Search Results (29)

Objectives: This study examined whether moving tactile stimuli applied to the soles along the anterior–posterior (AP) and medial–lateral (ML) axes induce body sway during quiet stance. Methods: Fifteen healthy participants in quiet stance received plantar moving tactile stimuli along the AP or ML axis under occluded and unoccluded vision conditions. Results: The center of pressure (COP) along the ML axis was dependent on the phase of moving tactile stimuli along the ML axis under occluded vision condition. The direction of body sway was opposite to the stimulus loci. The total COP displacement during moving tactile stimuli along the AP axis was larger than that without stimuli, particularly under occluded vision conditions. Discussion: Humans likely perceive body sway towards the stimulated side. Based on this, when humans perceive body sway along the ML axis, they compensate for it by swaying the body in the direction contralateral to the stimulated side. Body sway along the ML axis, in accordance with the plantar loci receiving input of moving tactile sensation along the same axis, becomes apparent under occluded vision condition. Through intermodal reweighting, the contribution of tactile sensation to the control of body sway along the AP axis increases to compensate for the lack of visual input regulating body sway along this axis. Full article

Introduction: Recurrent ankle sprains can lead to chronic ankle instability. The flossing technique aims to modify the function and characteristics of fascial tissue. The objective was to evaluate the effectiveness of flossing and sliding techniques in improving subjects with previous ankle sprains. Methods: Randomized, double-blind clinical study with a follow-up period. Twenty-six subjects were assigned to two study groups: experimental (flossing technique and passive manual therapy techniques) and placebo control group (flossing technique without compression and manual therapy techniques without sliding). The intervention lasted three weeks, with two sessions per week. The study variables were dorsiflexion under load (Leg Motion^®), ankle mobility under unloaded conditions (goniometer), pressure pain threshold (algometer), and stability (Rs Scan^® pressure platform). Three measurements were taken: pre-treatment (T0), post-treatment (T1), and after 3 weeks of follow-up (T2). Results: There were significant intergroup differences in dorsiflexion under load (F = 4.90; p = 0.02). Range of motion in plantar flexion without load (F = 3.78; p = 0.04), in the ellipse area (F = 4.72; p = 0.01), left stability (F = 3.74; p = 0.03), and right stability (F = 3.73; p = 0.03) without visual support. Conclusions: A physiotherapy protocol using flossing and manual sliding therapy can increase loaded dorsal flexion in young adults with previous ankle sprains. This intervention can also improve ankle plantar flexion under unloaded conditions. The area of the ellipse without visual support can improve in young adults with a history of ankle sprains following a program of flossing and manual therapy. Full article

Accurately distinguishing hemiplegic gait from healthy gait is significant for alleviating clinicians’ diagnostic workloads and enhancing rehabilitation efficiency. The center of pressure (CoP) trajectory extracted from pressure sensor arrays can be utilized for hemiplegic gait recognition. Existing research studies on hemiplegic gait recognition based on plantar pressure have paid limited attention to the differences in recognition performance offered by CoP trajectories along different directions. To address this, this paper proposes a neural network model based on time–frequency domain feature interaction—the temporal–frequency domain interaction network (TFDI-Net)—to achieve efficient hemiplegic gait recognition. The work encompasses: (1) collecting CoP trajectory data using a pressure sensor array from 19 hemiplegic patients and 29 healthy subjects; (2) designing and implementing the TFDI-Net architecture, which extracts frequency domain features of the CoP trajectory via fast Fourier transform (FFT) and interacts or fuses them with time domain features to construct a discriminative joint representation; (3) conducting five-fold cross-validation comparisons with traditional machine learning methods and deep learning methods. Intra-fold data augmentation was performed by adding Gaussian noise to each training fold during partitioning. Box plots were employed to visualize and analyze the performance metrics of different models across test folds, revealing their stability and advantages. The results demonstrate that the proposed TFDI-Net outperforms traditional machine learning models, achieving improvements of 2.89% in recognition rate, 4.6% in F1-score, and 8.25% in recall. 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

