Dynamic plantar pressure patterns in children and adolescents with Charcot-Marie-Tooth disease

BackgroundThe dynamic plantar pressure patterns of children and adolescents with Charcot-Marie-Tooth (CMT) disease and its relationship to musculoskeletal alterations may help to understand the natural history of the disease and improve therapeutic interventions.Research questionThe study compared dynamic plantar pressure patterns in children and adolescents with and without CMT. It also tested the associations between isometric muscle strength (IMS), passive range of motion (ROM), foot posture and dynamic plantar pressure patterns in CMT.MethodsThis cross-sectional study compared children and adolescents (aged 8–18 years) with CMT (n = 40) with a typical group (n = 40). The plantar pressure distribution during gait was recorded, and the contact area (CA), peak pressure (PP), contact time (CT) and pressure-time integral (PTI) in five foot regions (rearfoot, midfoot lateral, midfoot medial, lateral forefoot and medial forefoot) were analysed. The IMS of the dorsiflexors and plantar flexors, passive ROM, and foot posture were also recorded.ResultsPP (medial midfoot and medial forefoot) and PTI (rearfoot, lateral midfoot and medial forefoot) were higher in children with CMT compared with the typical group. The adolescents with CMT presented a less CA (whole foot) and a higher CT (medial midfoot) when compared with typical group. For CMT, in the medial midfoot, plantar flexor IMS associated with PP (β=-11.54, p = 0.01) and PTI (β=-3.38, p = 0.04); supinated foot posture associated with PP (β = 33.89, p = 0.03) and PTI (β = 12.01, p = 0.03).SignificanceChildren with CMT showed clear changes in most of the dynamic plantar pressure variables, while adolescents with CMT showed changes mostly in CA and CT. This information together with the associations established between supinated foot, dorsiflexion ROM and plantar flexions IMS can be useful for guiding rehabilitation professionals in their therapies.     

Functional,impulse-based quantification of plantar pressure patterns in typical adult gait

BackgroundDynamic pedobarography is used to measure the change in plantar pressure distribution during gait. Clinical methods of pedobarographic analysis lack, however, a standardized, functional segmentation or require costly motion capture technology and expertise. Furthermore, while commonly used pedobarographic measures are mostly based on peak pressures, progressive foot deformities also depend on the duration the pressure is applied, which can be quantified via impulse measures.Research QuestionOur objectives were to: (1) develop a standardized method for functionally segmenting pedobarographic data during gait without the need for motion capture; (2) compute pedobarographic measures that are based on each segment’s vertical impulse; and (3) obtain a normative set of such pedobarographic measures for non-disabled gait.MethodsPedobarographic data was collected during gait from sixty adults with normal feet. Using the maximum pressure map for each trial, an expert and novice rater independently identified the hallux, heel, medial forefoot, and lateral forefoot and computed nine normalized vertical impulse measures.ResultsFrom the computed impulse measures, the Heel-to-Forefoot Balance was 33.3 ± 5.5%, the Medial-Lateral Forefoot Balance (with hallux) 59.2 ± 8.0%, the Medial-Lateral Forefoot Balance (without hallux) 53.5 ± 7.7%, and the Hallux-to-Medial Forefoot Balance 21.0 ± 8.9% (mean ± standard deviation). The intra- and inter-rater reliability ranged between 0.93 and 1.00 and between 0.89 and 0.99, respectively (ICC(2,1)).SignificanceWe developed a simple, stand-alone method for pedobarographic segmentation that is mechanistically linked to relevant anatomical regions of the foot. The normative impulse measures exhibited excellent reliability. This normative dataset is currently used in the clinical assessment of different foot deformities and gait impairments, and in the evaluation of treatment outcomes.     

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

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.     

