Analysis of hip joint loading during walking with different shoe types using instrumented total hip prostheses.

Hip joint loads need careful consideration during postoperative physiotherapy after joint replacement. One factor influencing joint loads is the choice of footwear, but it remains unclear which footwear is favorable. The objective of the present study was to investigate the influence of footwear on hip joint loads in vivo. Instrumented hip endoprostheses were used for in vivo load measurements. The parameters resultant contact force (Fres), bending moment (Mbend) and torsional moment (Mtors) were evaluated during treadmill walking at 4 km/h with different shoe types. In general, footwear tended to increase hip joint loading, with the barefoot shoe having the least influence. Fres and Mbend were significantly increased during heel strike for all shoe types in comparison to barefoot walking, with everyday shoe (34.6%; p = 0.028 and 47%; p = 0.028, respectively) and men's shoe (33.2%; p = 0.043 and 41.1%; p = 0.043, respectively) resulting in the highest changes. Mtors at AbsMax was increased by all shoes except for the barefoot shoe, with the highest changes for men's shoe (+ 17.6%, p = 0.043) and the shoe with stiffened sole (+ 17.5%, p = 0.08). Shoes, especially those with stiff soles or elaborate cuishing and guiding elements, increase hip joint loads during walking. The influence on peak loads is higher for Mtors than for Fres and Mbend. For patients in which a reduction of hip joints loads is desired, e.g. during physiotherapy after recent surgery or to alleviate symptoms of osteoarthritis, low profile shoes with a flexible sole may be preferred over shoes with a stiff sole or elaborate cushioning elements.

Walk a Mile in the Leadership's Shoes: Why Focus on Quality Improvement?

Quality Improvement (QI) throughout health care in the United States continues to be of growing importance to both patients and providers. Leaders in health care including physicians, nurses, hospital administrators, and payors are all responsible for ensuring the continuation and growth of QI initiatives. This article will discuss various ways that healthcare leaders, with specific regard to orthopedic surgery, have utilized QI measures to provide better, more efficient, care to patients.

Lower Extremity Abnormalities in Children.

Leg and foot problems in childhood are common causes of parental concern. Rotational problems include intoeing and out-toeing. Intoeing is most common in infants and young children. Intoeing is caused by metatarsus adductus, internal tibial torsion, and femoral anteversion. Out-toeing is less common than intoeing and occurs more often in older children. Out-toeing is caused by external tibial torsion and femoral retroversion. Angular problems include genu varum (bowleg) and genu valgum (knock knee). With pes planus (flatfoot), the arch of the foot is usually flexible rather than rigid. A history and physical examination that include torsional profile tests and angular measurements are usually sufficient to evaluate patients with lower extremity abnormalities. Most children who present with lower extremity problems have normal rotational and angular findings (i.e., within two standard deviations of the mean). Lower extremity abnormalities that are within normal measurements resolve spontaneously as the child grows. Radiologic studies are not routinely required, except to exclude pathologic conditions. Orthotics are not beneficial. Orthopedic referral is often not necessary. Rarely, surgery is required in patients older than eight years who have severe deformities that cause dysfunction.

Unna's boot: experience of care of people with venous ulcers / Bota de Unna: experiencia del cuidado de personas con úlcera varicosa / Bota de Unna: vivência do cuidado por pessoas com úlcera varicosa

ABSTRACT Objective: to understand the experience of care of people with venous ulcers using an Unna's boot. Method: a qualitative study, based on the social phenomenology by Alfred Schütz, was carried out with 12 adults interviewed in 2015. The statements were analyzed and organized in thematic categories. Results: the following categories emerged: "Unna's boot annoyance versus wound improvement", "Difficulties for accessing care with the Unna's boot", "Care for healing and preventing recurrence", and "Receiving more attention from the healthcare professional". Conclusion: the experience of care of people using an Unna's boot revealed the annoyance caused by this device, which was overcome due to the wound improvement. However, access to care was compromised by the lack of structure at the service, frustrating the patients' expectations regarding wound healing. The issues of these people's intersubjective universe should be considered in the management of care of venous ulcers.

