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Abstract: Background: We hypothesized that a total replacement of the first metatarsophalangeal joint (MTP-1) would alter the walking pattern with medialisation of the ground reaction force (GRF) of the foot and subsequently cause an increase in bone mineral density (BMD) in the medial metatarsal bones and a decline of BMD in the lateral metatarsal bones. Methods: Twelve patients receiving total joint replacements (Roto-Glide®) of MTP-1 were enrolled in a prospective cohort. BMD and pedobarography of the heel bone and the metatarsal heads were performed preoperatively and at least 12 months postoperatively. Results: BMD in the lateral metatarsals and GRF under the lateral column of the operated feet decreased significantly on the operated feet. Conclusions: Total joint replacement of MTP-1 tends to reduce GRF under the lateral column of the foot causing a corresponding decline in BMD and pedobarographic measures. Our findings support the further use of the Roto-Glide® prosthesis for osteoarthritis of the first metatarsophalangeal joint. [Copyright &y& Elsevier]

Plantar pressure characteristics during fencing movements may provide more specific information about the influence of foot loading on overload injury patterns. Twenty-nine experienced fencers participated in the study. Three fencing-specific movements (lunge, advance, retreat) and normal running were performed with three different shoe models: Ballestra (Nike, USA), Adistar Fencing Lo (Adidas, Germany), and the fencers' own shoes. The Pedar system (Novel, Munich, Germany) was used to collect plantar pressures at 50 Hz. Peak pressures, force–time integrals and contact times for five foot regions were compared between four athletic tasks in the lunge leg and supporting leg. Plantar pressure analysis revealed characteristic pressure distribution patterns for the fencing movements. For the lunge leg, during the lunge and advance movements the heel is predominantly loaded; during retreat, it is the hallux. For the supporting leg, during the lunge and advance movements the forefoot is predominantly loaded; during retreat, it is the hallux. Fencing-specific movements load the plantar surface in a distinct way compared with running. An effective cushioning in the heel and hallux region would help to minimize foot loading during fencing-specific movements. [ABSTRACT FROM PUBLISHER]

Background/Purpose: Children with type 1 osteogenesis imperfecta (OI) present with abnormal gait characteristics, including reduced power generation during pushoff. However, the exact biomechanical factors associated with reduced power generation are not clearly understood. The purpose of this study was to investigate the biomechanical factors associated with a reduction in ankle power generation in children with type 1 OI. Methods: Twenty-four participants with type 1 OI (12.5 ± 3.6 years of age) and 24 typically developing children (12.4 ± 3.7 years of age) were evaluated. Three-dimensional gait analysis, isometric plantar flexion strength using dynamometry, and pedobarography were collected on each participant. Results were statistically compared between the groups and a correlation matrix analyzed the associations among the measures. Results: Children with OI presented with weaker plantar flexors, reduced ankle power generation, and decreased sagittal plane ankle angular velocity during pushoff. However, they presented with similar moment arm distances and ground reaction force magnitudes as typically seen in developing children. There was a higher incidence of pes valgus, increased subarch angles, increased time spent loading the midfoot, and deceased time spent loading the forefoot in children with OI. Plantar flexion strength and the time spent at the midfoot and forefoot were most associated with ankle power generation. Conclusion: The presence of pes valgus alone does not indicate a reduction of push-off power in children with type 1 OI, but those individuals who have both a flat foot and reduced time spent loading the forefoot during pushoff are the most likely to have reduced push-off power. [ABSTRACT FROM AUTHOR]

