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The shoe-surface interface has been implicated as a possible risk factor for anterior cruciate ligament (ACL) injuries. The purpose of this study is to develop a biomechanical, cadaveric model to evaluate the effect of various shoe-surface interfaces on ACL strain. There will be a significant difference in ACL strain between different shoe-surface combinations when a standardized rotational moment (a simulated cutting movement) is applied to an axially loaded lower extremity. The study design was a controlled laboratory study. Eight fresh-frozen cadaveric lower extremities were thawed and the femurs were potted with the knee in 30 deg of flexion. Each specimen was placed in a custom-made testing apparatus, which allowed axial loading and tibial rotation but prevented femoral rotation. For each specimen, a 500 N axial load and a 1.5 Nm internal rotation moment were placed for four different shoe-surface combinations: group I (Astro Turf-turf shoes), group II (modern playing turf-turf shoes), group III (modern playing turf-cleats), and group IV (natural grass-cleats). Maximum strain, initial axial force and moment, and maximum axial force and moment were calculated by a strain gauge and a six component force plate. The preliminary trials confirmed a linear relationship between strain and both the moment and the axial force for our testing configuration. In the experimental trials, the average maximum strain was 3.90, 3.19, 3.14, and 2.16 for groups I-IV, respectively. Group IV had significantly less maximum strain (p Keywords: noncontact ACL injuries, shoe-surface interface, ACL strain

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.apergo.2004.11.001 Byline: Lee Yung-Hui, Hong Wei-Hsien Keywords: High-heeled shoes; Insert; Impact force; Pressure distribution Abstract: Studying the impact of high-heeled shoes on kinetic changes and perceived discomfort provides a basis to advance the design and minimize the adverse effects on the human musculoskeletal system. Previous studies demonstrated the effects of inserts on kinetics and perceived comfort in flat or running shoes. No study attempted to investigate the effectiveness of inserts in high heel shoes. The purpose of this study was to determine whether increasing heel height and the use of shoe inserts change foot pressure distribution, impact force, and perceived comfort during walking. Ten healthy females volunteered for the study. The heel heights were 1.0cm (flat), 5.1cm (low), and 7.6cm (high). The heel height effects were examined across five shoe-insert conditions of shoe only; heel cup, arch support, metatarsal pad, and total contact insert (TCI). The results indicated that increasing heel height increases impact force (p Author Affiliation: Department of Industrial Management, National Taiwan University of Science and Technology, No. 43, Kee-Lung Road, Sec IV, Taipei, Taiwan, 106 ROC Article History: Received 26 January 2004; Accepted 12 November 2004

Diabetics who do not have severe foot deformities probably do not need special shoes or special shoe inserts to prevent foot ulcers, according to a study of 400 people. On the other hand, diabetics with foot deformities or those who do not receive proper foot care on a regular basis might benefit., Context: Many people with diabetes experience lower-limb ulcers. Footwear has been implicated as a primary cause of foot ulcers, yet research is limited on the efficacy of shoe and insert combinations to prevent reulceration. Objective: To determine whether extra-depth and -width therapeutic shoes used with 2 types of inserts reduce reulceration in diabetic individuals with a history of foot ulcer. Design, Setting, and Participants: Randomized clinical trial of 400 diabetes patients with history of foot ulcer in 2 Washington State health care organizations who did not require custom shoes for foot deformity and were enrolled between August 1997 and December 1998 and followed up for 2 years. Data collected at regular intervals documented physical, foot, and diabetes characteristics; footwear use; foot lesions; and ulcers. Interventions: Participants were randomly assigned to receive 3 pairs of therapeutic shoes and 3 pairs of customized medium-density cork inserts with a neoprene closed-cell cover (n=121); to receive 3 pairs of therapeutic shoes and 3 pairs of prefabricated, tapered polyurethane inserts with a brushed nylon cover (n=119); or to wear their usual footwear (controls; n=160). Main Outcome Measure: Foot reulceration, compared among the 3 groups. Results: Two-year cumulative reulceration incidence across the 3 groups was low: 15% in the cork-insert group, 14% in the prefabricated-insert group, and 17% in controls. In the intent-to-treat analysis, patients assigned to therapeutic shoes did not have a significantly lower risk of reulceration compared with controls (risk ratio [RR] for the cork-insert group, 0.88; 95% confidence interval [CI), 0.51-1.52 and RR the for prefabricated-insert group, 0.85; 95% CI, 0.48-1.48). All ulcer episodes in patients assigned to therapeutic shoes and 88% wearing nonstudy shoes occurred in patients with foot insensitivity. Conclusions: This study of persons without severe foot deformity does not provide evidence to support widespread dispensing of therapeutic shoes and inserts to diabetic patients with a history of foot ulcer. Study shoes and custom cork or preformed polyurethane inserts conferred no significant ulcer reduction compared with control footwear. This study suggests that careful attention to foot care by health care professionals may be more important than therapeutic footwear but does not negate the possibility that special footwear is beneficial in persons with diabetes who do not receive such close attention to foot care by their health care providers or in individuals with severe foot deformities.

The primary causes of morbidity and mortality from trauma in persons ages 65 and older are falls and fall-related injuries (1). Thirty percent of persons older than 65 are said […]

Although shoes are most often considered a simple part of a child's clothing, some health professionals believe that shoes can be a tool to correct deformities of the foot and prevent disability in later life. Studies show that persons who have always walked barefoot develop an excellent ability to move around on their feet, as well as thickened soles, creases in the sole allowing for flexibility of the foot, spreading of the toes due to alignment of the bones in the toes with those in the foot, variability in the size of the arch, and lack of deformity of foot when standing still. The arch of the foot develops over the first six to eight years of life, and the foot changes from a flat to a more arched pattern. The development of the arch is not influenced by the type of footwear worn. Shoes were first worn 10,000 years ago to protect the feet from injury and became a status symbol in Greece, Rome, and Europe. Heels were introduced in the 16th century, possibly to secure the foot in the stirrup, but later were associated with social status. Within the past 2,000 years, shoes have been designed according to fashion trends. Children's shoes were initially designed for support and tended to be rigid and compressive. However, a 1980 survey of pediatricians showed that most preferred soft shoes, preferably tennis shoes, for children. The fact that barefoot subjects have stronger and healthier feet and arch development is not influenced by footwear suggests that rigid footwear is unnecessary. The usefulness of corrective footwear has not been consistently shown. Some useful shoe changes include shoe lifts to produce equal lengths of both limbs; shoe inserts to produce more even distribution of weight bearing; and shock absorbers to alleviate heel or shin pain. Children's shoes should be shaped like the normal foot, flexible, flat, porous, lightweight, extended above the ankle in toddlers, and inexpensive. They should have good traction and be acceptable in appearance. In the future, children's shoes should be designed for function, comfort, and protection. (Consumer Summary produced by Reliance Medical Information, Inc.)

They might not be the most attractive part of your body, but your feet are real workhorses. In fact, the American Podiatric Medical Association calls them "biological masterpieces." Okay, we're [...]