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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.

Background Incidence and clinical characteristics of foot pressure ulcers (FPU) in hospitalized elderly patients are not well known. The aim of the study was to determine the incidence of FPU during hospitalization, to describe main FPU characteristics and to assess main risk factors for FPU in hospitalised elderly subjects. Methodology An observational prospective study was performed in which patients 65 years or older admitted to Vascular Surgery, Orthopaedic or Geriatric departments were followed from admission to discharge. Trained nurses evaluated all recruited patients on a daily basis for possible FPU. Main characteristics of the patient (age, sex and co-morbidities) and the ulcer (location, grade) were registered. Results 299 patients were recruited (62.2% women, mean age 82.3 years, mean number of co-morbidities 2.8). Prevalence of FPU was 30.1% at admission and 73.9% at discharge. Incidence of FPU during hospitalization was 9.5 new FPU/100 person-day. 97.0% of the new FPU were grade 1 (erythema) and the most common locations were in the heel (57.6%), the external lateral part of the foot (13.1%), and the hallux of the fist toe (11.8%). Apart from immobility, main risk factors for FPU are age, geriatric residence origin and not able to outdoor life. Conclusions FPU has a high incidence among hospitalised elderly patients; most of them are grade 1 and located in the heel. More attention must be paid in the prevention of pressure ulcers in hospitalized frail subjects.

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.

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.

The purpose of this study was to investigate the differences in plantar pressure under the lead and trail foot between two lunge tasks to the net in the dominant (LD) and non-dominant (LND) directions, and to explore how fatigue affects the plantar pressure patterns whilst performing movements before and after a competitive match. Peak and mean pressure were measured with the Biofoot-IBV in-shoe system from five repetitions of each task, with sensors positioned under the calcaneus, midfoot and phalanges on the lead and trail foot. Data were collected pre and immediately post-playing an official first national league competition match. The study was conducted with a sample of thirteen first league badminton players. A 2 × 2 repeated ANOVA found significant differences between the two tasks and between pre- and post-match (fatigued state). Players also had different foot pressure distributions for the LD and LND tasks, which indicated a difference in loading strategy. In a fatigued state, the plantar pressure shifted to the medial aspect of the midfoot in the trail limb, indicating a reduction in control and a higher injury risk during non-dominant lunge tasks.

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.

Background: Glaucoma, is the most common cause of irreversible visual deficits, presents as an injury to the optic nerve and it is mainly associated with elevated intraocular pressure. The main symptom of glaucoma is a reduction of the visual field, which is usually a source of complaint at the advanced stage of disease. Because of visual deficit, gait dysfunctions, including low gait speed and increased bumping into objects, postural sway, and falling are occurred. Many studies have used stopwatch or motion-sensing devices to report on gait function following glaucoma. However, there are few reports on gait dysfunction assessed by examining foot pressure. This study investigated gait ability following glaucoma according to different gait conditions by assessing foot pressure. Methods: Thirty older adults (15 in the sex- and age-matched normal group and 15 in the glaucoma group) were recruited for this study. All participants were walked under 2 different gait conditions in an F-scan system and the subject’ assessments were randomly assigned to rule out the order effect. Conditions included: gait over an obstacle in a straight 6 m path, gait in a straight path without an obstacle in the 6 m path. Gait variables included cadence, gait cycle, stance time, center of force (COF) deviation, and COF excursion. About 10 minutes were taken for gait evaluation. Results: When walking without an obstacle on a 6 m path, there were significant differences between the 2 groups in gait speed, cadence, gait cycle, and stance time (P

BACKGROUND 3D-printed insoles are widely used. This study was conducted to test a customized three-dimensional (3D)-printed heel support insole based on arch lift and to investigate whether the pressure distribution on the sole was improved while maintaining foot function. MATERIAL AND METHODS The design was based on a 3D plantar contour scanning modeling technique. Thirty healthy male participants walked along a 10-m track under 3 self-controlled interventions. A customized 3D-printed heel support insole based on arch lift was inserted into the socks for the experimental condition A. For condition B, a customized 3D-printed heel-supporting insole was inserted into the socks, and a standardized pre-made heel-supporting insole was inserted into the socks as a control (condition C). We used the Footscan® pressure plate to measure the plantar parameters in the forefoot contact and foot flange phases in each condition. RESULTS Compared with condition B and the control condition, the peak pressure under the heel was significantly lower in condition A (P0.05), and the peak pressure in the midfoot region was not significantly increased (P0.05). CONCLUSIONS The biomechanical properties of the customized 3D-printed heel support are better than those of the traditional heel support insole, especially when there is a need for an additional increase in heel height. Patients do not decrease midfoot motion function while using this customized insole.

To determine prevalence, incidence and risk factors for foot pressure ulcers in ambulatory children with spina bifida.Retrospective cohort study of 72 ambulatory children (age range 0-23.9 years) with spina bifida treated at a pediatric tertiary care facility. Data on foot pressure ulcers were recorded and analyzed to determine prevalence, incidence and predictive factors.Foot pressure ulcers occurred in 50/143 limbs (35%) over 10.5 ± 3.5 years. Average incidence was 0.10 foot pressure ulcer incidents per person-year, and prevalence in years with complete follow-up was 8.8%. Prevalence was related to age [higher for ages 11-15 (17%), than ages 0-10 (5%) and 16+ years (7%),Foot pressure ulcers occur in nearly 1 out of 10 ambulatory children with spina bifida, most often in pre-teens or young teen-agers with foot deformities, who use braces. This information can help direct skin care education and prevention to those most vulnerable.Implications for RehabilitationFoot pressure ulcers occur in children and adolescents with spina bifida, most commonly in those aged 11-15 years, with foot deformities and who use braces.Ulcer development was unrelated to stiffness of foot deformity, body mass index, lesion or functional level, or presence of comorbidities such as Arnold-Chiari malformation, syringomyelia or shunted hydrocephalus.Skin care education and preventative measures should be provided to all patients, but with particular emphasis for those with these risk factors.

Following 1st metatarsophalangeal joint replacement, there is a normalisation of foot pressure distribution as demonstrated by peak pressures of the 1st and 5th metatarsal heads and their ratio as measured by pedobarographs. This compares favourably with the unaffected foot. Functional dorsiflexion range of motion is maintained and there is a significant improvement in the reported patient outcome measure.