PATAKY, T. C, and C. MAIWALD. Spatiotemporal Volumetric Analysis of Dynamic Plantar Pressure Data. Med. Sci. Sports Exerc, Vol. 43, No. 8, pp. 1582-1589, 2011. Purpose: The purposes of this study were (i) to develop a three-dimensional interactive visualization tool for exploring plantar pressure time series and spatiotemporal statistical volumes and (ii) to demonstrate the benefits of volumetric analyses using various running and walking data sets. Methods: A data exploration tool was developed in Python using the open-source Visualization Toolkit. Multiple-pressure isosurfaces were computed and were then rendered with interactive rotation and adjustable thresholds and transparencies. Plantar pressure data were collected: (i) from two running subjects, one with a heel-loading pattern and one with a forefoot-loading pattern; (ii) from one individual while running straight and then while performing a cutting maneuver; and (iii) from one subject walking at three different speeds. All data were spatiotemporally aligned, and mean volumes were computed. Statistical volumes were also computed for the walking data set, and significance was assessed topologically using techniques from three-dimensional brain imaging. Results: After converting raw plantar pressure data into a rapidly readable format, volumetric renderings were presented in -50 ms. a negligible time lag for interactive data exploration. We observed that consideration of only spatial two-dimensional variables yielded "impulse illusions" that could be resolved most effectively with three-dimensional renderings. For all data sets, we found that dynamic foot behavior was clearest through interactive three-dimensional exploration. Conclusions: Plantar pressure data contain high-quality biome-chanical information in their original three-dimensional form. The main benefit of the proposed visualization technique is that it affords qualitatively rich and unique holistic explorations of dynamic foot behavior. [ABSTRACT FROM AUTHOR]

Abstract: Analysis of pedobarographical data requires geometric identification of specific anatomical areas extracted from recorded plantar pressures. This approach has led to ambiguity in measurements that may underlie the inconsistency of conclusions reported in pedobarographical studies. The goal of this study was to design a new analysis method less susceptible to the projection accuracy of anthropometric points and distance estimation, based on rarely used spatio-temporal indices. Six pedobarographic records per person (three per foot) from a group of 60 children aged 11–12 years were obtained and analyzed. The basis of the analysis was a mutual relationship between two spatio-temporal indices created by excursion of the peak pressure point and the center-of-pressure point on the dynamic pedobarogram. Classification of weight-shift patterns was elaborated and performed, and their frequencies of occurrence were assessed. This new method allows an assessment of body weight shift through the plantar pressure surface based on distribution analysis of spatio-temporal indices not affected by the shape of this surface. Analysis of the distribution of the created index confirmed the existence of typical ways of weight shifting through the plantar surface of the foot during gait, as well as large variability of the intrasubject occurrence. This method may serve as the basis for interpretation of foot functional features and may extend the clinical usefulness of pedobarography. [Copyright &y& Elsevier]

The article reports on research which was conducted to compare first ray resection arthroplasty and arthrodesis in the treatment of the rheumatoid foot in terms of patient satisfaction and clinical and functional outcome. Researchers evaluated 53 patients with rheumatoid arthritis. They found that patients who underwent arthrodesis revealed better foot function during the dynamic roll-over process even though the resection arthroplasty patients were subjectively more satisfied.

Abstract: Pedobarographic images reflect the dynamic interaction between the plantar foot and supporting surfaces during gait and postural activities. Since intra-foot and inter-subject contact geometry are grossly similar, images may be spatially registered and directly compared. Previously arbitrary subjects have been selected as registration templates, but this can conceivably introduce anatomical bias. The purposes of this study were: (i) to compute an unbiased pedobarographic template from a large sample of healthy young adult subjects, and (ii) to demonstrate how the resulting template may be used for practical clinical and scientific analyses. Images were obtained from N =104 subjects and were registered (10,712 pairs) using (i) an optimal linear scaling technique and (ii) a nonlinear, locally affine, globally smooth technique. The nonlinear technique was found to offer biomechanically non-trivial advantages over the linear technique, most likely due to non-proportional inter-subject geometry. Specifically, the nonlinear template was able to detect morphological signals in a hallux valgus sample with greater sensitivity than the linear template. Validity of the approach was confirmed by independently assessing left and right feet, through a statistical comparison of local maximal pressures, and also through examination of random subject subsets. The current template, representative of an average healthy foot, could be a valuable resource for automated clinical and scientific analyses of foot morphology and function. [Copyright &y& Elsevier]

