Development of the Hiesho (sensitivity of hands or feet to cold) Care Practice Scale for pregnant women.

AIM: Evidence-based indicators are needed to increase the frequency of practicing care for hiesho, which can be a risk factor during childbirth. Such practice will lead to hiesho prevention. This study aimed to develop a Hiesho Care Practice Scale (HCPS) for pregnant women and examine its reliability and validity. METHODS: To develop a HCPS and examine its reliability and validity, we conducted a questionnaire-based survey among nurses who provide hiesho care for pregnant women in Japan. RESULTS: The analysis included 100 participants (recovery rate: 96%). Exploratory factor analysis produced four factors and 20 items. The model's fit indices obtained from the confirmatory factor analysis include goodness of fit of .80, adjusted goodness of fit of .75, comparative fit index of .88, and root mean squared error of approximation of .08. The correlation coefficients for the patient coaching skill evaluation scale for criterion-related validity test ranged from .23 to .51 (p < .01). Cronbach's α was .88, and intraclass correlation coefficient (ICC) was .81. CONCLUSIONS: The HCPS developed in this study consisted of four factors and 20 items, and its reliability and validity were verified. This scale enables the subjective and objective evaluation of hiesho care practice in the nursing profession. It may contribute to standardizing and developing improvement measures for hiesho care among pregnant women by nurses and midwives.

Effects of neural mobilization of sciatic nerve and its branches in plantar foot pressures and stabilometry.

Benefits of neural mobilization (NM) have been described in musculoskeletal patients. The effects of NM on balance appear to be unclear in research, and no studies have tested the possible effects of NM on plantar pressures. Eighteen subjects were evaluated pre and post bilateral gliding of the sciatic nerve and its branches posterior tibial nerve, lateral dorsocutaneous, medial and intermediate dorsocutaneous nerves. Static variables of the plantar footprint and stabilometric variables were measured in a pre-post study. We found no differences in plantar pressure variables, Rearfoot maximum pressure (p = 0.376), Rearfoot medium pressure (p = 0.106), Rearfoot surface (p = 0.896), Midfoot maximum pressure (p = 0.975), Midfoot medium pressure (p = 0.950), Midfoot surface (p = 0.470) Forefoot maximum pressure (p = 0.559), Forefoot medium pressure(p = 0.481), Forefoot surface (p = 0.234), and stabilometric variables either, X-Displacement eyes-open (p = 0.086), Y-Displacement eyes-open (p = 0.544), Surface eyes-open (p = 0.411), Medium speed latero-lateral displacement eyes-open (p = 0.613), Medium speed anteroposterior displacement eyes-open (p = 0.442), X Displacement eyes-closed (p = 0.126), Y-Displacement eyes-closed (p = 0.077), Surface eyes-closed (p = 0.502), Medium speed latero-lateral displacement eyes-closed (p = 0.956), Medium speed anteroposterior displacement eyes-closed (p = 0.349). All variables don´t have significant differences however the measurements had a high reliability with at least an ICC of 0.769. NM doesn´t change plantar pressures or improve balance in healthy non-athletes subjects. NCT05190900.

Effects of postural and kinesthetic awareness on static standing balance and plantar pressure in chronic stroke: a randomized controlled trial.

OBJECTIVE: To determine effects of postural and kinesthetic awareness on plantar pressure and static standing stability in chronic stroke patients. METHODS: The cross-sectional single-blind study was conducted at the University of Lahore Teaching Hospital, Lahore, Pakistan, from January 19 to March 2, 2023, and comprised stroke patients of both genders. aged 45-60 years having visual spatial neglect. They were randomised into control group A and experimental group B. Group A received routine physical therapy, while group B additionally received postural and kinesthetic awareness sessions. Static component of the Berg balance scale was used to measure balance, and PoData Stabiliometeric plate ("Chinesport, Italy") to measure plantar pressure. Data was analysed using SPSS version 25. RESULTS: Of the 52 patients, 26(50%) were in group A with mean age 51.97±4.37 years and mean weight 79.48±5.7kg. The remaining 26(50%) patients were in group B with mean age 50.69±4.41 years and mean weight 78.27±4.55kg. The outcome measures were significantly better in group B compared to group A (p<0.05). CONCLUSIONS: Postural and kinesthetic awareness could possibly be a well-grounded rehabilitative strategy that may support and enhance the balance of individuals with chronic stroke. Clinical Trial Number: The study was registered at the United States National Institutes of Health (ClinicalTrials.gov) with registration number NCT05915195.