RESUMEN Objetivo: comprender la experiencia del cuidado de personas con úlcera varicosa utilizando la Bota de Unna. Método: estudio cualitativo, fundamentado en fenomenología social de Alfred Schütz, realizado con 12 adultos entrevistados en 2015. Testimonios analizados y organizados en categorías temáticas. Resultados: surgieron las categorías: "Incomodidad de la Bota de Unna versus mejora de la herida", "Dificultades para el acceso al cuidado con la Bota de Unna", "Cuidar para cicatrizar y prevenir recidivas" y "Recibir más atención del profesional de salud". Conclusión: la experiencia de cuidado de personas utilizando la Bota de Unna expresó la incomodidad del dispositivo, superado por la mejora de la herida. No obstante, el acceso al cuidado resultó comprometido por falta de estructura del servicio, frustrando expectativas de los participantes respecto a la cicatrización de la herida. Las cuestiones del universo intersubjetivo de estas personas deben considerarse en la gestión del cuidado de la úlcera varicosa.

RESUMO Objetivo: compreender a vivência de cuidado de pessoas com úlcera varicosa em uso da Bota de Unna. Método: estudo qualitativo fundamentado na fenomenologia social de Alfred Schütz, realizado com 12 adultos entrevistados em 2015. Os depoimentos foram analisados e organizados em categorias temáticas. Resultados: foram desveladas as categorias: "O incômodo da bota de Unna versus a melhora da ferida", "Dificuldades para o acesso ao cuidado com a Bota de Unna", "Cuidar para cicatrizar e prevenir recidivas" e "Receber mais atenção do profissional de saúde". Conclusão: a vivência de cuidado de pessoas em uso da Bota de Unna revelou o incômodo proporcionado por este dispositivo, superado pela melhora da ferida. Porém, o acesso ao cuidado foi comprometido pela falta de estrutura do serviço, frustrando as expectativas dos participantes em relação à cicatrização da ferida. As questões do universo intersubjetivo dessas pessoas devem ser consideradas na gestão do cuidado da úlcera varicosa.

Durability of running shoes with ethylene vinyl acetate or polyurethane midsoles.

Ethylene vinyl acetate and polyurethane are widely used materials for shoe midsoles. The present study investigated the durability of running shoes made from ethylene vinyl acetate and one type of polyurethane (polyurethane-1), which have similar hardness and density, and another type of polyurethane (polyurethane-2), which has high hardness/density. All shoes differed from one another only in terms of the midsole material used. Eight male runners participated in the present study and used the shoes to run 500 km (10 × 50 km). The cushioning and energy return characteristics of each shoe were measured using an impact tester before and after each 50-km run. The results showed that as the running distance increased, the peak force of midsole materials changed with different patterns. Ethylene vinyl acetate and polyurethane-1 showed greater cushioning than polyurethane-2 over 500 km (ethylene vinyl acetate, 918.2-968.0 N; polyurethane-1, 909.6-972.9 N; polyurethane-2, 983.0-1105.6 N). Polyurethane-1 showed greater cushioning from 200 km to 300 km compared with 0 km (0 km, 972.9 ± 66.3 N; 200 km, 909.6 ± 61.2 N; 250 km, 921.9 ± 51.2 N; 300 km, 924.6 ± 51.9 N). The cushioning of ethylene vinyl acetate shoes was diminished after 500 km compared with that at 0 km (968.0 ± 25.9 N vs. 921.1 ± 20.1 N). Ethylene vinyl acetate resulted in greater energy returns than polyurethane. Both foam category and hardness/density affected the critical biomechanical properties of running shoes.

Contralateral peak plantar pressures with a postoperative boot: a preliminary study.

