scholarly journals The Reduction of 1st Metatarsal Plantar Pressures With a Novel Offloading Device (the Mandakini) in a Singaporean Population

2021 ◽  
Author(s):  
Melissa Yan Ting Lee ◽  
Pui Wah Kong ◽  
Thanaporn Tunprasert
Keyword(s):  
Peak Pressure ◽  
Cost Effective ◽  
Target Population ◽  
Local Hospital ◽  
Plantar Pressures ◽  
Time Integral ◽  
Comfort Levels ◽  
Pressure Time ◽  
Significant Difference ◽  
Patients With Diabetes

Abstract AimsThere is an overall lack of affordable and accessible offloading modalities for diabetic foot ulceration. The Mandakini is a cheap offloading device made-up of gloves. This study aims to investigate its effectiveness in reducing plantar pressures compared to 7mm semi-compressed felt (SCF) and barefoot walking. Materials and methodsPlantar pressures of 30 healthy staff from a local hospital in Singapore were captured under three offloading conditions – the Mandakini, SCF and barefoot walking (control). Peak pressure (PP), pressure-time integral (PTI) and contact time (CT) at the 1st metatarsal and its surrounding regions were analysed. Participants rated their comfort levels in each condition on a visual analogue scale from 1 to 10.Results Statistically significant reductions in PP and PTI of 43 ± 12 kPa (14%) and 14 ± 4 kPa.s (16%) respectively were observed at the 1st metatarsal with the Mandakini compared to control (p=0.001, p=0.002). Reductions were however significantly lower than SCF which reduced PP and PTI by 83 ± 11 kPa (28%) and 28 ± 3 kPa.s (33%) respectively compared to control (p<0.001, p<0.001). No statistically significant difference in CT was observed with the Mandakini compared to control (p=0.499). Comfort levels were not significantly different between the Mandakini and SCF with means 5.7 ± 1.8 and 6.2 ± 2.1 respectively (p=0.257). Conclusion This study highlights the Mandakini’s potential in providing cost-effective offloading through pressure redistribution. Nonetheless, in barefoot conditions, SCF should remain the preferred modality. Future pressure studies on patients with diabetes will provide better representations of the Mandakini’s effectiveness on the target population.

Immediate Effects of Weight-Bearing Calf Stretching on Ankle Dorsiflexion Range of Motion and Plantar Pressure During Gait in Patients with Diabetes Mellitus

2021 ◽  
pp. 153473462110313
Author(s):  
Noriaki Maeshige ◽  
Mikiko Uemura ◽  
Yoshikazu Hirasawa ◽  
Yoshiyuki Yoshikawa ◽  
Maiki Moriguchi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Plantar Pressure ◽  
Peak Pressure ◽  
Weight Bearing ◽  
Ankle Dorsiflexion ◽  
Diabetic Foot Ulcers ◽  
Plantar Surface ◽  
Time Integral ◽  
Pressure Time ◽  
Patients With Diabetes

High plantar pressure is a risk factor for diabetic foot ulcers, and it is known that restriction of ankle dorsiflexion range of motion (ROM) causes high plantar pressure. Stretching is a non-invasive and general means to improve ROM; however, the effect of stretching on the ROM and plantar pressure has not been clarified in patients with diabetes mellitus. We aimed to study the effects of intermittent weight-bearing stretching on ankle dorsiflexion ROM and plantar pressure during gait in patients with diabetes mellitus. Seven patients with diabetes mellitus participated, and their triceps surae was stretched using weight-bearing stretching with a stretch board. Five minutes of stretching was performed 4 times with a rest interval of 30 s. Ankle dorsiflexion ROM was measured with the knee flexed and extended. Peak pressure and pressure-time integral during gait were measured and calculated for the rearfoot, midfoot, forefoot, and total plantar surface before and after stretching. Ankle dorsiflexion ROM with the knee extended or bent increased significantly after stretching ( P < .05). Peak pressure and the pressure-time integral decreased significantly, especially in the forefoot ( P < .01), and these also decreased significantly in the total plantar surface ( P < .05). The duration of foot-flat decreased after stretching ( P < .05). Weight-bearing stretching improved ankle dorsiflexion ROM and reduced plantar pressure during gait. These results suggest that weight-bearing calf stretching may be an effective means to prevent and treat diabetic foot ulcers.