Shock absorption and stability during landings is provided by both, gymnast ability and mat properties. The aims of this study were to determine the influence of different mat constructions on their energy absorption and stability capabilities, and to analyse how these properties affect gymnast's plantar pressures as well as subjective mat perception during landing. Six mats were tested using a standard mechanical drop test. In addition, plantar pressures and subjective perception during landing were obtained from 15 expert gymnasts. The different mats influenced plantar pressures and gymnasts' subjective perception during landing of gymnasts. Significant correlations between plantar pressures at the medial metatarsal and lateral metatarsal zones of the gymnasts' feet with the different shock absorption characteristics of the mats were found. However, subjective perception tests were not able to discriminate mat functionality between the six mats as no significant correlations between the mechanical mat properties with the subjective perception of these properties were found. This study demonstrated that plantar pressures are a useful tool for discriminating different landing mats. Using similar approaches, ideally including kinematics as well, could help us in our understanding about the influences of different mats upon gymnast-mat interaction. [ABSTRACT FROM AUTHOR]

The article discusses research which was conducted to evaluate the clinical relevance of hindfoot alignment view in total ankle replacement. Researchers evaluated 28 patients who had undergone total ankle replacement. They found that adjusting the hindfoot correctly with hindfoot alignment view may improve long-term outcome and survival of total ankle replacement.

Abstract: A variety of biomechanical data are sampled from smooth n-dimensional spatiotemporal fields. These data are usually analyzed discretely, by extracting summary metrics from particular points or regions in the continuum. It has been shown that, in certain situations, such schemes can compromise the spatiotemporal integrity of the original fields. An alternative methodology called statistical parametric mapping (SPM), designed specifically for continuous field analysis, constructs statistical images that lie in the original, biomechanically meaningful sampling space. The current paper demonstrates how SPM can be used to analyze both experimental and simulated biomechanical field data of arbitrary spatiotemporal dimensionality. Firstly, 0-, 1-, 2-, and 3-dimensional spatiotemporal datasets derived from a pedobarographic experiment were analyzed using a common linear model to emphasize that SPM procedures are (practically) identical irrespective of the data''s physical dimensionality. Secondly two probabilistic finite element simulation studies were conducted, examining heel pad stress and femoral strain fields, respectively, to demonstrate how SPM can be used to probe the significance of field-wide simulation results in the presence of uncontrollable or induced modeling uncertainty. Results were biomechanically intuitive and suggest that SPM may be suitable for a wide variety of mechanical field applications. SPM''s main theoretical advantage is that it avoids problems associated with a priori assumptions regarding the spatiotemporal foci of field signals. SPM''s main practical advantage is that a unified framework, encapsulated by a single linear equation, affords comprehensive statistical analyses of smooth scalar fields in arbitrarily bounded n-dimensional spaces. [Copyright &y& Elsevier]

The authors present the findings of their evaluation of plantar pressure changes and postural balance differences in pregnant women, whose center of gravity is altered due to weight gain. They determined that forefoot pressures increase during the last trimester with increased postural sway. They suggest exercise and modified shoes to relieve foot pain.

The interaction of the limbs with the substrate can teach a lot about an animal's gait mechanics. Unlike ground-reaction forces, plantar pressure distributions are rarely studied in animals, but they may provide more detailed information about the loading patterns and locomotor function of specific anatomical structures. With this study, we aim to describe pressures for a large and diverse sample of mammalian species, focusing on scaling effects. We collected dynamic plantar pressure distributions during voluntary walking in 28 mammal species. A dynamic classification of foot use was made, which distinguished between plantiportal, digitiportal and unguliportal animals. Analysis focused on scaling effects of peak pressures, peak forces and foot contact areas. Peak pressure for the complete mammal sample was found to scale to (mass)1/2, higher than predicted assuming geometric similarity, and we found no difference between the different types of foot use. Only the scaling of peak force is dependent on the dynamic foot use. We conclude that plantar peak pressure rises faster with mass than expected, regardless of the type of foot use, and scales higher than in limb bones. These results might explain some anatomical and behavioural adaptations in graviportal animals. [ABSTRACT FROM AUTHOR]

The article presents a study on clinical outcomes of the additional use of intraoperative pedobarography on patients with arthrodesis or correction of the foot or ankle. It is stated that 100 patients were randomized in the study and 52 were randomized for IP use, with patients analyzed using the American Orthopaedic Foot and Ankle Society (AOFAS) score, Short Frome 36 (SF-36), and the Visual Analogue Scale Foot and Ankle (VAS FA).

