Immediate effect of Masai Barefoot Technology shoes on knee joint moments in women with knee osteoarthritis

Footwear modification can beneficially alter knee loading in patients with knee osteoarthritis. This study evaluated the effect of Masai Barefoot Technology shoes on reductions in external knee moments in patients with knee osteoarthritis. Three-dimensional motion analysis was used to examine the effect of Masai Barefoot Technology versus control shoes on the knee adduction and flexion moments in 17 women (mean age, 63.6 years) with radiographically confirmed knee osteoarthritis. The lateral and anterior trunk lean values, knee flexion and adduction angles, and ground reaction force were also evaluated. The influence of the original walking pattern on the changes in knee moments with Masai Barefoot Technology shoes was evaluated. The knee flexion moment in early stance was significantly reduced while walking with the Masai Barefoot Technology shoes (0.25 ± 0.14 N m/kg m) as compared with walking with control shoes (0.30 ± 0.19 N m/kg m); whereas the knee adduction moment showed no changes. Masai Barefoot Technology shoes did not increase compensatory lateral and anterior trunk lean. The degree of knee flexion moment in the original walking pattern with control shoes was correlated directly with its reduction when wearing Masai Barefoot Technology shoes by multiple linear regression analysis (adjusted R² = 0.44, P < 0.01). Masai Barefoot Technology shoes reduced the knee flexion moment during walking without increasing the compensatory trunk lean and may therefore reduce external knee loading in women with knee osteoarthritis.     

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

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 × 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.     

Comparaison de la répartition des appuis plantaires entre chaussures d'entraînement et chaussures à pointes chez de jeunes sprinters

AimsTo compare plantar patterns between training and spikes shoes in young sprinters.Methods and resultsEleven athletes performed two trials of 2 × 60 m maximal speed with training and spikes shoes, respectively. Contact area was significantly smaller with spikes in total and under the toes; pressure and force were significantly higher with spikes under the forefoot mainly in medial and lateral.ConclusionsWearing spikes shoes, higher loads are applied mainly under the 1st and the 2nd metatarsal heads. This may have relevance in order to clarify the mechanisms of injuries like metatarsalgia or stress fractures of the forefoot.     

3D gait analysis with and without an orthopedic walking boot

IntroductionOrthopedic walking boots have been widely used in place of traditional fiberglass casts for a variety of orthopedic injuries and post-surgical interventions. These walking boots create a leg length discrepancy (LLD). LLD has been shown to alter the kinematics and kinetics of gait and are associated with lumbar and lower limb conditions such as: foot over pronation, low back pain, scoliosis, and osteoarthritis of the hip and knee joints. Past gait analyses research with orthopedic boots is limited to findings on the ipsilateral limb. Thus, the purpose of the study was to examine bilateral gait kinematics & kinetics with and without a walking boot.MethodsForty healthy participants (m = 20, f = 20, age 20.7 ± 1.8 yrs., ht. 171.6 ± 9.5 cm, wt. 73.2 ± 11.0 kg, BMI 24.8 ± 3.2) volunteered. An eight camera Vicon Motion Capture System with PIG model and two AMTI force plates were utilized to record the walking trial conditions: (1) bilateral tennis shoes (2) boot on right foot, tennis shoe on left foot (3) boot on right foot, barefoot on left foot. Data were processed in Nexus 2.2.3 and exported to Visual 3D for analysis.ResultsWhen wearing the boot, there were significant differences in most joint angles and moments, with larger effects on long limb.ConclusionThe walking boot alters the gait in the same way as those with existing LLD, putting them at risk for development of secondary knee, hip, and low back pain during treatment protocol.     