Effect of customised preformed foot orthoses on gait parameters in children with juvenile idiopathic arthritis: A multicentre randomised clinical trial

BackgroundChildren with juvenile idiopathic arthritis (JIA) can experience significant physical impairment of the lower extremity. Prolonged joint disease and symptoms may cause gait alterations such as reduced walking speed and increased plantar pressures in diseased areas of their feet. There is limited robust clinical trials investigating the effect of non-invasive mechanical therapies such as foot orthoses (FOs) on improving gait parameters in children with JIA.Research questionAre customised preformed FOs effective in improving gait parameters in children with JIA?MethodsA multicentre, parallel design, single-blinded randomised clinical trial was used to assess the gait impacts of customised preformed FOs on children with JIA. Children with a diagnosis of JIA, exhibiting lower limb symptoms and aged 5–18 were eligible. The trial group received a low-density full length, Slimflex Simple device which was customised chair side and the control group received a sham device. Peak pressure and pressure time integrals were used as the main gait outcomes and were measured using portable Tekscan gait analysis technology at baseline, 3 and 6 months. Differences at each follow-up were assessed using the Wilcoxon rank sum test.Results66 participants were recruited. Customised preformed FOs were effective in altering plantar pressures in children with JIA versus a control device. Reductions of peak pressures and pressure time integrals in the heel, forefoot and 5th metatarsophalangeal joint were statistically significant in favour of the trial group. This was associated with statistically significant increased midfoot contact with the trial device at baseline, 3 and 6-month data collections. The trial intervention was safe and well accepted by participants, which is reflected in the high retention rate (92%).SignificanceClinicians may prescribe customised preformed FOs in children with JIA to deflect pressure from painful joints and redistribute from high pressure areas such as the rearfoot and forefoot.     

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

IntroductionOutsole parameters of the shoe can be adapted to offload regions of pain or region of high pressures. Previous studies already showed reduced plantar pressures in the forefoot due to a proximally placed apex position and higher longitudinal bending stiffness (LBS). The aim of this study was to determine the effect of changes in rocker radii and high LBS on the plantar pressure profile during gait.Method10 participants walked in seven shoe conditions of which one control shoe and six rocker shoes with small, medium and large rocker radii and low and high longitudinal bending stiffness. Pedar in-shoe plantar pressure measuring system was used to quantify plantar pressures while walking on a treadmill at self-selected walking speed. Peak plantar pressure, maximum mean pressure and force-time integral were analyzed with Generalized Estimated Equation (GEE) and Tukey post hoc correction (α = .05).ResultsSignificantly lower plantar pressures were found in the first toe, toes 2–5, distal and proximal forefoot in all rocker shoe conditions as compared to the control shoe. Plantar pressures in the first toe and toes 2–5 were significantly lower in the small radius compared to medium and large radii. For the distal forefoot both small and medium radii significantly reduced plantar pressure compared to large radii. Low LBS reduced plantar pressure at the first toe significantly compared to high LBS independent of the rocker radius. Plantar pressures in the distal forefoot and toes 2–5 were lower in high LBS compared to low LBS.ConclusionManipulation of the rocker radius and LBS can effectively reduce peak plantar pressures in the forefoot region during gait. In line with previous studies, we showed that depending on the exact target location for offloading, different combinations of rocker radius and LBS need to be adopted to maximize treatment effects.     

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

PurposeThe 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.MethodsFourteen 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.ResultsMild-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.ConclusionIn 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.     

Inter- and intra-observer reliability of masking in plantar pressure measurement analysis