Objective: Long-standing rheumatoid arthritis (RA) causes foot problems in approximately 90% of the patients. In this study, we aimed to document the plantar pressure distribution changes in RA patients with heel valgus and to compare results in those without valgus. Material and Methods: This study was performed on 22 feet of 11 RA patients with bilateral heel valgus (Group 1) and 28 feet of 14 RA patients without heel valgus deformity (Group 2). Both static and dynamic pedobarographic evaluations were performed in both groups to determine the plantar pressure values and to make comparisons between the groups. Erosion scores of both groups were also compared. Results: In dynamic pedobarographic evaluation, only the plantar contact area was found to be greater in Group 1 than Group 2. However, in the static evaluation, forefoot pressure percentage, plantar contact area and forefoot plantar contact area values were higher in Group 1 than Group 2. In radiographic evaluation, erosion scores were again found to be higher in Group 1. Conclusion: According to results of the pedobarographic evaluation in this study, heel valgus deformity in the RA patients led to increases in plantar contact area and forefoot pressure percentages. [ABSTRACT FROM AUTHOR]

Abstract: Background: In the past few years, several studies have tried to identify clinical limitations of patients suffering from end-stage ankle osteoarthritis. However, very few have attempted to assess foot and ankle function in a more objective biomechanical way, and in particular, using dynamic pedobarography. The aim of this study was to explore plantar pressure distribution characteristics in a large cohort of patients with end-stage ankle osteoarthritis. Methods: 120 patients (female, 54; male, 66; 120 cases) suffering from posttraumatic end-stage ankle osteoarthritis were included. The clinical examination consisted of an assessment of the American Orthopaedic Foot and Ankle Society hindfoot score, a pain score, the range of motion for ankle dorsiflexion and plantar flexion, and the body mass index. Radiological parameters included the radiological tibiotalar alignment and the radiological ankle osteoarthritis grading. Plantar pressure distribution parameters were assessed using dynamic pedobarography. Findings: Intra-individual comparison between the affected and the opposite feet revealed significant differences for several parameters: maximum force and contact area were decreased in the whole osteoarthritic foot. Peak pressure in the hindfoot and toes area was decreased as well. No correlations could be found between pedobarographic data and clinical parameters, such as hindfoot score, pain score, and range of motion. However, results indicated a positive correlation between dorsiflexion and the pedobarographic parameters. Interpretation: In conclusion, posttraumatic end-stage ankle osteoarthritis leads to significant alterations in plantar pressure distribution. These might be interpreted as an attempt of the patient to reduce the weight-bearing load on the painful ankle. Other explanations include bony deformity and ankle malalignment, as a consequence of either the initial trauma or of the degenerative process itself, pain related disuse atrophy of surrounding muscles, or scarred soft tissue. [Copyright &y& Elsevier]

• Studies employing gait analysis for two treatments for hallux rigidus were sought. • Heterogeneity was noted among studies and a narrative review was undertaken. • Knowledge gaps and inconsistent results were identified with both the procedures. • High powered, prospective, comparative studies are required. Both arthrodesis and total arthroplasty are acceptable surgical options for end stage hallux rigidus without significant angular deformity. Total arthroplasty preserves first metatarsophalangeal joint (MTPJ) motion, which may help restore a more physiological gait pattern. Is there a difference in the findings of gait studies after 1st MTPJ total arthroplasty or arthrodesis for end-stage hallux rigidus? PRISMA guidelines were followed to conduct a systematic review of literature for studies reporting gait analysis after the above procedures. Predetermined criteria were used to select papers and evaluated the findings of kinematic (spatial-temporal and dynamic motion), kinetic and foot pressure (pedobarographic) studies. 12 titles were short-listed for synthesis. There was 1 randomized controlled trial comparing the two procedures. Among the remaining cohort studies, 5 reported on total arthroplasty and 6 on arthrodesis of the 1st MTPJ. Due to significant heterogeneity, a narrative synthesis was undertaken. No studies in the arthroplasty group reported spatial-temporal or kinetic parameters. Only 2 papers, 1 in each group, recorded motion within the foot. One of them showed preserved dynamic motion at the 1st MTPJ after total arthroplasty. Pedobarographic studies had discordant findings in studies within both groups regarding restoration of weight bearing through the medial forefoot and the pulp of the great toe during gait. Currently available studies are heterogenous and report inconsistent findings, which do not convincingly answer our research question. Prospective comparative studies with a large sample size, using standardized methodology in accredited laboratories with detailed reporting of kinetic, kinematic and pedobarographic components of gait analysis are required in order to draw concrete conclusions. [ABSTRACT FROM AUTHOR]