Background: Wrist immobilization is a common clinical intervention for wrist injuries; however, its repercussions on gait parameters and plantar support have not been extensively investigated. Objectives: The purpose of the study was to determine whether wrist immobilization causes alterations in foot pressure and center of gravity, considering hand dominance and visual conditions (eyes open or closed). Methods: The research experiment was conducted using the PodoPrint S4 platform. Basic descriptive statistics were calculated to summarize the variables. Additionally, in the mixed linear model (t-tests use Satterthwaite’s method) an analysis of variance for repeated measures (ANOVA-RM) was conducted for the determination of the objectives of the study. Results: This study included a total of 44 participants (29 females and 15 males), with an average age of 36.5 years (SD = 17.5). Immobilization, independent of eye condition, resulted in significant alterations in antero-posterior oscillation and in a larger plantar support area. In addition, the results suggest that the eye state significantly influences plantar support, independent of limb immobilization or dominance. Conclusions: Our findings reveal significant alterations in antero-posterior oscillation and plantar support due to immobilization, suggesting a dynamic interplay between wrist function and lower limb biomechanics. Full article

The plantar surfaces of the feet are important for balance control during walking, specifically by allowing for the perception of pressure movements during stance. Background/Objectives: The current study aimed to perturb CoP movement perception in healthy individuals by applying vibrations to the soles of the feet in different stimulation sequences: a natural pattern that followed CoP movement (gait-like) and a perturbing pattern that did not follow the CoP (random) during walking. We hypothesized that the gait-like stimulation sequence would be similar to walking without any stimulation and therefore have no effect on balance measures and that the random sequence would negatively affect balance measures such as the anteroposterior (AP) and mediolateral (ML) margins of stability (MoSs) and foot placement area. Methods: Subjects walked at a level angle and 5.0 and 8.0 degrees of incline and with low visual conditions to increase reliance on tactile sensations from the feet. Results: No significant effect of the stimulation sequence was found at any incline, while there was a significant effect of incline. As the incline increased from level to 5 deg, subjects reduced their AP MoS measured at heel strikes from 4.36 ± 0.56 cm to 1.95 ± 1.07 cm and increased their foot placement area from 24.04 ± 11.13 cm² to 38.98 ± 17.47 cm². However, the AP MoS measured at midstance did not significantly change as the incline increased. Conclusions: The stimulation sequence had no effect on the dependent measures, but the subjects could still feel the vibrations on the plantar surfaces during walking; this implies that similar stimulation techniques could be a useful method for applying directive biofeedback without negatively impacting gait. Overall, this study demonstrates the detailed control of our tactile system and the adaptability of healthy individuals while walking with a perturbing stimulation. 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: Patellofemoral pain (PFP) significantly affects patients’ daily activities and consequently reduces their quality of life. Custom-made foot orthoses (FOs) are a common method of medical treatment that positively influences biomechanical factors such as the kinematics of the lower extremity and reduces pain perception in patients. However, there is a gap in research regarding the influence of different FO treatments on knee pain. Therefore, this study addresses the impact of biomechanical foot orthoses (BMFOs) and sensorimotor foot orthoses (SMFOs) on patients with foot deformity and PFP. Methods: A total of 26 participants (9 men, 17 women; 27.7 ± 10.7 years; 175.0 ± 0.1 cm; 75.7 ± 18.8 kg; BMI: 24.7 ± 5.6) took part in this randomized controlled clinical trial. In the pre-test, knee pain was evaluated using the Kujala Anterior Knee Pain Scale after the physician’s anamnesis and plantar pressure measurement. A 3-month intervention with SMFO and BMFO was performed, and weekly development was evaluated using 11-item visual analog scales (VASs). Repeated measures analyses of variance were used to assess differences between time of measurements (ToMs) and the interaction effect between ToMs and treatment groups (SMFO, BMFO). Results: Statistical analysis revealed no statistically significant interaction between ToMs and treatment groups but a significant main effect on Kujala anterior knee pain scores (M_Diff = 10.189; p = 0.014) and 12-week VAS (p = 0.001). Conclusions: The findings indicate that both treatment approaches effectively alleviated perceived knee pain in the PFP sample with foot deformity, with neither approach demonstrating superior efficacy. This trial was registered in the WHO International Clinical Trials Registry Platform (ICTRP) and German Clinical Trials Register (DRKS00035082). Full article

Diabetic foot complications constitute a large and rapidly growing global health problem, causing one million lower-extremity amputations annually. These amputations are typically preceded by preventable diabetic foot ulcers (DFUs). However, 80% of the world’s diabetics now reside in low- and middle-income countries, where many healthcare settings lack the resources required to implement recommended DFU risk assessment and prevention strategies. There is an unmet need for a more resource-efficient DFU risk assessment method. In this study, a low-cost, purely mechanical plantar pressure evaluation device was designed toward this end. The device consists of a grid of plastic bistable compliant mechanisms, which present a visual series of binary outputs in response to applied pressure. By having diabetic patients step on the device, non-specialist healthcare providers can easily assess patients’ plantar pressures, which are predictive of future DFUs. A prototype was fabricated and pilot-tested with 41 healthy subjects. It demonstrated a sensitivity of 25.6%, although sensitivity reached 60% for heavier subjects. Sensitivity could likely be significantly improved by lowering the device’s profile and increasing the sensing area. Strained health systems may then be able to use this device to allocate scarce healthcare resources more efficiently to prevent costly DFUs and amputations. Full article