Plantar pressure measurement is an important tool in gait analysis. Manual placement of small masks (masking) is increasingly used to calculate plantar pressure characteristics. Little is known concerning the reliability of manual masking. The aim of this study was to determine the reliability of masking on 2D plantar pressure footprints, in a population with forefoot deformity (i.e. hallux valgus). Using a random repeated-measure design, four observers identified the third metatarsal head on a peak-pressure barefoot footprint, using a small mask. Subsequently, the location of all five metatarsal heads was identified, using the same size of masks and the same protocol. The 2D positional variation of the masks and the peak pressure (PP) and pressure time integral (PTI) values of each mask were calculated. For single-masking the lowest inter-observer reliability was found for the distal-proximal direction, causing a clear, adverse impact on the reliability of the pressure characteristics (PP and PTI). In the medial-lateral direction the inter-observer reliability could be scored as high. Intra-observer reliability was better and could be scored as high or good for both directions, with a correlated improved reliability of the pressure characteristics. Reliability of multi-masking showed a similar pattern, but overall values tended to be lower. Therefore, small sized masking in order to define pressure characteristics in the forefoot should be done with care.     

Functional characterization of plantar pressure patterns in gait of typically developing children using dynamic pedobarography

BackgroundAbnormal foot posture is a common complaint presented in pediatric and pediatric orthopedic clinics. Functional, objective assessment of foot posture, with the potential for early identification of pathologic foot deformities, has, however, been lacking to date. While quantifying functional and regional impulses via dynamic pedobarography can improve the clinical assessment of children’s feet, normative values have not yet been reported or characterized.Research QuestionThe objectives of this study were to: (1) quantify and characterize the pattern and spectrum of foot impulses in walking-aged, typically developing children; and (2) compare these to impulses from non-disabled adults.MethodsFoot impulses of 102 participants (52 female) in five pre-determined age groups (2−3, 4–6, 7–10, 11−14, 15−17 years) were examined using dynamic pedobarography. Each pressure map (3 per foot per child) was divided according to anatomical foot regions: the hallux, heel, medial forefoot, lateral forefoot, lesser toes (D2 to D5), and midfoot. The impulse was calculated for each region and used to generate regional percent impulses and impulse ratios to assess anteroposterior and mediolateral balance within the foot.ResultsThe impulse through the midfoot was highest in the youngest age group, with a corresponding lower impulse through the medial forefoot. As age advanced, the midfoot impulse decreased (p = 0.001), and the forefoot balance shifted slightly more medially (%Medial Forefoot: p = 0.004; Medial-Lateral Forefoot Balance: p = 0.019). When compared to adults, there were no significant differences between 15−17 year old children and adults in any of the regional percent impulses and impulse ratios. This indicates that skeletal maturity of the foot by late adolescence results in functional characteristics seen in adults.SignificanceThe age-standardized norms of functional and regional impulse measures in children reported in this study can be used as a comparative benchmark in the clinical assessment of children presenting with various foot deformities.     

Plantar loading and cadence alterations with fatigue

PURPOSE: The purpose of this investigation was to identify changes in loading characteristics of the foot associated with fatigue during running. METHODS: Nineteen healthy subjects ranging from 20 to 30 yr (mean = 22.3, SD = 2.4) were equipped with the Pedar in-shoe measurement system (Novel GmbH) for the assessment of plantar loading. After acclimation to the treadmill, subjects were progressed through the Ohio State protocol for exercise testing until fatigue was reported using Borg's RPE scale. Six right footsteps were recorded at 150 Hz for each subject's comfortable running pace under normal and fatigued conditions. A series of repeated measures multiple analysis of variance was performed for all dependent variables analyzed in this study including peak force (PF), force-time integral (FTI), peak pressure (PP), and pressure-time integral (PTI) for all regions of the plantar surface. RESULTS: Decreased step time, significantly smaller values under the heel for PP, PF, FTI, CT, and PTI, and trends toward increased medial forefoot loading were identified while subjects were running under fatigued conditions (alpha < 0.05). CONCLUSION: These results suggest that subjects change running technique and plantar surface loading characteristics in response to fatigued conditions through increased cadence, decreased loading of the heel, and increased medial forefoot loading.     