Biomechanics of slow running and walking with a rocker shoe

Evidence suggests a link between the loading of the Achilles tendon and the magnitude of the ankle internal plantar flexion moment during late stance of gait, which is clinically relevant in the management of Achilles tendinopathy. Some studies showed that rocker shoes can reduce the ankle internal plantar flexion moment. However, the existing evidence is not conclusive and focused on walking and scarce in running. Sixteen healthy runners participated in this study. Lower extremity kinetics, kinematics and electromyographic (EMG) signals of triceps surae and tibialis anterior were quantified for two types of shoes during running and walking. The peak ankle plantar flexion moment was reduced significantly in late stance of running (0.27 Nm/kg; p < 0.001) and walking (0.24 Nm/kg; p < 0.001) with the rocker shoe compared to standard shoe. The ankle power generation and plantar flexion moment impulse were also reduced significantly when running and walking with the rocker shoe (p < 0.001). No significant changes in the knee and hip moments were found in running and walking. A significant delay of the EMG peak, approximately 2% (p < 0.001), was present in the triceps surae when walking with rocker shoes. There were no significant changes in the EMG peak amplitude of triceps surae in running and walking. The peak amplitude of tibialis anterior was significantly increased (64.7 μV, p < 0.001) when walking with rocker shoes. The findings show that rocker shoes reduce the ankle plantar flexion moment during the late stance phase of running and walking in healthy people.     

Spatial and temporal gait characteristics of elderly individuals during backward and forward walking with shoes and barefoot

Backward walking (BW) is an inherent component of mobility and function in daily activities, particularly indoors, when it is more likely that a person is barefoot. No studies to date have compared the spatio-temporal characteristics of BW with and without shoes in elderly individuals.This study compared spatio-temporal measures of BW and forward walking (FW) among elderly individuals while barefoot or wearing shoes. Forty-seven elderly individuals (13 men and 34 women, 76.7 ± 7.7 years of age) were evaluated. Participants were requested to walk at a comfortable, self-selected pace across the GAITRite^® walkway for three trials under each of four conditions: walking forward (FW) and BW wearing their own comfortable low-heeled walking shoes and FW and BW walking without shoes. Gait speed, stride length and cadence were significantly reduced in BW versus FW, with an increase in double limb support (DLS), both with and without shoes. Barefoot BW resulted in significantly increased gait speed and cadence, and decreased DLS compared to BW with shoes. BW stride length was not affected by footwear. While barefoot FW was also associated with a significant increase in cadence and decrease in DLS time compared to walking with shoes, it decreased stride length and had no detrimental effect on gait speed. Assessment of the spatio-temporal parameters of walking barefoot and with shoes during FW and BW can contribute to our understanding of the ability of elderly individuals to adapt to changing walking conditions, and should be included in the assessment of functional mobility of elderly individuals.     

Walking cadence affects rate of plantar foot temperature change but not final temperature in younger and older adults

This study examined the relationship between (1) foot temperature in healthy individuals and walking cadence, (2) temperature change at different locations of the foot, and (3) temperature change and its relationship with vertical pressures exerted on the foot. Eighteen healthy adult volunteers (10 between 30 and 40 years – Age: 33.4 ± 2.4 years; 8 above 40 years – Age: 54.1 ± 7.7 years) were recruited. A custom-made insole with temperature sensors was placed directly onto the plantar surface of the foot and held in position using a sock. The foot was placed on a pressure sensor and the whole system placed in a canvas shoe. Participants visited the lab on three separate occasions when foot temperature and pressure data were recorded during walking on a treadmill at one of three cadences (80, 100, 120 steps/min). The plantar foot temperature increased during walking in both age groups 30–40 years: 4.62 ± 2.00 °C, >40 years: 5.49 ± 2.30 °C, with the rise inversely proportional to initial foot temperature (30–40 years: R² = −0.669, >40 years: R² = −0.816). Foot temperature changes were not different between the two age groups or the different foot locations and did not depend on vertical pressures. Walking cadence affected the rate of change of plantar foot temperature but not the final measured value and no association between temperature change and vertical pressure was found. These results provide baseline values for comparing foot temperature changes in pathological conditions which could inform understanding of pathophysiology and support development of evidence based healthcare guidelines for managing conditions such as diabetic foot ulceration (DFU).     