Background: Metatarsalgia is a common pathology that is initially treated conservatively, but failure to do so requires surgery, such as the minimally invasive distal metatarsal osteotomy (DICMO). Methods: In this prospective study of 65 patients with primary metatarsalgia who underwent DICMO, plantar pressures, American Orthopaedic Foot and Ankle Society MetaTarsoPhalangeal-InterPhalangeal scale (AOFAS-MTP-IP) and Visual Analog Scale (VAS) were evaluated pre-operatively and post-operatively and there was a subgroup in which an inclinometer was used to observe the importance of the inclination of the osteotomy. Results: The results show a significant reduction in plantar pressures after DICMO surgery without overloading the adjacent radii, especially in the subgroup with an inclinometer to guide the osteotomy. The AOFAS-MTP-IP scale evidenced a marked improvement in metatarsal function and alignment with scores close to normal. The VAS scale showed a substantial decrease in pain after DICMO osteotomy. Conclusions: DICMO, with an inclinometer for a 45° osteotomy, proved to be a safe and effective procedure for primary metatarsalgia, although further comparative studies are needed to confirm its superiority. Full article

(1) Background: Occupational fatigue is a primary factor leading to work-related musculoskeletal disorders (WRMSDs). Kinematic and kinetic experimental studies have been able to identify indicators of WRMSD, but research addressing real-world workplace scenarios is lacking. Hence, the authors of this study aimed to assess the influence of physical strain on the Borg CR-10 body map, ergonomic risk scores, and foot pressure in a real-world setting. (2) Methods: Twenty-four participants (seventeen men and seven women) were included in this field study. Inertial measurement units (IMUs) (n = 24) and in-shoe plantar pressure measurements (n = 18) captured the workload of production and office workers at the beginning of their work shift and three hours later, working without any break. In addition to the two 12 min motion capture processes, a Borg CR-10 body map and fatigue visual analog scale (VAS) were applied twice. Kinematic and kinetic data were processed using MATLAB and SPSS software, resulting in scores representing the relative distribution of the Rapid Upper Limb Assessment (RULA) and Computer-Assisted Recording and Long-Term Analysis of Musculoskeletal Load (CUELA), and in-shoe plantar pressure. (3) Results: Significant differences were observed between the two measurement times of physical exertion and fatigue, but not for ergonomic risk scores. Contrary to the hypothesis of the authors, there were no significant differences between the in-shoe plantar pressures. Significant differences were observed between the dominant and non-dominant sides for all kinetic variables. (4) Conclusions: The posture scores of RULA and CUELA and in-shoe plantar pressure side differences were a valuable basis for adapting one-sided requirements in the work process of the workers. Traditional observational methods must be adapted more sensitively to detect kinematic deviations at work. The results of this field study enhance our knowledge about the use and benefits of sensors for ergonomic risk assessments and interventions. Full article

Step length asymmetry is a characteristic feature of gait in post-stroke patients. A novel anterioposterior weight-shift training method with visual biofeedback (AP training) was developed to improve the forward progression of the trunk. This study aimed to investigate the effect of AP training on gait asymmetries, patterns, and gait-related function in subacute stroke patients. Forty-six subacute stroke patients were randomly assigned to the AP training group or the control group. The AP training group received conventional gait training and AP training five times per week for 4 weeks. The control group received the same intensity of conventional gait training with patient education for self-anterior weight shifting. Plantar pressure analysis, gait analysis, energy consumption, and gait-related behavioral parameters were assessed before and after training. The AP training group showed significant improvement in step length asymmetry, forefoot contact area and pressure, Berg balance scale score, and Fugl-Meyer assessment scale of lower extremity score compared to the control group (p < 0.05). However, there was no significant between-group difference with respect to energy cost and kinetic and kinematic gait parameters. In conclusion, AP training may help improve the asymmetric step length in stroke patients, and also improve anterior weight shifting, balance, and motor function in subacute stroke survivors. Full article

