Search Results (34)

Diabetic foot ulcers (DFUs) are a serious complication of diabetes, associated with high recurrence and amputation rates. Adherence to offloading devices is critical for wound healing but remains inadequately monitored in real-world settings. This study evaluates the SmartBoot edge-computing system—a wearable, real-time remote monitoring solution integrating an inertial measurement unit (Sensoria Core) and smartwatch—for its validity in quantifying cadence and step count as digital biomarkers of frailty, and for detecting adherence. Twelve healthy adults wore two types of removable offloading boots (Össur and Foot Defender) during walking tasks at varied speeds; system outputs were validated against a gold-standard wearable and compared with staff-recorded adherence logs. Additionally, user experience was assessed using the Technology Acceptance Model (TAM) in healthy participants (n = 12) and patients with DFU (n = 81). The SmartBoot demonstrated high accuracy in cadence and step count across conditions (bias < 5.5%), with an adherence detection accuracy of 96% (Össur) and 97% (Foot Defender). TAM results indicated strong user acceptance and perceived ease of use across both cohorts. These findings support the SmartBoot system’s potential as a valid, scalable solution for real-time remote monitoring of adherence and mobility in DFU management. Further clinical validation in ongoing studies involving DFU patients is underway. Full article

With the global increase in women’s participation in running, understanding factors like footwear in performance and injury prevention has become essential. Minimalist shoes (MSs) and traditional shoes (TSs) influence muscle activation patterns, affecting running technique. Proper coordination of the core muscles is essential for efficient stride and posture. This study analyzed muscle activation in nulliparous women running in MSs and TSs at different speeds and explored the correlations with age and BMI. A crossover clinical trial assessed the EMG activation of the lumbar erector (LE), gluteus maximus (GM), pelvic floor, and internal oblique (IO) muscles during treadmill running at 6, 9, and 11 km/h. Fifty-one healthy women (26.55 ± 5.11 years; body mass index (BMI): 21.29 ± 2.07 kg/m²) participated. The protocol included a warm-up, 30 s runs at each speed, and a 5-minute washout between trials. The statistical analyses included Wilcoxon, Friedman, and Spearman’s correlation tests. GM and IO showed the highest activation (p < 0.001) regardless of the footwear or speed. No significant differences were found between MSs and TSs. Weak-to-moderate correlations emerged between BMI and LE muscle activation with MSs, and between BMI and IO with both footwear. Significant correlations were also found with IO activations, but none with PF muscles. The correlations between personal variables, shoe types, and muscle activation suggest that individual and external factors may influence neuromuscular modulation, impacting injury prevention and personalized interventions. 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: Lacing techniques are often viewed as a functional necessity, but recent research has highlighted their role as a customization tool for foot health and comfort. This review synthesizes findings from studies examining the biomechanical effects of different lacing patterns on pressure distribution, tendon loading, and foot mechanics. Methods: We analyzed studies that investigated various lacing techniques, including tightness and patterns. Objective measurements, such as pressure insoles and cadaveric models, were used to quantify the effects. Diverse study populations, including individuals with foot health concerns and athletes, were considered. This study was conducted as a scoping review following the JBI methodology, adhering to the PRISMA-ScR guidelines. Results: The studies collectively reveal that lacing patterns significantly influence dorsal pressure distribution during activities like running. Customized lacing can optimize foot biomechanics, reducing the risk of injuries related to abnormal pressure distribution. A total of 27 records were identified from the initial search. After removing duplicates and screening, four articles were included in the final review. Additionally, certain lacing configurations were found to reduce peak Achilles tendon tension, a crucial finding for injury-prone individuals. Conclusions: Proper lacing techniques are not just a functional aspect but a means to enhance foot health and prevent injuries. Healthcare professionals can provide personalized lacing recommendations to patients, with implications for those with specific foot conditions, athletes, and individuals at risk of injuries. The importance of patient education on the significance of lacing techniques cannot be overstated, emphasizing the need for informed choices when lacing shoes. These findings underscore the multifaceted role of lacing techniques in promoting foot health and well-being. Full article

