Plantar pressure assessments are useful for understanding the functions of the foot and lower limb and for predicting injury incidence rates. Musculoskeletal fatigue is likely to affect plantar pressure profiles. This study aimed to characterize college elite basketball players' plantar pressure profiles and pain profiles during static standing and walking.
Fifty-one male elite basketball players and 85 male recreational basketball players participated in this study. An optical plantar pressure measurement system was used to collect the arch index (AI), regional plantar pressure distributions (PPDs), and footprint characteristics during static and dynamic activities. Elite basketball players' pain profiles were examined for evaluating their common musculoskeletal pain areas.
The AI values were in the reference range in recreational basketball players and considerably lower in elite basketball players. Elite basketball players' static PPDs of both feet were mainly exerted on the lateral longitudinal arch and the lateral heel and were relatively lower on the medial longitudinal arch and medial and lateral metatarsal bones. The PPDs mainly transferred to the lateral metatarsal bone and lateral longitudinal arch and decreased at the medial heel during the midstance phase of walking. The footprint characteristics of elite basketball players illustrated the features of calcaneal varus (supinated foot) of high arches and dropped cuboid foot. The lateral ankle joints and anterior cruciate ligaments were the common musculoskeletal pain areas.
Elite basketball players' AI values indicated high arches, and their PPDs tended to parallel the features of the high-arched supinated and dropped cuboid foot. Their pain profiles resonated with the common basketball injuries and reflected the features of Jones fracture and cuboid syndrome. The potential links among high-arched supinated foot, Jones fracture, and cuboid syndrome are worth further study.
We describe the effects of the Austin bunionectomy on plantar pressure distribution and radiographic measurements in the forefoot in 31 subjects (44 feet) with mild-to-moderate hallux valgus deformity and 36 control subjects (36 feet). Plantar pressure measurements before and 24 months after surgery showed peak pressure beneath the hallux reduced to normal values. Peak pressure measurements beneath the first, second, and third metatarsal heads in hallux valgus feet were relatively unchanged after surgery and remained higher than normal values. The operation produced significant decreases in mean preoperative radiographic measurements of hallux abductus, metatarsus primus varus, and first metatarsal protrusion distance in these patients to below-normal values. (J Am Podiatr Med Assoc 95(4): 357–365, 2005)
Among other adverse consequences, childhood obesity is known to influence foot structure and functionality. Yet little information is available regarding how the physiologic foot-ground interaction is altered when a localized load is carried, as occurs in the case of schoolbags. We investigated plantar contact area and pressure modifications induced by backpack carriage under actual conditions. We hypothesized that a localized load acting on the body would further increase the already excessive plantar pressure that exists with overweight and obese status.
Seventy overweight and obese schoolchildren aged 6 to 11 years underwent two 30-sec trials on a pressure platform during a regular school day, with and without a backpack. Total and subregion contact areas along with peak plantar pressures were obtained, and results were compared with those of an equal-numbered group of normal-weight schoolchildren.
Overweight and obese children generally had larger contact areas and higher peak plantar pressures compared with their normal-weight peers. In overweight and normal-weight participants, the backpack induced a similar generalized increase in contact area and pressures. However, the largest changes were observed in the forefoot, suggesting that load action tends to modify the physiologic pressure patterns.
Backpack carriage raises the already elevated peak plantar pressures in overweight children during upright stance and modifies the physiologic pressure patterns. Further investigations are needed to clarify the features of such phenomenon when dynamic activities are performed and to verify the existence of fatigue and overexertion on the foot as well as other possible negative long-term effects. (J Am Podiatr Med Assoc 103(4): 306–313, 2013)
The intent of this study was to determine whether differences in function, walking characteristics, and plantar pressures exist in individuals after operative fixation of an intra-articular calcaneal fracture (HFX) compared with individuals with operative repair of an Achilles tendon rupture (ATR).
Twenty patients (ten with HFXs and ten with ATRs) were recruited approximately 3.5 months after operative intervention. All of the participants completed the Lower Extremity Functional Scale and had their foot posture assessed using the Foot Posture Index. Walking velocity was assessed using a pressure mat system, and plantar pressures were measured using an in-shoe sensor. In addition to between-group comparisons, the involved foot was compared with the uninvolved foot for each participant.