The Influence of Running on Foot Posture and In-Shoe Plantar Pressures

2016 ◽  
Vol 106 (2) ◽  
pp. 109-115 ◽  
Author(s):  
María Bravo-Aguilar ◽  
Gabriel Gijón-Noguerón ◽  
Alejandro Luque-Suarez ◽  
Javier Abian-Vicen
Keyword(s):  
Heel Strike ◽  
Neutral Position ◽  
Training Time ◽  
Plantar Pressures ◽  
Time Integral ◽  
Pressure Time ◽  
Limb Injuries ◽  
Before And After ◽  
Foot Posture ◽  
The Mean

Background: Running can be considered a high-impact practice, and most people practicing continuous running experience lower-limb injuries. The aim of this study was to determine the influence of 45 min of running on foot posture and plantar pressures. Methods: The sample comprised 116 healthy adults (92 men and 24 women) with no foot-related injuries. The mean ± SD age of the participants was 28.31 ± 6.01 years; body mass index, 23.45 ± 1.96; and training time, 11.02 ± 4.22 h/wk. Outcome measures were collected before and after 45 min of running at an average speed of 12 km/h, and included the Foot Posture Index (FPI) and a baropodometric analysis. Results: The results show that foot posture can be modified after 45 min of running. The mean ± SD FPI changed from 6.15 ± 2.61 to 4.86 ± 2.65 (P &lt; .001). Significant decreases in mean plantar pressures in the external, internal, rearfoot, and forefoot edges were found after 45 min of running. Peak plantar pressures in the forefoot decreased after running. The pressure-time integral decreased during the heel strike phase in the internal edge of the foot. In addition, a decrease was found in the pressure-time integral during the heel-off phase in the internal and rearfoot edges. Conclusions: The findings suggest that after 45 min of running, a pronated foot tends to change into a more neutral position, and decreased plantar pressures were found after the run.

Is TCC-EZ a Suitable Alternative to Gold Standard Total-Contact Casting?

2021 ◽  
Vol 111 (5) ◽  
Author(s):  
Umangi K. Bhatt ◽  
Hui Ying Foo ◽  
Mahalia P. McEvoy ◽  
Sarah J. Tomlinson ◽  
Cara Westphal ◽  
...  
Keyword(s):  
Gold Standard ◽  
Peak Pressure ◽  
Pressure Reduction ◽  
Reduced Pressure ◽  
Suitable Alternative ◽  
Total Contact Cast ◽  
Plantar Pressures ◽  
Signed Rank ◽  
Significant Difference ◽  
Peak Pressures

Background The total-contact cast (TCC) is the gold standard for off-loading diabetic foot ulcers (DFUs) given its nonremovable nature. However, this modality remains underused in clinical settings due to the time and experience required for appropriate application. The TCC-EZ is an alternative off-loading modality marketed as being nonremovable and having faster and easier application. This study aims to investigate the potential of the TCC-EZ to reduce foot plantar pressures. Methods Twelve healthy participants (six males, six females) were fitted with a removable cast walker, TCC, TCC-EZ, and TCC-EZ with accompanying brace removed. These off-loading modalities were tested against a control. Pedar-X technology measured peak plantar pressures in each condition. Statistical analysis of four regions of the foot (rearfoot, midfoot, forefoot, and hallux) was conducted with Friedman and Wilcoxon signed rank tests. Significance was set at P &lt; .05. Results All of the off-loading conditions significantly reduced pressure compared with the control, except the TCC-EZ without the brace in the hallux region. There was no statistically significant difference between TCC-EZ and TCC peak pressure in any foot region. The TCC-EZ without the brace obtained significantly higher peak pressures than with the brace. The removable cast walker produced similar peak pressure reduction in the midfoot and forefoot but significantly higher peak pressures in the rearfoot and hallux. Conclusions The TCC-EZ is a viable alternative to the TCC. However, removal of the TCC-EZ brace results in minimal plantar pressure reduction, which might limit clinical applications of the TCC-EZ.

CLEAR Cleat: A Proof-of-Concept Trial of an Aerobic Activity Facilitator to Reduce Plantar Forefoot Pressures and Their Potential in Those with Foot Ulcers

2008 ◽  
Vol 98 (4) ◽  
pp. 261-267 ◽  
Author(s):  
Erin E. Klein ◽  
Ryan T. Crews ◽  
Stephanie C. Wu ◽  
James S. Wrobel ◽  
David G. Armstrong
Keyword(s):  
Contact Area ◽  
Peak Pressure ◽  
Proof Of Concept ◽  
Aerobic Activity ◽  
Time Integral ◽  
Plantar Aspect ◽  
Pressure Time ◽  
The Right ◽  
Recumbent Bicycle ◽  
Healthy Participants

Background: Exercise has not been studied extensively in persons with active neuropathic diabetic foot wounds, primarily because a device does not exist that allows patients to exercise while sufficiently off-loading pressure at the ulcer site. The purpose of this project was to demonstrate a device that reduces cycling plantar forefoot pressure. Methods: Ten healthy participants rode a recumbent bicycle under three cycling conditions. While the left foot interaction remained constant with a standard gym shoe and pedal, the right foot was exposed to a control condition with standard gym shoe and pedal, gym shoe and specialized cleat, and gym shoe with an off-loading insole and specialized cleat. Pressure and contact area of the plantar aspect of the feet were recorded for a 10-sec interval once during each minute of each condition’s 7-min trial. Results: The off-loading insole and specialized cleat condition yielded significantly lower (P &lt; .01) peak pressure, contact area, and pressure–time integral values in the forefoot than the specialized cleat condition with gym shoe, which yielded significantly lower values (P &lt; .01) than the standard gym shoe and pedal. Conclusion: Modifications to footwear may alter plantar forefoot pressures, contact area, and pressure–time integrals while cycling. The CLEAR Cleat could play a significant role in the facilitation of fitness in patients with (or at high risk for) neuropathic wounds. (J Am Podiatr Med Assoc 98(4): 261–267, 2008)

scholarly journals Lower limb kinetic comparisons between the chasse step and one step footwork during stroke play in table tennis