The article presents a study that examined the clinical, subjective, radiological and pedobarographic outcome of isolated primary subtalar arthrodesis. Isolated subtalar arthrodesis is described as a surgical procedure for isolated subtalar pathologies which do not respond to conservative treatment. The study found that the peak pressure distribution under the contralateral side is different from that of a normal foot. It found that the normal foot exerts a significantly higher ground reaction force than both feet of patients with subtalar arthrodesis.

Abstract: Traditional pedobarographic analyses subsample pressure data over a number of discrete anatomical regions of interest (ROIs). To our knowledge, the sensitivity of these data to ROI boundary definitions has not been previously addressed. Eight subjects each performed 20 trials of self-paced walking; commercial software was used to define 10 ROIs for each of the 160 total peak pressure images, and regional peak pressures (RPPs) were extracted for each image (total: 1600 values). We then asked three specific questions regarding RPP sensitivity to ROI boundary definition: (1) Is the ROI centroid representative of the RPP location? (2) How frequently do RPPs lie on the ROI boundary? and (3) By how much do RPP values change if the ROI boundary is changed by one pixel (resolution: 5.08×7.62mm)? We found that the RPP locations differed from the ROI centroid in 80% of the cases and that the RPPs lay on the ROI boundary with a probability of 65%. We also found that a single-pixel change in the ROI boundary caused a mean RPP change of 10.8%. The most sensitive region was the midfoot for which a single-pixel ROI change yielded a median 29.4% change in RPP. These results indicate that RPP data are biased by regionalization schemes, which delineate pressure fields based on anatomy rather than on the field''s geometric properties, and ultimately that regionalization may constitute a poor method of quantifying complex pressure fields. RPP sensitivity should be considered when making statistical inferences regarding foot function. [Copyright &y& Elsevier]

Abstract: In order to establish the clinical utility of pedobarography in the treatment of childhood foot pathology, a reliable set of pedobarograph data describing non-pathologic feet is required. The purpose of this study was to describe the pedobarographic profiles of normal children across all ages, with specific focus on young children and explore age-related differences in foot pressure patterns. The Tekscan HR Mat™ pressure measurement system was used in a protocol involving a dynamic test at self-selected speed and walking pattern of 146 normal children (age range 1.6–14.9 years). Relative force and timing data were obtained across five foot segments (heel, lateral midfoot, medial midfoot, lateral forefoot, and medial forefoot). Analysis of variance (ANOVA) techniques were applied to determine if there were any age-related differences in foot pressure profiles in children across four a priori pedobarograph variables: % of stance at initiation at the heel, % of stance at initiation at the medial midfoot, maximum % force at the heel, maximum % force at the medial midfoot. Differences in foot pressure profiles were distinguished across three age groups: (1) Group 1: <2 years; (2) Group 2: 2–5 years; and (3) Group 3: >5 years. Age-related differences in initiation patterns, force transmission, and the amount of time spent on each foot segment provide evidence for maturation of children''s foot pressure profiles from a flatfoot pattern in the young child to a curvilinear pattern in the older child. [Copyright &y& Elsevier]

We prospectively reviewed 22 patients (31 feet) who underwent a scarf osteotomy between January 2001 and March 2002. There were 20 females and 2 males. Ages ranged from 35 to 77 years (mean = 57 years). American Orthopedic Foot and Ankle Society (AOFAS) scores improved from a preoperative mean of 47.94 ± 13.57 and increased significantly to 96.10 ± 6.15 (P < .01) after 12 months. The hallux valgus angle improved in all patients from a preop mean of 31.4 ± 8.0 degrees to 11.0 ± 10.8 degrees at 12 months. The intermetatarsal angle improved from 13.0 ± 4.2 degrees to 6.1 ± 3.2 degrees. All of these changes were significant. Bony union was achieved in all patients. There were no significant changes in peak pressure, pressure/time, or force/time pedobarography noted after 12 months. Significant improvement in pain scores from preoperative mean of 21.29 ± 11.0 to 32.90 ± 9.57 at 5 years (P < .01) was noted and 90.9% of patients remained satisfied with the operation and would recommend the procedure. There were 2 complications. One patient experienced a traumatic neuroma and another avascular necrosis of the first metatarsal head. The scarf osteotomy is a safe and effective procedure with reproducible and excellent medium-term results. Level of Clinical Evidence: 2. [Copyright &y& Elsevier]