Background Previous reliability studies on peak plantar pressure measurements in patients with previous diabetic foot ulceration (DFU) did not stratify their analyses according to whether the foot had a previous ulcer. Research question Does test-retest reliability of peak foot pressure measurements from the various foot regions differ between the ulcerated and non-ulcerated feet? Methods Data from 23 participants with peripheral neuropathy and healed plantar DFU were analysed in this test-retest reliability comparison study. Plantar pressure was evaluated on two sessions using Pedar®-X in-shoe system, with a mean of 7.2 days (SD = 1.6) between sessions. Results The intraclass correlation coefficient (ICC) and coefficient of variation (CV) were calculated for 10 foot regions. Overall, test-retest reliability was excellent (ICCs, 0.82 to 0.95) for all peak pressure variables. CV ranged between 6.3% and 18.3%, and exceeded 15% over the hallux and medial forefoot regions in the ulcer foot (18.3% and 16.4%, respectively). Hallux peak pressure CV was significantly higher over the ulcer foot than over the non-ulcer foot (5.7%, 95% CI, 1.7%–10.2%). Peak pressure CV over the forefoot also tended to be higher over the ulcer foot (medial forefoot: 6.1%, 95% CI, -0.5%–14.5%; lateral forefoot: 4.1%, 95%CI, -0.7%–11.1%). Significance Peak plantar foot pressure may be useful to distinguish between groups of patients with peripheral neuropathy and healed plantar DFU. However, clinical decisions based on ulcer foot hallux and forefoot peak pressure measurements should be interpreted with caution.

Objective: The aim of this study was to perform the static and dynamic biomechanical assessment of postural structure and analyze variations of foot pressure in elite golfers. Methods: A total of 8 golfers (3 female, mean age 15.33 ± 0.57 years; mean height 167 ± 3.61 cm and mean weight 59.3 ± 11.71 kg; 5 male, mean age 17 ± 0.83 years; mean height 177.2 ± 8.61 cm; mean weight 72.8 ± 15.61 kg) from Turkish National Team were participated to this study. Digital Biometry Images Scanning (DBIS) system was used for BioPostural analyses. All participants were applied Modular Electronic Baropodometric test for foot pressure evaluation and Stabilometry for body balance evaluation. Results were analyzed by SPSS 16.0 (SPSS Inc., Chicago, IL, USA) program, using Wilcoxon test. Results: In static evaluation, there were significant differences in forefoot and rearfoot surface (cm2) (p

(1) Background: The aim of this study was to evaluate differences in the static and dynamic distribution of foot pressure on the ground and to investigate the relationships between body mass index (BMI) and mean variables of plantar pressure between soccer players and their non-athlete peers. (2) Methods: The study involved 18 first-division Polish soccer players and 30 non-athlete physiotherapy students. The research experiment was conducted using the FreeMed platform. Basic descriptive statistics were calculated to summarize the variables. Additionally, in the static and dynamic tests, Spearman’s rank correlations between body mass index (BMI) and plantar load were calculated. (3) Results: Statistically significant differences between groups were observed in the loading of the dominant limb. A statistically significant correlation between BMI and loading of both limbs was found in the static test and between BMI and loading of the dominant limb in the dynamic test. (4) Conclusions: The baropodometric mat used in our study helped determine the plantar pressure distribution of soccer players and their non-athlete peers. Correlation analysis revealed that BMI was only associated with the mean plantar pressure of the dominant limb in the control group. Further research on a larger group of athletes is needed to determine how much sporting activity may affect the development to modifications within feet in soccer players.

Objectives. Foot ulcers often occur in people with diabetes because of pressure-induced tissue ischemia. Vibration has been reported to be helpful in alleviating mechanical damage and promoting wound healing. The objective of this study is to explore whether vibration can relieve reactive hyperemia in foot tissue under occlusive compression. Methods. Thirteen healthy adults participated in the study. Each foot was placed under occlusive compression without or with vibration intervention, which was randomly assigned every other day. The dorsal foot skin blood flow (SBF) was measured pre- and postintervention for each subject in each test. Temporal variations and spectral features of SBF were recorded for comparison. Results. The results showed that subjects displayed an obvious reactive hyperemia in the foot tissue after pressure occlusion, whereas they displayed a more regular SBF when vibration was applied along with occlusive compression. Moreover, the amplitude of metabolic, neurogenic, and myogenic pathways for SBF was significantly reduced during the hyperemia process when vibration was applied. Conclusions. This study demonstrated that vibration can effectively reduce the level of hyperemia in foot tissue under occlusive compression and also induce less protective physiological regulatory activities. This is helpful for protecting foot tissue from pressure-induced ischemic injury and foot ulcers.

Purpose: The aim of the experiment presented in this study was to determine the pressure distribution within the forefoot depending on the type of orthopaedic footwear used. Methods: The study included 27 women aged 20 to 25. The Zebris FDM-2 dynamographic platform was used in foot pressure measurements. The load distribution was measured in three types of orthopaedic footwear: MedSurg, MedSurgPro and OrthoWedge. The full gait cycle was recorded. The Cavanagh masks were applied to the load distribution results processed into a graphic form. The data were analysed using Statistica v.13.1. Results: In the forefoot area, i.e. the metatarsal bones and toes 1–5, the lowest loads were reported in the shoes that off-load the forefoot (0.2 N/cm2, p < 0.001). In the area of the first to fifth metatarsal bones and the hallux, the highest load was observed in the rocker shoe, accounting for 19.7 N/cm2 (p < 0.001). For comparison, high pressure in the flat shoe was found in the area of toes 2 to 5 (p < 0.001). Conclusions: In the area of the metatarsal and toe bones, the pressure exerted was highest in the commonly used rocker shoe. The flat shoe provides an even and uniform load in all areas of the forefoot, while this type of shoe does not significantly reduce the pressure forces on the forefoot. The shoe that was the most effective in off-loading was the forefoot off-loading shoe (OrthoWedge). Barefoot walking puts less load on the forefoot compared to the flat and rocker shoes used after orthopaedic procedures.

