scholarly journals Multistep Measurement of Plantar Pressure Alterations Using Metatarsal Pads

1994 ◽  
Vol 15 (12) ◽  
pp. 654-660 ◽  
Author(s):  
An-Hsiung Chang ◽  
Ziad U. Abu-Faraj ◽  
Gerald F. Harris ◽  
Joe Nery ◽  
Michael J. Shereff
Keyword(s):  
Plantar Pressure ◽  
Metatarsal Head ◽  
Plantar Surface ◽  
Plantar Pressures ◽  
Quantitative Studies ◽  
Pressure Time ◽  
Second Metatarsal ◽  
Peak Pressures ◽  
Male Subjects ◽  
Multiple Step

Metatarsal pads are frequently prescribed for nonoperative management of metatarsalgia due to various etiologies. When appropriately placed, they are effective in reducing pressures under the metatarsal heads on the plantar surface of the foot. Despite the positive clinical reports that have been cited, there are no quantitative studies documenting the load redistribution effects of these pads during multiple step usage within the shoe environment. The objective of this study was to assess changes in plantar pressure metrics resulting from pad use. Ten normal adult male subjects were tested during a series of 400-step trials. Pressures were recorded from eight discrete plantar locations at the hindfoot, midfoot, and forefoot regions of the insole. Significant increases in peak pressures, contact durations, and pressure-time integrals were noted at the metatarsal shaft region with pad use ( P ≤ .05). Statistically significant changes in metric values were not seen at the other plantar locations, although metatarsal pad use resulted in mild decreases in mean peak pressures at the first and second metatarsal heads and slight increases laterally. Contact durations decreased at all metatarsal head locations, while pressure-time integrals decreased at the first, second, third, and fourth metatarsal heads. A slight increase in pressure-time integrals was seen at the fifth metatarsal head. The redistribution of plantar pressures tended to relate not only to the dimensions of the metatarsal pads, but also to foot size, anatomic foot configuration, and pad location. Knowledge of these parameters, along with careful control of pad dimensions and placement, allows use of the metatarsal pad as an effective orthotic device for redistributing forefoot plantar pressures.

Effect of Orthotic Therapy on Claw Toe Loading

2004 ◽  
Vol 94 (3) ◽  
pp. 246-254 ◽  
Author(s):  
Penny J. Claisse ◽  
Jodi Binning ◽  
Julia Potter
Keyword(s):  
Pressure Measurement ◽  
Plantar Pressure ◽  
Metatarsal Head ◽  
Plantar Surface ◽  
Time Integral ◽  
Pressure Time ◽  
Second Metatarsal ◽  
Plantar Pressure Measurement ◽  
Access To Data ◽  
Toe Deformity

This study demonstrates the effect of orthotic therapy for toe deformity on toe and metatarsal head pressures using a new analysis method facilitated by an in-shoe pressure-measurement system’s ability to export detailed data. Plantar pressure–time integrals in 11 individuals (22 feet) with claw deformity of the lesser toes were measured with and without toe props. Differences in pressure–time integrals at every individual sensor unit were then calculated for the two conditions, and significance was tested using the paired t-test. Plantar surface charts with contours of equal significant pressure–time integral change showed significant reduction under 17 second toes (77%), 22 third toes (100%), 15 fourth toes (68%), 13 second metatarsal heads (59%), 16 third metatarsal heads (73%), and 16 fourth metatarsal heads (73%). All 22 feet showed increases under the prop in the area of the third toe sulcus. This innovative approach to plantar pressure analysis could improve access to data that show significant pressure–time integral changes and, therefore, could advance the clinical application of plantar pressure measurement. (J Am Podiatr Med Assoc 94(3): 246–254, 2004)

Effectiveness of the Fixtoe Device® in Plantar Pressure Reduction: A Preliminary Study.

2021 ◽  
Author(s):  
Maria Ruiz-Ramos ◽  
Ángel Manuel Orejana-García ◽  
Ignacio Vives-Merino ◽  
Carmen Bravo-Llatas ◽  
José Luis Lázaro-Martínez ◽  
...  
Keyword(s):  
Plantar Pressure ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Clinical Results ◽  
Cross Sectional ◽  
Time Integral ◽  
Pressure Time ◽  
Second Metatarsal ◽  
Maximal Pressure ◽  
Taping Technique

