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Introduction: Sarcopenia is a common age-related disease, defined as a decrease in muscle strength and function owing to reduced skeletal muscle. One way to diagnose sarcopenia is through gait analysis and foot-pressure imaging., Motivation and Research Gap: We collected our own multimodal dataset from 100 subjects, consisting of both foot-pressure and skeleton data with real patients, which provides a unique resource for future studies aimed at more comprehensive analyses. While artificial intelligence has been employed for sarcopenia detection, previous studies have predominantly focused on skeleton-based datasets without exploring the combined potential of skeleton and foot pressure dataset. This study conducts separate experiments for foot-pressure and skeleton datasets, it demonstrates the potential of each data type in sarcopenia classification., Methods: This study had two components. First, we collected skeleton and foot-pressure datasets and classified them into sarcopenia and non-sarcopenia groups based on grip strength, gait performance, and appendicular skeletal muscle mass. Second, we performed experiments on the foot-pressure dataset using the ResNet-18 and spatiotemporal graph convolutional network (ST-GCN) models on the skeleton dataset to classify normal and abnormal gaits due to sarcopenia. For an accurate diagnosis, real-time walking of 100 participants was recorded at 30 fps as RGB + D images. The skeleton dataset was constructed by extracting 3D skeleton information comprising 25 feature points from the image, whereas the foot-pressure dataset was constructed by exerting pressure on the foot-pressure plates., Results: As a baseline evaluation, the accuracies of sarcopenia classification performance from foot-pressure image using Resnet-18 and skeleton sequences using ST-GCN were identified as 77.16 and 78.63%, respectively., Discussion: The experimental results demonstrated the potential applications of sarcopenia and non-sarcopenia classifications based on foot-pressure images and skeleton sequences., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Naseem, Kim, Seo, Lee, Chung, Shin and Lee.)

The unilateral anterior cruciate ligament reconstruction can create asymmetry in vertical ground reaction force and muscle activities, which could be amplified by pronated feet. The study compared plantar pressure variables, amplitude, and muscular frequency in individuals with pronated feet and anterior cruciate ligament reconstruction (PF/ACLR) versus control during running. As part of a cross-sectional study, 15 individuals with PF/ACLR (aged 23.2 ± 4.5 years) and 15 healthy control participants (aged 22.9 ± 4.1 years) ran barefoot at a speed of 3.3 m/s±5% on an 18-m runway. During running, a foot scan and electromyography systems were used to record the peak plantar pressure variables and electromyography activity of the main lower limb muscles, respectively. Results demonstrated lower peak plantar pressure values at the Toe 1 region (p < 0.001, d = 1.83) for the PF/ACLR group. The PF/ACLR group had larger peak plantar pressure values at toes second to fifth (p = 0.013, d = 1.15), fourth (p = 0.026, d = 0.97), fifth (p < 0.001, d = 1.74) metatarsal, and medial (p = 0.002, d = 1.41), and lateral (p = 0.001, d = 1.51) heel regions. The PF/ACLR group presented larger tibialis anterior (p = 0.003, d = 1.15), vastus lateralis (p = 0.001, d = 1.27), and gluteus medius (p = 0.009, d = 0.60) amplitude at the loading phase. At the mid-stance phase, larger tibialis anterior (p = 0.039, d = 0.99) and vastus lateralis (p = 0.00.024, d = 1.52) amplitudes were observed. For the push-off phase, the PF/ACLR group presented larger vastus medialis (p = 0.037, d = 0.82), biceps femoris (p = 0.004, d = 1.14), and semitendinosus (p = 0.001, d = 0.96) amplitudes. Our results demonstrated that pronated feet and anterior cruciate ligament reconstruction significantly impact plantar pressure variables and muscular amplitude in the lower limb during running., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background Context: Patients with lower lumbar stenosis and disc herniation report disability in standing and ambulation, despite normal neurological examination. The L5 and S1 nerve roots support the entire motor and sensory function of the foot, and their radiculopathy can affect foot loading during standing and walking. This has not been quantified before., Purpose: To quantify alterations in static and dynamic foot pressure transfers in patients with lower lumbar nerve root compression, and document any beneficial effects of surgical decompression., Study Design: Prospective, case-control study., Patient Sample: Cases-Patients with unilateral radiculopathy (L5/S1) with normal neurology (n=50); Controls - Healthy volunteers (n=50)., Methods: The volunteers and patients underwent pedobarographic analysis during standing (static) and walking (dynamic), and fifteen (12 dynamic and three static) parameters were documented. The patient's preoperative values were compared with that of the healthy volunteers. All the 50 patients underwent surgical decompression, and clinical outcome measures (VAS/ODI at 3 months) were documented. Pedobarographic analysis was repeated in the postoperative period (48 hours) and 3-month follow-up and compared with the preoperative scores., Results: In healthy controls, the mean values of all 15 parameters were comparable between the right and the left side (p>.05). When compared to controls, the patients had significantly lower maximum foot loads (p=.01) and average foot loads (p=.05) on the affected side during walking indicating lesser load transmission, in the preoperative period. Within the affected foot, the load transfer was higher on the first metatarsal/ medial arch while significantly less on the lateral metatarsals (p=.04). The percentage load on whole foot and forefoot was significantly less on standing (p=.01). Significant improvements were noted in the postoperative period, especially in the maximum foot surface area (p=.01), maximum and average foot loads, and improved weight transfers on lateral arch and forefoot (p=.02). The load on whole foot increased significantly from 46.1%±5.5% (preoperative) to 48.1%±5.5% (postoperative) and 49.9%±3.3% at follow-up (p=.01)., Conclusion: This is the first study using pedobarography to document altered foot pressure patterns during ambulation in patients with disc herniation and stenosis. Decreased load transfer, asymmetrical and unphysiological distribution of pressures on the affected foot were observed during weight bearing, which improved after surgical decompression., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Both proprioceptive training and modified Broström-Gould surgery can improve ankle stability in patients with chronic ankle instability (CAI), but further biomechanical evaluation is necessary to determine the optimal treatment., Purpose: To compare the clinical outcomes and biomechanical changes after proprioceptive training versus modified Broström-Gould surgery in patients with CAI., Study Design: Randomized controlled trial; Level of evidence, 2., Methods: A total of 56 patients with CAI were assigned randomly to either a nonoperative group (n = 28) who underwent 3 months of proprioceptive training or an operative group (n = 28) who underwent modified Broström-Gould surgery. Foot and Ankle Ability Measure (FAAM) scores, foot pressure during walking, center of pressure (COP) velocity, and time for the COP to reach the balance boundary (time to boundary [TTB]) during single-leg standing were collected before the intervention (baseline) and at 3, 6, and 12 months after the intervention. Two-way repeated-measures analysis of variance was used to compare group differences and changes over time., Results: The nonoperative group had significant improvements from baseline in FAAM-Sports score and significantly decreased TTB in both the anterior-posterior and medial-lateral directions at all timepoints, while the operative group showed significant improvements only in FAAM-Sports scores and TTB and COP velocity in the anterior-posterior direction at 6 and 12 months postintervention. During walking, the nonoperative group had significantly increased peak force under the medial foot at 3 months, which dropped back to baseline levels at 12 months, while the operative group had significantly increased peak force under the medial midfoot and hindfoot that persisted until 12 months ( P  < .05)., Conclusion: In this study, both proprioceptive training and modified Broström-Gould surgery led to improved subjective functional scores, foot pressure distribution during walking, and postural stability during standing for patients with CAI but with different biomechanical patterns. Proprioceptive training led to an earlier recovery of sports function and better medial-lateral stability recovery, while surgery provided more persistent results., Registration: ChiCTR1900023999 (Chinese Clinical Trial Registry)., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Funding was received from the National Key Research and Development Program of China (2019YFB1706905, 2018YFF0301100) and the National Natural Science Foundation of China (82072428). AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from the Peking University Third Hospital Medical Science Research Ethics Committee (IRB00006761-M2019164)., (© 2024 The Author(s).)

