Search Results (47)

Introduction: Numerous overuse injuries affecting the lower limbs of elite athletes have been associated with biomechanical alterations in plantar loading of the foot. This study aimed to analyze the plantar pressure distribution in elite male soccer players and its relationship with various morphological and functional factors, including foot type, metatarsal and digital alignment, and on-field position. Material and Method: Dynamic foot pressure measurements were obtained from 21 soccer players who participated in the UEFA Champion League. The participants had an average age of 27 years, with an average height of 180.9 cm, weight of 76.9 kg, and BMI of 23.4. An insole system (BioFoot/IBV) with telemetry transmission was employed to record plantar loading patterns during normal gait and running. Results: During the support or contact phase, the central and medial metatarsal areas exhibited the highest peak pressure under both walking and running conditions. When walking, the right foot exerted 13–60% more pressure on the outer metatarsal and toe areas. The left foot experienced up to 13% more peak pressure in the middle metatarsal area. During running, the total pressure difference between the feet ranged from −8% to +19%. The right foot usually had more peak pressure on the heel and first toe. In players with valgus feet, the pressure in the central metatarsal area increased from 1086 kPa (walking) to 1490 kPa (running), representing a 37% increase. Conversely, in players with cavus-varus feet, the pressure in this central area increased from 877 kPa to 1804 kPa, a 105% increase. Conclusions: Foot morphology and playing position significantly influenced the plantar pressure patterns in elite soccer players. The central metatarsal region bears the highest load, particularly during running, with distinct variations across foot types and field positions. These findings highlight the need for individualized biomechanical assessments to prevent overuse injuries and optimize performance. Full article

Understanding the foot strike pattern (FSP) and impact force of running-related injuries is crucial for athletes and researchers. This study investigated a novel method for detecting FSP using the loadsol^® sensor insole during treadmill running. Twelve collegiate athletes ran at three different speeds (12, 15, and 20 km/h), with their FSP determined using both the kinematic method based on the foot strike angle and the loadsol^® method based on the plantar force applied to the rear-, mid-, and forefoot sensor areas. This study provides significant insights into FSP detection. Comparing the kinematic method to the loadsol^® method, the rearfoot, midfoot, and forefoot strike detection rates were 94.7%, 37.1%, and 81.8%, respectively. Moreover, the FSP was not uniform, even during treadmill running at a constant speed, with most participants exhibiting mixed patterns across different speeds. The loadsol^® sensor insole could offer a promising device for in-field measurement of FSP and impact forces, potentially helping researchers and athletes better understand and predict the potential running-related injury risks by monitoring step-to-step variations in running biomechanics. Full article

Foot plantar pressure refers to the pressure or force that the foot generates in contact with the ground, varying across different regions of the foot. This parameter is essential in static and dynamic analyses to access accurate diagnoses, study the human body biomechanics, create functional footwear designs, aid in rehabilitation and physiotherapy, and prevent injuries in athletes during sports practice. This study presents an experimental comparison between two different plantar pressure measurement devices, Pedar^® (sensorized insoles) and Physiosensing^® (pressure platform). The devices were selected based on their capacity to measure contact area and peak pressure points. Results showed that Physiosensing^® provided a more uniform measurement of the contact area, proving its efficiency for weight distribution and stability analysis applications, particularly in posture assessment and balance studies. The Pedar^® system showed higher capacity in peak pressure point detection. Therefore, the insole system is more suitable for applications requiring precise high-pressure zone localization. Comparative analysis highlights the strengths and limitations of each device and offers insights regarding its optimal usage in clinical, sports, and research settings. Full article