Abstract Background: Metatarsalgia is a common foot condition. The metatarsophalangeal stabilizing taping technique described by Yu et al. has shown good clinical results as a provisional treatment in propulsive metatarsalgia. 35 The Fixtoe Device®, a novel orthopedic device, intends to simulate stabilizing tape. However, to date, there is no evidence of its effectiveness.Methods: The aim of this study was to assess plantar pressure changes using the Fixtoe Device®, in comparison with the traditional method (stabilizing tape) in a young, healthy sample thorough a cross-sectional study. Maximal pressure (Kpa) and pressure-time integral (Kpa/s) in the second metatarsal head were measured in twenty-four healthy volunteers. Registers were taken in four different conditions: barefoot, traditional stabilizing tape, Fixtoe Device® without metatarsal pad, and Fixtoe Device® with metatarsal pad. Results: Mean second metatarsal head maximal pressure and mean pressure-time integral showed statistical difference among the four analyzed conditions (p < 0.0001 in both cases). The improvement in maximal pressure and pressure-time integral obtained in each intervention also showed significance (p < 0.0001 in both cases). Comparing the improvement of the Fixtoe Device® with and without metatarsal pad with that of tape condition showed a moderate to high and moderate effect size for both peak pressure and pressure-time integral reduction.Conclusions: The Fixtoe Device® reduces median maximal pressure and median pressure-time integral under the second metatarsal head in healthy young individuals. The Fixtoe Device® shows higher effectiveness than the traditional second metatarsophalangeal joint stabilizing taping technique. To our knowledge, this is the first investigation proving the effectiveness of the recently developed Fixtoe Device® in terms of plantar pressure modification, which leads the way to its use in clinics.

scholarly journals Effect of Mini-invasive Floating Metatarsal Osteotomy on Plantar Pressure in Patients With Diabetic Plantar Metatarsal Head Ulcers

2020 ◽  
pp. 107110072097609
Author(s):  
Eran Tamir ◽  
Michael Tamar ◽  
Moshe Ayalon ◽  
Shlomit Koren ◽  
Noam Shohat ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Plantar Pressure ◽  
Case Series ◽  
Metatarsal Head ◽  
Metatarsal Osteotomy ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Retrospective Case Series ◽  
Pressure Time ◽  
Peak Plantar Pressure

Background: Distal metatarsal osteotomy has been used to alleviate plantar pressure caused by anatomic deformities. This study’s purpose was to examine the effect of minimally invasive floating metatarsal osteotomy on plantar pressure in patients with diabetic metatarsal head ulcers. Methods: We performed a retrospective case series of prospectively collected data on 32 patients with diabetes complicated by plantar metatarsal head ulcers without ischemia. Peak plantar pressure and pressure time integrals were examined using the Tekscan MatScan prior to surgery and 6 months following minimally invasive floating metatarsal osteotomy. Patients were followed for complications for at least 1 year. Results: Peak plantar pressure at the level of the osteotomized metatarsal head decreased from 338.1 to 225.4 kPa ( P < .0001). The pressure time integral decreased from 82.4 to 65.0 kPa·s ( P < .0001). All ulcers healed within a mean of 3.7 ± 4.2 weeks. There was 1 recurrence (under a hypertrophic callus of the osteotomy) during a median follow-up of 18.3 months (range, 12.2-27). Following surgery, adjacent sites showed increased plantar pressure and 4 patients developed transfer lesions (under an adjacent metatarsal head); all were managed successfully. There was 1 serious adverse event related to surgery (operative site infection) that resolved with antibiotics. Conclusion: This study showed that the minimally invasive floating metatarsal osteotomy successfully reduced local plantar pressure and that the method was safe and effective, both in treatment and prevention of recurrence. Level of Evidence: Level III, retrospective case series of prospectively collected data.

scholarly journals The Difference of In-Shoe Plantar Pressure Between Level Walking and Stair Walking

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0026
Author(s):  
Min Gyu Kyung ◽  
Chungho Lee ◽  
Jae Hee Lee ◽  
Yoon Jae Cho ◽  
Cao Linying ◽  
...  
Keyword(s):  
High Pressure ◽  
Plantar Pressure ◽  
Pressure Load ◽  
Stair Ascent ◽  
Time Integral ◽  
Stair Descent ◽  
Level Walking ◽  
Pressure Time ◽  
Stair Walking ◽  
Peak Pressures