There were no differences in age, height, weight, or number of days since surgery between the two groups. The HFX group had lower Lower Extremity Functional Scale scores, slower walking velocities, and different forefoot loading patterns compared with the ATR group. The involved limb of both groups was less pronated.
The results indicate that individuals with an HFX spend more time on their involved limb and walk slower than those with an ATR. Plantar pressures in the HFX group were higher in the lateral forefoot and lower in the medial forefoot and in the ATR group were symmetrically lower in the forefoot.
We sought to establish the in-shoe plantar pressure distribution during normal level walking in type 2 diabetic patients of Chinese, Indian, and Malay descent without clinical evidence of peripheral neuropathy.
Thirty-five patients with type 2 diabetes mellitus without loss of tactile sensation and foot deformities and 38 nondiabetic individuals in a control group had in-shoe plantar pressures collected. Maximum peak pressure and peak pressure-time integral of each foot were analyzed as separate variables and were masked into 13 areas. Differences in pressure variables were assessed by analysis of covariance, adjusting for relevant covariates at the 95% confidence interval.
No significant differences were noted in maximum peak pressures after adjusting for sex, race, age, height, and body mass. However, patients with diabetes mellitus had significantly higher mean ± SD pressure-time integrals at the right whole foot (309.50 ± 144.17 kPa versus 224.06 ± 141.70 kPa, P < .05) and first metatarsal (198.65 ± 138.27 kPa versus 121.54 ± 135.91 kPa, P < .05) masked areas than did those in the control group after adjustment.
Patients without clinical observable signs of foot deformity (implying absence of motor neuropathy) and sensory neuropathy had similar in-shoe maximum peak pressures as controls. This finding supported the notion that either component of neuropathy needs to be present before plantar pressures are elevated. Patients with diabetes mellitus demonstrated greater pressure-time integrals, implying that this variable might be the first clinical sign observable even before peripheral neuropathy could be tested. (J Am Podiatr Med Assoc 101(6): 509–516, 2011)
Excessive body weight seems to be a risk factor for foot loading. We sought to investigate the effect of different body mass index (BMI) levels on plantar pressure distribution during walking.
In total, 163 women aged 45 to 65 years (mean ± SD: age, 57.4 ± 5.3 years; BMI, 27.0 ± 5.3) participated in the study. The women were divided, on the basis of BMI, into a normal-weight, overweight, or obese group. The study used the four following plantar pressure parameters (PPPs): contact percentage, absolute pressure impulse, relative pressure impulse, and absolute peak pressure, which were recorded in ten foot regions using a pressure measurement system.
The normal-weight group, compared with the overweight and obese groups, had significantly lower absolute PPP values. In the hallux, second through fifth metatarsals, midfoot, and heel regions, we observed significant between-group differences in the two absolute PPPs (peak pressure and pressure impulse) (P < .001). Between-group differences in the relative PPPs were found in the fourth metatarsal, midfoot, and medial heel (relative impulse) and in the second metatarsal (contact percentage) (P < .001).
Higher BMI values correspond to a higher load on the foot during walking in women. The relative foot load in obese women is characterized by a pressure increase in the lateral forefoot and midfoot and by a pressure decrease in the medial heel.