Medial gastrocnemius silent contractures (MGSCs) are prevalent, notably impacting functional status and increasing the risk of foot and ankle disorders, especially among aging populations. Although traditionally managed by podiatrists and physiotherapists, the role of rehabilitation nursing in addressing MGSCs is gaining recognition. This paper elucidates the contributions of rehabilitation nursing to the functional rehabilitation of MGSC patients and underscores its vital role within the multidisciplinary team. Initially, the paper defines the clinical and physiological characteristics of MGSCs and their implications in foot and ankle disorders. It then meticulously explores rehabilitation nursing interventions—including personalized stretching regimens, vibration therapy, balance exercises, and judicious footwear selection—emphasizing their efficacy in enhancing muscle flexibility, joint mobility, and postural stability. The emphasis is on patient-centered approaches and education to foster treatment adherence and positive rehabilitation outcomes. The significance of interdisciplinary collaboration is highlighted, focusing on how rehabilitation nursing optimizes patient care and mitigates complications. The paper advocates for recognizing and integrating rehabilitation nursing in managing MGSC-related disorders, emphasizing its importance in achieving successful functional outcomes. Full article

Background: Child footwear, both in pathologies and in normal situations, can affect the foot in various ways depending on its characteristics. Below, some features of child footwear are described, and how they can influence the foot, including suitable size, shape and design, flexibility, and transpirable material; inadequate footwear includes situations with flat foot, equine foot, and hammer toes. It is important to highlight that each child is unique and may have different footwear needs. In case of specific pathologies or concerns, it is recommended to consult a specialist in podology or foot medicine for personalized assessment and recommendations. Methods: The present systematic review was conducted in accordance with the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: Children’s footwear must adapt to all stages of children’s growth, starting from when they begin to walk, to promote the correct evolution of their musculoskeletal system. For up to six months, they do not need to wear shoes; socks and similar clothing are enough to warm your feet like a second skin. The flexibility of respectful footwear is essential between six months and three or four years. From that age onwards, the soles can be somewhat thicker, and the buttress can have a certain firmness, but the shoes should remain flexible. Conclusions: Eco-friendly footwear, which typically comes from small businesses and factories, is sometimes described as “ergonomic footwear”. However, there is some reluctance towards this term. When choosing this type of footwear for children, it is important to not just look at the label; rather, one should verify that it meets all the necessary characteristics to be considered respectful. Full article

Background: Adequate compliance with wearing therapeutic footwear (TF) to prevent diabetic foot ulcers is known to be low. The primary aim of this study was to identify population awareness about the ulceration and/or recurrence risk according to footwear choice. The secondary aim was to evaluate the compliance level in footwear choice based on a patient’s own risk. Methods: Forty podiatrists participated from 1 September 2017 to 31 August 2018, providing six-section forms which included personal data, risk classification, footwear characteristics and a knowledge questionnaire. Results: This study included 1507 patients. Those with active ulcers were excluded. A total of 43% of patients belonged to risk class 0, 19% to risk class 1, 19% to risk class 2 and 19% to risk class 3. A total of 58% had foot deformities. Conclusions: Nearly half of patients with a high risk of ulceration had knowledge of their own risk but the majority of them did not follow the recommendations. Only a small percentage (36%) of risk class 3 patients wore footwear suitable for their risk class. There was poor consideration of footwear choice among patients. We highlight critical issues in patient education and compliance with wearing footwear appropriate to their risk class. Full article

This study endeavors to explore the intricate interplay between the fundamental skills of basketball—defensive slide, crossover dribbling, and full approach jump—and the shoe outsole friction coefficient, with the overarching goal of advancing our comprehension regarding the pivotal role of footwear in athlete performance. Employing a comprehensive methodology that integrates 3D motion capture, force platform dynamometry, and biomechanical modeling, the study seeks to quantify the inherent motor control intricacies associated with these fundamental skills. Data collection involved 12 varsity players, and the research systematically assesses the influence of the shoe friction coefficient on both skill quality and injury risk, utilizing a set of 13 parameters for evaluation. The findings unveil that, with an increased friction coefficient, the following changes occur: for the defensive slide, we observed decreased contact time (p < 0.05), boosted medio–lateral impulse (p < 0.05), and lowered ankle torque (p < 0.01); for crossover dribbling, we observed increased anterior–posterior impulse (p < 0.05) and ankle torque (p < 0.05); for the full approach jump, we observed decreased contact time (p < 0.05) and increased jump height (p < 0.05). Generally, the equal increment in the shoe outsole friction coefficient did not result in equal changes in the selected parameters of motor skill control, indicating a non-linear relationship between the performance quality of essential basketball skills and the shoe friction coefficient. The results suggest the potential existence of an optimal value for skill execution. Notably, the study identifies that, while an augmentation in the friction coefficient enhances specific skill aspects, there is a discernible saturation point, signifying diminishing returns. This investigation makes a substantial contribution to our understanding of the precise impacts of shoe friction coefficients on basketball skills, thereby prompting considerations for the judicious selection of optimal friction coefficients and advocating for possible personalized footwear recommendations based on individual biomechanical profiles. Full article