BACKGROUND Foot deformities result in pain and changes in plantar pressure distribution in rheumatoid arthritis (RA) patients. Medical insoles are commonly prescribed for declining pain and modifying foot pressure distribution in these patients. The purpose of this study was to evaluate the effect of a pre-fabricated insole with metatarsal pad and medial longitudinal arch support on plantar pressure distribution in rheumatoid arthritis patients. METHODS Fifteen females with RA participated in this study. All patients received a pair of pre-fabricated insoles that were individually modified using metatarsal pads and medial longitudinal arch supports. Mean peak pressure (kPa), maximum force (N), and contact area (cm2) were calculated for the heel, midfoot, metatarsophalangeal joint, and toe regions using the Pedar-X system immediately and after a month follow-up. FINDINGS In the heel and metatarsophalangeal joint regions, maximum pressure and force showed a significant reduction in the follow-up assessment (p < 0.05). The comparison showed a significant increase in maximum pressure and force in the midfoot when participants walked with insole compared to without insole condition (p < 0.001). INTERPRETATION Using a pre-fabricated insole with an individually modified metatarsal pad and medial longitudinal arch support could alter rheumatoid arthritis patients' plantar pressures after one month of follow-up. This type of insole is simple and inexpensive and showed a significant effect on decreasing pressures under the metatarsal heads.

Background Abnormal foot contact patterns following stroke affect functional gait; however, objective analysis targeting independent walking is lacking. Research question How do walking abilities and foot pressure patterns differ between post-stroke individuals who achieved independent walking and healthy controls? Secondarily, how do the abilities and patterns in post-stroke individuals change before and after achieving independent walking? Can these changes become criteria for permitting independent walking? Methods Twenty-eight individuals with hemiplegia and 32 controls were enrolled. Motor dysfunction score (MDScore), walking speed (WSpeed), and foot pressure patterns were measured when they were first able to walk without orthosis or physical assistance (1st assessment) and when they achieved independent walking around discharge (2nd assessment). Foot pressure patterns were measured using insole-type foot pressure-measuring system. Ratios of partial foot pressure to body weight (%PFP), ratios of anteroposterior length of center of pressure (COP; %Long), and backward moving distance of COP to the foot length (%Backward) were calculated. Parameters during the 2nd assessment were compared with those of controls and those during the 1st assessment. During the 2nd assessment, relationships among the parameters, MDScore, and WSpeed were analyzed. Results During the 2nd assessment, no difference was observed in both %Long and %Backward between the non-paretic limbs and the controls. While the %Backward was higher, the %PFP of toes and %Long were lower in the paretic limb than in the controls. Although the %Backward was lower, both %PFP of toes and %Long of the paretic limb were higher in the 2nd assessment than in the 1st assessment. During the 2nd assessment, both %Long and % Backward values of the paretic limb moderately correlated with MDScore and WSpeed. Significance After improvement of foot pressure in toes, both an increase in anteroposterior length and a decrease in backward moving of COP path were objective signs permitting independent walking.

© 2020 Elsevier Ltd Obese people are often encouraged to lose body mass by exercise. The aim of the study was to determine the effect of body mass and ankle muscle strength on the dynamic foot-pressure distribution before and after running. Twenty-five normal weight (72.0 ± 5.3 kg), 25 overweight (80.8 ± 5.6 kg) and 25 obese (96.8 ± 6.5 kg) age- and height-matched male recreational runners joined the study. Before and after 30 min running, dynamic foot-pressure distribution during running, and ankle plantarflexor, dorsiflexor, invertor and evertor muscle strength were measured using a foot-scan pressure-plate and isokinetic dynamometer, respectively. Body mass index and percentage fat mass correlated positively to almost all components of foot-pressure distribution; this explantion was extracted from 14% (for toe 1) to 52% (for dynamic arch index) of peak foot pressure and between 21% (for metatarsal 1) to 48% (for midfoot) of the impulse underneath different foot zones. Only plantarflexor muscle strength significantly predicted plantar pressure and impulse underneath the T1, T2-5, midfoot area and the dynamic arch index. After running, plantarflexor and invertor muscle strength predicted from 30% (for metatarsal 2) to 58% (for metatarsal 1) of peak foot-pressure and impulse underneath the different foot zones. Obesity is associated with excessive plantar loading that is aggravated after running by fatigue-related reductions in plantar flexor and invertor muscle strength. To prevent foot pain and injuries related to excessive foot pressures, at the start of the weight control process non-weight bearing rather than weight-bearing exercise is advisable.

Surgeons working in orthopedics and trauma surgery are frequently exposed to repetitive actions and non-ergonomic positions in their operative activities with the regular use of lead aprons. Musculoskeletal complaints of the neck and back among surgeons are reported in the literature as up to 80%. In this study, the effects of lead aprons on the posture of surgeons are examined using videorasterstereography, foot pressure measurement and questionnaires.All subjects (n = 31) were examined before and after exposure to wearing lead aprons during surgery using videorasterstereography and pedography. In addition, a survey with a separately created questionnaire and the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) was carried out.An average duration of lead apron use of 102.6 min showed an increase in forefoot load (p = 0.002) especially in the elderly subjects and thoracic kyphosis (p 0.001) especially in the younger doctors with a significant lateral deviation (p = 0.006). In addition, the lateral deviation was shown to correlate with an increasing body size or a shorter period of employment (p = 0.008; r = 0.51/p = 0.026; r = - 0.44). Significantly fewer surgeons experienced back complaints on working days without lead apron use in the operating room compared to days in the OR (p = 0.011).The impact of wearing front covered lead aprons during operations in the field of orthopaedics and trauma surgery leads to more frequent back complaints, even among young and healthy doctors. Under an average duration of surgery of 102 min a temporary postural deviation occurs that can be demonstrated by means of videorasterstereography and foot pressure measurement. The subjects showed a shifted weight distribution on the forefoot, a gain in thoracic kyphosis and an increase in lateral deviation, which also correlated with an increasing height and shorter length of employment.Orthopädisch-unfallchirurgisch tätige Ärzte sind in ihrer operativen Tätigkeit häufig repetitiven Bewegungen und unergonomischen Positionen unter regelmäßigem Einsatz von Röntgenschürzen ausgesetzt. Muskuloskelettale Beschwerden des Nackens und Rückens unter Chirurgen werden in der Literatur mit bis zu 80% angegeben. Wie sich der Einfluss der Frontröntgenschürzen auf die Haltung der Ärzte auswirkt, wird in dieser Studie mittels Videorasterstereografie, Fußdruckmessung und Fragebögen untersucht.Alle Probanden (n = 31) wurden vor und nach Belastung durch das Tragen von Röntgenschürzen bei operativen Eingriffen mittels Videorasterstereografie und Pedografie untersucht. Zusätzlich erfolgte die Durchführung einer Fragebogenanalyse zur Prävalenz von Rückenbeschwerden u. a. mit dem Cornell Musculoskeletal Discomfort Questionnaire (CMDQ).Unter einer mittleren Belastungszeit von 102,6 min zeigt sich eine Zunahme der Vorfußbelastung (p = 0,002) vor allem bei älteren Probanden und der thorakalen Kyphose (p 0,001) vor allem bei den jüngeren Ärzten bei einer generellen Lotabweichung (p = 0,006). Zudem zeigte sich die Lotabweichung abhängig von einer zunehmenden Körpergröße oder einer kürzeren Beschäftigungsdauer (p = 0,008; r = 0,51/p = 0,026; r = − 0,44). Signifikant weniger Probanden verspüren Rückenbeschwerden an Arbeitstagen ohne Einsatz im Operationssaal im Vergleich zu OP-Tagen (p = 0,011).Die Belastung durch das Tragen von Frontröntgenschürzen während operativer Eingriffe im Fach Orthopädie und Unfallchirurgie führt zu häufigeren Rückenbeschwerden auch bereits bei jungen gesunden Ärzten. So kann bei einer mittleren Operationsdauer von 102 min eine videorasterstereografisch und pedografisch nachweisbare temporäre Haltungsabweichung mit Mehrbelastung des Vorfußes, Lotabweichung und Zunahme der thorakalen Kyphose nachgewiesen werden, die zudem mit zunehmender Körpergröße und kürzerer Beschäftigungsdauer korrelieren.