Background/Objectives: The most common limb-salvage procedure for end-stage ankle arthropathy with severe bone defect is arthrodesis. Successful fusion requires rigid metal fixation, effective filling of the bone defect space, and maximal securing of the contact area between the tibia and talus. In cases with severe bone defect, sufficient grafting using autogenous bone alone is limited, and there is still controversy regarding the effectiveness of allogeneic or xenogeneic bone grafting. This study aimed to evaluate the intermediate-term clinical outcomes after shortening arthrodesis using fibular osteotomy for ankle arthropathy with severe bone defect. Methods: Twenty-two patients with shortening ankle arthrodesis were followed up ≥ 3 years. All operations were performed by one senior surgeon and consisted of internal fixation with anterior fusion plate, fibular osteotomy, and autogenous bone grafting. The causes of ankle joint destruction were failed total ankle arthroplasty (7 cases), neglected ankle fracture (6 cases), delayed diagnosis of degenerative arthritis (5 cases), avascular necrosis of talus (2 cases), and diabetic neuroarthropathy (2 cases). Clinical outcomes including daily living and sport activities were evaluated with the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM). Radiological evaluation included fusion rate, time to fusion, leg length discrepancy, and degenerative change in adjacent joints. Results: The FAOS and FAAM scores significantly improved from a mean of 21.8 and 23.5 points preoperatively to 82.2 and 83.4 points at final follow-up, respectively (p < 0.001). Visual analogue scale for pain during walking significantly improved from a mean of 7.7 points preoperatively to 1.4 points at final follow-up (p < 0.001). The average time to complete fusion was 16.2 weeks, and was achieved in all patients. The average difference in leg length compared to the contralateral side was 11.5 mm based on physical examination, and 13.8 mm based on radiological examination. During the average follow-up of 56.2 months, no additional surgery was required due to progression of degenerative arthritis in the adjacent joints, and no cases required the use of height-increasing insoles in daily life. Conclusions: Shortening ankle arthrodesis using fibular osteotomy and anterior fusion plate demonstrated satisfactory intermediate-term clinical outcomes and excellent fusion rate. Advantages of this procedure included rigid fixation, preservation of the subtalar joint, effective filling of the bone defect space, and maximal securing of the contact area for fusion. The leg length discrepancy, which was concerned to be a main shortage, resulted in no significant clinical symptoms or discomfort in most patients. Full article

Background: Defects of the foot and ankle area pose a significant challenge for both patients and surgeons. While the primary objective of microvascular free flap reconstructions of lower leg defects is limb preservation, there should be an effort to obtain the best functional and aesthetic results possible and to restore the patient’s quality of life. The aim of this study was to investigate the long-term post-operative functional outcome, health-related quality of life, scar quality, and aesthetic satisfaction in patients following microsurgical reconstructions of defects of the foot and ankle area. Methods: We conducted a monocentric, controlled cohort study of adult patients who underwent microsurgical reconstructions for defects of the foot and ankle area between 2006 and August 2022 at our department. As a control, we recruited healthy individuals. Patient-Reported Outcome Measures questionnaires were used to assess long-term results regarding functionality (LEFS: Lower Extremity Functional Scale), health-related quality of life (SF-36: Short-Form 36 Health Survey Questionnaire), scar quality (PSAS: Patient Scar Assessment Scale), aesthetic satisfaction (Aesthetic Likert Scale), pain at rest and activity (10-point Numeric Rating Scale) and usage of footwear. Results: Of the 55 potential patients who had received microvascular free flaps for reconstructions of ankle and foot defects and were eligible for study inclusion, 13 (23.6%) agreed to participate in this study. The study cohort consisted of 84.6% male subjects and the mean follow-up period was 8.6 years (±5.2). Significant moderate limitations were observed with regard to physical function of the lower extremity (LEFS: 42.5 ± 20.5, p = 0.002). Significant limitations were found in the SF-36 subscales of pain (55.8 ± 34.5, p = 0.019), physical functioning (55.0 ± 29.7, p = 0.013), and physical role functioning (38.5 ± 44.0, p = 0.006). The study yielded favorable outcomes with regard to aesthetic satisfaction (14.3 ± 4.4) and scar quality (23.5 ± 13.5). Out of all the patients, 61% were required to wear orthopedic shoes or insoles. Conclusions: Patients undergoing microsurgical reconstructions for ankle and foot defects experience moderate long-term physical limitations and persistent pain during activity. Furthermore, we observed a significant long-term impact on specific physical domains of health-related quality of life, whereas mental health seems less affected. Full article

Background/Objectives: Orthoses are commonly used in the treatment of various foot and ankle injuries and deformities. An effective technology in foot orthoses is a vacuum system to improve the fit and function of the orthosis. Recently, a new technology was designed to facilitate the wearing of the foot orthoses while maintaining function without the need for vacuum suction. Methods: A plantar dynamic pressure distribution measurement was carried out in 25 healthy subjects (13 w/12 m, age 23–58 y) using capacitive measuring insoles in two differently designed inlays within the VACOpedes^® orthosis (Group A: vacuum inlay vs. Group B: XELGO^® inlay) and a regular off-the-shelf shoe (Group C, OTS). The peak plantar pressure, mean plantar pressure and maximum force were analyzed in the entire foot and in individual regions of the medial and lateral forefoot, the midfoot and the hindfoot. Finally, the wearing comfort was compared using a visual analog scale from 1 to 10 (highest comfort). Results: The peak pressure of both inlays was significantly lower than in the OTS shoe (A: 230.6 ± 44.6 kPa, B: 218.0 ± 49.7 kPa, C: 278.6 ± 50.5 kPa; p < 0.001). In a sub-analysis of the different regions, the XELGO^® inlay significantly reduced plantar pressure in the medial forefoot compared to the vacuum orthosis (A: 181.7 ± 45.7 kPa, B: 158.6 ± 51.7 kPa, p < 0.002). The wearing comfort was significantly higher with the XELGO^® inlay compared to the vacuum inlay (A: 5.68/10, B: 7.24/10; p < 0.001). Conclusions: The VACOpedes^® orthosis with a new XELGO^® inlay showed at least equivalent relief in all pressure distribution measurements analyzed and greater relief in the forefoot area than the VACOpedes^® orthosis with a vacuum inlay, as well as increased wearing comfort. Full article