Aims: Adherence to therapeutic footwear is vital for effective diabetic foot ulcer prevention and treatment. Understanding the key adherence factors and potential barriers is important for footwear design and implementation. Our team is creating intelligent offloading footwear to prevent lower extremity amputations in people living with diabetes (PLwD). This exploratory study assessed the ability of the established Unified Theory of Acceptance and Use of Technology (UTAUT) model to predict behavioral intention to use or recommend this intelligent offloading footwear by PLwD, caregivers of PLwD, or medical professionals treating PLwD., Methods: Online and paper questionnaires were implemented to assess the impact of the UTAUT model factors (performance expectancy, effort expectancy, social influence, facilitating conditions) and psychosocial factors (attitude, anxiety, self-efficacy) on the overall behavioral intention to use the footwear. Furthermore, factors influencing potential acceptance and rejection of the footwear were explored., Results: Patients (4.0/5) and medical professionals (4.1/5) showed a behavioral intention to "agree" to use or recommend the footwear when it becomes available. Structural equation modeling showed that the UTAUT constructed model may not be the best indicator for behavioral intention here based on a lack of statistical significance. However, the logistic regression modeling showed that the social influence for PLwD (p=0.004) and the attitude toward the footwear for medical professionals (p=0.001) may be the most important when designing and implementing the footwear, though several other factors (performance expectancy, effort expectancy, facilitating conditions, and self-efficacy) were also important for one or both of these populations. Additionally, cost and clinician support were shown to be important factors influencing potential acceptance of the footwear., Conclusions: The study found promising intention to use the intelligent footwear in the future. This highlights the need to continue future development and implementation of the footwear to incorporate these results, thus improving the likelihood of high adherence of the footwear., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Hemler, Sommerich, Correia and Pataky.)

Backgrounds: Freezing of gait (FoG) is a common and debilitating symptom of Parkinson's disease (PD) that can lead to falls and reduced quality of life. Wearable sensors have been used to detect FoG, but current methods have limitations in accuracy and practicality. In this paper, we aimed to develop a deep learning model using pressure sensor data from wearable insoles to accurately detect FoG in PD patients., Methods: We recruited 14 PD patients and collected data from multiple trials of a standardized walking test using the Pedar insole system. We proposed temporal convolutional neural network (TCNN) and applied rigorous data filtering and selective participant inclusion criteria to ensure the integrity of the dataset. We mapped the sensor data to a structured matrix and normalized it for input into our TCNN. We used a train-test split to evaluate the performance of the model., Results: We found that TCNN model achieved the highest accuracy, precision, sensitivity, specificity, and F1 score for FoG detection compared to other models. The TCNN model also showed good performance in detecting FoG episodes, even in various types of sensor noise situations., Conclusions: We demonstrated the potential of using wearable pressure sensors and machine learning models for FoG detection in PD patients. The TCNN model showed promising results and could be used in future studies to develop a real-time FoG detection system to improve PD patients' safety and quality of life. Additionally, our noise impact analysis identifies critical sensor locations, suggesting potential for reducing sensor numbers., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Park, Moon, Lee, Oh, Lee, Jang, Cho and Lee.)

This research presents a comprehensive study focused on the design, implementation, and analysis of an innovative fiber Bragg grating (FBG) based foot pressure assessment system. FBG sensors strategically placed on the great toe, metatarsal 1, metatarsal 2, and heel provided distinct peak resonant wavelengths, strains, and pressures during experimental cycles. Participant 1 exhibited peak resonant wavelength of 1537.745 nm for great toe, 1537.792 nm for metatarsal 1, 1537.812 nm for metatarsal 2, and 1537.824 nm for heel. Participant 2 showcased distinct graphical representations with peak resonant wavelengths ranging from 1537.903 to 1537.917 nm. In a fracture patient condition, the FBG-based system monitored weight-bearing capacity, integrated with real-time X-ray imaging for dynamic insights of rehabilitation as distinct approach. The strains and pressures at each position exhibited notable variations along with the sensitivity of 1.31με obtained across all positions, underscoring the FBG-based system's reliability in capturing subtle foot pressure., (© 2024 Wiley‐VCH GmbH.)

In the dynamic world of fashion, high-heeled footwear is revered as a symbol of style, luxury and sophistication. Yet, beneath the facade of elegance of classy footwear lies the harsh reality of discomfort and pain. Thus, this study aims to investigate the influence of wearing high-heeled shoes on the sensation of pain across different body regions over a period of 6 h. It involved fifty female participants, all habitual wearers of high-heeled shoes, aged between 20 and 30 years. Each participant kept a record of their perceptions of pain and discomfort every hour for a total of 6 h using a 0-10 pain scale with 0 indicating no pain and 10 indicating severe pain. The findings reveal a progressive rise in pain throughout wear, with the most intense pain reported in the back, calcaneus, and metatarsals. The analysis shows that after approximately 3.5 h, participants experience significant increases in pain levels. However, the relationship between heel height and pain is not linear. It appears that a heel height of 7.5 cm is the threshold where overall body pain becomes significant. The study suggests that a duration of 3.5 h of wear and a heel height of 7.5 cm serve as critical points to decrease overall body pain. Moreover, beyond this heel height, knee pain diminishes compared to other body areas possibly due to the shift towards a more neutral posture. The study findings, coupled with the recommendations, can assist footwear designers in crafting not only stylish but also comfortable shoes., (© 2024. The Author(s).)

Prolonged standing at work is associated with health risks. The appearance of lower-limb and lower-back discomfort is one of the most prevalent factors in prolonged standing workers. The aim of this research was to evaluate the effect of an eight-hour workday on foot pressure and musculoskeletal discomfort in standing workers. Thirty-six assembly-line workers (six women) were recruited to participate in a cross-sectional study to assess foot pressure and surface, foot, knee, and lower-back discomfort before and after a real workday. Baropodometry outcomes (surface and pressure) were evaluated by the pressure platform SensorMedica and musculoskeletal discomfort was evaluated by Cornell's Musculoskeletal Discomfort Questionaire. Total foot surface ( p = 0.01) and foot discomfort ( p = 0.03) increased significantly at the end of the workday. Prolonged standing during 8 h workday increased the foot discomfort and total foot surface in assembly-line workers. No foot pressure variable (forefoot, rearfoot, or total) was significantly modified after the workday in assembly-line workers.

This study compared muscle strength and foot pressure among patients with metatarsalgia, patients with plantar fasciitis, and healthy controls. A total of 31 patients with foot pain (14 metatarsalgia and 17 plantar fasciitis) and 29 healthy controls participated in the study. The strengths of the plantar flexor and hip muscles were measured using isokinetic and handheld dynamometers, respectively. Foot pressure parameters, including the pressure-time integral (PTI) and foot arch index (AI), were assessed using pedobarography. Compared with the healthy control group, plantar flexor strength was significantly reduced in the affected feet of the metatarsalgia and plantar fasciitis groups (F = 0.083, all p < 0.001); however, hip strength was significantly decreased only in the affected feet of the metatarsalgia group (F = 20.900, p < 0.001). Plantar flexor (p < 0.001) and hip (p = 0.004) strength were significantly lower in the metatarsalgia group than in the plantar fasciitis group. The PTI was lower in the forefeet of the affected feet in the metatarsalgia (p < 0.001) and plantar fasciitis (p = 0.004) groups. Foot AI (p < 0.001) was significantly reduced only in the metatarsalgia group. These results suggest the need to consider the evaluation of muscle strength and foot pressure in both feet for the diagnosis and treatment of foot pain., (© 2024. The Author(s).)

Gait disorders are a fundamental challenge in Parkinson's disease (PD). The use of laser-light visual cues emitted from shoes has demonstrated effective in improving freezing of gait within less restrictive environments. However, the effectiveness of shoes-based laser-light cueing may vary among individuals with PD who have different types of impairments. We introduced an innovative laser-light visual shoes system capable of producing alternating visual cues for the left and right feet through one-side cueing at a time, while simultaneously recording foot inertial data and foot pressures. The effects of this visual cueing system on gait patterns were assessed in individuals with PD, both those with well-gait and those with worse-gait. Our device successfully quantified gait characteristics, including the asymmetry in the center of pressure trajectory, in individuals with PD. Furthermore, visual cueing prolonged stride times and increased the percentage of stance phase, while concurrently reducing stride length in PD individuals with well-gait. Conversely, in PD individuals with worse-gait, visual cueing resulted in a decreased freeze index and a reduction in the proportion of intervals prone to freezing episodes. The effects of visual cueing varied between PD individuals with well-gait and those with worse-gait. Visual cueing slowed down gait in the well-gait group while it appeared to mitigate freezing episodes in worse-gait group. Future researches, including enhancements to extend the projection distance of visual cues and clinical assessments conducted in real-world settings, will help establish the clinical utility of our proposed visual cueing system., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Chan, Chen, Kuo, Chen, Liaw, Liao, Lin, Chien and Chang.)