BACKGROUND: Frequent use of walking boots in podiatric medicine often elicits patient complaints and sequelae from the imposed limb-length discrepancy. This study was designed primarily to determine whether peak plantar pressures are decreased in the contralateral foot when a moderately worn athletic shoe is worn opposite a high-calf walking boot and, if so, secondarily to determine whether a specialized surgical shoe worn on the contralateral foot can also effectively reduce this pressure. The pressure reductions were then compared to determine whether significantly greater plantar pressure reduction was provided by either the athletic shoe or the surgical shoe. METHODS: Participants without a foot abnormality walked on a treadmill in four footwear combinations: barefoot bilaterally, high-calf rocker-bottom sole (HCRB) walking boot/ barefoot, HCRB walking boot/athletic shoe, and HCRB walking boot/modified walking boot shoe. Measurements were taken with the participants wearing socks. Peak plantar calcaneal pressures were collected. RESULTS: Peak plantar pressures under the calcaneus opposite the HCRB walking boot were significantly reduced from barefoot pressures when either an athletic shoe or the modified walking boot shoe was worn. However, no significant difference was seen when comparing the reduction by the athletic shoe with that by the modified walking boot. CONCLUSIONS: Wearing an athletic shoe on the foot opposite an HCRB walking boot reduces calcaneal pressures; however, wearing a modified device with structural properties of an HCRB walking boot sole is no better than an athletic shoe at reducing peak calcaneal pressures.

Effect on injuries of assigning shoes based on foot shape in air force basic training.

BACKGROUND: This study examined whether assigning running shoes based on the shape of the bottom of the foot (plantar surface) influenced injury risk in Air Force Basic Military Training (BMT) and examined risk factors for injury in BMT. METHODS: Data were collected from BMT recruits during 2007; analysis took place during 2008. After foot examinations, recruits were randomly consigned to either an experimental group (E, n=1042 men, 375 women) or a control group (C, n=913 men, 346 women). Experimental group recruits were assigned motion control, stability, or cushioned shoes for plantar shapes indicative of low, medium, or high arches, respectively. Control group recruits received a stability shoe regardless of plantar shape. Injuries during BMT were determined from outpatient visits provided from the Defense Medical Surveillance System. Other injury risk factors (fitness, smoking, physical activity, prior injury, menstrual history, and demographics) were obtained from a questionnaire, existing databases, or BMT units. RESULTS: Multivariate Cox regression controlling for other risk factors showed little difference in injury risk between the groups among men (hazard ratio [E/C]=1.11, 95% CI=0.89-1.38) or women (hazard ratio [E/C]=1.20, 95% CI= 0.90-1.60). Independent injury risk factors among both men and women included low aerobic fitness and cigarette smoking. CONCLUSIONS: This prospective study demonstrated that assigning running shoes based on the shape of the plantar surface had little influence on injury risk in BMT even after controlling for other injury risk factors.

Increased hallux angle in children and its association with insufficient length of footwear: a community based cross-sectional study.

BACKGROUND: Wearing shoes of insufficient length during childhood has often been cited as leading to deformities of the foot, particularly to the development of hallux valgus disorders. Until now, these assumptions have not been confirmed through scientific research. This study aims to investigate whether this association can be statistically proven, and if children who wear shoes of insufficient length actually do have a higher risk of a more pronounced lateral deviation of the hallux. METHODS: 858 pre-school children were included in the study. The study sample was stratified by sex, urban/rural areas and Austrian province. The hallux angle and the length of the feet were recorded. The inside length of the children's footwear (indoor shoes worn in pre-school and outdoor shoes) were assessed. Personal data and different anthropometric measurements were taken. The risk of hallux valgus deviation was statistically tested by a stepwise logistic regression analysis and the relative risk (odds ratio) for a hallux angle > or = 4 degrees was calculated. RESULTS: Exact examinations of the hallux angle could be conducted on a total of 1,579 individual feet. Only 23.9% out of 1,579 feet presented a straight position of the great toe. The others were characterized by lateral deviations (valgus position) at different degrees, equalling 10 degrees or greater in 14.2% of the children's feet.88.8% of 808 children examined wore indoor footwear that was of insufficient length, and 69.4% of 812 children wore outdoor shoes that were too short. A significant relationship was observed between the lengthwise fit of the shoes and the hallux angle: the shorter the shoe, the higher the value of the hallux angle. The relative risk (odds ratio) of a lateral hallux deviation of > or = 4 degrees in children wearing shoes of insufficient length was significantly increased. CONCLUSIONS: There is a significant relationship between the hallux angle in children and footwear that is too short in length. The fact that the majority of the children examined were wearing shoes of insufficient length makes the issue particularly significant. Our results emphasize the importance of ensuring that children's footwear fits properly.