Diabetic foot ulcer patients are usually unaware of excessive pressure on their feet due to lost pressure sensitivity. Offloading insoles are used to alleviate foot pain. This study investigated the effect of infill pattern and infill density on plantar pressure reduction for 3D-printed insoles while walking. The study involves five infill patterns: grid, honeycomb, triangle, cubic, and gyroid, along with several infill densities ranging from 14% to 20%. The test 3D-printed thermoplastic polyurethane specimens were assessed for mechanical properties to identify suitable infill patterns for creating prototypes of insoles. The results indicated that the honeycomb infill pattern exhibited the highest maximum compression load at 50% compressive strain and has a significant area under the loading-unloading curve, signifying high energy absorption. Conversely, the gyroid infill pattern exhibited the lowest maximum compression load at 50% compressive strain and minimal energy absorption. Both infill patterns with 20% infill density were applied in 3D-printed insoles and tested on the foot plantar pressure of healthy male volunteers during walking. No statistically significant differences in plantar pressure were observed between the two infill patterns compared to walking without insoles. A reduction in plantar pressure at hindfoot was observed when using the insoles, although this change was not statistically significant. Full article

Monitoring plantar foot temperatures is essential for assessing foot health, particularly in individuals with diabetes at increased risk of complications. Traditional thermographic imaging measures foot temperatures in unshod individuals lying down, which may not reflect thermal characteristics of feet in shod, active, real-world conditions. These controlled settings limit understanding of dynamic foot temperatures during daily activities. Recent advancements in wearable technology, such as insole-based sensors, overcome these limitations by enabling continuous temperature monitoring. This study leverages a data-driven clustering approach, independent of pre-selected foot regions or models like the angiosome concept, to explore normative thermal patterns in shod feet with insole-based sensors. Data were collected from 27 healthy participants using insoles embedded with 21 temperature sensors. The data were analysed using clustering algorithms, including k-means, fuzzy c-means, OPTICS, and hierarchical clustering. The clustering algorithms showed a high degree of similarity, with variations primarily influenced by clustering granularity. Six primary thermal patterns were identified, with the “butterfly pattern” (elevated medial arch temperatures) predominant, representing 51.5% of the dataset, aligning with findings in thermographic studies. Other patterns, like the “medial arch + metatarsal area” pattern, were also observed, highlighting diverse yet consistent thermal distributions. This study shows that while normative thermal patterns observed in thermographic imaging are reflected in insole data, the temperature distribution within the shoe may better represent foot behaviour during everyday activities, particularly when enclosed in a shoe. Unlike thermal imaging, the proposed in-shoe system offers the potential to capture dynamic thermal variations during ambulatory activities, enabling richer insights into foot health in real-world conditions. Full article

This study investigates the benefits of innovative full-contact insoles, crafted using polyester fabric sheets of thermoplastic extruded materials, for individuals with hallux valgus-induced plantar pain. Thirty-five individuals with hallux valgus-induced foot pain were randomly allocated to either the experimental group, wearing innovative full-contact insoles 6 h daily, or the control group, using regular foot insoles, over a period of 12 weeks. Data collection occurred at baseline, and at 1 week, 2 months, and 3 months after the initial fitting. Results indicated that the innovative full-contact insoles significantly reduced anteroposterior displacement by an average of 0.9 cm (p = 0.025) and displacement area by 0.79 cm² (p = 0.012). Gait improvements included an increase in the swing phase (36.46%, p = 0.008) and a reduction in stance phase duration (63.54%, p = 0.019). Pressure peaks at critical foot regions like the second metatarsal and medial heel were reduced by up to 39.45 kPa (p = 0.016) and 104.07 kPa (p = 0.031), while contact areas in the midfoot increased by 6.17 cm² (p = 0.039). Foot pain decreased by an average score of 1.28 points on a 10-point scale across various measures (p = 0.041). These findings suggest that the innovative full-contact insoles effectively enhance pressure distribution and gait dynamics in patients with hallux valgus, providing a viable option for managing foot discomfort. Full article