Footwear characteristics are related to running mechanics in runners with patellofemoral pain

Running footwear is known to influence step rate, foot inclination at foot strike, average vertical loading rate (VLR) and peak patellofemoral joint (PFJ) force. However, the association between the level of minimalism of running shoes and running mechanics, especially with regards to these relevant variables for runners with patellofemoral pain (PFP), has yet to be investigated. The objective of this study was to explore the relationship between the level of minimalism of running shoes and habitual running kinematics and kinetics in runners with PFP. Running shoes of 69 runners with PFP (46 females, 23 males, 30.7 ± 6.4 years) were evaluated using the Minimalist Index (MI). Kinematic and kinetic data were collected during running on an instrumented treadmill. Principal component and correlation analyses were performed between the MI and its subscales and step rate, foot inclination at foot strike, average VLR, peak PFJ force and peak Achilles tendon force. Higher MI scores were moderately correlated with lower foot inclination (r = −0.410, P < 0.001) and lower peak PFJ force (r = −0.412, P < 0.001). Moderate correlations also showed that lower shoe mass is indicative of greater step rate (ρ = 0.531, P < 0.001) and lower peak PFJ force (ρ = −0.481, P < 0.001). Greater shoe flexibility was moderately associated with lower foot inclination (ρ = −0.447, P < 0.001). Results suggest that greater levels of minimalism are associated with lower inclination angle and lower peak PFJ force in runners with PFP. Thus, this population may potentially benefit from changes in running mechanics associated with the use of shoes with a higher level of minimalism.     

Estimation of foot trajectory during human walking by a wearable inertial measurement unit mounted to the foot

To establish a supportive technology for reducing the risk of falling in older people, it is essential to clarify gait characteristics in elderly individuals that are possibly linked to the risk of falling during actual daily activities. In this study, we developed a system to monitor human gait in an outdoor environment using an inertial measurement unit consisting of a tri-axial accelerometer and tri-axial gyroscope. Step-by-step foot trajectories were estimated from the sensor unit attached to the dorsum of the foot. Specifically, stride length and foot clearance were calculated by integrating the gravity-compensated translational acceleration over time during the swing phase. Zero vertical velocity and displacement corrections were applied to obtain the final trajectory, assuming the slope of the walking surface is negligible. Short, normal, and long stride-length walking of 10 healthy participants was simultaneously measured using the proposed system and a conventional motion capture system to evaluate the accuracy of the estimated foot trajectory. Mean accuracy and precision were approximately 20 ± 50 mm, for stride length, and 2 ± 7 mm for foot clearance, indicating that the swing phase trajectory of the sensor unit attached to the foot was reconstructed more accurately and precisely using the proposed system than with previously published methods owing to the flat floor assumption. Although some methodological limitations certainly apply, this system will serve as a useful tool to monitor human walking during daily activities.     

Light curtain for detecting footfall instants during treadmill walking—An exploratory study

Footswitches, instrumented insoles, and forceplates are commonly used for detecting footfall instants during treadmill walking. This study aimed to explore the feasibility of using an optoelectronic light curtain for detecting initial foot contact (FC) and toe-off (TO) instants during treadmill walking. A commercial light curtain comprised of an array of parallel infrared light beams was installed 5 mm above the treadmill belt. Ten subjects walked on the treadmill at 0.5, 1.0 and 1.4 m/s and their gait was captured using seven optoelectronic cameras. Footswitches were secured over the heel and big toe of the right foot and the corresponding areas of the shoe. Footfall instants from the light curtain, markers, and foot footswitches were compared with the shoe footswitches serving as a criterion. The respective time differences were computed for each step and used to evaluate the agreement with the criterion and variability across subjects. FC instants from foot footswitches were on average within 10 ms of the criterion. Both video and light curtain FC instants were detected at least 30 ms before the criterion. For TO, both the foot footswitches and video instants preceded the criterion. In contrast, the TO from the light curtain occurred >110 ms after the criterion but the variability was the smallest. The results indicated that using a light curtain for detecting footfall instants is feasible. The advantages of light curtain are relatively low cost, no subject preparations, and real-time signals. Greater accuracy is expected with further optimization of the setup.     