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

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

Forefoot plantar shear stress distribution in hallux valgus patients

BackgroundHallux valgus is a common foot disorder often experienced with secondary callosities and metatarsalgia. Many factors including improper shoes might be responsible in the pathophysiology of the problem. Hallux valgus deformity has been shown to alter the biomechanics of the whole foot rather than affecting only the great toe. Due to changes in the biomechanical functioning of the first ray, other regions of the forefoot area have been shown to bear abnormal loads with increased vertical loading on medial, central and lateral forefoot regions. The purpose of this study was to investigate the pattern of forefoot plantar shear loading in hallux valgus patients and compare these results with those of control subjects.MethodsA total of 28 subjects were recruited for the study of which 14 were clinically diagnosed with hallux valgus. A custom built platform was used to collect peak pressure and shear data. A repeated measures analysis of variance was used to analyze the recorded data.FindingsAntero-posterior shear was significantly lower in the deformity group (p < 0.05). The lateral forefeet of the patients, however, experienced slightly higher shear loads (p > 0.05).InterpretationPropulsive shear force generation mechanism under the medial forefoot was impaired in the disorder group. In general, shear loading of the plantar feet shifted laterally. Previously hypothesized higher medio-lateral shear magnitudes under the hallux were not confirmed.     

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

ObjectivesImproving 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.MethodsForty-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.ResultsAdapted 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.ConclusionsUsing 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.     

Understanding the role of foot biomechanics on regional foot orthosis deformation in flatfoot individuals during walking

BackgroundFoot orthoses (FOs) are one of the most common interventions to restore normal foot mechanics in flatfoot individuals. New technologies have made it possible to deliver customized FOs with complex designs for potentially better functionalities. However, translating the individuals’ biomechanical needs into the design of customized FOs is not yet fully understood.Research questionOur objective was to identify whether the deformation of customized FOs is related to foot kinematics and plantar pressure during walking.MethodsThe kinematics of multi-segment foot and FOs contour were recorded together with plantar pressure in 17 flatfoot individuals while walking with customized FOs. The deformation of FOs surface was predicted from its contour kinematics using an artificial neural network. Plantar pressure map and deformation were divided into five anatomically based regions defined by the corresponding foot segments. Forward stepwise linear mixed models were built for each of the four gait phases to determine the feet-FOs interaction.ResultsIt was observed that some associations existed between foot kinematics and pressure with regional FOs deformation. From heel-strike to foot-flat, longitudinal arch angle was associated with FOs deformation in forefoot. From foot-flat to midstance, rearfoot eversion accounted for variation in the deformation of medial FOs regions, and forefoot abduction for the lateral regions. From midstance to heel-off, rearfoot eversion, longitudinal arch angle, and plantar pressure played significant role in deformation. Finally, from heel-off to toe-off, forefoot adduction affected the deformation of forefoot and midfoot.SignificanceThis study provides guidelines for designing customized FOs. Flatfoot individuals with excessive rearfoot eversion or very flexible medial arches require more support on medial FOs regions, while the ones with excessive forefoot abduction need the support on lateral regions. However, a compromise should be made between the level of support and the level of increase in plantar pressure to avoid stress on foot structures.     

The influence of population characteristics and measurement system on barefoot plantar pressures: A systematic review and meta-regression analysis

BackgroundThe measurement of plantar pressure distributions during gait can provide insights into the effects of musculoskeletal disease on foot function. A range of hardware, software, and protocols are available for the collection of this type of data, with sometimes disparate and conflicting results reported between individual studies. In this systematic review and meta-regression analysis of dynamic regional peak pressures, we aimed to test if 1) the system used to obtain the pressure measurements and 2) the characteristics of the study populations had a significant effect on the results.MethodsA systematic review of the literature was undertaken to identify articles reporting regional peak plantar pressures during barefoot walking. A mixed-effects modeling approach was used to analyze the extracted data. Initially, the effect of the system used to collect the data was tested. Following this, the effect of participant characteristics on the results were analyzed, using moderators of cohort type (defined as the primary health characteristic of the participants), age, sex, and BMI.Results115 participant groups were included in the analysis. Sufficient cohorts were available to test those that consisted of healthy individuals, and those with diabetes and diabetic neuropathy. Significant differences were found between results reported by studies using different pressure measurement systems in 8 of the 16 regions analyzed. The analysis of participant characteristics revealed a number of significant relationships between regional peak pressures and participant characteristics, including: BMI and midfoot plantar pressures; elevated forefoot pressures as a result of diabetic neuropathy; and sex-differences in regional loading patterns.ConclusionsAt the level of the literature, we confirmed significant effects of disease status, age, BMI, and sex on regional peak plantar pressures. Researchers and clinicians should be aware that measurements of peak plantar pressure variables obtained from different collection equipment are not directly comparable.     