Abstract: Background: The growing popularity of endurance sports activities is associated with a growing number of metatarsal stress fractures in recreational runners. Excessive foot loading has been suggested as a potential cause for these problems [Bennell, K, Matheson G, Meeuwisse W, Brukner P. Risk factors for stress fractures. Sports Med 1999;28(2):91–122]. Therefore, the question arises whether long distance running affects foot loading characteristics like ground reaction forces and peak pressure in specific areas of the foot. Purpose: To investigate the effects of long distance running on plantar pressure patterns before and after a marathon race. Study design: Repeated measurements of recreational runners before and after a marathon race. Methods: Two hundred participants of the third Muenster marathon, 2004, were measured before and after the race with plantar pressure measurements during barefoot walking on a capacitive platform. The ratio between forefoot and toe loading was calculated to assess a suggested loading shift between these areas. Results: The results of the whole group of participants revealed a significant difference in foot loading characteristics before and after the race. Post-race peak pressure and impulse values were higher in the forefoot regions and reduced under the toes. Conclusions: The increased peak pressure under the metatarsal heads after the race indicates a load shift from the toes to the metatarsal heads. This suggests an increased loading of the metatarsal bones and could explain the increased incidence of metatarsal stress fractures in long distance runners. [Copyright &y& Elsevier]

Abstract: Objectives: Impaired foot function may jeopardize the mobility of patients with rheumatoid arthritis (RA). However, there are still no guidelines concerning the adequate early treatment of painful rheumatoid feet which do not yet require surgery. An assessment method for RA feet appears necessary in order to detect foot problems before functional limitations develop. Therefore, the aim of the present study was to evaluate the use of pedobarographic measurements for detecting changes in plantar loading characteristics and their relationship to foot pain in patients with RA. Methods: One hundred and twelve patients with RA (55.0±11.0 years of age) were divided into three groups according to their Health Assessment Questionnaire (HAQ) Score and compared to a control group of 20 healthy adults (CG). Thirty-six patients with good physical capacity belonged to group 1 (RA1; HAQ-score: 0–1.0), 38 patients with moderate capacity to group 2 (RA2; score: 1.1–2.0) and 38 patients with low capacity to group 3 (RA3; score: 2.1–3.0). Each patient''s foot pain was clinically assessed. Pedobarography was used to analyze foot loading parameters while walking barefoot. Results: In the forefoot, average pressures under the lateral forefoot were higher in RA1 patients than in RA2 patients and controls (p <0.05) despite an inconspicuous clinical examination of the foot in RA1 patients. RA1 patients also demonstrated higher plantar pressures than RA2 under the second metatarsal head (p <0.05). In contrast, no significant differences in maximum force could be demonstrated between patient groups. Furthermore, in RA3 patients with lower physical capacity, foot pain was increased as compared to RA1 and RA2 patients. Conclusion: In RA patients, pedobarographic patterns show specific changes which characterize the level of functional capacity. In patients with foot involvement, pedobarographic measurements can be useful during the earlier stages of the disease, when clinical examination does not yet indicate the need for more aggressive treatment or orthopedic interventions. [Copyright &y& Elsevier]