Purpose: To investigate the effect of dynamic orthotic garments (Thera togs) on foot pressure distribution, postural control, and endurance in children with spastic diplegic CP., Patients and Methods: This is a single-blind randomized controlled clinical trial involving 34 (8-10 years) with spastic diplegic CP. The control group received conventional physical therapy (CPT), whereas the study group received CPT in addition to wearing TheraTogs. We recorded foot pressure distribution, trunk control measurement scale, trunk position sense, Pediatric Berg Balance Scale (PBS), and six-minute walking distance (6MWD)., Results: Both groups showed improvement. The study group had significant improvement in foot pressure distribution (p-value 0.003, 0.001, <0.001 for forefoot, midfoot, and rearfoot mean pressures respectively, and 0.005, <0.001, and 0.005 for forefoot, midfoot, and rearfoot peak pressures respectively), Pediatric balance scale, The trunk control measurement scale, and Trunk position sense (p-value < 0.001) and six-minute walking distance (p-value 0.029). Our data suggest that adding TheraTogs to conventional physiotherapy improves foot pressure, postural control, and endurance in children with spastic diplegic cerebral palsy., Conclusion: Both TheraTogs and conventional physical therapy corrected foot pressure distribution, trunk control, improved balance, and increased 6MWD in children with spastic diplegic CP but the improvement was more significant in TheraTogs group., Clinical Trial Registration: NCT05271149., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Emara et al.)

Background: The correspondence between various aspects of human postural parameters and the spatial relation of the jaws is of increasing interest among scientists. Emerging research suggests that the stomatognathic system and posture play, in a broad sense, significant roles., Objectives: The aim of the study was to analyze the relationship between various malocclusion types and gait parameters, the distribution of foot pressure on the ground, and body balance., Methods: The study involved 155 patients aged 12-16. The subjects were divided into groups according to their malocclusion-Angle's class II ( n = 32), Canine class II ( n = 31), and Overbite ( n = 46). The control group ( n = 46) comprised children not demonstrating any defects. The study data were collected by direct observation of the oral cavity. Gait analysis was carried out using the Wiva ® Science sensor, and the distribution of foot forces on the ground and body balance was determined via the E.P.S R/1 pedobarographic mat. The non-parametric Mann-Whitney U test was applied for statistical analysis., Results: Analysis of the results obtained showed statistically significant differences in left step duration ( p = 0.042) and the duration of the right step ( p = 0.021), as well as the projection of the body's center of gravity on the left foot ( p = 0.027)., Conclusions: Distoocclusion in the anterior part of the mandible may cause different positioning of the head and neck, as well as varying tension of the muscles, further leading to balance disorders while walking.

Cognitive function of human brain requires temporal execution of emotional or attentional tasks, or their inter-dependence influences. Smooth execution of such tasks requires spontaneous distribution of cognitive load at specific regions of brain based on its classification. A strong connectivity between peripheral sensors and central nervous system is thought to assist the cognitive load distribution effectively. Novelty of current study evaluates the modulation of foot pressure and its mapping with distributed cognitive load while executing attentional biased emotional tasks. Emotional stimulus in form of happy and sad faces with attentional paradigm drawn on them were used in the study. Behavioral results were measured with respect to the analysis of response time (RT) and response accuracy (%). Neurological signals were acquired using 10-channel EEG data acquisition system, whereas, another 6 channels were used to measure foot pressure in the left and right feet at three different locations of foot. Acquired signals were further analyzed in time and frequency domains to interpret the cognitive load distribution, and the influence of foot pressure on distribution of cognitive loads. We found that the foot pressure accelerated the response accuracy rate in attending the local scope of attention, which was not in the case of global scope of attention. This means that the global attention does not require any pressure from peripheral sensory neurons. Our event related potential (ERP) results revealed that the early sensory negative N100 characterized the processing of global scope of attention coupled with high-foot pressure. However, the late positive peak of P300 and P600 associated with local scope of attention along with high-foot pressure. The global scope of attention with low-foot pressure modulates delta and theta oscillations. These results largely contribute to the literature on cognitive neuroscience of attention and it corelation with the peripheral sensory foot pressure., Competing Interests: Declaration of competing interest The authors declare that they don't have any conflict of interest relating to the publication of this research article titled “Processing of attentional and emotional stimuli depends on retrospective response of foot pressure: conceptualizing neuron-cognitive distribution in human brain”., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: To explore the characteristics of Non-Negative Matrix Factorization (NNMF) in analyzing the mechanical characteristics of foot functional units during walking and running. Methods: Eighteen subjects (9 males and 9 females) were recruited, and the ground reaction force curves of each foot region during walking and running were collected using a plantar pressure measurement system. NNMF was used to extract the mechanical features of different foot regions and to determine the number of foot functional units. The differences between the base matrices of walking and running were compared by traditional t-tests, and the differences in coefficient matrices were compared by one-dimensional statistical parameter mapping. Results: 1) When the number of foot functional units for walking and running were both 2, the Variability Accounted For (VAF) by the matrix exceeded 0.90 (VAF walk = 0.96 ± 0.02, VAF run = 0.95 ± 0.04); 2) In foot functional unit 1, both walking and running exhibited buffering function, with the heel region being the main force-bearing area and the forefoot also participating in partial buffering; 3) In foot functional unit 2, both walking and running exhibited push-off function, with the middle part of the forefoot having a higher contribution weight; 4) In foot functional unit 1, compared to walking, the overall force characteristics of the running foot were greater during the support phase of the 0%-20% stage, with the third and fourth metatarsal areas having higher contribution weights and the lateral heel area having lower weights; 5) In foot functional unit 2, compared to walking, the overall force was higher during the beginning and 11%-69% stages of running, and lower during the 4%-5% and 73%-92% stages. During running, the thumb area, the first metatarsal area and the midfoot area had higher contribution weights than during walking; in the third and fourth metatarsal areas, the contribution weights were lower during running than during walking. Conclusion: Based on the mechanical characteristics of the foot, walking and running can both be decomposed into two foot functional units: buffering and push-off. The forefoot occupies a certain weight in both buffering and push-off functions, indicating that there may be a complex foot function transformation mechanism in the transverse arch of foot. Compared to walking, running completes push-off earlier, and the force region is more inclined towards the inner side of the foot, with the hallux area having a greater weight during push-off. This study suggests that NNMF is feasible for analyzing foot mechanical characteristics., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Bai, Huo and Liu.)

Background: The presence of hallux limitus in adulthood is frequently encountered in clinical practice, generating other biomechanical, structural, and functional compensations in dynamics secondary to blockage of the main pivot in the sagittal plane, the first metatarsophalangeal joint. In addition, the presence of functional hallux limitus (FHL) in school-age children is also increasing. Currently, there is a lack of scientific literature about this condition in the pediatric population, and early diagnosis is necessary to reduce future biomechanical disorders and avoid the development of foot arthritis. The purpose of this research was to identify static plantar pressures in school-age children with and without hallux limitus., Methods: A total sample of 106 children aged between six and twelve years old was divided into two groups: the case group (53 subjects with functional hallux limitus) and the control group (53 subjects without functional hallux limitus). Data were acquired with the participants in a standing barefoot position on the pressure platform, and the hallux limitus functional test was performed in a sitting position to classify the individuals into the determined study group. The variables analyzed in the research were: plantar pressure, bilateral forefoot and rearfoot surface area, bilateral forefoot and rearfoot ground reaction forces, bilateral forefoot and rearfoot distribution of body weight, total left and right surface area, maximum pressure of the left foot and right foot, medium pressure of the left foot and right foot, ground reaction forces of the left foot and right foot, and the weight of each foot., Results: Age was the only descriptive quantitative variable that showed a significant difference between the two study groups, with a p -value of 0.031. No statistically significant differences were found between groups in the bilateral forefoot and rearfoot surface area, ground reaction forces, distribution of body weight, or maximum and medium plantar pressure in the left and right foot., Conclusions: Changes in the location of the maximum pressure were observed, particularly in older participants with FHL, but these results were not significant. The findings of this study did not show significant differences between the static plantar pressures of school-age individuals with and without functional hallux limitus.

