Evaluation of in-shoe plantar pressure and shear during walking for diabetic foot ulcer prevention.

OBJECTIVE: To investigate reliability and changes of in-shoe plantar pressure and shear during walking at three cadences with two insole designs. This was a precursor to the investigation of plantar loading in people with diabetes for potential foot ulcer prevention. METHOD: A sensorised insole system, capable of measuring plantar pressure and shear at the heel, fifth metatarsal head (5MH), first metatarsal head (1MH) and hallux, was tested with ten healthy participants during level walking. Reliability was evaluated, using intra-class correlation coefficient (ICC), while varying the cadences and insole types. Percentage changes in pressure and shear relative to values obtained at self-selected cadence with a flat insole design were investigated. RESULTS: Mean±standard deviation of maximum pressure, medial-lateral and anterior-posterior shear of up to 380±24kPa, 46±2kPa and -71±4kPa, respectively, were measured. The ICC in ranges of 0.762-0.973, 0.758-0.987 and 0.800-0.980 were obtained for pressure, anterior-posterior and medial-lateral shear, respectively. Opposite anterior-posterior shear directions between 5MH and 1MH (stretching), and between 1MH and hallux (pinching) were observed for some participants. Increasing cadence increased pressure and anterior-posterior shear (by up to +77%) but reduced medial-lateral shear at the heel and hallux (by up to -34%). Slower cadence increased anterior-posterior shear (+114%) but decreased medial-lateral shear (-46%) at the hallux. The use of a flexible contoured insole resulted in pressure reduction at the heel and 5MH but an increase in anterior-posterior shear at the heel (+69%) and hallux (+75%). CONCLUSION: The insole system demonstrated good reliability and is comparable to reported pressure-only systems. Pressure measurements were sensitive to changes in cadence and insole designs in ways that were consistent with the literature. However, our plantar shear showed localised shear changes with cadences and insoles for the first time, as well as stretching and pinching effects on plantar tissue. This opens new possibilities to investigate plantar tissue viability, loading characteristics and orthotic designs aimed towards foot ulcer prevention.

A Wearable Insole System to Measure Plantar Pressure and Shear for People with Diabetes.

Pressure coupled with shear stresses are the critical external factors for diabetic foot ulceration assessment and prevention. To date, a wearable system capable of measuring in-shoe multi-directional stresses for out-of-lab analysis has been elusive. The lack of an insole system capable of measuring plantar pressure and shear hinders the development of an effective foot ulcer prevention solution that could be potentially used in a daily living environment. This study reports the development of a first-of-its-kind sensorised insole system and its evaluation in laboratory settings and on human participants, indicating its potential as a wearable technology to be used in real-world applications. Laboratory evaluation revealed that the linearity error and accuracy error of the sensorised insole system were up to 3% and 5%, respectively. When evaluated on a healthy participant, change in footwear resulted in approximately 20%, 75% and 82% change in pressure, medial-lateral and anterior-posterior shear stress, respectively. When evaluated on diabetic participants, no notable difference in peak plantar pressure, as a result of wearing the sensorised insole, was measured. The preliminary results showed that the performance of the sensorised insole system is comparable to previously reported research devices. The system has adequate sensitivity to assist footwear assessment relevant to foot ulcer prevention and is safe to use for people with diabetes. The reported insole system presents the potential to help assess diabetic foot ulceration risk in a daily living environment underpinned by wearable pressure and shear sensing technologies.

Foot and ankle characteristics associated with fear of falling and mobility in community-dwelling older people: a cross-sectional study.