Basic considerations for geriatric footwear.

Proper and appropriate shoes that fit well can help keep elderly patients walking. Footwear is needed for protection and should permit the patient to function as normally as possible. The shoe must function as a unit with the patient and be compatible with and supportive to the patient's functional requirements and ambulatory needs. Though selecting shoes for older patients should always place comfort and function above style, patients also need to function in society, making intelligent compromise a consideration for the patient's overall welfare.

The biomechanical management of diabetic foot ulcers

The primary goal in the treatment of diabetic foot ulcers is to obtain wound closure as expeditiously as possible and prevent the recurrence of foot wounds due to neuropathy, foot deformity, and poor circulation. Interventions that bring about the quick resolution of afoot wound and reduce the rate of recurrence have been shown to lower the risk of developing a secondary infection and decrease the incidence of lower extremity amputation in the diabetic patient.

An approach to understanding and treating common foot problems in the diabetic population

The goal of this paper is to provide an overview of common foot problems seen in diabetic individuals. Initial therapeutic intervention such as debridement ofpre-ulcerative lesions may prevent limb-threatening ulcerations from occurring. It is also essential that an understanding of the foot deformity and imbalance responsible for the high ulcerating pressures be identified and addressed for long-term treatment of these patients. The nature of compensatory foot imbalance with recommended re-alignment and balance therapies to prevent pathologic foot compensation and principles of padding and specific off-loading techniques are highlighted. Evaluation and therapy of often neglected digital deformities and treatment of nail pathology are reviewed.

A quantitative assessment of healing sandals and postoperative shoes in offloading the neuropathic diabetic foot.

The purpose of this report is to compare plantar pressures between custom healing sandals and postoperative shoes using unmodified prescription shoe gear as a control. Using a repeat measures design, we recorded the plantar forefoot pressures of eight patients classified as diabetic foot category 1 (neuropathy, no significant deformity, no history of ulceration) with each ambulating in three devices: 1) unmodified prescription shoe gear, 2) postoperative shoe gear, and 3) a custom-fabricated healing sandal. Each subject served as his or her own control. The healing sandal significantly reduced plantar forefoot pressure in all areas of the forefoot except the fifth metatarsal head. The postoperative shoe did not significantly reduce pressure at any site in the forefoot when compared with unmodified prescription shoe gear.

A comparison of weightbearing pressures in various postoperative devices.

Currently, there are a multitude of computerized gait analysis systems to evaluate weightbearing patterns in the foot. The following study utilizes the F-Scan System of foot pressure analysis. This system was applied to evaluate plantar pressures as they occur in various postoperative shoe gear and to determine which devices are most clinically beneficial in ambulatory surgery. A pressure sensor recorded plantar pressures in 20 feet wearing various types of postoperative shoe wear. Initially, a stockinette was used to simulate barefoot pressure, followed by a wooden postoperative shoe, a Darco postoperative shoe, a Darco closed postoperative shoe, a Darco "softie," a Darco wedge, an Equalizer Premium Walker, an Equalizer Low Top Walker, and an Aircast. The results demonstrated that the Equalizer Premium Walker was most efficient in reducing forefoot pressures, while the postoperative surgical shoes had variable results, noticeably with several increases in pressure being recorded.

Footwear and ankle stability in the basketball player.

Ankle stability in basketball players is affected by footwear. Athletic shoe manufacturers have introduced specialized lacing systems and high-top performance shoes to improve ankle stability. These performance shoes not only aid in preventing ankle injuries, but also protect injured ankles.

Biomechanics of footwear.

This article discusses biomechanical principles that indicate a number of basic design criteria for shoes and the properties of good footwear in terms of normal daily activities at home, at school, and at work. These properties also apply to normal occupational footwear and safety footwear.