Background: Identifying elderly individuals with locomotive syndrome is important to prevent disability in this population. Although screening tools for locomotive syndrome are available, these require time commitment and are limited by an individual's ability to complete questionnaires independently. To improve on this limitation, we developed a screening tool that uses information on the distribution of pressure on the plantar surface of the foot with an artificial intelligence (AI)-based decision system to identify patients with locomotor syndrome. Herein, we describe our AI-based system and evaluate its performance., Methods: This was a cross-sectional study of 409 participants (mean age, 73.5 years). A foot scan pressure system was used to record the planter pressure distribution during gait. In the image processing step, we developed a convolutional neural network (CNN) to return the logit of the probability of locomotive syndrome based on foot pressure images. In the logistic regression step of the AI model, we estimated the predictor coefficients, including age, sex, height, weight, and the output of the CNN, based on foot pressure images., Results: The AI model improved the identification of locomotive syndrome among elderly individuals compared to clinical data, with an area under curve of 0.84 (95% confidence interval, 0.79-0.88) for the AI model compared to 0.80 (95% confidence interval, 0.75-0.85) for the clinical model. Including the footprint force distribution image significantly improved the prediction algorithm (the net reclassification improvement was 0.675 [95% confidence interval, 0.45-0.90] P < 0.01; the integrated discrimination improvement was 0.059 [95% confidence interval, 0.039-0.088] P < 0.01)., Conclusions: The AI system, which includes force distribution over the plantar surface of the foot during gait, is an effective tool to screen for locomotive syndrome., Competing Interests: Declaration of competing interest The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this manuscript., (Copyright © 2022 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Introduction: Recent studies found that wearable exoskeletons can reduce physical effort and fatigue during squatting. In particular, subject-specific assistance helped to significantly reduce physical effort, shown by reduced metabolic cost, using human-in-the-loop optimization of the exoskeleton parameters. However, measuring metabolic cost using respiratory data has limitations, such as long estimation times, presence of noise, and user discomfort. A recent study suggests that foot contact forces can address those challenges and be used as an alternative metric to the metabolic cost to personalize wearable robot assistance during walking. Methods: In this study, we propose that foot center of pressure (CoP) features can be used to estimate the metabolic cost of squatting using a machine learning method. Five subjects' foot pressure and metabolic cost data were collected as they performed squats with an ankle exoskeleton at different assistance conditions in our prior study. In this study, we extracted statistical features from the CoP squat trajectories and fed them as input to a random forest model, with the metabolic cost as the output. Results: The model predicted the metabolic cost with a mean error of 0.55 W/kg on unseen test data, with a high correlation (r = 0.89, p < 0.01) between the true and predicted cost. The features of the CoP trajectory in the medial-lateral direction of the foot (xCoP), which relate to ankle eversion-inversion, were found to be important and highly correlated with metabolic cost. Conclusion: Our findings indicate that increased ankle eversion (outward roll of the ankle), which reflects a suboptimal squatting strategy, results in higher metabolic cost. Higher ankle eversion has been linked with the etiology of chronic lower limb injuries. Hence, a CoP-based cost function in human-in-the-loop optimization could offer several advantages, such as reduced estimation time, injury risk mitigation, and better user comfort., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ramadurai, Jeong and Kim.)

Background: Diabetic foot neuropathy is one of the complications of diabetes that affects around 50% of diabetic people. Because peripheral neuropathy involves nerve loss around the foot areas, patients with diabetic neuropathy frequently lose sensation in their feet while walking or standing. Furthermore, since sensory nerves are damaged, the area that holds the majority of the foot pressure and temperature is at high risk of injury. If not diagnosed and treated properly, it can cause foot injury and eventually lead to edema, gangrene, ulcers, amputation, and even death. There are now several techniques of detecting diabetic neuropathy, but they are limited in their availability, cost-effectiveness, and complexity., Aims: The primary goal of this research was to develop devices for early detection and treatment of diabetic foot neuropathy., Methods: The proposed device combines a foot pressure monitoring method and a foot temperature measurement method to diagnose diabetic neuropathy early on, with red light therapy added as a treatment method. For 2 weeks, the device measures the patient's foot pressure and temperature, and light therapy is provided if a change in pressure or temperature at a specific area is observed., Results: The device prototype was successfully developed, and numerous tests were carried out in accordance with the design specifications. For pressure measurement and temperature measurement, measurement accuracy of 99.05% and 99.30%, respectively, were attained., Conclusion: The early detection and treatment device developed in this study could be used at home by diabetic patients as well as in hospitals to test for and treat diabetic foot neuropathy at an early stage. The device incorporates two different methods of diabetic foot neuropathy detection with high measurement accuracy which makes it suitable for use in resource-limited areas at low cost. The incorporation of red light therapy together with the two methods of diabetic neuropathy detection gives another unique feature for our device., (© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Background: The number of incidents related to walking while using smartphones is rising. However, it is not clear how smartphone usage might affect a gait pattern in terms of the foot pressure, and this may address the mechanism leading to incidents while using smartphones., Research Question: How do the characteristics of walking while using a smartphone affect foot pressure patterns?, Methods: In this cross-sectional study, we recruited 40 healthy young participants and investigated the walking speed, step length, coefficient of variance of the walking cycle (CV), anteroposterior length of the center of pressure (COP) trajectory (%Long), partial foot pressure ratios (% partial foot pressure [%PFP]), and COP existence time (COPexT) under the following four conditions: normal walking, screen gazing, while using social networking services (SNS), and while using a cognitive application. Parameters were compared among the four conditions using a repeated-measures ANOVA. Further, according to the presence or absence of an incident history (e.g. stumbles, collisions), participants were divided into either the incident or non-incident group. Parameters were compared between the two groups using a two-way repeated-measures ANOVA., Results: Under the SNS and cognitive application conditions, the walking speed, step length, %Long, %PFP, and COPexT in the heel were significantly lower, and the CV and %PFP in the metatarsal region were higher than those under normal walking or screen gazing. %PFP in the heel and metatarsal regions showed a significant group-by-condition interaction; the incident group had lower %PFP in the heel region and higher %PFP in the metatarsal region than the non-incident group., Significance: These findings indicate a trend of loading more pressure on the forefoot than on the heel. This pattern was markedly evident in individuals with a history of incidents related to the smartphone usage and may be one of the factors causing stumbles and collisions., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest associated with this manuscript., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Abnormal foot posture and poor muscle performance are potential causes of plantar fasciitis (PF). However, no study has compared the differences between lower extremity muscle performance and foot pressure in patients who have PF with and without abnormal foot postures. This study aimed to compare the differences in lower extremity muscle performance, such as in the hip, quadriceps, hamstring, and plantar flexor, and foot pressure in patients who have PF with and without flat foot postures. Seventy patients with plantar heel pain were enrolled (37 flat feet and 33 without flat feet). The hip muscle strength was measured using a handheld digital dynamometer. The strength and reaction time of the quadriceps, hamstring, and plantar flexor muscles were evaluated using an isokinetic device. Foot pressure parameters were assessed using pedobarography. The strength of the plantar flexor muscles was significantly lower ( p = 0.008), while the reaction time of the plantar flexor muscles was significantly faster ( p = 0.007) for the involved feet of PF patients with flat feet than in those without flat feet. This study confirmed the differences in muscle performance between patients who have PF with different foot postures. Therefore, clinicians and therapists should plan treatment considering the differences in these characteristics for the management of these patients.

Background: Lack of stability during stance negatively impacts gait and motor function for children with unilateral cerebral palsy. Improving stability and balance are the focus for gait rehabilitation). The One-Leg-Standing-Test may give valuable information about motor function and stability of stance for patients with unilateral cerebral palsy., Objective: This study aimed to investigate the relationship between the One-Leg-Standing-Test and the gross-motor-function-measurement and single-limb support time., Methods: The study included 18 patients with unilateral cerebral palsy (age 11.08 [SD 2.84] years old). The One-Leg-Standing-Test and pedobarographic evaluation were performed. Sections D and E of the gross-motor-function-measurement were assessed, and in pedobarographic evaluation, the single-limb support time (the total duration of mid-stance and terminal-stance during walking) was calculated to describe stability during stance., Results: For patients, the One-Leg-Standing-Test scores and single-limb support time values were lower on the affected side than on the unaffected side. The One-Leg-Standing-Test was correlated with single-limb support time ( p = .02, r = 0.60) and section E ( p < .01, r = 0.59) values. The One-Leg-Standing-Test was also correlated to total stance phase and section D., Conclusion: The One-Leg-Standing-Test gives valuable information about gross-motor-function but cannot be substituted for motor function tests. The single-limb support time value may be used to describe stability in stance during walking.

