A Review of the Plantar Pressure Distribution Effects from Insole Materials and at Different Walking Speeds

Among people with diabetes mellitus (DM), the two common strategies for decreasing peak plantar pressure (PPP) to reduce diabetic foot ulcers (DFUs) risks are to modify walking speeds and to change insole materials. This study reviewed the PPP reduction based on various walking speeds and insole materials. The articles were retrieved from four major scientific databases and manual search. We identified 1585 articles, of which 27 articles were selected for full-text analysis. We found that in faster walking speeds, the forefoot PPP was higher (308 kPa) than midfoot (150 kPa) and rearfoot (251 kPa) PPP. The appropriate walking speed for reducing the forefoot PPP was about 6 km/h for non-DM and 4 km/h for DM people. The forefoot PPP in DM people was 185% higher than that of non-DM people. Ethylene–vinyl acetate (EVA) insole material was the most popular material used by experts (26%) in the forefoot and reduced 37% of PPP. In conclusion, the suitable walking speed for DM was slower than for non-DM people, and EVA was the most common insole material used to decrease the PPP under the forefoot. The clinicians might recommend DM people to walk at 4 km/h and wear EVA insole material to minimize the DFUs.

Comparison of Plantar Force, Pressure and Impulse During Walking in Men and Women With Flat Feet

Objective: This study aims to compare the variables of plantar force, pressure and impulse during walking in men and women with flat feet. Methods: The study population consists of non-athlete students with and without flat feet. Of these, 48 (male and female) were selected as study samples. The peak pressure, force and impulse on the foot were measured during walking by a foot scanner at a sampling frequency of 253 Hz. Shapiro-Wilks test was used to examine the normality of data distribution, and data analysis was performed using MANOVA in SPSS software, considering the significance level at P<0.05. Results: Men with flat feet had more peak plantar pressure and force in the midfoot than healthy men, and more peak plantar pressure on the hallux. Women with flat feet had more peak plantar pressure and force on the hallux, toes T2-T3-T4-T5, M2 metatarsal head, and midfoot than healthy women. Men with flat feet had peak plantar pressure on the M4 metatarsal head than women with flat feet. Men with flat feet had different plantar impulses in the hallux, M2 metatarsal head, and lateral heal. Women with flat feet had more plantar impulses in the hallux, toes T2-T3-T4-T5, and midfoot than healthy women. There was a significant difference between men and women with flat feet in plantar impulses in metatarsal heads M3 and M4, midfoot, and lateral and medial heels Conclusion: Different effects of gender and sole structure on the distribution of plantar pressure should be considered in the production and design of shoes, medical insoles and special sports footwear.

Finite Element Approach Towards Selection of Appropriate Materials to Redistribute Peak Plantar Pressure in Diabetic Foot with Neuropathy

Objective: The aim of this study was to assess the effect of customized insole (CMI) variations on plantar pressure in diabetic foot with neuropathy, using finite element analysis (FEA). Material and Methods: A three-dimensional foot model was constructed using FEA to study the peak contact pressure between the foot and the CMI. Nora® Lunalastike, Ethylene Vinyl Acetate (EVA), Amfit® and TPU were chosen for insole materials; and from these eight CMI models were created. The top surface of the tibia and fibula were fixed, and a displacement of 3 mm was exerted from the ground along with upwards Achilles tendon force.Results: The peak contact pressure contour showed that a softer material, CMI-A (E = 1.04 MPa), resulted in a better reduction of peak contact pressure compared to a stiffer material; CMI-D (E = 11 MPa). In addition, it was shown that the use of a single material to fabricate the CMI resulted in higher peak contact pressure; with the exception of CMI-A, in comparison to a dual-layer material of CMI-E and CMI-F. Using FEA, can effectively enhance the insole material selection process, without need of a trial and error practice in a clinical setting.Conclusion: The use of dual materials to fabricate CMIs, with the softer material as a top layer, is beneficial compared to a stiffer top layer material in the reduction of peak plantar pressure for diabetic foot with neuropathy.