Abstract: Background: Augmentation of the Achilles tendon with flexor hallucis longus is an established method to treat neglected ruptures and severe cases of chronic tendinopathy. After transfer of the muscle/tendon, good pain reduction and improved plantar flexion have been reported. To date, only one study has investigated the effect of FHL transfer on forefoot biomechanics. Theoretically, there should be a partial transfer of forefoot loading towards the lateral metatarsal heads during push-off, resulting in an asymmetric gait. Methods: 13 patients were examined clinically and using pedobarography with a mean follow-up of 46 months (minimum 24) after Achilles tendon augmentation with flexor hallucis longus. Parameters of the forefoot were investigated to detect differences in pressure and force distribution, load transfer to other areas of the forefoot, and asymmetries compared to the non-operated leg. The results are discussed with regard to clinical relevance. Findings: Clinically, there were no subjective or objective gait asymmetries. All patients were free of pain and without restrictions during normal walking. In general, pedobarography showed an unloading of the first toe with a load transfer to the metatarsal heads on the operated side. All results featured high inter-subject and within-subject variability. Interpretation: Due to the high within-subject variability, there is inconsistency within the results making interpretation difficult. However, the results confirm the hypothesis that unloading of the first toe during push-off and an asymmetrical loading pattern can be measured after harvesting of the flexor hallucis longus. The clinical situation of the patients did not reflect a visible amount of gait asymmetry. Differences in loading patterns 2 years after flexor hallucis longus transfer for Achilles tendon augmentation appear to be well compensated. [Copyright &y& Elsevier]

Abstract: Background: Foot pain in patients with rheumatoid arthritis is common and can be associated with excessive forefoot plantar pressure loading. Running and off-the-shelf orthopaedic footwear are commonly recommended to manage foot pain and discomfort in these patients. The aim of this study was to evaluate the effect of running footwear as an alternative to off-the-shelf orthopaedic footwear on plantar pressure loading characteristics in people with forefoot pain associated with rheumatoid arthritis. Methods: Twenty participants diagnosed with rheumatoid arthritis reporting chronic forefoot pain participated in this experimental, randomised, single-blind, cross-over trial of three footwear conditions: control, running and off-the-shelf orthopaedic. Outcome measures included measurement of peak pressure and pressure-time integral, with an in-shoe plantar pressure measurement system, beneath the total foot, forefoot, midfoot and rearfoot. Furthermore, perceived comfort and footwear acceptability were determined for each footwear condition. Findings: Compared to the control footwear, forefoot peak pressures were reduced by 36% in the running footwear and by 20% in the orthopaedic footwear, compared to the control (P <0.001). Forefoot pressure-time integrals were reduced by 33% in the running footwear and by 23% in the orthopaedic footwear (P <0.001). The largest reductions were achieved with the running footwear across the whole plantar surface of the foot. Perceived comfort did not differ between running and orthopaedic footwear, although both were significantly more comfortable than the control footwear. Overall, more participants nominated the running footwear as the most acceptable footwear condition. Interpretation: The results of this preliminary study show that running footwear was most effective at reducing plantar pressure loading and was regarded as a comfortable and acceptable footwear alternative by participants with forefoot pain associated with rheumatoid arthritis. [Copyright &y& Elsevier]

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Objective: The aim of this study was to evaluate pedobarographic findings and balance in knee osteoarthritis. Design: A total of 48 patients with knee osteoarthritis and 30 controls were included in this study. Pedobarographic measures were obtained from all patients and controls. Pain intensity of patients was measured using the Visual Analog Scale. The percentage of pressure on forefoot and hindfoot was measured using static pedobarography, and the peak pressures at forefoot, midfoot, and hindfoot were measured using dynamic pedobarography. The center-of-pressure sway length and width were measured for evaluation of balance. Results: The percentage of right hindfoot pressure (P < 0.05) and peak pressure of the right forefoot during walking were lower in the osteoarthritic group than in the controls (P < 0.05). The sway width in the patient group was higher than in the control group (P < 0.05). The Visual Analog Scale score at rest was negatively correlated with peak pressures of both right and left hindfeet in the osteoarthritic group (P < 0.05). The grade of osteoarthritis was positively correlated with sway length and sway width (P < 0.05). Conclusion: Pedobarography may become a useful technique to determine foot pressures that change because of disturbed weightbearing and balance problems in knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Abstract: Foot-function parameters (foot-contact patterns, oscillations of the centre of pressure (COP), peak pressures, relative vertical impulses and foot shape indices) were characterized in 10 toddlers at 1, 2, 3, 4, 6, 8, 10, 12, 16 and 20 weeks after the onset of independent walking. Significant changes were found in foot-contact patterns and COP oscillations. Improvements in balance, reflected in the decreased oscillations of the COP, coincided with changes in foot roll-over. These findings suggest that the development of a “heel-to-toe” roll-over pattern after 1 year of walking already starts early after the onset of independent walking. We could not identify any changes in load distribution underneath the plantar surface of the foot, suggesting that maturation of foot loading develops at a slower pace. [Copyright &y& Elsevier]