The effects of high custom made shoes on gait characteristics and patient satisfaction in hemiplegic gait

ObjectiveTo determine the effects of a temporary high custom made orthopaedic shoe on functional mobility, walking speed, and gait characteristics in hemiplegic stroke patients. In addition, interference of attentional demands and patient satisfaction were studied.DesignClinical experimental study.SettingUniversity Medical Centre.ParticipantsNineteen stroke patients (12 males; mean age 55 years (standard deviation (SD) 10 years); mean time post onset 3.6 months (SD 1.4 months)) with a spastic paresis of the lower extremity.Main outcome measuresFunctional mobility was assessed with the timed up and go test, walking speed and gait characteristics were measured with clinical gait analysis and performed with and without a verbal dual task. Patient satisfaction was determined with a questionnaire.ResultsWalking with the high orthopaedic shoe resulted in improved functional mobility (22%; p < .001), walking speed (37%; p < .001) and gait characteristics compared to walking with normal shoes. The dual task interfered with functional mobility during walking. The interference was equally big for normal shoes as for the orthopaedic shoe. Patients evaluated walking with the high orthopaedic shoe as an improvement (p < .001). An average of 84% reported improvements in foot lifting, swing progression, taking weight, confidence while walking, safety, walking distance and walking speed.ConclusionIn the early recovery phase after stroke, when regaining walking ability, a temporary high orthopaedic shoe can improve hemiplegic gait, even with dual task interference.     

Exoskeleton plantarflexion assistance for elderly

Elderly are confronted with reduced physical capabilities and increased metabolic energy cost of walking. Exoskeletons that assist walking have the potential to restore walking capacity by reducing the metabolic cost of walking. However, it is unclear if current exoskeletons can reduce energy cost in elderly. Our goal was to study the effect of an exoskeleton that assists plantarflexion during push-off on the metabolic energy cost of walking in physically active and healthy elderly. Seven elderly (age 69.3 ± 3.5 y) walked on treadmill (1.11 m s²) with normal shoes and with the exoskeleton both powered (with assistance) and powered-off (without assistance). After 20 min of habituation on a prior day and 5 min on the test day, subjects were able to walk with the exoskeleton and assistance of the exoskeleton resulted in a reduction in metabolic cost of 12% versus walking with the exoskeleton powered-off. Walking with the exoskeleton was perceived less fatiguing for the muscles compared to normal walking. Assistance resulted in a statistically nonsignificant reduction in metabolic cost of 4% versus walking with normal shoes, likely due to the penalty of wearing the exoskeleton powered-off. Also, exoskeleton mechanical power was relatively low compared to previously identified optimal assistance magnitude in young adults. Future exoskeleton research should focus on further optimizing exoskeleton assistance for specific populations and on considerate integration of exoskeletons in rehabilitation or in daily life. As such, exoskeletons should allow people to walk longer or faster than without assistance and could result in an increase in physical activity and resulting health benefits.     