Purpose: To compare the clinical outcomes, rate of return to sports, postural control, and muscle strength between the arthroscopic and open modified Broström procedure for chronic lateral ankle instability (CLAI) patients., Methods: From September 2018 to April 2019, 70 patients diagnosed with CLAI were prospectively included with arthroscopic modified Broström procedure (n = 36) and open modified Broström procedure (n = 34). They were evaluated at five time points (preoperation and 3 months, 6 months, 1 year and 2 years postoperatively). The main results examined the rate of return to sports, American Orthopaedic Foot and Ankle Society Score (AOFAS), Foot and Ankle Ability Measure (FAAM), visual analogue scale (VAS), centre of pressure (COP) excursion velocity, time to boundary (TTB), plantar pressure, isokinetic muscle strength and complications., Results: Compared with the open group, the arthroscopic group demonstrated a significantly shorter period of return to the preinjury sport (13.2 ± 2.4 weeks vs. 18.7 ± 3.1 weeks, P = 0.023) and a higher early sport ratio (80.6 vs. 61.8%, P = 0.011) combined with better FAAM sports and AOFAS at 3 months and 6 months postoperatively and VAS at 3 months postoperatively. In addition, better anterior-posterior postural control stability, less time to peak force under lateral hindfoot and better dorsiflexion strength were shown in the arthroscopic group at 6 months postoperatively. No significant difference was found in clinical scores, posture control or muscle strength at the 1- or 2-year follow-up between the two groups., Conclusions: Shorter period and higher rates of return to sport activities and better clinical scores, posture control and muscle strength were achieved in the arthroscopic group at 6 months postoperatively, and no clinical differences were found between arthroscopic and open modified Broström procedure 1 year or 2 years postoperatively. Arthroscopic modified Broström procedure is a reliable procedure for CLAI injuries with the demand for fast exercise recovery., Clinical Registration: ChiCTR1900023999., Level of Evidence: II., (© 2022. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)

The purpose of this study was to investigate and evaluate balance ability, isokinetic moments, and physical fitness according to the growth period from middle school to university in male taekwondo players. Thirty-five taekwondo players (middle school, n=11; high school, n=15; university, n=9) participated in this study. The anteriorposterior and medial-lateral CoP displacement at balance ability was better in university players than in high school and middle school players. The isokinetic knee joint muscle strength of the right extension and flexion % body weight (BW) at 60°/s was higher in university players than in high school players. The average power of right flexion BW at 180°/sec was higher in middle school players than in high school players. Back strength was higher in university players than in middle and high school players. The repeated jump was higher in high school players than in middle school players. The standing broad jump was higher in university players than in middle school players. The side-step was higher in university players than in high school players. The average power and total energy of anaerobic power were higher in university and high school players than in middle school players. The peak drop in anaerobic power was higher in middle school players than in high school players. Based on the results of the present study, the growth period should be considered when applying training such as balance, isokinetic moments, and physical fitness to male taekwondo players., Competing Interests: CONFLICT OF INTEREST No potential conflicts of interest relevant to this article were reported., (Copyright © 2021 Korean Society of Exercise Rehabilitation.)

Background: Isolated gastrocnemius tightness (IGT) has been suggested as an etiologic factor in mechanical disorders of the foot and ankle without a clear pathophysiological mechanism in the literature. We hypothesized that restricted ankle dorsiflexion inducing increased forefoot pressure in IGT patients could be this pathophysiological mechanism., Methods: Case/control experimental observational investigation. Forty lower limbs in 20 asymptomatic IGT patients were included and compared to controls. Quantitative gait analyses coupled with dynamic baropodometry were used for comparison between groups. The primary outcome was maximum ankle dorsiflexion during stance phase. Secondary outcomes were knee flexion and forefoot pressure., Results: Maximum ankle dorsiflexion and maximum forefoot pressure were similar between groups. Increased knee flexion was found in the asymptomatic IGT group., Conclusions: IGT induced compensatory knee flexion during stance phase, which probably prevents increased pressure on the forefoot by allowing ankle dorsiflexion., Level of Evidence: Level IV, Case/control experimental observational investigation., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2020 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Plantar pressure, the pressure exerted between the sole and the supporting surface, has great potentialities in various research fields, including footwear design, biometrics, gait analysis and the assessment of patients with diabetes. This research designs an optical-based foot plantar pressure measurement system aimed for human postural control and person identification. The proposed system consists of digital cameras installed underneath an acrylic plate covered by glossy white paper and mounted with LED strips along the side of the plate. When the light is emitted from the LED stripes, it deflects the digital cameras due to the pressure exerted between the glossy white paper and the acrylic plate. In this way, the cameras generate color-coded plantar pressure images of the subject standing on the acrylic-top platform. Our proposed system performs personal identification and postural control by extracting static and dynamic features from the generated plantar pressure images. Plantar pressure images were collected from 90 individuals (40 males, 50 females) to develop and evaluate the proposed system. In posture balance evaluation, we propose the use of a posture balance index that contains both magnitude and directional information about human posture balance control. For person identification, the experimental results show that our proposed system can achieve promising results, showing an area under the receiver operating characteristic (ROC) curve of 0.98515 (98.515%), an equal error rate (EER) of 5.8687%, and efficiency of 98.515%.

Objective: To analyze characteristics and related factors of the plantar pressure during the level walking and single leg standing in the chronic ankle instability (CAI) individuals., Methods: From April 2019, 75 CAI individuals and 40 healthy individuals were enrolled in this study. Both of the static and dynamic plantar pressure were measured during six times level walking and three times single leg standing testing. The data including peak force, time to peak force in various foot contact areas and the time to boundary (TTB) and velocity of center of pressure (COP) were measured and compared between the affected side and the unaffected side and between the CAI cases and the healthy individuals. The correlations between the plantar pressure and the gender, Beighton score, affected side and body mass index (BMI) were analyzed., Results: The characteristics of plantar pressure distribution in the CAI individuals included: (1) During the level walking, the affected side showed the similar pressure contribution as the unaffected side ( P >0.05). While compared with healthy individuals, there was a significantly higher peak force in the 5th metatarsal area ( t =-3.86, P =0.03) of the affected side, lower peak force in the 1st ( t =2.99, P =0.02), 2nd metatarsal head areas ( t =2.09, P =0.01) of the affected side, medial hindfoot areas of both sides (affected, t =2.33, P =0.01; unaffected, t =3.74, P =0.02) and toes areass of both sides (affected, t =2.23, P =0.01; unaffected, t =3.28, P =0.02) and a delay to peak force in the 4th metatarsal head area ( t =3.33, P =0.01) of the affected side. (2) During the single leg standing, the CAI individuals showed significantly worse balance control in the anterior/posterior direction ( P < 0.05) and lateral/medial direction ( P < 0.05) compared with the healthy controls, and the affected side had more severe balance control deficit in the lateral/medial direction ( P < 0.05). (3) The women ( P < 0.05) and the individuals with higher Beighton scores ( P < 0.05) showed worse balance control deficit in the lateral/medial direction., Conclusion: CAI individuals showed significantly a more lateral shifted plantar distribution during the level walking compared with the healthy individuals and the tendency was worse on the affected sides, and showed worse balance control in the anterior/posterior direction and lateral/medial direction during the single leg standing. The women and those with generalized ligament laxity showed significantly worse balance control.