Effect of Custom-Made Foot Orthotics on Multi-Segment Foot Kinematics and Kinetics in Individuals with Structural Hallux Limitus.

The first metatarsophalangeal joint (MTPJ) and the first ray are crucial in walking, particularly during propulsion. Limitation in this joint's sagittal plane motion, known as hallux limitus, can cause compensatory movements in other joints. Some studies assessed the impact of various foot orthoses designs on the foot biomechanics; however, a comprehensive understanding is lacking. This study compared the effects of two custom-made foot orthoses (CFOs) on the foot joint kinematics and kinetics in patients with structural hallux limitus (SHL). In this quasi-experimental study, 24 patients with hallux limitus were assessed in three conditions: (i) barefoot, (ii) shod with a cut-out custom foot orthosis (cut-out CFO), and (iii) shod with an anterior forefoot-stabilized element custom foot orthosis (AFSE CFO), fitted into a minimalist neoprene shoe. Multi-segment foot kinematics and kinetics were assessed during the stance phase of the gait. A decrease in ankle and midfoot inversion, as well as in ankle plantarflexion, was found in both orthotic conditions. Regarding the first MTPJ, a greater dorsiflexion was observed with the patient being barefoot compared to both of the conditions under study. From the current finding, it should be concluded that neither of the custom foot orthoses produced the predefined functional effects.

Sticking the landing: A comparison of shod vs barefoot landing kinetics and foot muscle characteristics in gymnasts, cheerleaders, and non-athletes.

OBJECTIVES: The ability to control landings and stabilize quickly is essential in sports like gymnastics and cheerleading, where landing quality impacts scores. The similarities and contrasts between these sports, where one trains primarily barefoot and the other shod, may increase understanding of the kinetic role of the foot during landings. DESIGN: Sixteen gymnasts (GYM), sixteen cheerleaders (CHR), and sixteen non-athletes (NAT) performed single-foot shod and barefoot drop landings onto a force plate. METHOD: Foot muscle strength was assessed using a custom test and ultrasound imaging was used to measure six foot muscles. Group differences in muscle sizes and strength measurements were compared using one-way ANOVAs (α = 0.05). Landing mechanics metrics were evaluated using 3 x 2 between-within ANOVAs (α = 0.05). Pairwise comparisons were made using Tukey post-hoc tests. RESULTS: Barefoot landings resulted in greater peak vertical ground reaction force (pVGRF) and lower time to pVGRF (TTpVGRF). Significant group main effect differences were found between GYM and NAT for all kinetic measures (GYM: shorter time to stability (TTS) and TTpVGRF, and greater pVGRF), while no significant differences in landing kinetics were found between CHR and either GYM or NAT. No interactions were found between group and condition. GYM and CHR had significantly greater summed foot muscle size than NAT, however, only CHR displayed significantly greater toe flexion force than NAT. CONCLUSIONS: Our data suggests that while wearing shoes does not affect groups differently, footwear reduces initial peak VGRFs but does not influence later stabilization times.

In vivo imaging identified efficient antimicrobial treatment against Mycobacterium marinum infection in mouse footpads.

Mycobacterium marinum (M. marinum) is the most common causative bacteria of cutaneous non-tuberculous mycobacterial (NTM) infections, including fish tank granuloma. Treating M. marinum-caused infection takes longer than other NTM diseases because M. marinum is less susceptible to antimicrobial agents. A standard treatment regimen for M. marinum infection has not been established yet, and few in vivo experiments have been performed in mammals to evaluate the bactericidal effects of antimicrobials. In this study, we developed a noninvasive in vivo imaging method to assess the therapeutic efficacy of antimicrobials against M. marinum infection. The data obtained using fluorescent protein or bioluminescence from luciferase will offer valuable insights into bacteria visualization across various bacterial infections. Furthermore, through this imaging technique, we demonstrated that combining clarithromycin, rifampicin, ethambutol, and minocycline effectively cleared M. marinum from the footpad. Granulomas with necrotic abscesses formed on the footpad of M. marinum-infected mice, primarily due to neutrophils involved in the host's cell-mediated immune response. Inflammatory cytokine and chemokine levels significantly increased 7 days post-infection, aligning with the footpad swelling and granuloma formation observed in the untreated group. Interestingly, immune mediators and cells induced by M. marinum footpad infection were crucial factors associated with hypersensitivity and granuloma formation, as seen in pulmonary tuberculosis. This novel imaging analysis using a cutaneous NTM mouse model might be a powerful tool for the comprehensive analysis of mycobacterial infections.

