peak and loading rate during the vertical drop in subjects with ankle instability. Subjects with chronic ankle instability displayed an altered, stiffer kinematic landing strategy and related alterations in landing kinetics, which might predispose them for episodes of giving way and actual ankle sprains. Copyright © 2015 Elsevier Ltd. All rights reserved.

Predicting timing of foot strike during running, independent of striking technique, using principal component analysis of joint angles.

PubMed

Osis, Sean T; Hettinga, Blayne A; Leitch, Jessica; Ferber, Reed

2014-08-22

As 3-dimensional (3D) motion-capture for clinical gait analysis continues to evolve, new methods must be developed to improve the detection of gait cycle events based on kinematic data. Recently, the application of principal component analysis (PCA) to gait data has shown promise in detecting important biomechanical features. Therefore, the purpose of this study was to define a new foot strike detection method for a continuum of striking techniques, by applying PCA to joint angle waveforms. In accordance with Newtonian mechanics, it was hypothesized that transient features in the sagittal-plane accelerations of the lower extremity would be linked with the impulsive application of force to the foot at foot strike. Kinematic and kinetic data from treadmill running were selected for 154 subjects, from a database of gait biomechanics. Ankle, knee and hip sagittal plane angular acceleration kinematic curves were chained together to form a row input to a PCA matrix. A linear polynomial was calculated based on PCA scores, and a 10-fold cross-validation was performed to evaluate prediction accuracy against gold-standard foot strike as determined by a 10 N rise in the vertical ground reaction force. Results show 89-94% of all predicted foot strikes were within 4 frames (20 ms) of the gold standard with the largest error being 28 ms. It is concluded that this new foot strike detection is an improvement on existing methods and can be applied regardless of whether the runner exhibits a rearfoot, midfoot, or forefoot strike pattern. Copyright © 2014 Elsevier Ltd. All rights reserved.

A simple field method to identify foot strike pattern during running.

PubMed

Giandolini, Marlène; Poupard, Thibaut; Gimenez, Philippe; Horvais, Nicolas; Millet, Guillaume Y; Morin, Jean-Benoît; Samozino, Pierre

2014-05-07

Identifying foot strike patterns in running is an important issue for sport clinicians, coaches and footwear industrials. Current methods allow the monitoring of either many steps in laboratory conditions or only a few steps in the field. Because measuring running biomechanics during actual practice is critical, our purpose is to validate a method aiming at identifying foot strike patterns during continuous field measurements. Based on heel and metatarsal accelerations, this method requires two uniaxial accelerometers. The time between heel and metatarsal acceleration peaks (THM) was compared to the foot strike angle in the sagittal plane (αfoot) obtained by 2D video analysis for various conditions of speed, slope, footwear, foot strike and state of fatigue. Acceleration and kinematic measurements were performed at 1000Hz and 120Hz, respectively, during 2-min treadmill running bouts. Significant correlations were observed between THM and αfoot for 14 out of 15 conditions. The overall correlation coefficient was r=0.916 (P<0.0001, n=288). The THM method is thus highly reliable for a wide range of speeds and slopes, and for all types of foot strike except for extreme forefoot strike during which the heel rarely or never strikes the ground, and for different footwears and states of fatigue. We proposed a classification based on THM: FFS<-5.49ms

A comparative biomechanical analysis of habitually unshod and shod runners based on a foot morphological difference.

PubMed

Mei, Qichang; Fernandez, Justin; Fu, Weijie; Feng, Neng; Gu, Yaodong

2015-08-01

Running is one of the most accessible physical activities and running with and without footwear has attracted extensive attention in the past several years. In this study 18 habitually male unshod runners and 20 habitually male shod runners (all with dominant right feet) participated in a running test. A Vicon motion analysis system was used to capture the kinematics of each participant's lower limb. The in-shoe plantar pressure measurement system was employed to measure the pressure and force exerted on the pressure sensors of the insole. The function of a separate hallux in unshod runners is analyzed through the comparison of plantar pressure parameters. Owing to the different strike patterns in shod and unshod runners, peak dorsiflexion and plantarflexion angle were significantly different. Habitually shod runners exhibited a decreased foot strike angle (FSA) under unshod conditions; and the vertical average loading rate (VALR) of shod runners under unshod conditions was larger than that under shod conditions. This suggests that the foot strike pattern is more important than the shod or unshod running style and runners need to acquire the technique. It can be concluded that for habitually unshod runners the separate hallux takes part of the foot loading and reduces loading to the forefoot under shod conditions. The remaining toes of rearfoot strike (RFS) runners function similarly under unshod conditions. These morphological features of shod and unshod runners should be considered in footwear design to improve sport performance and reduce injury. Copyright © 2015 Elsevier B.V. All rights reserved.