Background: The present study aimed to elucidate the effects of heel lifts on spinal alignment, walking, and foot pressure pattern in elderly individuals with spinal kyphosis., Methods: The spinal alignment, walking speed, step length and foot pressure of 33 community-dwelling elderly individuals with spinal kyphosis (3 men, 30 women; mean age 77.3 years) were examined before and after the application of 10-mm moderately elastic heel lifts., Findings: Spinal alignment of total inclination (mean value 6.9°vs 4.5°) and thoracic angle (43.6°vs 36.2°) were significantly lower after the application of heel lifts than before the application. The lumbar angle (7.3°vs 10.0°) was significantly higher after the application than before the application. Walking speed (0.78 vs 0.88 m/s) and step length (0.42 m vs 0.45 m) were significantly higher after the application. The partial foot pressure as a percentage of body weight of the hallux (6.7% vs 9.0%) and lateral toes (6.5% vs 9.0%) was significantly higher after the application of heel lifts than before the application. The partial foot pressure as a percentage of body weight of the heel (68.9% vs 57.5%) was significantly lower after the application than before the application., Interpretation: In conclusion, heel lifts influenced the sagittal spinal alignment of elderly individuals. Walking speed and step length increased after the application of these devices. Increase in foot pressure in the hallux and lateral toe areas was probably related to these improvements in walking parameters., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Muscle weakness is an important etiological factor in plantar fasciitis (PF), but available data on the role of the quadriceps, hamstring, and gastrocnemius (GCM) muscles are limited. The aim of this study was to compare the strength and reaction time of the quadriceps, hamstring, and GCM muscles and foot pressure between patients with PF and normal controls., Methods: A total of 21 PF patients and 21 normal controls were enrolled. Muscle strength was measured by the peak torque per body weight (Nmkg - 1  × 100). Muscle reaction time was evaluated by the acceleration time (AT, milliseconds). Foot pressure and posture were assessed by pedobarography [valgus/varus index (VV index), %]., Results: The strength of the quadriceps was significantly lower in the affected ankles of the PF group than in the control group (p = 0.005). The AT of the quadriceps and hamstring muscles was significantly increased in the affected ankles of the PF group than in the control group (quadriceps: p = 0.012, hamstring: p = 0.001), while the AT of the GCM muscle was significantly decreased (p = 0.009) and significantly correlated negatively with quadriceps muscle strength (r = -.598, p = 0.004) and AT (r = -.472, p = 0.031). Forefoot (p = 0.001) and hindfoot (p = 0.000) pressure were significantly greater, with the VV index showing hindfoot valgus, in the affected ankles in the PF group compared to the control group (p = 0.039)., Conclusions: This study demonstrated weakness and delayed reaction time of the quadriceps and hamstring muscles, with a rapid reaction time of the GCM muscle, in patients with PF., Clinical Relevance: Clinicians and therapists should assess the function of the quadriceps and hamstring muscles when planning the management of PF patients without muscle tightness.

Purpose: The ageing process can be accompanied by a degeneration of the spine and increase the risk of thoracic hyperkyphosis (excessive spinal forward curvature) amongst elderly people. This condition can in turn impair mobility, reduce balance, and increase the risk of falling and mortality in affected individuals. The use of corrective orthotic bracing has been shown to improve spinal posture, and increase stability and balance amongst the elderly. However, there is little evidence that evaluates the use of corrective braces on foot pressure changes in these subjects. Methods: In this study, we evaluated the use of a thoracolumbosacral orthosis (TLSO) on 19 subjects over 60 years old who presented with hyperkyphosis. We measured foot pressure using the Pedar-X system before (without brace) and after (with brace) immediate using a TLSO in both static (quite standing) and dynamic (walking on a 5 meters freeway) scenarios. Results: The results demonstrated that using a TLSO immediately decreases forefoot pressures in stasis, and around the first metatarsal, as well as pressures relating to the second to fifth metatarsals under dynamic conditions. Hindfoot pressures were increased, but not significantly. Conclusion: This study showed that using a TLSO can be beneficial for elderly people with hyperkyphosis.Implications for rehabilitationThe ageing process can be accompanied by a degeneration of the spine and increase the risk of thoracic hyperkyphosis.The use of corrective orthotic bracing has been shown to improve spinal posture, and increase stability and balance amongst the elderly.Using a TLSO decreases forefoot pressures in stasis, and around the first metatarsal, as well as pressures relating to the second to fifth metatarsals under dynamic conditions.

Biomechanical changes to the lower extremity in patients with diabetes mellitus are typically greatest with peripheral neuropathy, although peripheral arterial disease also impacts limb function. Changes to anatomic structures can impact daily function. These static changes, coupled with kinetic and kinematic changes of gait, lead to increased vertical and shear ground reactive forces, resulting in ulcerations. Unsteadiness secondary to diminished postural stability and increased sway increase fall risk. These clinical challenges and exacerbation of foot position and dynamic changes associated with limb salvage procedures, amputations, and prostheses are necessary and can impact daily function, independence, quality of life, and mortality., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The science of foot pressure studies the forces acting on the bottom and different regions of the foot along with the pressure exerted on the plantar surface with the interacting surface in contact. The information derived gave impact to human biomechanical assessment on body balance and ergonomics posture during gait. Various experiments designed at generating foot pressure data returns only with limited knowledge generated. Obviously, the procedure for experiment design needs to be properly understood from the foot morphology aspects; healthiness, footwear, surface in contact, load and forces impacts, and the foot sensitivity as well as the specification for the foot pressure. This paper reviews the proper preliminary experimental setups for foot pressure measurement analysis during static or dynamic gait. The strength and limitations of recent devices used and considerable variables are also discussed. The overall review explains that the comfortable natural gait in relation to the aspects of sensitivity, load, time duration, and stability are the standard considerations for plantar pressure experiments., (Copyright © 2018 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Background: Mobile rehabilitation systems for patients with gait disorder are being developed. Safety functions to prevent patients from falling are considered during product development; however, few studies have been conducted on systems that have been prevalidated for healthy adults prior to application to patients., Objective: This study analyzed the characteristics of lower extremity muscles and foot pressure in healthy adults during unbalanced walking with differences in the speed of left and right speed using a two-belt treadmill., Methods: Twenty subjects performed gait motions with a difference in the weight support conditions (0% and 30%) and the left and right lower limb speeds (1-3 km/h). Each subject's muscular activities and foot pressure signals were collected. The gait patterns of the faster side exhibit similar characteristics to the paralyzed leg, and the slower side is similar to the non-paralyzed leg., Results: Weight-supporting healthy subjects showed asymmetric gait patterns, similar to hemiplegic patients, because of the difference in the speed of the left and right side., Conclusions: The quantitative results can be used to develop a training protocol for two-belt treadmills with differently controlled left and right speeds for gait rehabilitation in hemiplegic patients.

Objective: To compare the rearfoot alignment (leg-heel angle, LHA) during standing and walking, and foot pressure during walking between individuals with medial tibial stress syndrome (MTSS) and asymptomatic individuals participating in daily sports., Design: A cross-sectional study., Setting: Research laboratory., Participants: MTSS (18 legs) and control (15 legs) participants., Main Outcome Measures: The LHA in the frontal plane during walking and standing; partial foot pressures expressed as the percentage of body weight (%PFP); and transverse width of the center of pressure (COP) path expressed as the percentage of foot width (%Trans) on walking., Results: The LHA while walking was significantly higher in MTSS individuals, whereas the LHA while standing was not significantly different. The %PFPs of medial metatarsal areas were significantly higher in MTSS patients, whereas the %Trans was significantly lower., Conclusions: In individuals with MTSS, the LHA is similar to controls while standing but higher (more everted) while walking while there is higher pressure under the medial metatarsal areas and the COP is more medial. Rearfoot malalignment in individuals with mild to moderate MTSS can be detected on walking, even if the alignment on standing is normal., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Symptomatic planovalgus deformity is a condition commonly seen in patients with cerebral palsy. The authors propose a new procedure for the management of this deformity through rotational reinsertion of the lateral layers of the Achilles tendon, and then they assess its benefit by comparing plantar pressure distribution patterns in children preoperatively and at 6- and 12-month intervals postoperatively. Pedobarographic measurements, range of motion of the ankle, and radiographic indexes were used to assess the outcome of the surgery. The functional abilities of the patients were assessed based on the Gross Motor Function Classification System. A total of 37 feet (22 patients) were included, with a mean ± standard deviation age at surgery of 11.8 ± 2.7 (range 9.1 to 14.5) years. All feet were managed through rotational reinsertion of the lateral layers of the Achilles tendon. Surgical correction of planovalgus has good outcomes. Significant changes were observed with statistical significance at the 5% (p ≤ .05) level in plantar pressure distribution in children preoperatively and at 6- and 12-month intervals postoperatively. The results show that the proposed method of surgery is effective in the correction of planovalgus in ambulatory children with cerebral palsy., (Copyright © 2018 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Foot pressure analysis is a valuable tool that can be used to quantify foot function in children. For researchers and clinicians who use foot pressure analysis, data from a typically developing population is used for comparison with subjects that have musculoskeletal conditions. However, differences between foot pressure data collection technology, data collection procedures and post-processing techniques make comparisons between devices, as well as direct comparisons of pediatric foot pressure data, difficult. When comparing data from multiple studies it is imperative that the studies utilize the same data collection and processing techniques, otherwise the data should not be directly compared. The purpose of this paper is to provide a summary of typically developing foot pressure data, explore factors that affect foot pressure data collection and provide suggestions for the standardization of foot pressure data collection and post processing. The results of this review demonstrate that the minimum data collection and processing recommendations for foot pressure data collection and post-processing are: using a midgait or two-step approach, allowing subjects to walk at their self-selected speed, collecting a minimum of three trials per foot, identifying at minimum medial and lateral hindfoot, forefoot, midfoot, the hallux and toes, and that parameters be reported in standard units., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