Anthropometric Measurements of Foot in Undergraduate Medical Students of a Medical College: A Descriptive Cross-sectional Study.

INTRODUCTION: Anthropometry is one of the important parameters for differentiation of sex which varies significantly based on hereditary, geographical, racial, sexual, and other factors. This study was done to provide baseline foot anthropometric data for Nepali medical students to improve the accuracy of stature estimations and enhance forensic and clinical applications. The aim of the study was to calculate anthropometric measurements of foot in undergraduate medical students of a medical college. METHODS: A descriptive cross-sectional study was conducted on medical students studying at a tertiary care hospital during the period of November 6, 2022 to February 28, 2023 after obtaining ethical clearance from the Institutional Review Committee (Reference number: 06/2022). A total population sampling method was used. The present study was conducted to determine the mean foot index from the right and left foot, mean measurements of the left and right foot, and sex-related dimensions of the foot in Nepalese medical students. Data were collected and analyzed using SPSS. RESULTS: Out of 115 participants, the mean foot index for male and female were 38.34±2.13 and 39.33±2.22 respectively. The mean length of the right foot for males and females were 24.12±0.98 cm and 22.10±1.25 cm respectively. The mean length of the left foot for males and females was 24.20±1.06 cm and 22.07±1.24 cm respectively. CONCLUSIONS: This study provides mean values of different measurements of the right and left foot of both sexes of the age group of 18-24 years in the students of a medical college.

Distally based sural flaps for soft tissue defects following traumatic osteomyelitis of lower leg and foot.

This retrospective study aimed to determine the incidence and risk factors for osteomyelitis recurrence and present our experiences in treating traumatic osteomyelitis in the lower leg and foot. We retrospectively reviewed data from 174 patients with distally based sural flaps for treating traumatic osteomyelitis with soft tissue defects in the lower leg and foot from November 2003 to February 2021. Possible risk factors for osteomyelitis recurrence were compared between the osteomyelitis control and recurrence groups. A total of 162 (93.1%) flaps survived uneventfully, while 12 (6.9%) flaps developed partial necrosis. Five patients had a bone defect with an average length of 5 cm. The free vascularized bone grafts were performed in two patients, and bone transportations were performed in three patients. All patients were followed up with an average period of 72.8 months. There were 152 patients (87.4%) in control group and 22 patients (12.6%) in recurrence group. The recurrence rates of osteomyelitis were significantly higher when the patient's age was 40 years or more and the duration was 10 weeks or more (P < 0.05). Cierny-Mader (C-M) classification type IV osteomyelitis was also significantly associated with osteomyelitis recurrence (p = 0.049). This flap combined with appropriate osteomyelitis treatment was an effective method to treat traumatic osteomyelitis of lower leg and foot with a soft tissue defect. Both patient age ≥ 40 years old and C-M type IV osteomyelitis were nonnegligible risk factors for osteomyelitis recurrence.

Effect of Whole-body Vibration on Changing Foot Position and Postural Stability in Young Adults - Comparative Study.

BACKGROUND: Whole-body vibration is commonly used in physiotherapy. The vibration platform generates mechanical stimuli that primarily influence the neuromuscular system. Vibration can improve proprioception and balance. The aim of the study was to assess the impact of whole-body vibration on foot position and postural stability. MATERIAL AND METHODS: A group of 31 participants took part in 6 vibration sessions at 15Hz and 30Hz over 2 weeks. Foot position parameters (angle and distance) and postural stability indicators before and after vibration were assessed on the Biodex Balance System. Vibration was performed on the Galileo Med35 platform (3x3 min). A control group consisted of 26 people who were only assessed on the Biodex platform. RESULTS: There was no change in the angle of both feet (p>0.05) after vibration at the frequency of 15 Hz. The angle of the right foot increased (p=0.013) after vibration at 30 Hz. Vibration increased the distance between the feet for both 15Hz (p=0.000) and 30Hz (p=0.000) sessions. There was no correlation between the change in feet spacing and the change in the overall stability index, anteroposterior stability index and mediolateral stability index (p>0.05). In the control group, no changes (p>0.05) in the angle and foot spacing were noted between consecutive measurements. CONCLUSIONS: 1. Whole body vibration can increase the width of quadrilateral of support in static conditions but has a minimal effect on changing the angle of the feet. 2. The width of the quadrilateral of support after whole-body vibration does not appear to affect postural stability under static conditions. 3. It is recommended that postural stability is assessed before and after whole body vibration while the initial position of the feet is maintained.