Reliability of peak foot pressure in patients with previous diabetic foot ulceration

BackgroundPrevious reliability studies on peak plantar pressure measurements in patients with previous diabetic foot ulceration (DFU) did not stratify their analyses according to whether the foot had a previous ulcer.Research questionDoes test-retest reliability of peak foot pressure measurements from the various foot regions differ between the ulcerated and non-ulcerated feet?MethodsData from 23 participants with peripheral neuropathy and healed plantar DFU were analysed in this test-retest reliability comparison study. Plantar pressure was evaluated on two sessions using Pedar^®-X in-shoe system, with a mean of 7.2 days (SD = 1.6) between sessions.ResultsThe intraclass correlation coefficient (ICC) and coefficient of variation (CV) were calculated for 10 foot regions. Overall, test-retest reliability was excellent (ICCs, 0.82 to 0.95) for all peak pressure variables. CV ranged between 6.3% and 18.3%, and exceeded 15% over the hallux and medial forefoot regions in the ulcer foot (18.3% and 16.4%, respectively). Hallux peak pressure CV was significantly higher over the ulcer foot than over the non-ulcer foot (5.7%, 95% CI, 1.7%–10.2%). Peak pressure CV over the forefoot also tended to be higher over the ulcer foot (medial forefoot: 6.1%, 95% CI, -0.5%–14.5%; lateral forefoot: 4.1%, 95%CI, -0.7%–11.1%).SignificancePeak plantar foot pressure may be useful to distinguish between groups of patients with peripheral neuropathy and healed plantar DFU. However, clinical decisions based on ulcer foot hallux and forefoot peak pressure measurements should be interpreted with caution.     

Pressure characteristics in painful pes cavus feet resulting from Charcot-Marie-Tooth disease

Charcot–Marie–Tooth (CMT) disease often presents with peripheral muscle imbalance associated with a painful cavus (medial high-arched) foot deformity which becomes increasingly severe and rigid as the disease progresses. The purpose of this study was to investigate the effect of pes cavus on foot pain and dynamic plantar pressure in CMT, and to explore the relationships between plantar pressure and pain. Sixteen participants diagnosed with CMT and painful pes cavus were assessed for foot posture, ankle dorsiflexion range of motion, levels of foot pain, functional impairment, health-related quality of life and plantar pressure distribution while walking. Plantar pressure parameters (mean pressure, peak pressure, pressure–time integral) and contact duration were measured using the Novel Pedar^® in-shoe capacitance transducer system and the foot was divided into rearfoot, midfoot and forefoot regions for analysis. Increasing cavus foot deformity was associated with more widespread foot pain and increased pressure under the forefoot and midfoot regions. In contrast, peak pressure decreased under the rearfoot. Neither relationship was found between foot pain intensity and any of the pressure variables, nor was ankle dorsiflexion range of motion correlated with pain location, intensity or degree of pes cavus. Although pes cavus in CMT is associated with substantial pain and dysfunction, there is no clear link between foot pain and plantar pressure. The more severe the degree of pes cavus, however, the more pressure develops under the lateral margin of the foot; probably as a result of the changed foot–ground contact seen during gait.     