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12481
Author(s):  
Yuqi He ◽  
Dong Sun ◽  
Xiaoyi Yang ◽  
Gusztáv Fekete ◽  
Julien S. Baker ◽  
...  
Keyword(s):  
Lower Limb ◽  
Peak Pressure ◽  
Table Tennis ◽  
Time Integral ◽  
Pressure Time ◽  
One Step ◽  
Force Time ◽  
The One ◽  
Plantar Force ◽  
Force Time Integral

Background Biomechanical footwork research during table tennis performance has been the subject of much interest players and exercise scientists. The purpose of this study was to investigate the lower limb kinetic characteristics of the chasse step and one step footwork during stroke play using traditional discrete analysis and one-dimensional statistical parameter mapping. Methods Twelve national level 1 table tennis players (Height: 172 ± 3.80 cm, Weight: 69 ± 6.22 kg, Age: 22 ± 1.66 years, Experience: 11 ± 1.71 year) from Ningbo University volunteered to participate in the study. The kinetic data of the dominant leg during the chasse step and one step backward phase (BP) and forward phase (FP) was recorded by instrumented insole systems and a force platform. Paired sample T tests were used to analyze maximum plantar force, peak pressure of each plantar region, the force time integral and the pressure time integral. For SPM analysis, the plantar force time series curves were marked as a 100% process. A paired-samples T-test in MATLAB was used to analyze differences in plantar force. Results One step produced a greater plantar force than the chasse step during 6.92–11.22% BP (P = 0.039). The chasse step produced a greater plantar force than one step during 53.47–99.01% BP (P < 0.001). During the FP, the chasse step showed a greater plantar force than the one step in 21.06–84.06% (P < 0.001). The one step produced a higher maximum plantar force in the BP (P = 0.032) and a lower maximum plantar force in the FP (P = 0) compared with the chasse step. The one step produced greater peak pressure in the medial rearfoot (P = 0) , lateral rearfoot (P = 0) and lateral forefoot (P = 0.042) regions than the chasse step during BP. In FP, the chasse step showed a greater peak pressure in the Toe (P = 0) than the one step. The one step had a lower force time integral (P = 0) and greater pressure time integral (P = 0) than the chasse step in BP, and the chasse step produced a greater force time integral (P = 0) and pressure time integral (P = 0.001) than the one step in the FP. Conclusion The findings indicate that athletes can enhance plantarflexion function resulting in greater weight transfer, facilitating a greater momentum during the 21.06–84.06% of FP. This is in addition to reducing the load on the dominant leg during landing by utilizing a buffering strategy. Further to this, consideration is needed to enhance the cushioning capacity of the sole heel and the stiffness of the toe area.

Plantar Pressure Measurements and Geometric Analysis of Patients With and Without Morton’s Neuroma

2018 ◽  
Vol 39 (7) ◽  
pp. 829-835 ◽  
Author(s):  
Reza Naraghi ◽  
Linda Slack-Smith ◽  
Alan Bryant
Keyword(s):  
Contact Time ◽  
Time Pressure ◽  
Peak Pressure ◽  
Control Subjects ◽  
Time Integral ◽  
Foot Progression Angle ◽  
Foot Length ◽  
Pressure Time ◽  
Arch Index ◽  
And Control

Background: The purpose of this research was to see if there were any differences in peak pressure, contact time, pressure-time integrals, and geometric variables such as forefoot width, foot length, coefficient of spreading, and arch index between subjects with Morton’s neuroma (MN) and control subjects. Methods: Dynamic peak plantar pressure, contact time, pressure-time integral, and geometric data were extracted using the EMED-X platform in 52 subjects with MN and 31 control subjects. Differences in peak pressure, contact time, pressure-time integral, and geometric data between participants with and those without MN were determined using independent-samples t tests. There were no significant differences in age, weight, height, and body mass index between patients with MN and control subjects. Results: There were no significant differences in the peak pressures of all masked areas and pressure-time integrals under metatarsal 2 to 4 heads between patients with MN and control subjects. In addition, no significant differences were observed between patients with MN and control subjects in geometric measurements of forefoot length, width, coefficient of spreading, foot progression angle, and arch index. Conclusion: No relationship was found in this study between peak pressure, contact time, and pressure-time integral under the metatarsal heads, forefoot width, foot length, coefficient of spreading, and foot progression angle in a symptomatic MN group compared with a control group. The need to perform osteotomies to treat MN not associated with other lesser metatarsal phalangeal joint pathologies is questionable. Level of Evidence: Level III, Case-Control Study

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.

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