Exploring plantar pressure distribution in patients with newly diagnosed diabetes: Implications for foot ulcer prevention in an overweight Mexican population.

INTRODUCTION: Elevated plantar pressure (PP) constitutes a risk factor for developing foot ulcers. Once present, elevated PP increases morbidity and mortality in patients with diabetes. Given the high prevalence of overweight and obesity in the Mexican population, this study aimed to describe the magnitudes and the distribution of the PP observed in a sample of newly diagnosed patients with diabetes, adjusting for body mass index (BMI) groups (normal weight, overweight, grade I obesity, and grade II and III obesity). MATERIALS AND METHODS: A total of 250 volunteers attending a comprehensive care program for the management of type 2 diabetes received foot assessments that included vascular and neurological evaluation, the identification of musculoskeletal changes, and measurements of PP. RESULTS: Diabetic neuropathy and peripheral arterial disease were present in 21.6% and 11.2% of all participants. Musculoskeletal alterations were present in 70.8% of participants. A positive and significant correlation (p<0.001) was observed between BMI and the peak PP of all anatomical regions assessed. After adjusting for BMI, significant differences (p<0.001) were seen between groups. The metatarsal region, particularly under the third metatarsal head, denoted the highest magnitudes across all BMI. CONCLUSIONS: Periodic PP assessment is recommended to identify the distribution of high-pressure points along the plantar surface. However, as a preventive measure, it is suggested to encourage patients with diabetes and overweight or obesity to wear appropriate footwear and pressure-relief insoles to relieve high-pressure areas - often seen in these populations - to help prevent foot complications.

Tropicoporus tropicalis: A Newly Recognised Pathogen in Eumycetoma and Refractory Mycoses in Humans.

Tropicoporus tropicalis (formerly Phellinus tropicalis) is a saprophytic basidiomycete that has been implicated in refractory mycoses in humans, particularly in patients with chronic granulomatous disease. Despite its clinical significance, T. tropicalis is an under-recognised cause of eumycetoma, with no prior reports available. We present a case of white grain eumycetoma with associated osteomyelitis of the left foot, caused by T. tropicalis, confirmed through 18S-ITS1-5.8S-ITS2-28S rRNA gene amplification and sequencing. The patient was treated with itraconazole 200 mg daily, leading to gradual improvement. A review of the literature on T. tropicalis infections in humans reveals its characteristic manifestations, which include osteomyelitis, soft tissue abscesses, pulmonary nodules and keratitis. These infections are locally destructive but have the potential to disseminate. Diagnosis is often delayed and relies on molecular techniques. Amphotericin B combined with an azole appears to be the most effective treatment, often necessitating concurrent surgical drainage. In conclusion, T. tropicalis is a newly recognised pathogen associated with eumycetoma and poses an increased risk of osteomyelitis. Molecular identification, such as sequencing the internal transcribed spacer (ITS) region from cultures or tissue specimens, is crucial for accurate identification of this pathogen.

Exploration of the Conditions for Occurrence of Photoplethysmographic Signal Inversion above the Dorsalis Pedis Artery.

Inversion of the photoplethysmographic (PPG) signal is a rarely reported case. This signal anomaly can have implications for PPG-based cardiovascular assessments. The conditions for PPG signal inversion in the vicinity of the dorsalis pedis (DPA) artery of the foot were investigated. Wireless multi-wavelength PPG sensing with skin-probe contact pressure and local skin temperature were studied at different sensor positions, and the occurrence of inversion (OOI) was investigated. Twelve healthy adult volunteers were studied over four LED wavelengths at three levels of contact pressure for 11 probe positions. A novel algorithm quantified the proportion of inverted samples with respect to the abovementioned variables. Our algorithm classifying inverted vs. non-inverted pulses achieved 98.3% accuracy. Ten of the participants had at least one inverted signal identified. The impact of interindividual variation on inversion prevalence was large, but different LEDs, relative position to the DPA and sensor contact pressure also affected OOI. Skin surface and room temperatures showed no impact on OOI. Lateral measurements showed 39.6% more inversion at maximum compared to minimum contact pressure. Mechanical capillary bed variations and arterial reflections during venous engorgement are considered viable explanations for our observations. These findings motivate an expanded study of the occurrence of PPG signal inversion.

Evaluation of the Working Mechanism of a Newly Developed Powered Ankle-Foot Orthosis.

