• 1.

    Kanade RV, Van Deursen RW, Harding KG, et al: Investigation of standing balance in patients with diabetic neuropathy at different stages of foot complications. Clin Biomech (Bristol, Avon) 23: 1183, 2008.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Cavanagh PR, Bus SA: Off-loading the diabetic foot for ulcer prevention and healing. JAPMA 100: 360, 2010.

  • 3.

    Tamir E, Daniels TR, Finestone A, et al: Off-loading of hindfoot and midfoot neuropathic ulcers using a fiberglass cast with a metal stirrup. Foot Ankle Int 28: 1048, 2007.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 4.

    Piaggesi A, Macchiarini S, Rizzo L, et al: An off-the-shelf instant contact casting device for the management of diabetic foot ulcers: a randomized prospective trial versus traditional fiberglass cast. Diabetes Care 30: 586, 2007.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 5.

    Gusinde J, Pauser J, Swoboda B, et al: Foot loading characteristics of different graduations of partial weight bearing. Int J Rehabil Res 34: 261, 2011.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 6.

    Carl HD, Putz C, Weseloh G, et al: Insoles for the rheumatic foot: a clinical and pedobarographic analysis. Orthopäde 35: 1176, 2006.

  • 7.

    Czurda T, Seidl M, Seiser AS, et al: Triple arthrodesis in treatment of degenerative hindfoot deformities: clinical, radiological and pedobarographic results. Z Orthop Unfall 147: 356, 2006.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    DeFrino PF, Brodsky JW, Pollo FE, et al: First metatarsophalangeal arthrodesis: a clinical, pedobarographic and gait analysis study. Foot Ankle Int 23: 496, 2002.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Hahn F, Maiwald C, Horstmann T, et al: Changes in plantar pressure distribution after Achilles tendon augmentation with flexor hallucis longus transfer. Clin Biomech (Bristol, Avon) 23: 109, 2008.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Hodge MC, Bach TM, Carter GM: Novel Award First Prize Paper: orthotic management of plantar pressure and pain in rheumatoid arthritis. Clin Biomech (Bristol, Avon) 14: 567, 1999.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Horisberger M, Hintermann B, Valderrabano V: Alterations of plantar pressure distribution in posttraumatic end-stage ankle osteoarthritis Clin Biomech (Bristol, Avon) 24: 303, 2009.

    • Crossref
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 12.

    Jeans KA, Karol LA: Plantar pressures following Ponseti and French physiotherapy methods for clubfoot. J Pediatr Orthop 30: 82, 2010.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 13.

    Jorge Filho D, Battistella LR, Lourenço C: Computerized pedobarography in the characterization of ankle-foot instabilities of haemophilic patients. Haemophilia 12: 140, 2006.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Lipscombe S, Molloy A, Sirikonda S, et al: Scarf osteotomy for the correction of hallux valgus: midterm clinical outcome. J Foot Ankle Surg 47: 273, 2008.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 15.

    Ashry HR, Lavery LA, Murdoch DP, et al: Effectiveness of diabetic insoles to reduce foot pressures. J Foot Ankle Surg 36: 268, 1997.

  • 16.

    Carl HD, Pfander D, Swoboda B: Assessment of plantar pressure in forefoot relief shoes of different designs. Foot Ankle Int 27: 117, 2006.

  • 17.

    Rosenbaum D, Hautmann S, Gold M, et al: Effects of walking speed on plantar pressure patterns and hindfoot angular motion. Gait Posture 2: 191, 1994.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Pauser J, Jendrissek A, Swoboda B, et al: Inaccuracy of a physical strain trainer for the monitoring of partial weight bearing. Arch Phys Med Rehabil 11: 1847, 2011.

    • Crossref
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 19.

    Pauser J, Jendrissek A, Brem M, et al: Foot loading with an ankle-foot orthosis: the accuracy of an integrated physical strain trainer. Int Orthop 36: 1411, 2012.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 20.

    Arts ML, Bus SA: Twelve steps per foot are recommended for valid and reliable in-shoe plantar pressure data in neuropathic diabetic patients wearing custom made footwear. Clin Biomech (Bristol, Avon) 26: 880, 2011.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    van Deursen R: Footwear for the neuropathic patient: offloading and stability. Diabetes Metab Res 24: 96, 2008.

    • Crossref
    • Web of Science
    • Search Google Scholar
    • Export Citation

Assessment of Plantar Pressure in Hindfoot Relief Shoes of Different Designs

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  • 1 Division of Orthopaedic Rheumatology, University of Erlangen-Nuremberg, Erlangen, Germany.
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Background

Although there are several different concepts of hindfoot relief footwear, there are no studies on the extent of pressure reduction to be achieved by this footwear. Therefore, we sought to evaluate the reduction in plantar pressure to be achieved with two different hindfoot relief shoes.

Methods

Ten healthy volunteers performed three trials at a self-selected speed. Peak pressure values in mass-produced shoes (normal gait) were considered as 100% and were compared with measurements in two differently designed hindfoot relief shoes. Foot portions were defined as heel (0%–15% of total insole length), hindfoot (16%–30%), midfoot (31%–60%), and forefoot (61%–100%).

Results

Heel and hindfoot peak pressures were significantly reduced in both shoes compared with normal gait (P < .05), but the extent of peak pressure reduction under the heel and hindfoot varied significantly between the tested shoes. Midfoot peak pressure was not significantly reduced in tested shoes compared with baseline (P > .05) but differed significantly between the two shoes. Forefoot peak pressure was significantly reduced with one of the tested shoes (to a median 73% baseline; P = .004) but not with the other (median, 88% baseline).

Conclusions

Hindfoot relief shoes leave a considerable amount of peak pressure, predominantly under the hindfoot. The extent of peak pressure reduction for the heel and the hindfoot varies between different hindfoot relief shoes. Depending on the affected foot area, the kind of hindfoot relief shoe should be carefully chosen.

Corresponding author: Johannes Pauser, MD, Division of Orthopaedic Rheumatology, University of Erlangen-Nuremberg, Rathsberger Str. 57, D-91054 Erlangen, Germany. (E-mail: Johannes.pauser@ortho-rheuma.med.uni-erlangen.de)