This survey clarified foot pressure patterns and hindfoot deformities in individuals with advanced knee osteoarthritis (OA) and analyzed their associations with foot pain. Sixty-four individuals with unilateral knee OA who underwent total knee arthroplasty (TKA) were divided into the following groups: no foot pain (n=26; men:women, 4:22; mean age, 73.7 years), foot pain resolved after TKA (12; 2:10; 75.8), and foot pain remaining after TKA (26; 4:22; 74.7). Elderly individuals without pain or deformity in either knee (54; 10:44; 74.3) were controls. Navicular height ratio of the medial longitudinal arch, leg-heel angle, and partial foot pressure as the percentage of body weight (%PFP) were calculated.%PFPs of the medial and lateral heel regions before TKA were significantly lower for the no foot pain group than for controls. One year after TKA, %PFP improved significantly. In the foot pain resolved group, before TKA, the leg-heel angle was significantly higher, and%PFPs of the medial and lateral heel regions and navicular height ratio before TKA were significantly lower than those of controls. One year after TKA, all parameters improved significantly. In the foot pain remaining group, similar abnormalities were observed before TKA; however, significant improvement was only observed for%PFP of the medial heel region 1year after TKA. More than half of the patients with advanced knee OA had foot pain. This improved in approximately one-third, 1year after TKA. Hindfoot deformities are probably associated with foot pain in individuals with advanced knee OA., (Copyright © 2017 Elsevier B.V. All rights reserved.)

People suffering from locomotor impairment find turning manoeuvres more challenging than straight-ahead walking. Turning manoeuvres are estimated to comprise a substantial proportion of steps taken daily, yet research has predominantly focused on straight-line walking, meaning that the basic kinetic, kinematic and foot pressure adaptations required for turning are not as well understood. We investigated how healthy subjects adapt their locomotion patterns to accommodate walking along a gently curved trajectory (radius 2.75m). Twenty healthy adult participants performed walking tasks at self-selected speeds along straight and curved pathways. For the first time for this mode of turning, plantar pressures were recorded using insole foot pressure sensors while participants' movements were simultaneously tracked using marker-based 3D motion capture. During the steady-state strides at the apex of the turn, the mean operating point of the inside ankle shifted by 1 degree towards dorsiflexion and that for the outside ankle shifted towards plantarflexion. The largest change in relative joint angle range was an increase in hip rotation in the inside leg (>60%). In addition, the inside foot was subject to a prolonged stance phase and a 10% increase in vertical force in the posteromedial section of the foot compared to straight-line walking. Most of the mechanical change required was therefore generated by the inside leg with hip rotation being a major driver of the gentle turn. This study provides new insight into healthy gait during gentle turns and may help us to understand the mechanics behind some forms of impairment., (Copyright © 2017. Published by Elsevier Ltd.)

Background: In pedobarography, clinically meaningful comparison of measurements within or between subjects is limited by data variability and measurement error. This study aims to determine the components of the minimal detectable change (MDC) in impulse across all foot regions and the reliability of these measures., Methods: A convenience sample of foot pressures from 108 visits by normal, healthy subjects aged 2-17 years was studied. Each subject had three pedobarograph measurements taken per foot, with six subjects returning for a second visit for assessment of day-to-day variability. Using a five-region mask, segmental impulses were determined, and from these we obtained the coronal plane pressure index (CPPI). Inter-rater, intra-rater, and day-to-day data were analyzed using intraclass correlation coefficients (ICC) to quantify reliability. Variability of the data was analyzed to quantify the MDC., Results: Inter- and intra-rater reliability was high for all measurements while variability was low, indicating small direct measurement error. Generally, the largest contributing factor to the MDC was day-to-day variability. Step-to-step variability was more dependent on foot segment than age although minor age-related changes were noted. Finally, the high relative variability in the CPPI and the medial mid foot impulse resulted in very high MDCs for these measures., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

[Purpose] This study was conducted to determine the difference in foot pressures between flat and normal feet at different gait speeds on an ascending slope. [Subjects] This study enrolled 30 adults with normal (n=15) and flat feet (n=15), with ages from 21 to 30 years old, who had no history of neurological disorders or gait problems. A treadmill was used for the analysis of kinematic features during gait, using a slope of 10%, and gait velocities of slow, normal, and fast. [Methods] A foot pressure analyzer was used to measure changes in foot pressure. [Results] Compared to the normal subjects, the foot pressure of the flatfoot subjects showed a significant increase in the 2-3rd metatarsal region with increasing gait speed, whereas there were significant decreases in the 1st toe and 1st metatarsal regions with increasing gait speed. [Conclusion] The body weight of adults with flatfoot was concentrated on the 2-3rd metatarsal region during the stance phase and increased with walking speed on the ascending slope due to weakening of function of the medial longitudinal arch.

[Purpose] The aims of this study were to determine (1) the significance of walking and foot pressure in stroke patients, and (2) the association between changes in postural alignment of stroke patients. [Subjects and Methods] Foot pressure and walking ability based on postural alignment were measured in 50 stroke patients. Trunk imbalance, trunk rotation, pelvic tilt, kyphosis, lordosis were measured using DIERS formetric4D (DIERS International GmbH, Schlangenbad, Germany), which anlalyzes 3-dimensional spinal structure in order to measure postural alignment. To determine foot pressure, the support rate of weight and, average foot pressure were measured using DIERS pedoscan (DIERS International GmbH, Schlangenbad, Germany) apparatus as a pressure platform. [Results] DIERS formetric 4D, DIERS pedoscan, and a 10 m walking test were utilized to measure foot pressure and walking ability relative to changes in postural alignment in participating stroke patients. [Conclusion] This study confirmed the significance of foot pressure and walking ability as related postural alignment, indicating that postural alignment education and a recovery therapy program for functional improvement of stroke patients should be provided together.

[Purpose] This study aimed to improve the asymmetrical weight-bearing ratio by applying repetitive sit-to-stand training methods that feature a step-foot position to the paretic-side foot of hemiplegic patients; it sought also to provide the information needed to apply weight-bearing and balance training to hemiplegic patients. [Subjects and Methods] The subjects were divided into two groups: a spontaneous group and a step group. They all performed repetitive sit-to-stand training five times per week for a total of six weeks. The Biodex Balance System, TUG, and 5XSST were used to measure the static and dynamic standing balance of each patient. A foot mat system was used to measure foot pressure. [Results] In the balance measurements, differences in the Overall index, Ant-post index, Med-lat index, Fall risk index, TUG, and 5XSST after training was significantly different between the two study groups. In evaluating foot pressure measurements, we found that the COP (Ant-post), Peak pressure: hind foot, and Contact area: hind foot measurements significantly differed between the groups after the training. [Conclusion] Repetitive sit-to-stand training that involves positioning the non-paretic leg upward can be considered a significant form of training that improves the symmetric posture adjustment and balance of hemiplegic patients following a stroke.