Ankle-foot orthoses (AFOs) are commonly prescribed to children with cerebral palsy (CP). The conventional AFO successfully controls the first and second ankle rocker, but it fails to correct the third ankle rocker, which negatively effects push-off power. The current study evaluated a new powered AFO (PAFO) design, developed to address the shortcomings of the conventional AFO. Eight children with spastic CP (12.4 ± 3.4 years; GMFCS I-III; 4/4-♂/♀; 3/5-bi/unilateral) were included. Sagittal kinematic and kinetic data were collected from 20 steps during barefoot walking, with conventional AFOs and PAFOs. In the PAFO-condition, an actuation unit was attached to a hinged AFO and through push-pull cables to a backpack that was carried by the child and provided patient-specific assistance-as-needed. SnPM-analysis indicated gait cycle sections that differed significantly between conditions. For the total group, differences between the three conditions were found in ankle kinematics (49.6-66.1%, p = 0.006; 88.0-100%, p = 0.011) and angular velocity (0.0-6.0%, p = 0.001; 45.1-51.1%, p = 0.006; 62.2-73.0%, p = 0.001; 81.2-93.0%, p = 0.001). Individual SnPM-analysis revealed a greater number of significant gait cycle sections for kinematics and kinetics of the ankle, knee, and hip. These individual results were heterogeneous and specific per gait pattern. In conclusion, the new PAFO improved the ankle range-of-motion, angular velocity, and power during push-off in comparison to the conventional AFO.

Foot-Floor Contact Sequences: A Metric for Gait Assessment in Parkinson's Disease after Deep Brain Stimulation.

Digital gait monitoring is increasingly used to assess locomotion and fall risk. The aim of this work is to analyze the changes in the foot-floor contact sequences of Parkinson's Disease (PD) patients in the year following the implantation of Deep Brain Stimulation (DBS). During their best-ON condition, 30 PD patients underwent gait analysis at baseline (T0), at 3 months after subthalamic nucleus DBS neurosurgery (T1), and at 12 months (T2) after subthalamic nucleus DBS neurosurgery. Thirty age-matched controls underwent gait analysis once. Each subject was equipped with bilateral foot-switches and a 5 min walk was recorded, including both straight-line and turnings. The walking speed, turning time, stride time variability, percentage of atypical gait cycles, stance, swing, and double support duration were estimated. Overall, the gait performance of PD patients improved after DBS, as also confirmed by the decrease in their UPDRS-III scores from 19.4 ± 1.8 to 10.2 ± 1.0 (T0 vs. T2) (p < 0.001). In straight-line walking, the percentages of atypical cycles of PD on the more affected side were 11.1 ± 1.5% (at T0), 3.1 ± 1.5% (at T1), and 5.1 ± 2.4% (at T2), while in controls it was 3.1 ± 1.3% (p < 0.0005). In turnings, this percentage was 13.7 ± 1.1% (at T0), 7.8 ± 1.1% (at T1), and 10.9 ± 1.8% (at T2), while in controls it was 8.1 ± 1.0% (p < 0.001). Therefore, in straight-line walking, the atypical cycles decreased by 72% at T1, and by 54% at T2 (with respect to baseline), while, in turnings, atypical cycles decreased by 43% at T1, and by 20% at T2. The percentage of atypical gait cycles proved an informative digital biomarker for quantifying PD gait changes after DBS, both in straight-line paths and turnings.

Low tourniquet pressure has less impact on lower extremity nerve innervation: comparison of different tourniquet pressures used with intraoperative neuromonitoring with a randomized controlled study.

BACKGROUND: We aimed to investigate the compression and ischemic effects of two different tourniquet pressures on tissues during surgery show a clinical difference. METHODS: Patients aged 18-65 years who underwent foot and ankle surgery and applied a tourniquet in a single center between September 2022 and November 2023 were included in this prospective randomized study. Accordingly, tourniquet pressures were applied as limb occlusion pressure (LOP) + 50 mmHg in group 1 (12 patients) and LOP + 100 mmHg in group 2 (12 patients). The time point at which the femoral nerve motor evoked potential (MEP) decreased by 50%, the time point at which the MEP decreased by 100% for all nerves (femoral, tibial, and deep peroneal), and the time point at which all responses returned after the tourniquet was deflated were identified as the time points for analysis. RESULTS: There were no differences in demographic data (age, body mass index, and sex) between the two groups. The mean tourniquet pressure was 191 ± 16 mmHg in Group 1 and 247 ± 21 mmHg in Group 2 (p < 0.001). A 50% decrease in the femoral nerve MEP value was observed at an average of 47 min in Group 1 and 34 min in Group 2 (p < 0.001). A complete loss of MEP responses for all nerves was observed at an average of 69 min in Group 1 and 56 min in Group 2. After the tourniquet was deflated, all MEP responses returned to baseline values at an average of 8.5 min in Group 1 and 12.6 min in Group 2 (p = 0.007). The results showed that lower limb nerve innervation was affected later and returned to normal earlier after deflation of the tourniquet in Group 1 (low tourniquet pressure group). CONCLUSIONS: The innervations of the lower extremity nerves were affected later in the group in which low tourniquet pressure was applied (average 191 mmHg). Again, in this group (LOP + 50 mmHg), nerve conduction recovered an average of 10 min after deflation and four minutes earlier than in the high tourniquet pressure group. LEVEL OF EVIDENCE: Level I, diagnostic study. TRIAL REGISTRATION: NCT05926154.