Category: Basic Sciences/Biologics Introduction/Purpose: Stair walking is one of common activities of daily living. It is more demanding than level walking and can aggravate discomfort of the foot, such as Morton’s neuroma, plantar fasciitis, Achilles tendinitis, pressure related-ulcer, and etc. Therefore, analysis of increased pressure in specific plantar area at stair walking can be used as a risk assessment of foot discomfort and basic data in the clinical field. The purpose of this study is to analyze plantar pressure distribution and pressure patterns during gait cycle at stair walking compared to level walking. Methods: Fourty healthy male adults were recruited. Radiologic measurements and gait analysis were performed to check participants’ normality, and 35 healthy males with 20-28 years old were included. They performed level walking (18 meters walkway), stair (26 steps stair, height:16.7 cm, depth:29.8 cm) ascending, and descending in same type of running shoes. Measurements of in-shoe plantar pressure including peak pressure, pressure-time integral (PTI) were done by Pedar-X system. Only measurements of right steps were used to exclude the effect of the dominant foot. The sole was masked in 7 segments (hallux, 2nd-5th toes, medial forefoot, central forefoot, lateral forefoot, midfoot, heel region) to analyze properly. Percentages were assigned in relation to the size for each mask segment. Statistical analysis was performed using repeated measure ANOVA, and Bonferroni post hoc test was done. Results: Mean peak pressures in all regions except for the midfoot were higher during level walking than stair walking. During stair descent, mean peak pressures in all the regions except for the midfoot were generally lower than other types of walking, but it was the highest in the midfoot region. Pressure time integral (PTI) in the medial and central forefoot was higher during stair descent than level walking. PTI in the central and lateral forefoot, and the midfoot was higher when stair ascending than level walking. Pressure time integral (PTI) in the heel region was the highest during level walking, followed by stair ascent, stair descent. Conclusion: The risk of aggravation of discomfort in the midfoot area increases when stair descending. The medial region of forefoot bear high pressure load during stair descent, and the lateral region of forefoot and the midfoot region bear high pressure load during stair ascent. This is the first study to show plantar pressure patterns during level and stair walking in the large healthy gender-controlled population. We recommend that patients with pressure related foot lesions in the forefoot or midfoot avoid stair walking.

The Effect of Terrain on Foot Pressures During Walking

2005 ◽  
Vol 26 (10) ◽  
pp. 859-869 ◽  
Author(s):  
Olfat Mohamed ◽  
Kay Cerny ◽  
Wendy Jones ◽  
Judy M. Burnfield
Keyword(s):  
Repeated Measures ◽  
Metatarsal Head ◽  
First Metatarsal ◽  
Plantar Pressures ◽  
Time Integral ◽  
Pressure Time ◽  
Alpha Level ◽  
Mean Pressure ◽  
Musculoskeletal Pathology ◽  
Post Hoc

Background: High plantar pressures are associated with the development of foot ulcers in people with diabetic neuropathy. The effect of terrain on plantar pressures during walking has not been fully explored. Methods: Twenty 23- to 40-year-old subjects with no known musculoskeletal pathology walked across three terrains: padded carpet (R), grass (G), and concrete (C) while wearing Novel Pedar (Novel Electronics Inc. GMBH, Munich, Germany) insoles with and without shoes. Pressures were collected at 50 Hz. The sole of the foot was divided into: heel (H), lateral midfoot (LM), medial midfoot (MM), big toe and first metatarsal head (BT), and lateral toes and metatarsal heads (LT). Repeated measures ANOVA identified differences in pressures, forces, and contact areas across terrains. Post hoc Bonferroni adjustments were used to accept an overall alpha level of 0.05. Results: Peak pressure (PP), maximal mean pressure (MMP) and pressure time integral (PTI) were significantly higher ( p < 0.01) when walking barefoot on concrete than on grass or carpet for all foot regions except MM and LM. The percent increase in the three pressure variables ranged from 21% to 43%. Grass and carpet PP, MMP, and PTI were similar for the BT and LT. Wearing shoes significantly increased contact area and decreased all pressure variables on all three terrains. Conclusion: Walking barefoot, especially on concrete was associated with higher plantar pressure variables. Wearing shoes eliminated terrain differences in pressure except under the lesser toes. Persons with insensate feet should avoid walking barefoot on hard surfaces to avoid excessive plantar pressures. Wearing shoes and covering hard floors with nonslip, padded rugs may decrease plantar pressures and the risk of ulceration.