The influence of shoe aging on children running biomechanics

Athletic children are prone to overuse injuries, especially at the heel and knee. Since footwear is an extrinsic factor of lower limb injury risk, the aim of this study was to assess the influence of shoe aging on children running biomechanics. Fourteen children active in sports participated in a laboratory biomechanical evaluation. A new pair of shoes was provided to each participant at an inclusion visit. Four months later, the participants performed a running task and their kinematics and kinetics were assessed both with their used shoes and with a new pair of shoes identical to the first. Furthermore, mechanical cushioning properties of shoes were evaluated before and after in-vivo aging. After 4 months of use, the sole stiffness increased by 16% and the energy loss capacity decreased by 18% (p < 0.001). No ankle or knee kinematic adjustment was found at foot strike in used shoes but changes were observed later during stance. Running with used shoes produced a higher loading rate of the vertical ground reaction force (+23%, p = 0.016), suggesting higher compressive forces under the heel and placing children at risk to experience impact-related injuries. Nevertheless, the decreased peak ankle and knee power absorption in used shoes (−11%, p = 0.010 and −12%, p = 0.029, respectively) suggests a lower ankle and knee joints loading during the absorption phase that may be beneficial regarding stretch-related injuries.     

Validity and repeatability of three in-shoe pressure measurement systems

In-shoe pressure measurement devices are used in research and clinic to quantify plantar foot pressures. Various devices are available, differing in size, sensor number and type; therefore accuracy and repeatability. Three devices (Medilogic, Tekscan and Pedar) were examined in a 2 day × 3 trial design, quantifying insole response to regional and whole insole loading. The whole insole protocol applied an even pressure (50–600 kPa) to the insole surface for 0–30 s in the Novel TruBlue™ device. The regional protocol utilised cylinders with contact surfaces of 3.14 and 15.9 cm² to apply pressures of 50 and 200 kPa. The validity (% difference and Root Mean Square Error: RMSE) and repeatability (Intra-Class Correlation Coefficient: ICC) of the applied pressures (whole insole) and contact area (regional) were outcome variables. Validity of the Pedar system was highest (RMSE 2.6 kPa; difference 3.9%), with the Medilogic (RMSE 27.0 kPa; difference 13.4%) and Tekscan (RMSE 27.0 kPa; difference 5.9%) systems displaying reduced validity. The average and peak pressures demonstrated high between-day repeatability for all three systems and each insole size (ICC ≥ 0.859). The regional contact area % difference ranged from −97 to +249%, but the ICC demonstrated medium to high between-day repeatability (ICC ≥ 0.797). Due to the varying responses of the systems, the choice of an appropriate pressure measurement device must be based on the loading characteristics and the outcome variables sought. Medilogic and Tekscan were most effective between 200 and 300 kPa; Pedar performed well across all pressures. Contact area was less precise, but relatively repeatable for all systems.     

Effects of toe-out and toe-in gait with varying walking speeds on knee joint mechanics and lower limb energetics

Toe-out/-in gait has been prescribed in reducing knee joint load to medial knee osteoarthritis patients. This study focused on the effects of toe-out/-in at different walking speeds on first peak knee adduction moment (fKAM), second peak KAM (sKAM), knee adduction angular impulse (KAAI), net mechanical work by lower limb as well as joint-level contribution to the total limb work during level walking.Gait analysis of 20 healthy young adults was done walking at pre-defined normal (1.18 m/s), slow (0.85 m/s) and fast (1.43 m/s) walking speeds with straight-toe (natural), toe-out (15° > natural) and toe-in (15° < natural). Repeated measure ANOVA (p < 0.05) with post-hoc Tukey’s test was applied for statistical analysis.Toe-out gait increased fKAM at all walking speeds (highest at normal speed) while toe-in gait reduced fKAM at all speeds (highest at fast walking speed). Toeing-in reduced KAAI at all speeds while toeing-out affected KAAI only at normal speed. Increasing walking speed generally increased fKAM for all foot positions, but it did not affect sKAM considerably. Slowing down the speed, increased KAAI significantly at all foot positions except for toe-in. At slow walking speed, hip and knee joints were found to be major energy contributors for toe-in and toe-out respectively. At higher walking speeds, these contributions were switched. The ankle joint remained unaffected by changing walking speeds and foot progression angles.Toe-out/-in gait modifications affected knee joint kinetics and lower limb energetics at all walking speeds. However, their effects were inconsistent at different speeds. Therefore, walking speed should be taken into account when prescribing toe-out/-in gait.     