OBJECTIVE The aim of this study was to determine the clinical significance of the anterior-posterior displacement of the center of pressure in the foot (apCoP) in post-stroke gait rehabilitation. DESIGN This observational study was conducted in a tertiary hospital. Forty-two subacute post-stroke patients were included. The apCoP was measured twice with a wearable insole foot pressure measurement system, time interval more than 7 days. The results were compared between the first and second tests. The relationship between apCoP changes and spatiotemporal parameter changes were investigated. RESULTS The apCoP increased significantly between tests. The change in walking speed was significantly predicted by the change in the apCoP on the less affected side. The change in asymmetry of the single support phase was significantly correlated with the change in the apCoP on the more affected side. CONCLUSION The change in apCoP provides information about the restoration of body support, body forward progression control, and propulsion in the more affected lower limb during early post-stroke rehabilitation. The apCoP can be a useful parameter for the monitoring of functional changes in the more affected lower limb during post-stroke gait rehabilitation.

The human foot is easily deformed owing to the innate form of the foot or an incorrect walking posture. Foot deformations not only pose a threat to foot health but also cause fatigue and pain when walking, therefore, accurate diagnoses of foot deformations are required. However, the measurement of foot deformities requires specialized personnel, and the objectivity of the diagnosis may be insufficient for professional medical personnel to assess foot deformations. Thus, it is necessary to develop an objective foot deformation classification model. In this study, a model for classifying foot types is developed using image and numerical foot pressure data. Such heterogeneous data are used to generate a fine-tuned visual geometry group-16 (VGG16) and K&minus, nearest neighbor (k-NN) models, respectively, and a stacking ensemble model is finally generated to improve accuracy and robustness by combining the two models. Through k-fold cross-validation, the accuracy and robustness of the proposed method have been verified by the mean and standard deviation of the f1 scores (0.9255 and 0.0042), which has superior performance compared to single models generated using only numerical or image data. Thus, the proposed model provides the objectivity of diagnosis for foot deformation, and can be used for analysis and design of foot healthcare products.

Background: A nanomaterial-based electronic-skin (E-Skin) wearable sensor has been successfully used for detecting and measuring body movements such as finger movement and foot pressure. The ultrathin and highly sensitive characteristics of E-Skin sensor make it a suitable alternative for continuously out-of-hospital lumbar&ndash, pelvic movement (LPM) monitoring. Monitoring these movements can help medical experts better understand individuals&rsquo, low back pain experience. However, there is a lack of prior studies in this research area. Therefore, this paper explores the potential of E-Skin sensors to detect and measure the anatomical angles of lumbar&ndash, pelvic movements by building a linear relationship model to compare its performance to clinically validated inertial measurement unit (IMU)-based sensing system (ViMove). Methods: The paper first presents a review and classification of existing wireless sensing technologies for monitoring of body movements, and then it describes a series of experiments performed with E-Skin sensors for detecting five standard LPMs including flexion, extension, pelvic tilt, lateral flexion, and rotation, and measure their anatomical angles. The outputs of both E-Skin and ViMove sensors were recorded during each experiment and further analysed to build the comparative models to evaluate the performance of detecting and measuring LPMs. Results: E-Skin sensor outputs showed a persistently repeating pattern for each movement. Due to the ability to sense minor skin deformation by E-skin sensor, its reaction time in detecting lumbar&ndash, pelvic movement is quicker than ViMove by ~1 s. Conclusions: E-Skin sensors offer new capabilities for detecting and measuring lumbar&ndash, pelvic movements. They have lower cost compared to commercially available IMU-based systems and their non-invasive highly stretchable characteristic makes them more comfortable for long-term use. These features make them a suitable sensing technology for developing continuous, out-of-hospital real-time monitoring and management systems for individuals with low back pain.

BACKGROUND Calcaneal apophysitis is a self-limiting disorder that often affects adolescents with a high level of activity and leads to increased pain severity, impairments in gait parameters, and poor health-related quality of life. OBJECTIVE To investigate the combination of custom-made insoles and exercise on foot pressure distribution, spatial-temporal gait parameters, and pain intensity in patients with calcaneal apophysitis. STUDY DESIGN A one-group pretest-posttest design. METHODS Forty patients, aged between 8 and 15 years, diagnosed with calcaneal apophysitis, were included in this study. Patients were asked to use the custom-made insoles and to perform a home exercise program for 3 days a week. The duration of treatment was 4 weeks. The pain severity was evaluated with the Visual Analog Scale. The spatial-temporal gait parameters and foot pressure distribution were assessed with the Zebris FDM-THM-S treadmill system before and after the treatment. RESULTS At posttreatment assessment, there were significant changes in step length, stance phase percentage, swing phase percentage, and gait speed (P 0.05). Moreover, significant differences were found in forefoot, midfoot, and rearfoot pressure distribution (P < 0.05). There was also a significant decrease in pain intensity during activity compared to the pretreatment (P < 0.05). CONCLUSION Our study results suggest that the combination of the custom-made insoles and exercise program created improvements in spatial-temporal gait parameters and foot pressure distribution by reducing the pain severity.