Objective: The aim of this study was to assess probable plantar pressure alterations in rheumatoid arthritis (RA) patients by comparison with normal subjects and to investigate the probable relation between pressure distribution under the foot and radiologic foot erosion score. Methods: Two hundred feet of 50 chronic RA patients and 50 healthy controls were evaluated. Static and dynamic pedobarographic evaluations were used to define the plantar pressure distribution. Also, the modified Larsen scoring system was used to detect the staging of erosions on feet radiograms of the RA patients. Results: Static pedobarography revealed higher pressure and contact areas in the forefoot. All dynamic pedobarographic parameters except for plantar contact area were significantly different between the RA patients and control subjects. Patients with high erosion scores had higher static forefoot and dynamic phalanx peak pressure values. Conclusion: Pedobarographic investigation can be useful to evaluate pressure distribution disorders in RA feet and may provide suitable guidelines for the design of various plantar supports. [ABSTRACT FROM AUTHOR]

Background. Although previous studies have generally reported increased plantar pressure values with obesity, none of these studies has classified the obesity. Our aim in this study was to compare the plantar pressure distribution in obese and control adults during standing and walking.Methods. This study was performed on 100 feet of 50 study participants. The subjects gathered in two groups, each containing 25 study participants, as non-obese and class 1 obese according to their body mass index values. Static and dynamic pedobarographic evaluations were performed during standing and walking. The findings were compared between the groups and also the correlation of body mass index with the pedobarographic parameters was assessed.Findings. The static pedobarographic evaluation revealed significantly higher values in terms of forefoot peak pressure, total plantar force and total contact area in the feet of class 1 obese subjects when only middle foot peak pressure was found to be higher in class 1 obese subjects than controls as a dynamic pedobarographic parameter. Among the static parameters body mass index was found to have positive correlation with total plantar force (r=0.50, P=0.000) and total contact area (r=0.33, P=0.019). Only middle foot peak pressure (r=0.32, P=0.025) among the dynamic pedobarographic parameters had positive correlation with body mass index.Interpretation. This study may be a first step to evaluate the effect of different obesity categories on the plantar pressure values. Further studies are needed to investigate the effect of different obesity grades. [Copyright &y& Elsevier]

SUMMARY Aims This study analysed the effects of specially manufactured insoles on foot pressures in diabetic patients during a 1-year prospective observation period. Methods We studied 81 type 2 diabetic patients without foot lesions. Using pedobarography three different regions of interest were examined: maximum peak pressure (MPP) of the total foot area, heel region and head of metatarsal bone I-III. Eighteen patients with high risk pressure (MPP of total foot 474 ± 183 kPa; heel region 278 ± 147 kPa, metatarsal 389 ± 222 kPa) received optimal insole support. Sixty-three patients as a control group (MMP of total foot 367.7 ± 157 kPa; heel 263.1 ± 127 kPa, metatarsal 339.9 ± 171 kPa) received conventional footwear. Results After insole support a 30% pressure reduction of total foot MMP (474 ± 183 kPa vs. 290 ± 106 kPa) was achieved in the treatment group. After 6 months (324 ± 127 kPa) and 1 year (380 ± 190 kPa) a pressure reduction was found. Between the 6- and 12-month controls plantar pressures again increased. In the control group a significant increase of all peak pressures occurred. Conclusions Early insole support is successful in reducing plantar pressure. A repeated adjustment should be performed every 6 months to prevent foot pressure increases. The comparison of foot pressure development between the two groups showed constant levels in the treatment group. In the control group a marked increase of the pressure values was found. Identification and subsequent support of patients with high ulceration risk may help to reduce the high amputation rate. [ABSTRACT FROM AUTHOR]