Diabetic foot complications pose significant health risks, necessitating innovative approaches in orthotic design. This study explores the potential of additive manufacturing in producing functional footwear components with lattice-based structures for diabetic foot orthoses. Five distinct lattice structures (gyroid, diamond, Schwarz P, Split P, and honeycomb) were designed and fabricated using stereolithography (SLA) with varying strand thicknesses and resin types. Mechanical testing revealed that the Schwarz P lattice exhibited superior compressive strength, particularly when fabricated with flexible resin. Porosity analysis demonstrated significant variations across structures, with the gyroid showing the most pronounced changes with increasing mesh thickness. Real-time pressure distribution mapping, achieved through integrated force-sensitive resistors and Arduino-based data acquisition, enabled the visualization of pressure hotspots across the insole. The correlation between lattice properties and pressure distribution was established, allowing for tailored designs that effectively alleviated high-pressure areas. This study demonstrates the feasibility of creating highly personalized orthotic solutions for diabetic patients using additive manufacturing, offering a promising approach to reducing the plantar pressure in foot and may contribute to improved outcomes in diabetic foot care. Full article

Background and Objectives: Patients with diabetes polyneuropathy are at a heightened risk for developing foot ulcers, often due to dynamic plantar foot pressure patterns that lead to increased pressure and shear forces in specific foot areas. This study aimed to evaluate the effects of foot insoles on peak pressure and the pressure–time integral in patients with polyneuropathy diabetic foot ulcers over a twelve-week period followed by an eight-week follow up. Materials and Methods: This was a prospective, randomized, double-blinded, controlled clinical trial involving 60 patients aged between 50 and 65 years of both genders. Inclusion criteria included midfoot ulcer grades II or III, a history of polyneuropathy diabetic foot ulcers lasting between six months and one year, diabetes duration of seven to ten years, glycated hemoglobin levels between 7% and 9%, and a body mass index (BMI) ranging from 25 to 30 kg/m². Participants were randomly assigned to either the study group, which received foot insoles along with medication and wound care, or the control group, which received only medication and wound care. Measurements of peak pressure and pressure–time integrals were taken at the start of this study, after twelve weeks, and again eight weeks post-study. Results: The results indicated significant differences in peak pressure and pressure–time integral measurements for the rearfoot, midfoot, hallux, and both medial and lateral forefoot areas after twelve weeks of using foot insoles compared to the control group. This suggests that the use of foot insoles effectively reduces peak pressure and the pressure–time integral in these critical areas. Conclusions: The findings of this study support the use of foot insoles as a beneficial intervention for decreasing peak pressure and the pressure–time integral on the hallux, medial, and lateral forefoot in patients with polyneuropathic diabetic foot ulcers, and they could play a crucial role in preventing further complications. Full article

Introduction: Diabetic foot ulcers (DFU) are a devastating complication of diabetes. There are numerous challenges with preventing diabetic foot complications and barriers to achieving the care processes suggested in established foot care guidelines. Multi-faceted digital health solutions, which combine multimodal sensing, patient-facing biofeedback, and remote patient monitoring (RPM), show promise in improving our ability to understand, prevent, and manage DFUs. Methods: Patients with a history of diabetic plantar foot ulcers were enrolled in a prospective cohort study and equipped with custom sensory insoles to track plantar pressure, plantar temperature, step count, and adherence data. Sensory insole data enabled patient-facing biofeedback to cue active plantar offloading in response to sustained high plantar pressures, and RPM assessments in response to data trends of concern in plantar pressure, plantar temperature, or sensory insole adherence. Three non-consecutive case participants that ultimately presented with pre-ulcerative lesions (a callus and/or erythematous area on the plantar surface of the foot) during the study were selected for this case series. Results: Across three illustrative patients, continuous plantar pressure monitoring demonstrated promise for empowering both the patient and provider with information for data-driven management of pressure offloading treatments. Conclusion: Multi-faceted digital health solutions can naturally enable and reinforce the integrative foot care guidelines. Multi-modal sensing across multiple physiologic domains supports the monitoring of foot health at various stages along the DFU pathogenesis pathway. Furthermore, digital health solutions equipped with remote patient monitoring unlock new opportunities for personalizing treatments, providing periodic self-care reinforcement, and encouraging patient engagement—key tools for improving patient adherence to their diabetic foot care plan. Full article