This study aims to compare the effect of corticosteroid injection (CSI) followed by therapeutic ultrasound (TUS) with that of extracorporeal shock wave therapy (ESWT) in patients with chronic plantar fasciitis (PF) and to explore the impact of a sedentary lifestyle and obesity on treatment outcomes. Female patients with PF were randomly allocated to receive ESWT (group A, n = 25) or CSI + TUS (group B, n = 25). Interventions: Group A received four once-weekly sessions of ESWT (2000 shocks, 2.5 bar pressure, 10.0 Hz frequency). Group B received a local injection of 40 mg triamcinolone acetonide with 2 mL 1% xylocaine, followed by three sessions of TUS per week for two weeks. Pain visual analog scale (VAS pain), plantar fasciitis pain and disability scale (PFPDS), and fascia thickness using musculoskeletal ultrasound were all measured at baseline, 4 weeks, and 12 weeks after the end of treatment. VAS pain and PFPDS improved significantly in both groups after 4 and 12 weeks. In the ESWT group, the pain improved significantly more at 12 weeks (p = 0.004). In obese patients (BMI > 29.9 kg/m²), ESWT gave more long-term pain relief at 12 weeks follow-up. In both the ESWT and CSI + TUS groups, after 12 weeks, the VAS pain improved more in patients with a sedentary daily life than in those with active life (p = 0.021 and p = 0.014, resp.), as well as the PFPDS (p = 0.014 and p = 0.019, resp.). Plantar fascia thickness decreased in both groups at 12 weeks. In both groups, improvements in function (PFPDS) correlated significantly with decreased plantar fascia thickness at 4 and 12 weeks. In the CSI + TUS group only, the decrease in plantar fascia thickness was correlated with pain improvement at both follow-up visits. Echogenicity changed from hypoechoic to iso- or hyperechoic and improved significantly in both groups at 12 weeks follow-up, but changes were not different between the groups (p = 0.208). Both CSI + TUS and ESWT are effective treatments for female patients with chronic plantar fasciitis resulting in pain relief and improved function and fascia thickness. ESWT gave more pain relief at 12 weeks follow-up. CSI + TUS is effective as a rapid and short-term modality for relieving PF pain. According to previous studies, the addition of TUS does not appear to make CSI much more effective. Full article

Maintenance of equilibrium is influenced by postural symmetry and deviations such as a forward head. An exercise program involving an effect such as self-joint mobilization was developed to address spinal curvature; however, its effect on postural stability is still unclear. The purpose of this study was to address to what extent the self-mobilization exercise program would influence postural sway while standing still. The Exercise group (n = 16) performed the self-mobilization while lying supine on a cylinder-shaped tube (98 cm length, 15 cm diameter), consisting of three warm-up positionings followed by seven motions. The Control group (n = 16) laid supine on a flat surface with their legs flexed. Before and immediately after respective interventions, the plantar center of pressure was quantified while subjects were standing with eyes open and closed. The results show the exercise group reduced the postural sway in the antero-posterior direction only during the eyes-closed condition. Neither exercise nor control groups showed a significant change in postural sway during the eyes-open condition. Our findings indicate the self-mobilization exercise program improved the participant’s stability when visual feedback was not reliable for postural control. The improved postural control in the antero-posterior direction may be accounted for by facilitated activation of planterflexors and dorsiflexors which are primary muscles in ankle strategy for postural control. Effects of this exercise program on postural stability appear to be direction dependent, which provide insight when healthcare professionals incorporate exercise programs for postural symmetry. Full article

Background: There is still an ongoing debate about the role of the craniomandibular system, including occlusal conditions, on postural stability. This study aims to assess the role of antero-posterior malocclusion on postural control and plantar pressure distribution during standing and walking. Methods: 90 healthy volunteers (aged 19 to 35) were qualified for the study. The subjects were assigned to three groups, depending on the occlusion type. Each group (Angle Class I, II and III) consisted of 30 people. The research procedure included a clinical occlusal assessment performed by a dentist. Postural control measurements were carried out using a force platform by measuring plantar pressure distribution during standing (six trials with and without visual control) and walking test conditions. Results: The tendency to shift the CoP forward is demonstrated by Angle Class II subjects and backwards by Class I and III subjects (p < 0.001). Individuals with a malocclusion demonstrated significantly higher selected stabilographic parameters while standing on both feet (with eyes open and closed) and during the single-leg test with eyes open (p < 0.05). The analysis of the dynamic test results showed no significant correlations between Angle Classes and the selected gait parameters. Conclusions: Analyses conducted among individuals with malocclusions showed the impact of occlusion on static postural stability. In order to diagnose and effectively treat malocclusion, a multidisciplinary approach with the participation of dentists and physiotherapy specialists is necessary, with the use of stabilometric and kinematic posture assessments. Full article