Effect of Neutral-Cushioned Running Shoes on Plantar Pressure Loading and Comfort in Athletes with Cavus Feet

2008 ◽  
Vol 36 (11) ◽  
pp. 2139-2146 ◽  
Author(s):  
Caleb Wegener ◽  
Joshua Burns ◽  
Stefania Penkala ◽  
Grad Dip Ex Spr Sc
Keyword(s):  
Plantar Pressure ◽  
Regional Differences ◽  
Peak Pressure ◽  
Pressure Loading ◽  
Analog Scale ◽  
Reduced Pressure ◽  
Injury Rates ◽  
Plantar Pressures ◽  
Pressure Time ◽  
Running Shoes

Background High injury rates observed in athletes with cavus feet are thought to be associated with elevated plantar pressure loading. Neutral-cushioned running shoes are often recommended to manage and prevent such injuries. Purpose To investigate in-shoe plantar pressure loading and comfort during running in 2 popular neutral-cushioned running shoes recommended for athletes with cavus feet. Study Design Controlled laboratory study. Methods Plantar pressures were collected using the in-shoe Novel Pedar-X system during overground running in 22 athletes with cavus feet in 2 neutral-cushioned running shoes (Asics Nimbus 6 and Brooks Glycerin 3) and a control condition (Dunlop Volley). Comfort was measured using a validated visual analog scale. Results Compared with the control, both neutral-cushioned running shoes significantly reduced peak pressure and pressure-time integrals by 17% to 33% ( P < .001). The Brooks Glycerin most effectively reduced pressure beneath the whole foot and forefoot ( P < .01), and the Asics Nimbus most effectively reduced rearfoot pressure ( P < .01). Both neutral-cushioned running shoes reduced force at the forefoot by 6% and increased it at the midfoot by 12% to 17% ( P < .05). Contact time and area increased in both neutral-cushioned running shoes ( P < .01). The Asics Nimbus was the most comfortable, although both neutral-cushioned running shoes were significantly more comfortable than the control ( P < .001). Conclusion Two popular types of neutral-cushioned running shoes were effective at reducing plantar pressures in athletes with cavus feet. Clinical Relevance Regional differences in pressure reduction suggest neutral-cushioned running shoe recommendation should shift from being categorical in nature to being based on location of injury or elevated plantar pressure.

Variability of plantar pressure data. A comparison of the two-step and midgait methods

1999 ◽  
Vol 89 (10) ◽  
pp. 495-501 ◽  
Author(s):  
TG McPoil ◽  
MW Cornwall ◽  
L Dupuis ◽  
M Cornwell
Keyword(s):  
Data Collection ◽  
Plantar Pressure ◽  
Peak Pressure ◽  
Pressure Data ◽  
Step Method ◽  
Plantar Surface ◽  
Time Integral ◽  
Risk Of Injury ◽  
Pressure Time ◽  
Reliable Representation

The number of trials required to obtain a reliable representation of the plantar pressure pattern is an important factor in the assessment of people with insensate feet or the use of plantar pressure data as a basis for fabrication of foot orthoses. Traditionally, the midgait method has been used for the collection of pressure data, but the large number of walking trials required by this method can increase the risk of injury to the plantar surface of the insensate foot. As a result, the two-step method of plantar pressure data collection has been advocated. The purpose of this investigation was to determine the degree of variability in regional plantar pressure measurements using the midgait and two-step methods of data collection. Plantar pressure data were collected from ten volunteers (five men and five women) between the ages of 20 and 35 years in 20 trials using both data-collection protocols. The results of the study indicate that three to five walking trials are needed to obtain reliable regional peak pressure and pressure-time integral values when the two-step data-collection protocol is used. Although either method can be used for pressure data collection, one method should be used consistently when repeated assessments are required.

Plantar Pressures During Shod Gait in Diabetic Neuropathic Patients with and without a History of Plantar Ulceration

2009 ◽  
Vol 99 (4) ◽  
pp. 285-294 ◽  
Author(s):  
Isabel C. N. Sacco ◽  
Tatiana Almeida Bacarin ◽  
Maíra Grizzo Canettieri ◽  
Ewald M. Hennig
Keyword(s):  
Diabetic Neuropathy ◽  
Plantar Pressure ◽  
Clinical History ◽  
Control Group ◽  
Diabetic Patients ◽  
Plantar Pressures ◽  
Time Integral ◽  
Pressure Time ◽  
Plantar Ulcers ◽  
History Of