The number of people with diabetes is rising day-by-day, which also raises the incidence of diabetic ulcers, sensation loss in the foot’s plantar area, and in extreme instances, amputations. Using customized shoes, unloading orthoses, insoles, and other strategies may help control these issues to some degree. In this work, a novel modular diabetic insole was designed and fabricated to effectively offload the abnormal or peak plantar pressures in diabetic patients. The pressure values in the plantar region were quantified using an in-house-developed plantar pressure-measuring insole consisting of force sensitive resistor (FSR) sensors. The effectiveness of the modular diabetic insole was tested qualitatively and quantitatively. The qualitative performance of the insole was reported using Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) in terms of subjective parameters like comfort, ease of use, effectiveness, etc. and calculated as 4.7 ± 0.18. Thereafter, the wearable pressure-measuring insole was used to investigate the feasibility of modular insole for the plantar pressure offloading during standing and walking conditions. It was observed that the maximum average zonal pressure (AZP) was reduced by up to 99% from 121.30 ± 3.72 kPa to 0.22 ± 0.18 kPa for the standing condition whereas it was reduced to 6.76 ± 2.03 kPa from 197.71 ± 3.21 kPa with a percentage value of 96% for the walking condition. In conclusion, the findings of this work validate the effectiveness of the modular diabetic insole as an intervention tool for diabetic foot ulcer prevention. Full article

This research examines the flexural fatigue response of 3D-printed foot orthoses produced from various thermoplastic polyurethane (TPU) filaments, including Filaflex 60A, Filaflex 70A, Filaflex 82A, PolyFlex 90A, and varioShore. To subject the insoles to repeated flexion in the metatarsophalangeal area, specialized equipment was developed. A real-world testing scenario was applied to the Filaflex 82A insole, demonstrating that it can sustain over 1,400,000 steps over several months of normal walking (a cadence of approximately 120 steps per minute). Consequently, the experimental conditions were adjusted to double this pace to obtain pertinent results within a shorter testing timeframe. The insoles were subjected to 250 cycles per minute at constant clamping pressures of 176 kPa in the forefoot region. The objective of the evaluation was to determine if 700,000 testing cycles, equivalent to more than two and a half months of daily walking, would induce any damages in the internal structure (infill failure) or external condition (delamination, cracks) of the insoles. Except for compression marks, particularly notable on the foamed material (varioShore TPU) within the clamping zones of the testing device, none of the tested insoles exhibited any signs of external damage after 700,000 cycles. Moreover, the deformations observed in the insoles were non-permanent and nearly entirely disappeared within a few days of rest. The only insole that displayed deterioration of the infill structure was a TPU 82A insole that had been previously worn and then left on a shelf for approximately one year in uncontrolled conditions before being tested at repeated flexion on the apparatus. Additionally, a fifteen-minute walking test was carried out to assess the comfort of each insole, and it was found that the varioShore model, which had a 20% infill density and was 3D-printed at a temperature of 220 °C, stood out as the most comfortable among the tested insoles. Full article

In recent years, human activity monitoring and recognition have gained importance in providing valuable information to improve the quality of life. A lack of activity can cause health problems including falling, depression, and decreased mobility. Continuous activity monitoring can be useful to prevent progressive health problems. With this purpose, this study presents a wireless smart insole with four force-sensitive resistors (FSRs) that monitor foot contact states during activities for both indoor and outdoor use. The designed insole is a compact solution and provides walking comfort with a slim and flexible structure. Moreover, the inertial measurement unit (IMU) sensors designed in our previous study were used to collect 3-axis accelerometer and 3-axis gyroscope outputs. Smart insoles were located in the shoe sole for both right and left feet, and two IMU sensors were attached to the thigh area of each leg. The sensor outputs were collected and recorded from forty healthy volunteers for eight different gait-based activities including walking uphill and descending stairs. The obtained datasets were separated into three categories; foot contact states, the combination of acceleration and gyroscope outputs, and a set of all sensor outputs. The dataset for each category was separately fed into deep learning algorithms, namely, convolutional long–short-term memory neural networks. The performance of each neural network for each category type was examined. The results show that the neural network using only foot contact states presents 90.1% accuracy and provides better performance than the combination of acceleration and gyroscope datasets for activity recognition. Moreover, the neural network presents the best results with 93.4% accuracy using a combination of all the data compared with the other two categories. Full article