Criminal investigations aiming to track the route walked by missing persons and fugitives (MPFs) usually involve intelligence analysts, military planners, experts in mobile forensics, traditional investigative methods, and sniffer dog handlers. Nonetheless, when MPFs are devoid of any technological device and move in uninhabited rural areas devoid of tele cameras and densely covered by vegetation, tracking the route walked by MPFs may be a much more arduous task. In the XVIII century, the expert Georg Popp was able to link a homicide suspect to a sequence of different sites of criminal interest, located in the countryside, by studying the stains of soils found on the footwear and trousers of the suspect. In such complex cases, a very efficient approach for tracking the route walked by MPFs may consist of comparing the geological traces found on the MPFs and their belongings with soils exposed in the event scenes. In particular, the search for peculiar or rare particles and aggregates may strengthen the weight of the geological forensic evidence comparisons. A match of mineralogical, textural, and organic matter data may demonstrate the provenance of the traces from the soil of a specific site, thereby linking the MPFs to the scene of events. Based on the above, the present paper reports geological determinations accomplished for a “mediatic” casework. The results allowed a general high degree of compatibility among traces collected on the MPFs and on the soil from the scene of events to be ascertained. The most significant positive matches, based on the finding of ten peculiar and rare particles and assemblages, allowed the reconstruction of a route about 1.1 km long, as the crow flies, on the event site. Although this procedure was extremely time consuming and available only in a backwards reconstruction linked to the MPFs’ findings, it was of uttermost importance in strengthening the inferences proposed, and for which other methods could not provide any information. Full article

Firefighters are regularly exposed to risk of injuries as a result of their intervention activities connected with hazards from fire and explosion, as well as due to carrying heavy personal working equipment and injured victims from accidents. Another hazardous factor is working under unfavorable weather conditions and also moving on slippery or bumpy surfaces. Employers provide personal protective work equipment to employees if a hazard cannot be eliminated or reduced by technical means, such as means of collective protection or methods and forms of work organization. Personal Protective Equipment (PPE) should provide effective protection against existing and foreseeable hazards and should not in itself create a greater risk. It should be adapted to the existing and predictable working conditions and working environment at the work site, meet the criteria of ergonomics and the health condition of an employee as well as be suitable and adapted to the wearer’s body so that, if possible, there is no risk of harm to the employee’s health. The aim of this Special Issue is to explore the limits of sustainable implementation of additive technologies within current manufacturing practices and current requirements for personal protective equipment for firefighters. More precisely, the goal of this special article is to show new ideas in firefighting footwear such as a quick donning and doffing system as well as various other improvements and sustainable design of firefighting footwear. The aim is to present new ideas and concepts, the latest advances, and technical tools supporting the sustainable use of protective firefighting footwear. Special attention will be paid to standards that ensure the highest standard and quality. Full article

Administrative data can be precious in connecting information from different sectors. For the first time, we used data from the National Social Insurance Agency (INPS) to investigate the association between the occupational sectors and both non-accidental and accidental mortality. We retrieved information on occupational sectors from 1974 to 2011 for private sector workers included in the 2011 census cohort of Rome. We classified the occupational sectors into 25 categories and analyzed occupational exposure as ever/never have been employed in a sector or as the lifetime prevalent sector. We followed the subjects from the census reference day (9 October 2011) to 31 December 2019. We calculated age-standardized mortality rates for each occupational sector, separately in men and women. We used Cox regression to investigate the association between the occupational sectors and mortality, producing hazard ratios (HRs) and 95% confidence intervals (95%CI). We analyzed 910,559 30+-year-olds (53% males) followed for 7 million person-years. During the follow-up, 59,200 and 2560 died for non-accidental and accidental causes, respectively. Several occupational sectors showed high mortality risks in men in age-adjusted models: food and tobacco production with HR = 1.16 (95%CI: 1.09–8.22), metal processing (HR = 1.66, 95%CI: 1.21–11.8), footwear and wood (HR = 1.19, 95%CI: 1.11–1.28), construction (HR = 1.15, 95%CI: 1.12–1.18), hotels, camping, bars, and restaurants (HR = 1.16, 95%CI: 1.11–1.21) and cleaning (HR = 1.42, 95%CI: 1.33–1.52). In women, the sectors that showed higher mortality than the others were hotels, camping, bars, and restaurants (HR = 1.17, 95%CI: 1.10–1.25) and cleaning services (HR = 1.23, 95%CI: 1.17–1.30). Metal processing and construction sectors showed elevated accidental mortality risks in men. Social Insurance Agency data have the potential to characterize high-risk sectors and identify susceptible groups in the population. Full article