Analysis of Plantar Pressure Pattern after Metatarsal Head Resection. Can Plantar Pressure Predict Diabetic Foot Reulceration?

To evaluate the metatarsal head that was associated with the highest plantar pressure after metatarsal head resection (MHR) and the relations with reulceration at one year, a prospective was conducted with a total of sixty-five patients with diabetes who suffered from the first MHR and with an inactive ulcer at the moment of inclusion. Peak plantar pressure and pressure time integral were recorded at five specific locations in the forefoot: first, second, third, fourth, and fifth metatarsal heads. The highest value of the four remaining metatarsals was selected. After resection of the first metatarsal head, there is a displacement of the pressure beneath the second metatarsal head (p < 0.001). Following the resection of the minor metatarsal bones, there was a medial displacement of the plantar pressure. In this way, plantar pressure was displaced under the first metatarsal head following resection of the second or third head (p = 0.001) and under the central heads after resection of the fourth or fifth metatarsal head (p < 0.009 and p < 0.001 respectively). During the one-year follow-up, patients who underwent a metatarsal head resection in the first and second metatarsal heads suffered transfer lesion in the location with the highest pressure. Patients who underwent a minor metatarsal head resection (second–fifth metatarsal heads) showed a medial transference of pressure. Additionally, following the resection of the first metatarsal head there was a transference of pressure beneath the second metatarsal head. Increase of pressure was found to be a predictor of reulceration in cases of resection of the first and second metatarsal heads.

CORRELATIONS BETWEEN PLANTAR PRESSURE AND JOINT KINEMATICS IN FEMALE RECREATIONAL RUNNERS

performed simultaneous assessments of plantar pressure and joint kinematics; however, they have not investigated correlations between these parameters. The goal of this study was to assess relationships between joint kinematics and plantar pressure metrics during stance phase of running. Fifteen female recreational runners participated in this study. Three-dimensional motion analysis and plantar pressure data were collected simultaneously as the subjects ran on an instrumented treadmill. Participants ran at a self-selected speed while maintaining a heart rate (HR) at 70-80% of their maximum HR (max HR = 220 – age). Sagittal and coronal plane motion of the ankle and hip and sagittal plane motion of the knee, along with peak plantar pressure, peak ground reaction force (GRF), force impulse, and pressure impulse were examined. Spearman rho correlation tests were performed to determine correlations among lower extremity joint kinematics and plantar pressure metrics. Positive correlations were found between peak plantar pressure and ankle dorsiflexion, knee flexion, and ankle inversion as well as between running speed and peak GRF. These correlations gave insight into risk factors for injury based on the relationship between plantar pressure metrics and joint kinematics.

Validation of Plantar Pressure and Reaction Force Measured by Moticon Pressure Sensor Insoles on a Concept2 Rowing Ergometer

The purpose of this study was to determine the reliability and validity of plantar pressure and reaction force measured using the Moticon and Pedar-x sensor insoles while rowing on a Concept2 ergometer. Nineteen participants performed four 500 m trials of ergometer rowing at 22–24 strokes/min; two trials wearing Moticon insoles and two wearing Pedar-x insoles in a randomised order. Moticon and Pedar-x insoles both showed moderate to strong test–retest reliability (ICC = 0.57–0.92) for mean and peak plantar pressure and reaction force. Paired t-test demonstrated a significant difference (p < 0.001) between Moticon and Pedar-x insoles, effect size showed a large bias (ES > 1.13), and Pearson’s correlation (r < 0.37) showed poor agreement for all plantar pressure and reaction force variables. Compared to Pedar-x, the Moticon insoles demonstrated poor validity, however, the Moticon insoles had strong reliability. Due to poor validity, caution should be used when considering Moticon insoles to assess changes in pressure and force reliably over time, across multiple trials or sessions. Moticon’s wireless and user-friendly application would be beneficial for assessing and monitoring biomechanical parameters in rowing if validity between measures of interest and Moticon’s results can be established.