The foot is an important part of the human body that helps to maintain and shift a person’s center of gravity. The roles of the toes in balancing and walking have been the focus of recent research. However, there are few methods or systems that can be used to quantitatively evaluate toe function while walking with respect to aging. Therefore, the purpose of this study is to develop an evaluation method for toe function based on the plantar pressure distribution while walking and evaluate how it relates to general gait parameters. Herein, we propose a method to identify the boundary position between the toe and foot based on the foot pressure distribution matrix. This technique was applied to gait analysis for 1774 female and 1553 male participants aged 20–90 years. The results of the statistical analysis suggest that the toe area ratio may reflect gait function and aging.

The change of balance control mechanism caused by lumbar disc herniation (LDH) has not been well understood. The aim of the study was to investigate the effects of LDH on the dynamical coordinations of center of pressure (COP) during standing on sloped surfaces. Eight LDH patients and 8 gender- and age-matched healthy subjects were recruited to participant in the experiment. Three surface conditions (declining, level and inclining) were set up. Limb load asymmetry (LLA) and individual leg COP (COP more-affected and COP less-affected ) were calculated from the foot pressure distributions which recorded during quiet standing by a force plate. Cross recurrence quantification analysis (CRQA) was applied to assess the coordination of COP trajectories. Linear cross-correlation was applied to measure the correlation between CRQA parameters and COP area. LDH patients showed higher LLA and more deterministic structure of less-affected leg, especially on sloped surfaces, but there is not much difference in more-affected leg. CRQA parameters showed positive correlation with COP area on sloped surfaces. This study reveals that the LDH patients alter the postural control mechanism by magnifying the inter-limb asymmetry and reinforcing feedforward mechanism. The sloped surfaces magnified the changes of more deterministic and rigid patterns in less-affected side in the LDH. This study may provide a new strategy for clinical diagnosis and evaluation of LDH.

We examined the accuracy of Smart Socks – a device that measures foot pressure during gait for detecting step-count across various walking speeds. Thirty-six participants (17 men; 19 women) wore Smart Socks (Sock), a pedometer (Pedometer), and a smartphone with a commercially available Phone Application (Phone) pedometer to measure step-count during 3-min of treadmill or over-ground walking at 1.3, 2.2, 3.0, 3.8, and 4.7 km/h. Steps were compared to a gold-standard tally-counter (Count), collected by independent assessors. All devices (Sock, Pedometer, and Phone) underestimated step-count when compared to Count at 1.3 km/h (p0.05); however, Phone (291±28 steps) overestimated step-count (p0.05). These findings demonstrate that Smart Socks are more accurate than pedometers used in the present study for detecting step-count during treadmill or over-ground ambulation at slower walking speeds.

BACKGROUND: Foot pain and paresthesia are common in cycling, due to plantar pressure and repetitive loading. OBJECTIVES: The aim was to investigate the effect of foot insoles on plantar pressure of the foot in motorcycling, as well as self-reported comfort. STUDY DESIGN: A randomized crossover clinical trial. METHODS: A flexible foot pressure mat (GP MobilData WiFi® Gebiomized®) with different sizes was utilized. RESULTS: Maximum pressure values occurred predominantly in the hallux with 4.90 ± 1.19 N/cm2, followed by second and third metatarsal areas with 4.57 ± 0.73 N/cm2, followed by the first metatarsal area with 4.30 ± 0.96 N/cm2, and followed by the fourth and fifth metatarsal areas with 3.22 ± 0.89 N/cm2 when using the control foot insole and using aluminum foot insole, which reduces maximum pressure to 1.55 ± 0.34, 1.56 ± 0.75, 1.09 ± 0.43, and 1.07 ± 0.59 N/cm2, respectively ( p

This study aimed to assess the effects of plantar flexor lengthening (PFL) on dynamic foot pressures of children with cerebral palsy using pedobarographs. Of 97 enrolled, 13 children with 18 legs had PFL. Age at surgery was 4.7 (2.8-8.8) years. A significant increase in ankle dorsiflexion and heel impulse was achieved postoperatively and was maintained at 5 years. The coronal plane pressure index increased postoperatively, but reverted to preoperative levels at the 5-year follow-up. Children tend to have more valgus after PFL. In young children, there caution should be exercised to avoid over treating varus at the time of equinus correction to avoid overcorrection.

Background: There is insufficient evidence to establish the optimal treatment protocol for robot-assisted gait training. Objective: This study aimed to analyze the effects of robot-assisted gait and independent over-ground gait on foot pressure and to determine an effective training protocol for improvement of gait pattern in patients with incomplete spinal cord injury due to industrial accidents. Methods: Four patients with incomplete spinal cord injury due to an industrial accident who had gait disturbance underwent measurement of peak foot pressure and stance phase duration using a foot pressure analysis system with robot-assisted gait and independent over-ground gait. Results: The robot-assisted gait condition has lower peak foot pressure and shorter stance phase duration than the independent over-ground gait. Conclusions: In this study, robot-assisted gait was found to limit gait pattern improvement in patients with gait disturbance caused by incomplete spinal cord injury due to industrial accidents. Therefore, future research will be conducted to determine the optimal protocol for robot-assisted gait training for gait pattern improvement.