Walking gait data acquired with force platforms may be used for person re-identification (re-ID) in various authentication, surveillance, and forensics applications. Current force platform-based re-ID systems classify a fixed set of identities (IDs), which presents a problem when IDs are added or removed from the database. We formulated force platform-based re-ID as a deep metric learning (DML) task, whereby a deep neural network learns a feature representation that can be compared between inputs using a distance metric. The force platform dataset used in this study is one of the largest and the most comprehensive of its kind, containing 193 IDs with significant variations in clothing, footwear, walking speed, and time between trials. Several DML model architectures were evaluated in a challenging setting where none of the IDs were seen during training (i.e., zero-shot re-ID) and there was only one prior sample per ID to compare with each query sample. The best architecture was 85% accurate in this setting, though an analysis of changes in walking speed and footwear between measurement instances revealed that accuracy was 28% higher on same-speed, same-footwear comparisons, compared to cross-speed, cross-footwear comparisons. These results demonstrate the potential of DML algorithms for zero-shot re-ID using force platform data, and highlight challenging cases. Full article

Using insoles to modify walking biomechanics is of keen interest for the treatment of medial-compartment knee osteoarthritis. So far, insole interventions have focused on reducing the peak of the knee adduction moment (pKAM) and have led to inconsistent clinical outcomes. This study aimed to evaluate the changes in other gait variables related to knee osteoarthritis when patients walk with different insoles to provide insights into the necessity to enlarge the biomechanical analyses to other variables. Walking trials were recorded for 10 patients in four insole conditions. Changes among conditions were computed for six gait variables, including the pKAM. The associations between the changes in pKAM and the changes in the other variables were also assessed individually. Walking with different insoles had noticeable effects on the six gait variables, with high heterogeneity among patients. For all variables, at least 36.67% of the changes were of medium-to-large effect size. The associations with the changes in pKAM varied among variables and patients. In conclusion, this study showed that varying the insole could globally influence ambulatory biomechanics and that limiting measurement to the pKAM could lead to an important loss of information. Beyond the consideration of additional gait variables, this study also encourages personalized interventions to address inter-patient variability. Full article

In this study, the possibility of using modern AM technologies to produce designed heels for personalized orthopedic footwear with a medium heel was explored. Seven variants of heels were produced using three 3D printing methods and polymeric materials with different natures: PA12 heels made using the SLS method, photopolymer heels made using the SLA method, and PLA, TPC, ABS, PETG, and PA (NYLON) heels made using the FDM method. A theoretical simulation with forces of 1000 N, 2000 N, and 3000 N was performed in order to evaluate possible human weight loads and possible pressure during orthopedic shoe production. The compression test of the 3D-printed prototypes of the designed heels showed that it is possible to replace the traditional wooden heels of hand-made personalized orthopedic footwear with good-quality PA12 and photopolymer heels made using the SLS and SLA methods, but also with PLA, ABS, and PA (NYLON) heels printed using a cheaper FDM 3D printing method. All of the heels made using these variants withstood loads of more than 15,000 N without damage. It was determined that TPC is not suitable for a product of this design and purpose. Due to its greater brittleness, the possibility of using PETG for orthopedic shoe heels must be verified by additional experiments. Full article

Foot ulcers are amongst the most serious complications of diabetes. Guidelines recommend that people with diabetes wear appropriate footwear or insoles to reduce repetitive stresses. Excessive plantar pressure has been recognized as the major risk factor for plantar ulcers in diabetic individuals; custom insoles are indicated as the gold standard treatment to unload the foot structure. The aim of this study was to investigate the effect of custom insoles on biomechanical and neuromuscular functions in diabetic neuropathic individuals. Ten diabetic subjects walked with and without custom insoles at their preferred speed; ten controls were assessed for comparison. Data were captured through seven video cameras, plantar pressure insoles, and surface electromyography. The electrical activity of Rectus Femoris, Tibialis Anterior, Medius Gluteus and Gastrocnemius Lateralis were acquired bilaterally. The plantar pressure and surface electromyographic variables were determined, while videos were used to detect the gait cycle. The following comparisons were made across the variables through the non-parametric SPM1D test (p < 0.05): condition with vs. without insoles vs. controls. Custom insoles provided a reduction in plantar pressure through contact surface redistribution in association with a reduced electromyographic activity. Our results suggest optimizing the prevention approach by including personalized foot and ankle exercises. Full article