Background: Metatarsalgia is a common affliction in rheumatoid arthritis (RA), often requiring aggressive pharmacologic treatment that carries associated adverse effects. The aim of this study was to investigate whether simple insoles would have a beneficial effect on forefoot pain, disability, and functional limitation in participants with RA experiencing forefoot pain.
Method: A prospective, quasi-experimental, pretest-posttest trial was performed at a rheumatology outpatient clinic. Participants were supplied with a simple insole comprising a valgus pad and a plantar metatarsal pad and covered with a cushioning material. The Foot Function Index (FFI) was self-administered before and 3 months after insole use.
Results: Reductions in forefoot pain (from 56.78 to 42.97) and total (from 41.64 to 33.54) FFI scores were noted. Statistical significance for this reduction was achieved following the t test (P = .002 and P = .0085, respectively). However, although reductions in mean disability and activity limitation scores were recorded (from 50 to 44.85 and from 18 to 14.57, respectively), these did not reach significance (P = .151 and P = .092, respectively)
Conclusions: Simple insoles have been shown to be effective in reducing total and forefoot pain FFI scores in patients with RA experiencing metatarsalgia. This treatment offers advantages because these devices can be fabricated simply and cheaply, thus initiating the patient on an effective orthosis therapy immediately in the clinic without having to wait for prolonged periods until custom orthotic devices can be supplied.
An ideal postoperative shoe should be comfortable to wear and protect the foot during recovery from surgery or injury. Protection is assumed to be related to peak pressure and force-time integral under the foot. This study compared a commonly used postoperative shoe with a new postoperative shoe that incorporates a rigid sole with an 11° rocker bottom. The new postoperative shoe significantly reduced peak pressures on the forefoot by 20%. The amount of pressure and force-time integral reduction is compared with other values found in the literature for various shoe modifications. Indications for rocker-bottom shoes are also explored. (J Am Podiatr Med Assoc 91(10): 501-507, 2001)
Many indirect clinical techniques have been developed to assess foot posture; however, there is relatively little research investigating the relationships among these techniques. We investigated the relationships among the most commonly used clinical measures of foot posture—Foot Posture Index-6 (FPI-6), navicular drop (NDP), navicular drift (NDT), and static and dynamic arch indices (SAI and DAI)—in individuals with normal foot posture and those with pronated foot.
Sixty-three individuals with FPI-6 scores of 0 to 12 were included. A digital caliper was used to measure NDP and NDT; SAI and DAI were measured by electronic pedobarography. Assessments were applied on the dominant foot. Pearson correlation coefficients were calculated to determine the relationships among measures. Participants were classified into two groups, pronated foot (n = 33) and normal foot posture (n = 30), based on FPI-6 scores, providing a multisegmental and multiplanar assessment. The independent-samples t test was used to compare groups regarding NDP, NDT, SAI, and DAI.
We found a high correlation between NDP and FPI-6 (r = 0.754) and between NDP and NDT (r = 0.778) (all P < .001). A moderate correlation was found between NDT and FPI-6 (r = 0.599) and between DAI and SAI (r = 0.519) (all P < .001). A negligible correlation was found between NDP and DAI (r = 0.268; P = .033). Furthermore, NDP, NDT, and DAI values were higher in individuals with pronated foot compared with those with normal posture (P < .001 for NDP and NDT; P = .022 for DAI), whereas SAI values were not (P = .837).
These results suggest that there are moderate-to-strong relationships among FPI-6, NDP, and NDT and between SAI and DAI. The NDP, NDT, and DAI are suitable for the classification of foot posture based on FPI-6 scores. This study can guide clinicians and researchers to associate the foot posture measures with each other.
Background: Subjective comfort of footwear is important for shoe and orthosis design. This study compared shoe preferences between walking and running, using subjective comfort as an outcome tool.
Methods: Forty-one participants walked and ran 20 times each along a runway in three types of footwear (cushioning, lightweight, and stability) and chose the model that they preferred most for walking and running separately based on subjective comfort.
Results: More participants preferred the cushioning model (walking, 34%; running, 41%) or the lightweight model (walking, 44%; running, 41%) over the stability model (walking, 22%; running, 17%). χ2 tests revealed no differences between walking and running, runners and nonrunners, and lighter and heavier individuals. Women were more likely (odds ratio = 4.09) to prefer the lightweight model, whereas men preferred the cushioning (odds ratio = 2.05) and stability (odds ratio = 3.19) models. Most participants (71%) chose the same model for both activities.
Conclusions: Shoe preference varies among individuals and is influenced by sex. Most people feel comfortable walking and running in the same shoe model. (J Am Podiatr Med Assoc 100(6): 456–462, 2010)
There is a lack of data that could address the effects of off-the-shelf insoles on gait variables in healthy people.