Sitting foot: posture dependent changes of volume, edema and perfusion of the foot. A prospective interventional study with 27 volunteers.

BACKGROUND: Sitting is known to be bad for your cardiovascular health. We furthermore hypothesized that sitting posture will reduce perfusion of the foot and increase edema, possibly predisposing to disease like osteochondritis. METHODS: We included 27 healthy volunteers and performed MRI measurements including arterial spin labelling (ASL) and intravoxel incoherent motion (IVIM) perfusion as well as short tau inversion recovery (STIR) edema measurement and 3D volumetry. After randomization, the elevation of one foot during the day was used as an intervention. RESULTS: Intra- and interrater variability was 1-6%. ASL perfusion measurement was hindered by artifacts. IVIM perfusion showed no significant changes during supine measurements. Volumetry could demonstrate a highly significant (p = 0.00005) volume increase, while the intervention led to a significant (p = 0.0076) volume decrease during the day. However, the water content in STIR remained unchanged and the normalized (quotient bone/muscle) edema was reduced on the control side (p = 0.006) and increased on the intervention side (p = 0.01). CONCLUSIONS: Sitting all day leads to swelling of the healthy foot. Compensation in healthy subjects seems to prevent lasting perfusion changes or edema evolution in the bone despite an increase of muscle signal and volume increase. Thus, the etiology of osteochondritis needs further studies.

Effect of foot type on electromyography characteristics and synergy of lower limb muscles during running.

The foot structure is associated with different running mechanics. The central nervous system is responsible for using the muscles through synergies during locomotion. The purpose of the present study was to examine the effect of foot structure on the electromyography factors and the synergy of the selected muscles of the lower extremity. Tibialis anterior, extensor digitorum longus, peroneus longus, soleus, biceps femoris, vastus lateralis, gastrocnemius lateralis and medialis muscles activity of 60 barefoot recreational runners with different foot structures was recorded while running at a speed of 3.3 m/s. Muscle activity was measured in the running cycle. Besides, muscle synergies were extracted using non-negative matrix factorization algorithm. The results showed that there were differences between groups with different foot type in muscle activity under different phases of running in some muscles. Furthermore, the findings indicated that the number of synergies was similar in different groups and the relative weight of muscles was not different across groups. In conclusion, despite the difference in muscle activity under different phases of the running cycle, muscle synergies are similar among the groups. This can indicate similar control by the central nervous system in runners with different arch structures while running and the observed changes in muscle activity can be attributed to the type of forces exerted on the body, the length-tension relationship, and changes in the direction of the lower limbs in people with different arch structures.

Longitudinal weight and plantar pressure distribution while standing after tibial or malleolar fractures in patients with or without fracture union.

Fracture healing is usually monitored by clinical impressions and radiographs. Objective and easy methods for assessing fracture healing without radiation would be beneficial. The aim of this study was to analyse whether weight and plantar pressure while standing can be used to monitor healing of tibial or malleolar fractures and whether these parameters can discriminate between patients with and without union. Thirteen patients were longitudinally assessed during each postoperative clinical visit, of whom two developed a nonunion. Eleven matched healthy controls were assessed once. Additionally, five patients already experiencing nonunion were assessed once at the time of their nonunion diagnosis. All participants performed a standing task for ten seconds with pressure-sensing insoles. Greatest improvements were detected throughout the first three months in patients with union. However, six months after surgery, more than half of the parameters were still significantly different from those of the controls. The weight and pressure distributions did not differ between patients with or without union six months after surgery. A standing task can be used to monitor improvements in weight and pressure distribution throughout the healing process of tibial or malleolar fractures, but lacks potential to discriminate between patients with or without fracture union.