Assessment of the test–retest reliability of a foot placement accuracy protocol in assisted-living older adults

IntroductionThis study assessed the test–retest reliability of a foot placement accuracy protocol in a population of assisted-living elderly. The goal was to evaluate the execution of foot placement performance with increasing complexity of the walking condition.MethodsTwenty-five elderly participants (5 males, 20 females, 80.4 ± 8.6 years) were assessed by one observer in two sessions with 48 h between the measurements. Participants walked at self-selected pace along a pathway with three different walking conditions composed of two rectangular foam target locations and an obstacle on the walking surface. The main outcome measures were foot placement distance error, intra-class correlation coefficients (ICC), and the smallest detectable difference (SDD).ResultsMean absolute values of the foot placement distance errors were 14.0 ± 4.5 mm for medio-lateral deviation and 27.2 ± 2.1 mm for anterior–posterior deviation, respectively. ICC values for test–retest reliability showed ‘fair to good’ to ‘excellent’ reliability across all conditions with values ranging from 0.63 to 0.94. SDD values were between 3.6 and 37.3 mm.ConclusionThe protocol showed good reliability for test–retest measurements of foot placement accuracy, thus making this protocol a reliable and location-independent tool to assess performance of foot placement in elderly in assisted-living settings. In the future, measurements with elderly fallers and non-fallers should be conducted to assess validity of the protocol.     

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.     

Shod wear and foot alignment in clinical gait analysis

Sagittal plane alignment of the foot presents challenges when the subject wears shoes during gait analysis. Typically, visual alignment is performed by positioning two markers, the heel and toe markers, aligned with the foot within the shoe. Alternatively, software alignment is possible when the sole of the shoe lies parallel to the ground, and the change in the shoe’s sole thickness is measured and entered as a parameter. The aim of this technical note was to evaluate the accuracy of visual and software foot alignment during shod gait analysis. We calculated the static standing ankle angles of 8 participants (mean age: 8.7 years, SD: 2.9 years) wearing bilateral solid ankle foot orthoses (BSAFOs) with and without shoes using the visual and software alignment methods. All participants were able to stand with flat feet in both static trials and the ankle angles obtained in BSAFOs without shoes was considered the reference. We showed that the current implementation of software alignment introduces a bias towards more ankle dorsiflexion, mean = 3°, SD = 3.4°, p = 0.006, and proposed an adjusted software alignment method. We found no statistical differences using visual alignment and adjusted software alignment between the shoe and shoeless conditions, p = 0.19 for both. Visual alignment or adjusted software alignment are advised to represent foot alignment accurately.     

Immediate and short-term effects of wearing a single textured insole on symmetry of stance and gait in healthy adults

Asymmetry of standing balance and gait are common in individuals with neurological or musculoskeletal disorders and achieving symmetrical stance and gait is an important goal of rehabilitation. The aim of the study was to investigate if asymmetry of stance and gait observed immediately after the start of using a single textured insole remains during longer use of the insole. Ten young healthy adults walked in two different conditions: with a textured insole positioned in the left shoe or without the insole. Weight bearing, gait, and perceived level of discomfort were evaluated before using a textured insole, immediately after being provided with the insole, and after walking for 10 min with the insole. The center of pressure (COP) trajectory was calculated for the right and left foot in the insole and no-insole conditions. Asymmetry of stance and gait was present immediately after the start of using a textured insole (p < 0.05) but was not evident after 10 min of wearing the insole. The COP trajectory of the right foot after being provided with the left insole was significantly greater compared with walking with no insole (p < 0.05). Gait velocity, cadence, and the COP trajectory of the left foot were not affected by the use of the insole. The outcome of the study provides a background for the investigation of the effect of using a textural insole in gait rehabilitation.     

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.