[Purpose] The aim of this study was to examine whether plantar flexor static stretching and dynamic stretching using an Aero-Step results in changes in foot pressure during gait in healthy adults. [Subjects] Eighteen normal adults were randomly allocated to either a dynamic stretching using an Aero-Step group (DSUAS) group (n = 8) or a static stretching (SS) group (n = 10). [Methods] The DSUAS and SS participants took part in an exercise program for 15 minutes. Outcome measures were foot plantar pressure, which was measured during the subject's gait stance phase; the asymmetric ratio of foot pressure for both feet; and the visual analogue scale (VAS) measured during the interventions. [Results] There were significant differences in the asymmetric ratio of foot pressure for both feet and VAS between the two groups after intervention. However, there were no significant differences in foot plantar pressure during the gait stance phase within both groups. [Conclusion] DSUSAS is an effective stretching method, as pain during it is lower than that with SS, which can minimize the asymmetric ratio of foot pressure for both feet during gait due to asymmetric postural alignment.

[Purpose] The aim of this study was to determine the effect of application of a metatarsal bar on the pressure in the metatarsal bones of the foot using a foot analysis system (pressure on the forefoot, midfoot, and rearfoot). [Subjects and Methods] Forty female university students in their twenties were selected for this study, and an experiment was conducted with them as the subjects, before and after application of a metatarsal bar. The static foot regions were divided into the forefoot, midfoot, and rearfoot, and then the maximum, average, and low pressures exerted at each region were measured, along with the static foot pressure distribution ratio. 1) Static foot pressure: The tips of both feet were aligned to match the vertical and horizontal lines of the foot pressure measuring plate. The subjects were told to look toward the front and not to wear shoes. 2) Distribution ratio: The distribution ratio was measured in four regions (front, back, left, and right) using the same method as used for static foot pressure measurement. [Results] The results of this study showed that the maximum, average, and minimum static pressures in the forefoot were significantly decreased. The minimum static pressure in the midfoot was significantly increased, and the pressure in the other parts was significantly decreased. The maximum and average static pressures in the rearfoot were also significantly decreased. [Conclusion] As reduction of foot pressure with a metatarsal bar results in lowering of the arch and an increased contact surface, the foot pressure was dispersed. These results suggest that wearing shoes with a bar that can decrease the foot pressure is therapeutically helpful for patients with a diabetic foot lesion or rheumatoid arthritis.

Objective: The aim of the present study was to examine the effect of gait training using obstacle on the plantar pressure and contact time in elderly women., Methods: A total of 24 elderly women who were residing in communities in D city, South Korea aged 79.9 ± 2.2, 154.5 ± 7.6 cm in height, and 56.2 ± 5.2 kg in weight participated in this study. The participants conducted obstacle gait training for 8 weeks and foot contact time and foot pressure right before and after crossing the obstacle were measured for 3 times: before the intervention, at the 4 weeks, and 8 weeks using F-scan (Tekscan, USA)., Results: The results show that foot contact time did not decrease right before crossing the obstacle but decreased right after crossing the obstacle (p<0.05). Foot pressure moved from the end of the frontal foot to the midfoot (MF) and heel (HL) right before crossing the obstacle (p<0.05). Foot pressure increased in lesser toe (LT) right after crossing the obstacle (p<0.05)., Conclusion: These results indicate proper weight distribution in feet, increased foot stability due to increased muscle power and flexibility, and improved strategy to cope with the obstacle. The obstacle gait training may be helpful to the elderly who would either fear for or limit outdoor activities due to the risk of falls based on the result of this study., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

[Purpose] The aim of this study was to examine the effect of a pelvis-concentrated exercise program and walking on the changes in body shape and foot base pressure. [Subjects and Methods] Thirty adults from K University in Busan, Republic of Korea, were randomly divided into the Swiss-ball exercise group and McKenzie exercise group, and they conducted exercise for 40 min 3 times a week for 6 weeks. [Results] Global postural system results and foot base pressure significantly decreased in both groups. A comparison of foot base pressure after the intervention between the two groups revealed that the Swiss-ball exercise group exhibited a greater reduction than the McKenzie exercise group. [Conclusion] The results of this study indicated that the Swiss-ball exercise may improve posture and foot base pressure in male adults.

[Purpose] The purpose of this study was to investigate the effects of revised high-heeled shoes on the foot pressure ratio and static balance during standing. [Subjects and Methods] A single-subject design was used, 15 healthy women wearing revised high-heeled shoes and general high-heeled shoes in a random order. The foot pressure ratio and static balance scores during standing were measured using a SpaceBalance 3D system. [Results] Forefoot and rearfoot pressures were significantly different between the 2 types of high-heeled shoes. Under the 3 conditions tested, the static balance score was higher for the revised high-heeled shoes than for the general high-heeled shoes, but this difference was not statistically significant. [Conclusion] Revised high-heeled shoes are preferable to general high-heeled shoes, as they result in normalization of normalized foot pressure and a positive effect on static balance.

[Purpose] The purpose of this study was to analyze the effect of superficial trunk muscle exercise and deep trunk muscle exercise on the foot pressure of healthy adults. [Subjects] The subjects were 30 healthy females and males who agreed to participate in this study. There were two groups, a superficial trunk muscle exercise group and a deep trunk muscle exercise group, with 15 participants in each. [Methods] The exercises were conducted 5 times a week for 4 weeks for both groups. A gait analyzer was used to measure foot plantar pressure while walking on a plate. Participants were measured before starting the exercise and after 4 weeks. The paired t-test was used to analyze the pre-and post-test results. [Results] There were no significant differences in foot pressure in any region in the superficial trunk muscle exercise group. In the deep trunk muscle exercise group, there were statistically significant increase in F1, F4, F5, R1 and R3. In addition, there were significant decreases in R2 and R4. [Conclusion] After the 4-week deep trunk muscle exercise group decreases in foot pressure on the inner foot and increases on the outside of the feet indicate normal and overall even distribution of body weight on the feet.

[Purpose] This study was conducted to examine the effect of pelvic stabilization exercise and 3D equipment exercise on adult women with Functional Leg-Length Discrepancy (FLLD). [Subjects and Methods] Twenty female students in their 20's having FLLD without Structural Leg Length Discrepancy were selected. Exercise was performed for 50 min per session, three times a week, for six weeks. The Pelvic stabilization exercise (PSE) group performed pelvic stabilization exercises for 50 minutes, and the 3D exercise (3DE) group performed 3D Air Balance exercise for 10 minutes after performing the pelvic stabilization exercise program for 40 minutes. [Results] The PSE group showed statistically significant differences in tape measure method (TMM) and maximum pressure between pre-test and post-test, and 3DE showed statistically significant differences in TMM, the difference in maximum pressure, the difference in average pressure, and the difference in support area. At the end of the 6-week intervention, TMM, difference in maximum pressure, difference in average pressure, and difference in support area showed significantly greater reduction in the 3DE group. [Conclusion] The results show that 3D stabilization exercise was more effective at improving the stabilization of the deep muscles surrounding the pelvis and left-right muscular balance. We consider that 3D exercise should be included in exercise programs for improving pelvic cavity and spinal stability in the future.

[Purpose] The effects of core training using slings and Togus on the improvement of posture control in Taekwondo club students, that is, balance ability, were investigated. To that end, changes in the Taekwondo players' balance ability resulting from active core training for eight weeks were examined through fitness and foot pressure. [Subjects] The present study was conducted with 13 male Taekwondo players of K University in Deagu, South Korea. Once the experiment process was explained, consent was obtained from those who participated voluntarily. [Methods] Air cushions (Germany), Jumpers (Germany), and Aero-Steps (Germany) were used as lumbar stabilization exercise tools. As a method of training proprioceptive senses by stimulating somatesthesia in standing postures, the subjects performed balance squats, supine pelvic lifts, and push-up plus exercise using slings while standing on an Aero-Step and performed hip extension parallel squats (Wall Gym Ball), and standing press-ups on a Togu using their own weight. The subjects performed four sets of these isometric exercises while maintaining an exercise time per set at 30 seconds in each session and repeated this session three times per week. [Result] Left grip strength significantly increased and number of sit-ups, which indicates muscle endurance, also significantly increased after the eight weeks exercise compared with before the exercise. The values measured during the sit and reach test, which indicate flexibility, also significantly increase after the eight weeks of exercise compared with before the exercise but only in the left foot. [Conclusion] The result of present study suggest that active core exercise using Slings and Togus can be applied as a very effective exercise program for enhancing balance, which is an important physical factor for Taekwondo club students.