Thirty-three healthy volunteers ranging in age from 18 to 35 years were included to this study. Kinematic and kinetic data were obtained in barefoot, shoe-only, steel insole, silicone insole, and polyurethane insole conditions using an optoelectronic three-dimensional motion analysis system. A repeated measures analysis of variance test was used to identify statistically significant differences between insole conditions. The alpha level was set at P < .05
Maximum knee flexion was higher in the steel insole condition (P < .0001) compared with the silicone insole (P = .001) and shoe-only conditions (P = .032). Reduced maximum knee flexion was recorded in the polyurethane insole condition compared with the shoe-only condition (P = .031). Maximum knee flexion measured in the steel insole condition was higher compared to the barefoot condition (P = .020). Higher maximum ankle dorsiflexion was observed in the barefoot condition, and there were significant differences between the polyurethane insole (P < .0001), silicone insole (P = .001), steel insole (P = .002), and shoe conditions (P = .004). Least and highest maximum ankle plantarflexion were detected in the steel insole and silicone insole conditions, respectively. Maximum ankle plantarflexion in the barefoot and steel insole conditions (P = .014) and the barefoot and polyurethane insole conditions (P = .035) were significant. There was no significant difference between conditions for ground reaction force or joint moments.
Insoles made by different materials affect maximum knee flexion, maximum ankle dorsiflexion, and maximum ankle plantarflexion. This may be helpful during the decision-making process when selecting the insole material for any pathological conditions that require insole prescription.
Joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type (JHS/EDS-HT) is a rheumatologic condition characterized by generalized joint hypermobility and musculoskeletal and nonmusculoskeletal findings related to congenital laxity of connective tissue. Because foot pain and other foot problems are reported to make daily life problematic to manage for individuals with JHS/EDS-HT, and thanks to the availability of modern technology, the aim of the present study was to quantitatively characterize foot type in individuals with JHS/EDS-HT during upright standing.
Forty feet of 20 women with JHS/EDS-HT (mean ± SD age, 36.03 ± 14.01 years) were assessed clinically and with a pressure-sensitive mat during upright standing.
Forty-five percent of feet had a high arch (pes cavus), 27.5% had a normal arch, and 27.5% had a low arch (pes planus or flatfoot).
From a clinical perspective, the characterization of foot type in JHS/EDS-HT is important to identify, develop, and enhance the rehabilitative options. An understanding of the relationship between pes cavus and foot pain in these patients could, in fact, improve the clinical management of these patients.
Clinicians have traditionally assessed range of motion of the first metatarsophalangeal and ankle joints in a static position. It is unclear, however, if these measurements accurately reflect functional sagittal plane limitations of these joints during gait. For 50 patients (100 feet), we assessed available dorsiflexion at the first metatarsophalangeal and ankle joints, as well as the presence of pinch callus. We then compared these findings with 11 functional gait parameters, as measured using a pressure sensor system. After adjusting for age, weight, smoking status, glycosylated hemoglobin, and insensitivity to monofilament, we found that patients with pinch callus demonstrated statistically significant compensatory gait patterns in 7 of 11 measures. Hallux limitus and equinus patients demonstrated six and three statistically significant associations, respectively. Pinch callus seems to be as predictive of functional gait alterations as static first metatarsophalangeal joint and ankle dorsiflexion. (J Am Podiatr Med Assoc 94(6): 535–541, 2004)
Background: The selection of materials for the production of multilayer insoles for diabetic feet is a difficult task owing to the lack of technical information about these materials. Therefore, objective criteria were established for the selection of these materials.
Methods: Mechanical- and comfort-related tests for the mechanical characterization of different materials and their combinations were considered. These tests were conducted according to standardized test methods for polymeric cellular materials.
Results: Criteria for the use of cellular materials were obtained. The properties of accommodation, cushioning, and filling materials were established and the most adequate polymer nature for each of the three applications was identified. Variables that affect the properties of these material combinations were studied.
Conclusions: These test results will allow podiatrists to select insoles in a more objective way, thus achieving a more successful treatment for diabetic foot-related injuries. (J Am Podiatr Med Assoc 98(3): 229–238, 2008)
Diabetes-related foot ulcers are a leading cause of global morbidity, mortality, and health-care costs. People with a history of foot ulcers have a diminished quality of life attributed to limited walking and mobility. One of the largest concerns is ulceration recurrence. Approximately 40% of patients with ulcerations will have a recurrent ulcer in the year after healing, and most occur in the first 3 months after wound healing. Hence, this period after ulceration is called “remission” due to this risk of reulceration. Promoting and fostering mobility is an integral part of everyday life and is important for maintaining good physical health and health-related quality of life for all people living with diabetes. In this short perspective, we provide recommendations on how to safely increase walking activity and facilitate appropriate off-loading and monitoring in people with a recently healed foot ulcer, foot reconstruction, or partial foot amputation. Interventions include monitored activity training, dosed out in steadily increasing increments and coupled with daily skin temperature monitoring, which can identify dangerous “hotspots” prone to recurrence. By understanding areas at risk, patients are empowered to maximize ulcer-free days and to enable an improved quality of life. This perspective outlines a unified strategy to treat patients in the remission period after ulceration and aims to provide clinicians with appropriate patient recommendations based on best available evidence and expert opinion to educate their patients to ensure a safe transition to footwear and return to activity.