Peak Plantar Pressure as a Risk Factor for Lower Extremity Overuse Injury Among Infantry Soldiers

The majority of reported injuries among military populations are injuries due to cumulative repetitive microtrauma — overuse injuries. Plantar pressure measurement is a simple tool to analyse lower limb biomechanics through the assessment of forces applied to the foot. This study aimed to determine the relation between peak plantar pressure and lower extremity overuse. Sixty-six active-duty infantry male soldiers, with mean age 29.7 years (range 22–40 years), and mean service time 5.2 years (range 1–15 years) participated. The highest peak plantar pressure (PPP) at the forefoot occurred at the hallux (cases: 50.82 n/cm2, SD = 38.84; control: 34.39 n/cm2, SD= 28.03) and 3rd metatarsal head (cases: 54.40 n/cm2, SD = 33.83; control: 49.16 n/cm2, SD=28.87). The study demonstrated elevated PPP among cases. Statistically significant results were found at the hallux (χ2(1) = 6.8; p = 0.01), medial heel (χ2(1) = 5.18; p = 0.02) and lateral heel (χ2(1) = 12.12; p < 0.01) regions. The results show that plantar pressure assessment could be used as a useful screening tool for early lower extremity overuse injury detection.

Acute effects of a walking activity on plantar pressure in children with obesity

abstract Children with obesity present greater foot loads during walking when compared to eutrophic ones. However, the acute effects of a moderate walking on the distribution of plantar pressure in children with obesity are still incipient in the literature. Our aim was to verify the acute effects of six-minute walk test on plantar pressure in obese and eutrophic children. A pressure platform was used to record plantar pressure during walking for 62 children (37 girls), aged 7-10 years old, before and after the six-minute walk test. Children were divided into an obese group - OB (n = 20), and an eutrophic group - EU (n = 42). Peak plantar pressure (PPP), maximum force (MF), and contact area (CA) were assessed in three trials during walking at a comfortable speed. The analyses were performed in five plantar regions: rearfoot, midfoot, forefoot, hallux, and toes. For the PPP was higher under the midfoot region of the OB group after walking. In the comparison between groups, PPP, MF, and CA were higher for the OB group for most regions. We concluded that, after a moderate walking activity, children with obesity experience an increase in plantar loads, especially under the midfoot, which can bring greater discomfort and risk of injuries.

Baropodometric profile of patients assisted in a physiotherapy clinic

Background: Computerized baropodometry, a posturographic recording technique used in the diagnosis and assessment of plantar pressure, which records the pressure points exerted by the body on the plantar surface, is an accurate, objective and quantitative examination. Its record is used in the diagnosis and evaluation of plantar pressure, both in static and dynamic positions. Objective: Analyze the baropodometric profile of patients in a physiotherapy clinic. Methods: A cross-sectional study of documentary character of baropodometry exams registered in the database of a physiotherapy clinic in Teresina (PI), carried out from January 2015 to December 2018. Totaling 193 exams, which include the types of feet, peak plantar pressure and correlation between peak plantar pressure with age, weight, height and BMI. The collected data were analyzed statistically by the software Win Track version 12.0, and presented through tables and figures. In this research, all ethical precepts were carried out in accordance with the resolution of the National Health Council and was approved by the ethics committee. Results: There was a higher prevalence of hollow feet (96.89%), showing a greater occurrence of displacement of the center of gravity posteriorly to the right (46.11%), it was found that there was no satisfactory correlation of anthropometric parameters with peak plantar pressure (p>0.05). Conclusion: It was possible to observe that the examinations evaluated showed a higher prevalence of hollow feet and center of gravity posteriorized to the right. In addition, there was no satisfactory correlation between peak plantar pressure with the variables age, weight, height and BMI.