Total knee arthroplasty is a well-established treatment for managing end-stage symptomatic knee osteoarthritis. Currently, different designs of prostheses are available with majority ensuring similar clinical outcomes. Altered surface geometry is introduced to strive toward gaining superior outcomes. We aimed to investigate any differences in functional outcomes between 2 different polyethylene designs namely the Persona CR (cruciate retaining) and Persona UC (ultracongruent) tibial inserts (Zimmer-Biomet, Warsaw, IN).This prospective single blind, single-surgeon randomized controlled trial reports on 105 patients, (66 female and 39 male), who underwent simultaneous bilateral total knee arthroplasty using the Persona knee system (Zimmer-Biomet) UC inserts in one side and CR inserts in the contralateral side. By a blind assessor, at regular time intervals patients were assessed in terms of function and gait. The functional knee scoring scales used were the Western Ontario and McMaster Universities Osteoarthritis Index and Modified Knee Society Score. The gait parameters evaluated were foot pressure and step length.During the study period, no patient was lost to follow-up or underwent revision surgery for any cause. Western Ontario and McMaster Universities Osteoarthritis Index scores, Modified Knee Society Score, and knee range of motion of all 105 patients assessed preoperatively and postoperatively at 6 months, 1 year, and 2 years showed statistically better results (P.05) for UC inserts. Gait analysis measuring foot pressures and step length, however, did not show any statistically significant differences at 2-year follow-up.Ultracongruent tibial inserts show significantly better functional outcomes as compared to CR inserts during a 2-year follow-up period. However, in this study these findings were not shown to be attributed to differences in gait parameters.

Dancers are highly trained athletes who are at significant risk of injury due to the repetitive nature of their movement patterns. Most ballet injuries result from overuse and occur in the lower limbs. Therefore, the behavior of the lower limbs during a basic ballet movement should be studied in order to identify and subsequently correct mechanical factors that may contribute to injuries. This study analyzed a cou-de-pied derrière with demi-plié to piqué arabesque gesture executed by 18 ballet dancers identified in two groups: experienced dancers (EDs) and beginner dancers (BDs). Kinematic, baropodometric, and electromyographic analyses enabled the observation of differences between these study groups with regard to joint angles, velocities, foot pressure behavior, and muscle activation during execution of the gesture. Experienced dancers reached greater hip and lumbar spine hyperextension and demonstrated less forward torso flexion, which enables better execution of the gesture compared to BDs. The highest foot pressure in both groups was found in the first metatarsal, with a tendency toward the great toe. In terms of muscular activation, BDs exhibited lower electrical activity than EDs. It is concluded that: 1. ankle and knee angles in demi-plié are not defined by dancers' expertise; 2. the faster the leg is raised during piqué-arabesque the better the gesture; 3. special attention to the metatarsal heads is required due to the high pressures found in this study; and 4. activation of different muscle groups depends on the complexity of the gesture and dancer's expertise.

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. The 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.

Diabetic foot ulcers (DFU) are a costly public health concern. The predominant risk factor, peripheral neuropathy, results in loss of protective sensation and is associated with abnormally high plantar pressures. DFU prevention strategies, including orthotics and footwear, strive to reduce these high plantar pressures. Nevertheless, several constraints should be acknowledged regarding the research supporting the link between plantar pressure and DFUs. The majority of studies assess vertical, rather than shear, barefoot plantar pressure in laboratory-based environments, rather than during daily activity. Few studies investigated previous DFU location-specific pressure. Previous studies focus predominantly on walking, although studies monitoring activity suggest that more time is spent on other weight-bearing activities, where a lower ‘peak’ pressure might be applied on the foot over a longer duration. Although further research is needed, this may indicate that an expression of cumulative pressure applied over time, such as pressure-time integral, could be a more relevant parameter than peak pressure. A few studies have indicated that providing pressure feedback to the patient might reduce plantar pressures, with an emerging potential use of smart technology. However, further research is required to determine the efficacy of this approach. Constraints of previous plantar pressure research may explain its low prediction ability for DFU as part of prospective studies. Further vertical and shear pressure analyses, across all weight-bearing activities and referring to location-specific pressures are required to improve our understanding of pressures resulting in DFUs and to help improve effectiveness of interventions, such as therapeutic footwear and pressure-feedback.

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%.

Background Different arch support heights of the customized foot orthosis could produce different effects on the internal biomechanics of the foot. However, quantitative evidence is scarce. Therefore, we aimed to investigate and quantify the influence of arch support heights on the internal foot biomechanics during walking stance. Methods We reconstructed a foot finite element model from a volunteer with flexible flatfoot. The model enabled a three-dimensional representation of the plantar fascia and its interactions with surrounding osteotendinous structures. The volunteer walked in foot orthosis with different arch heights (low, neutral, and high). Muscle forces during gaits were calculated by a multibody model and used to drive a foot finite element model. The foot contact pressures and plantar fascia strains in different regions were compared among the insole conditions at the first and second vertical ground reaction force (VGRF) peak and VGRF valley instants. Results The results indicated that peak foot pressures decreased in balanced standing and second VGRF as the arch support height increased. However, peak midfoot pressures increased during all simulated instants. Meanwhile, high arch support decreased the plantar fascia loading by 5%–15.4% in proximal regions but increased in the middle and distal regions. Conclusion Although arch support could generally decrease the plantar foot pressure and plantar fascia loading, the excessive arch height may induce high midfoot pressure and loadings at the central portion of the plantar fascia. The consideration of fascia-soft tissue interaction in modeling could improve the prediction of plantar fascia strains towards design optimization for orthoses.

Floating toe (FT) is a frequently seen condition in which a toe is inadequately in contact with the ground. Although toes play an important role in stabilizing standing posture and walking, many aspects of the effects of FT on the body remain unclear. To our knowledge, there have been no reports about the relationship between FT and postural stability, especially in children. This study aimed to clarify the prevalence of FT and its relationship with static postural stability in children. Of the 400 children aged 8 years who participated in our cohort study, 396, who were examined for static postural stability, were included in this study. Postural stability and FT were assessed using a foot pressure plate. The sway path length of the center of pressure and the area of the ellipse defined as the size of the area marked by the center of pressure were measured as an evaluation of static postural stability. We calculated the “floating toe score (FT score: small FT score indicates insufficient ground contact of the toes)” using the image of the plantar footprint obtained at the postural stability measurement. The FT rate was very high at more than 90%, and the FT score in the eyes-closed condition was significantly higher than that in the eyes-open condition in both sexes. The FT score significantly correlated with the center of pressure path and area. Our results suggest that ground contact of the toes is not directly related to static postural stability in children, but it may function to stabilize the body when the condition becomes unstable, such as when the eyes are closed.

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.

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.