Hardness and posting of foot orthoses modify plantar contact area,plantar pressure,and perceived comfort when cycling

Objectives

To evaluate the effects of hardness and posting of orthoses on plantar profile and perceived comfort and support during cycling.

Regional plantar pressure during walking, stair ascent and descent

Regional plantar pressures during stair walking may be injurious in at risk populations. However, limited data are available examining the reliability of plantar pressure data collected during stair walking. The aims of this study were three fold; to assess the reliability of the plantar pressure data recorded during stair walking, to assess the effects of level ground and stair walking on plantar loading, and to develop regression equations to predict regional plantar pressures in stair walking from those collected on level ground. Fifteen subjects without conditions affecting their ability to walk on level surfaces or stairs were recruited. Each participant performed at least 10 steps in level ground and stair walking while plantar pressure data were recorded in six foot regions. Reliability was assessed using Intraclass Correlation Coefficient. A repeated measures ANOVA was used to assess the effect of activity on plantar pressure, and a linear regression was used to predict forefoot loading during stair walking. A reliability of 0.9 was achieved within 10 steps in all foot regions, with the forefoot requiring fewer steps. Plantar pressures were influenced by both, foot region and activity, with the heel and forefoot regions generally experiencing lower peak pressures and maximal forces during stair walking than level ground walking. The regression equations predicting peak pressure during stair walking accounted for between 37% and 70% of the variance of the stair walking data. These findings establish the reliability of plantar pressure data collected during stair walking. Future studies should investigate these parameters in clinical populations.     

Age-related differences in foot structure and function

The aim of this study was to compare foot characteristics and plantar force and pressure patterns in young and older people. Fifty young (mean age 20.9+/-2.6 years) and 50 older (mean age 80.2+/-5.7 years) people without foot problems underwent tests of foot posture, range of motion, strength, sensation and deformity. Plantar force and pressure distribution during gait were evaluated using a floor-mounted resistive sensor mat system. Older participants exhibited flatter/more pronated feet, reduced range of motion of the ankle and 1st metatarsophalangeal joints, a higher prevalence of hallux valgus, toe deformities and toe plantarflexor weakness, and reduced plantar tactile sensitivity. Plantar pressure analysis revealed decreased magnitude of forces and pressures under the heel (-13% to 16%), metatarsophalangeal joints (-11% to 16%) and hallux (-19% to 25%), but greater relative contact time under the heel (+21%), midfoot (+14%) and metatarsophalangeal joints (+5% to 8%) in older participants. Multiple regression analysis revealed that these age-related differences could be largely explained by differences in step length and various foot characteristics, particularly foot posture and the severity of hallux valgus. These findings indicate that ageing is associated with significant changes in foot characteristics which contribute to altered plantar loading patterns during gait.     

External feedback during walking improves measures of plantar pressure in individuals with chronic ankle instability

BackgroundIndividuals with chronic ankle instability (CAI) commonly present with an altered walking gait which favors the lateral aspect of their foot. Current rehabilitative protocols are unable to address these gait modifications which are potentially hindering improvements in patient-reported outcomes. Protocols for gait retraining are scarce, thus there is a need to develop intervention strategies and instruments to specifically target foot motion to address gait deficits in individuals with CAI.Research QuestionTo determine the ability of a novel laser device providing external visual feedback (ExFB) during real-time to cause alterations in plantar pressure measures in individuals with CAI.MethodsTwenty-six participants with CAI walked on a treadmill while real-time plantar pressure measures were being recorded during a baseline and feedback condition. Baseline trials were compared with ExFB trials within each subject.ResultsThe ExFB condition was able to significantly reduce plantar pressures on the lateral midfoot and forefoot compared to baseline. A statistically significant medial shift in center of pressure trajectory was also observed in the ExFB condition compared to baseline.SignificanceReal-time external feedback provided by a novel laser device has the ability to reduce lateral column plantar pressures during walking in individuals with CAI.