This study evaluated changes in pressure imparted to diabetic foot wounds using a novel negative pressure bridging technique coupled with a robust removable cast walker. Ten patients had plantar pressures assessed with and without a bridged negative pressure dressing on the foot. Off-loading was accomplished with a pressure-relief walker. Plantar pressures were recorded using two pressure-measurement systems. The location and value of peak focal pressure (taken from six midgait steps) were recorded at the site of ulceration. Paired analysis revealed a large difference (mean ± SD, 74.6% ± 6.0%) between baseline barefoot pressure and pressure within the pressure-relief walker (mean ± SD, 939.1 ± 195.1 versus 235.7 ± 66.1 kPa). There was a mean ± SD 9.9% ± 5.6% higher pressure in the combination device compared with the pressure-relief walker alone (mean ± SD, 258.0 ± 69.7 versus 235.7 ± 66.1 kPa). This difference was only 2% of the initial barefoot pressure imparted to the wound. A modified negative pressure dressing coupled with a robust removable cast walker may not impart undue additional stress to the plantar aspect of the foot and may allow patients to retain some degree of freedom (and a potentially reduced length of hospital stay) while still allowing for the beneficial effects of negative pressure wound therapy and sufficient off-loading. (J Am Podiatr Med Assoc 94(5): 456–460, 2004)
Foot pain and lower-limb neuroischemia in diabetes mellitus is common and can be debilitating and difficult to treat. We report a comparison of orthotic materials to manage foot pain in a 59-year-old man with type 1 diabetes mellitus, peripheral neuropathy, peripheral arterial disease, and a history of foot ulceration. We investigated a range of in-shoe foot orthoses for comfort and plantar pressure reduction in a cross-sectional study. The most comfortable and most effective pressure-reducing orthoses were subsequently evaluated for pain relief in a single system alternating-treatment design. After 9 weeks, foot pain was completely resolved with customized multidensity foot orthoses. The outcome of this case study suggests that customized multidensity foot orthoses may be a useful intervention to reduce foot pain and maintain function in the neuroischemic diabetic foot. (J Am Podiatr Med Assoc 98(2): 143–148, 2008)
Clinical recommendations for the prevention and healing of diabetic foot ulcers (DFUs) are somewhat clear. However, assessment and quantification of the mechanical stress responsible for DFU remain complex. Different pressure variables have been described in the literature to better understand plantar tissue stress exposure. This article reviews the role of pressure and shear forces in the pathogenesis of plantar DFU.
We performed systematic searches of the PubMed and Embase databases, completed by a manual search of the selected studies. From 535 potentially relevant references, 70 studies were included in the full-text review.
Variables of plantar mechanical stress relate to vertical pressure, shear stress, and temporality of loading. At this time, in-shoe peak plantar pressure (PPP) is the only reliable variable that can be used to prevent DFU. Although it is a poor predictor of in-shoe PPP, barefoot PPP seems complementary and may be more suitable when evaluating patients with diabetes mellitus and peripheral neuropathy who seem noncompliant with footwear. An in-shoe PPP threshold value of 200 kPa has been suggested to prevent DFU. Other variables, such as peak pressure gradient and peak maximal subsurface shear stress and its depth, seem to be of additional utility.
To better assess the at-risk foot and to prevent ulceration, the practitioner should integrate quantitative models of dynamic foot plantar pressures, such as in-shoe and barefoot PPPs, with the regular clinical screening examination. Prospective studies are needed to evaluate causality between other variables of mechanical stress and DFUs. (J Am Podiatr Med Assoc 103(4): 322–332, 2013)
Flexible flatfoot disturbs the load distribution of the foot. Various external supports are used to prevent abnormal plantar loading in flexible flatfoot. However, few studies have compared the effects of different external supports on plantar loading in flexible flatfoot. The objective of this study was to investigate the effects of elastic taping, nonelastic taping, and custom-made foot orthoses on plantar pressure-time integral and contact area in flexible flatfoot.
Twenty-seven participants with flexible flatfoot underwent dynamic pedobarographic analysis while barefoot and with elastic tape, nonelastic tape, and custom-made foot orthoses.
Pressure-time integral percentage was higher with foot orthoses than in the barefoot and taping conditions in the midfoot (P < .001) and was lower with foot orthoses than in barefoot in the right forefoot (P < .05). Pressure-time integral values were lower with foot orthoses in the second, third, and fourth metatarsals and the lateral heel (P < .05). With foot orthoses, contact area values were higher in the toes; second, third, and fourth metatarsi; midfoot; and heel compared with the other conditions (P < .05). Pressure-time integral in the right lateral heel and contact area in the left fourth metatarsal increased with nonelastic taping versus barefoot (P < .05).
Foot orthoses are more effective in providing dynamic pressure redistribution in flexible flatfoot. Although nonelastic taping has some effects, taping methods may be insufficient in altering the measured pedobarographic values in this condition.