In stroke patients, the NDT - (Bobath - Neurodevelopmental Treatment) and PNF (Proprioceptive Neuromuscular Facilitation) methods are used to achieve the main objective of rehabilitation, which aims at the restoration of maximum patient independence in the shortest possible period of time (especially the balance of the body). The aim of the study is to evaluate the effect of the NDT-Bobath and PNF methods on the field support and total path length measure foot pressure (COP) in patients after stroke. The study included 72 patients aged from 20 to 69 years after ischemic stroke with Hemiparesis. The patients were divided into 4 groups by a simple randomization. The criteria for this division were: the body side (right or left) affected by paresis and the applied rehabilitation methods. All the patients were applied the recommended kinesitherapeutic method (randomized), 35 therapy sessions, every day for a period of six weeks. Before initiation of therapy and after 6 weeks was measured the total area of the support and path length (COP (Center Of Pressure) measure foot pressure) using stabilometer platform - alpha. The results were statistically analyzed. After treatment studied traits decreased in all groups. The greatest improvement was obtained in groups with NDT-Bobath therapy. NDT-Bobath method for improving the balance of the body is a more effective method of treatment in comparison with of the PNF method. In stroke patients, the effectiveness of NDT-Bobath method does not depend on hand paresis.

International audience; Foot pressure ulcers are a common complication of diabetes because of patient’s lack of sensitivity due to neuropathy. Deep pressure ulcers appear internally when pressures applied on the foot create high internal strains nearby bony structures. Monitoring tissue strains in persons with diabetes is therefore important for an efficient prevention. We propose to use personalized biomechanical foot models to assess strains within the foot and to determine the risk of ulcer formation. Our workflow generates a foot model adapted to a patient’s morphology by deforming an atlas model to conform it to the contours of segmented medical images of the patient’s foot. Our biomechanical model is composed of rigid bodies for the bones, joined by ligaments and muscles, and a Finite Element mesh representing the soft tissues. Using our registration algorithm to conform three datasets, three new patient models were created. After applying a pressure load below these foot models, the Von Mises equivalent strains and “cluster volumes” (i.e. volumes of contiguous elements with strains above a given threshold) were measured within eight functionally meaningful foot regions. The results show the variability of both location and strain values among the three considered patients. This study also confirms that the anatomy of the foot has an influence on the risk of pressure ulcer.

Human gait recognition, an active research topic in computer vision, is generally based on data obtained from images/videos. We applied computer vision technology to classify pathology-related changes in gait in young children using a foot-pressure database collected using the GAITRite walkway system. As foot positioning changes with children’s development, we also investigated the possibility of age estimation based on this data. Our results demonstrate that the data collected by the GAITRite system can be used for normal/pathological gait classification. Combining age information and normal/pathological gait classification increases the accuracy of the classifier. This novel approach could support the development of an accurate, real-time, and economic measure of gait abnormalities in children, able to provide important feedback to clinicians regarding the effect of rehabilitation interventions, and to support targeted treatment modifications.

The knee adduction moment (KAM) is an established marker of compartmental load distribution across the tibiofemoral joint. Research suggests a link between the magnitude of the KAM and center of plantar pressure (COP) thus alterations in the two may be related. The objective of this study was to investigate whether the COP predictably shifts when the KAM is reduced through a gait adaptation. Twenty healthy adults underwent gait analysis walking with their normal gait pattern and with medial thrust gait, a gait adaptation known to significantly reduce the KAM. Simultaneous COP and 3-D kinetics were acquired to allow for a comparison of the change in COP to the change in the KAM. The COP was quantified by determining a customized medial-lateral pressure index (MLPI) which compares the COP tracing line during the first and second halves of stance to the longitudinal axis of the foot. Linear regressions assessing the association between the changes in KAM and MLPI indicated that 48.3% (p=0.001) of the variation in MLPI during the first half of stance can be explained by the KAM during the same period. A trend was observed between the association between the KAM and MLPI during the second half of stance (R(2)=0.16, p=0.080). Backwards elimination regression analysis was used to explore whether simultaneous consideration of the KAM and other potential confounding factors such as sagittal plane knee moments and speed explained variance in the MLPI during the first half of stance. Only the KAM exhibited explanatory power (β=0.695, p=0.001). During medial thrust gait, a reduction in the KAM was associated with a medial shift in the MLPI, and an increase in the KAM was associated with a lateral shift in the MLPI, especially in the first half of the stance phase. Together, these results demonstrate an inherent link between foot pressure and the KAM during medial thrust gait, and suggest that manipulating foot pressure may be a biomechanical mechanism for an intervention designed to improve loading conditions at the knee.

Background and objectives: Surgery is the primary and most effective treatment of breast cancer. Unilateral mastectomy disrupts the distribution of muscle tension between the right and the left sides of the body. The aim of the study was to evaluate postural balance in patients treated for breast cancer by mastectomy. Materials and methods: A controlled clinical study was conducted on 90 patients who have undergone surgical treatment for breast cancer (mastectomy) 5&ndash, 6 years prior (Breast Group&mdash, BG). The control group (CG) consisted of 74 healthy female volunteers. Analysis of balance was performed using the Alfa stabilography platform. A static test (Romberg&rsquo, s test) with open and closed eyes was used to assess balance. The following balance parameters were analyzed: path length, statokinesigram area, parameters of deflection and velocity of the foot pressure center. Results: The study demonstrated that patients from BG (5&ndash, 6 years after surgery) obtained worse results in both tests with open (maximum back deviation, maximum forward deviation, average Y deviation, average Y velocity, path length and path surface area) (p &lt, 0.05) as well as with closed eyes (maximum backward deviation, maximum forward deviation, mean Y deviation and path length) (p &lt, 0.05). Conclusions: Our study demonstrated that women 5&ndash, 6 years after surgery for breast cancer have impaired balance compared to healthy women, despite physiotherapy.