Background: Diabetic neuropathy leads to progressive loss of sensation, lower-limb distal muscle atrophy, autonomic impairment, and gait alterations that overload feet. This overload has been associated with plantar ulcers even with consistent daily use of shoes. We sought to investigate and compare the influence of diabetic neuropathy and plantar ulcers in the clinical history of diabetic neuropathic patients on plantar sensitivity, symptoms, and plantar pressure distribution during gait while patients wore their everyday shoes. Methods: Patients were categorized into three groups: a control group (CG; n = 15), diabetic patients with a history of neuropathic ulceration (DUG; n = 8), and diabetic patients without a history of ulceration (DG; n = 10). Plantar pressure variables were measured by Pedar System shoe insoles in five plantar regions during gait while patients wore their own shoes. Results: No statistical difference between neuropathic patients with and without a history of plantar ulcers was found in relation to symptoms, tactile sensitivity, and duration of diabetes. Diabetic patients without ulceration presented the lowest pressure–time integral under the heel (72.1 ± 16.1 kPa × sec; P = .0456). Diabetic patients with a history of ulceration presented a higher pressure–time integral at the midfoot compared to patients in the control group (59.6 ± 23.6 kPa × sec × 45.8 ± 10.4 kPa × sec; P = .099), and at the lateral forefoot compared to diabetic patients without ulceration (70.9 ± 17.7 kPa sec × 113.2 ± 61.1 kPa × sec, P = .0193). Diabetic patients with ulceration also presented the lowest weight load under the hallux (0.06 ± 0.02%, P = .0042). Conclusions: Although presenting a larger midfoot area, diabetic neuropathic patients presented greater pressure–time integrals and relative loads over this region. Diabetic patients with ulceration presented an altered dynamic plantar pressure pattern characterized by overload even when wearing daily shoes. Overload associated with a clinical history of plantar ulcers indicates future appearance of plantar ulcers. (J Am Podiatr Med Assoc 99(4): 285–294, 2009)

Reduction of plantar pressure with the rigid relief orthosis

1993 ◽  
Vol 83 (3) ◽  
pp. 115-122 ◽  
Author(s):  
A Novick ◽  
J Stone ◽  
JA Birke ◽  
DM Brasseaux ◽  
JB Broussard ◽  
...  
Keyword(s):  
Mechanical Stress ◽  
Plantar Pressure ◽  
Pressure Transducer ◽  
Clinical Effectiveness ◽  
Metatarsal Head ◽  
Lesion Site ◽  
Measurement Systems ◽  
Plantar Surface ◽  
First Metatarsal

The rigid relief orthosis was developed to protect vulnerable sites on the plantar surface of the insensitive foot against reulceration by providing both a nonyielding relief under the healed lesion site and a total contact fit. Clinically, the rigid relief orthosis has been effective in protecting the foot against the trauma induced by the repetitive mechanical stress of walking. This study used both the Hercules and F-Scan pressure transducer systems to measure pressure at the first metatarsal head in three orthotic treatments. Both measurement systems recorded significant reductions in pressure at the first metatarsal head with the rigid relief orthosis, establishing a quantitative rationale explaining its clinical effectiveness. Significant pressure differences were also recorded at the secondary sites of the heel, midfoot, and third metatarsal head.

Effect of a Metatarsal Pad on the Forefoot During Gait

2012 ◽  
Vol 102 (1) ◽  
pp. 18-24 ◽  
Author(s):  
Koen L. M. Koenraadt ◽  
Niki M. Stolwijk ◽  
Dorine van den Wildenberg ◽  
Jaak Duysens ◽  
Noël L. W. Keijsers
Keyword(s):  
Plantar Pressure ◽  
Stance Phase ◽  
Alternative Hypothesis ◽  
Metatarsal Head ◽  
Pain Reduction ◽  
Motion Analysis System ◽  
Extra Space ◽  
Second Metatarsal ◽  
The Mean ◽  
Analysis System

Background: Metatarsal pads are frequently prescribed for patients with metatarsalgia to reduce pain under the distal metatarsal heads. Several studies showed reduced pain and reduced plantar pressure just distal to the metatarsal pad. However, only part of the pain reduction could be explained by the decrease in plantar pressure under the forefoot. Therefore, an alternative hypothesis is proposed that pain relief is related to a widening of the foot and the creation of extra space between the metatarsal heads. This study focused on the effect of a metatarsal pad on the geometry of the forefoot by studying forefoot width and the height of the second metatarsal head. Methods: Using a motion analysis system, 16 primary metatarsalgia feet and 12 control feet were measured when walking with and without a metatarsal pad. Results: A significant mean increase of 0.60 mm in forefoot width during the stance phase was found when a metatarsal pad was worn. During midstance, the mean increase in forefoot width was 0.74 mm. In addition, walking with a metatarsal pad revealed an increase in the height of the second metatarsal head (mean, 0.62 mm). No differences were found between patients and controls. Conclusions: The combination of increased forefoot width and the height of the second metatarsal head produced by the metatarsal pad results in an increase in space between the metatarsal heads. This extra space could play a role in pain reduction produced by a metatarsal pad. (J Am Podiatr Med Assoc 102(1): 18–24, 2012)

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