BACKGROUND AND OBJECTIVE: The aim of this study was to explore the effectiveness of arch support functional insoles to prevent metatarsalgia. METHOD: Twenty-five healthy females participated in the study. A Vicon motion capture system was used to collect kinematics data of the lower limb. An AMTI force plate was used to record the vertical ground reaction force (GRF), and the Novel Pedar-X System was used to measure foot pressure while subjects wore normal insoles or functional insoles with an arch support during walking and jogging. RESULTS: With the arch support functional insoles, the first metatarsal (FM) region’s contact area was increased and the peak pressure and time-pressure integral of the FM and second and third metatarsal (SATM) were areas decreased. This suggests a lower risk of longitude stress injuries in these areas. The ankle dorsiflexion angle of jogging with the ‘arch support functional insoles’ (RF) and walking with the ‘arch support functional insoles’ (WF) were significantly increased at initial contact and the knee and hip flexion angle of RF and WF were reduced. The peak hip extension angle of WF and RF also declined. The vertical loading rate of RF was lower, which would be beneficial in reducing the risk of lower limb injuries during jogging. CONCLUSIONS: The results demonstrate that arch support functional insoles can be used effectively to prevent and decrease pain and promote a suitable weight-bearing pattern in the foot for promoting the health of young females.

Background The feet make the initial contact with the ground when walking and critically control both posture and gait. Claw toe, a structural change in the foot that may develop after stroke, triggers functional changes affecting both the lower limbs and balance. Objective We analyzed the effects of a toe spreader on foot pressure and gait in chronic stroke patients. Methods We enrolled 25 stroke patients. We used Gaitview AFA-50 and GAITRite instruments to measure plantar pressure distribution and gait with and without a toe spreader. Results The average and rear foot pressures increased somewhat when a toe spreader was used. However, the differences were not significant in post hoc tests. In terms of gait, all variables significantly improved when the toe spreader was used. Conclusions A toe spreader may improve overall gait and spatiotemporal gait parameters in chronic stroke patients.

This prospective study aimed to investigate the relationship between static balance and the incidence of non-contact anterior cruciate ligament (ACL) injury in female high school athletes. This study included 276 female high school handball or basketball players. At the time of admission, each subject’s static balance was measured with a gravicorder, and the incidence of non-contact ACL injury was investigated in the 3 years until the student graduated. The measured parameters of postural sway were locus length per time (the distance that a center of gravity of the foot pressure moves per second) and environmental area (AR: the area surrounded by the integumentary covering of the trace of the center of gravity). Twenty-seven players (9.8%) experienced an ACL injury during the 3-year observation period. Twenty-four injured players sustained a non-contact injury and three injured players sustained a contact injury. In this study, the three contact injury players were excluded. We compared the differences in the static balance between injured and uninjured players. The locus length per time was significantly longer in injured than in uninjured players (p = 0.046). Though there was no statistically significant difference between the two groups in AR (p = 0.190), AR tended to be larger in the ACL injured group. This result shows that poor static balance is a risk factor for non-contact ACL injury.

Physique changes during pregnancy lead to gait characteristic variations. This study aimed to analyse gait of pregnant individuals throughout pregnancy and post-partum. Sixteen healthy pregnant women volunteered as participants and had their lower limb kinematics analysed through a VICON three-dimensional motion system and plantar pressure measured with a Novel EMED force plate. Significant changes were observed in pelvic anterior motion, hip and ankle joint kinematics. Mean pressure distribution and COP trajectory deviation altered accordingly with increased pregnancy time, compared with post-partum. This longitudinal study of pregnant gait biomechanics in T2, T3 and PP reveals lower extremity kinematic and foot pressure alterations to adapt to pregnancy related changes, and the COP trajectory highlights a falling risk during pregnancy, particularly in T3.

Objective The purpose of this study is to compare the plantar foot pressure and the center of pressure (COP) pathway of normal and flat feet while crossing an obstacle at different heights. Methods Nineteen subjects (10 normal feet, 9 flat feet) participated in this study. The plantar foot surface was divided into the following seven regions for pressure measurement: two toe regions, three forefoot regions, one midfoot region, and one heel region. A one-way ANOVA with repeated measurements was used to compare the plantar foot pressure of normal and flat feet according to the obstacle height. Results The trend analysis showed a quadratic trend during level walking for the normal foot group, but a linear trend appeared as the obstacle height increased. In the flat foot group, the trend analysis showed a linear trend regardless of the obstacle height. In the 2nd-3rd metatarsal head region, the plantar pressure of the flat foot group increased more than the normal foot group as the obstacle height increased; however, in the 4th-5th metatarsal head region, the plantar pressure in flat feet was lower than in normal feet. In the heel region, the plantar pressure in both groups generally increased as the obstacle height increased, but the plantar pressure in the flat foot group was lower than in the normal foot group. Conclusion We believe that, due to a loss of longitudinal arch, the COP path and plantar pressure of flat feet may be different from normal feet when crossing obstacles of different heights.

The foot strike pattern (FSP, description of how the foot touches the ground at impact) is recognized to be a predictor of both performance and injury risk. The objective of the current investigation was to validate an original foot strike pattern assessment technique based on the numerical analysis of foot pressure distribution. We analyzed the strike patterns during running of 145 healthy men and women (85 male, 60 female). The participants ran on a treadmill with integrated pressure plate at three different speeds: preferred (shod and barefoot 2.8 ± 0.4 m/s), faster (shod 3.5 ± 0.6 m/s) and slower (shod 2.3 ± 0.3 m/s). A custom-designed algorithm allowed the automatic footprint recognition and FSP evaluation. Incomplete footprints were simultaneously identified and corrected from the software itself. The widely used technique of analyzing high-speed video recordings was checked for its reliability and has been used to validate the numerical technique. The automatic numerical approach showed a good conformity with the reference video-based technique (ICC = 0.93, p < 0.01). The great improvement in data throughput and the increased completeness of results allow the use of this software as a powerful feedback tool in a simple experimental setup.

This study investigated the feasibility of the Infrared (IR) sensor-based walking aids for detecting the gait intention. To compensate for the defects of Force Sensing Resistors (FSRs) or force sensors, such as the velocity control problem on gait slopes, we used IR sensors to investigate knee joint anterior displacement in order to recognize the gait intention. We also measure leg muscle activities and foot pressure, in order to verify our investigation. We placed two IR sensors on the rollator center to sense left and right leg walking intentions. We took EMG signals of four leg muscles, and analyzed them. Foot pressure analysis parameters were the measured force and mean pressure. We conducted experiments on twenty young healthy adults. The results show that knee joint anterior displacement increases according to gait slope and velocity. We confirm similar results of knee joint anterior displacement through the IR sensors.