BACKGROUND: Fear of falling is multifactorial in etiology and is associated with falls. It has been demonstrated that foot problems increase the risk of falls in older people. Therefore, the objective of this study was to investigate the associations of foot and ankle characteristics with fear of falling and mobility in community-dwelling older people. METHOD: One hundred and eighty-seven community-dwelling older adults (106 females) aged 62-90 years (mean 70.5 ± 5.2) from Isfahan, Iran, were recruited. Foot and ankle characteristics (including foot posture, range of motion, muscle strength, deformity, tactile sensation, pain and dynamic function), fear of falling (Fall Efficacy Scale International) and mobility (Timed Up and Go Test) were measured. Two multivariate linear regression analyses identified variables independently associated with fear of falling and mobility. RESULTS: Linear regression analysis revealed that less ankle plantarflexor muscle strength, greater pressure-time integral, foot pain, and reduced tactile sensitivity of the ankle were significantly and independently associated with increased fear of falling. The total variance explained by the model was 59%. Less ankle plantarflexor muscle strength, greater pressure-time integral, and slower centre of pressure velocity were significantly and independently associated with poorer mobility. The total variance explained by the model was 48%. CONCLUSION: Several foot and ankle characteristics are associated with fear of falling and mobility in older people. Targeting these modifiable risk factors may play a role in reducing fear of falling and enhancing mobility performance in this population.

Designing a robust controller for a lower limb exoskeleton to treat an individual with crouch gait pattern in the presence of actuator saturation.

Crouch gait is a gait anomaly observed in youngsters with cerebral palsy (CP). Rehabilitation robots are useful for treating individuals with crouch gait. Multiple factors have impact on crouch, including contracture, spasticity, weak motor control, and muscle feebleness, which make the designing and controlling of these exoskeletons for this population a challenging job. A harsh kinematic trajectory enforced by an exoskeleton control strategy may place individuals with spasticity at a high risk of muscle tissue injury. Therefore, in this article, a multi-input multi-output (MIMO) control method is proposed to reduce this risk and improve crouch gait pattern. A constrained control law is used in the model since high power demands may threaten the wearer. In addition, the controller needs to be robust enough against external disturbances and uncertainties. Thus, a nonlinear disturbance observer (NDO) is presented to compute the wearer-generated muscular torque and the uncertainties in the modeling. In addition, a robust constrained MIMO backstepping sliding controller (CMBSC) based on NDO is used to deal with the effect of actuator saturation and uncertainties. A simulation test was used to validate the proposed model and controller. The results of Simulation confirmed the efficiency of the proposed control method when applied to crouch gait with subject specific gait reference. Then, some experimental tests were undertaken to validate the efficiency of the proposed controller.

Foot and ankle biomechanics during walking in older adults: A systematic review and meta-analysis of observational studies.

BACKGROUND: The foot and ankle complex undergoes significant structural and functional changes with advancing age. RESEARCH QUESTION: The objective of this systematic review and meta-analysis was to synthesize and critique the research literature pertaining to foot and ankle biomechanics while walking in young and older adults. METHODS: Electronic databases (Web of Science, PubMed, Scopus and Embase) were searched from inception to April 2019 for cross-sectional studies which compared kinematics, kinetics and plantar pressure differences between young and older adults. Screening and data extraction were performed by two independent assessors, with disagreements resolved by consensus. RESULTS: A total of 39 articles underwent full-text screening, and 19 articles met the inclusion criteria and were included. Meta-analysis showed that older adults had less ankle joint plantar flexion (5 studies; weighted mean difference [WMD]: -5.15; 95 %CI: -6.47 to -3.83; P < 0.001) and less ankle joint power generation (6 studies; standardized mean difference [SMD]: -0.62; 95 %CI: -0.82 to -0.41; P < 0.001) during propulsion compared to young adults. These differences persisted in subgroup analyses comparing different walking speeds. Plantar pressure findings were highly variable due to differences in data collection protocols and meta-analysis was not possible. SIGNIFICANCE: Older adults have unique foot and ankle kinematics and kinetics during walking characterized by reduced ankle joint plantarflexion and power generation during propulsion.

Structural and functional foot and ankle characteristics associated with falls in older people.

BACKGROUND: Falls affect approximately one in three older people, and foot problems are amongst the modifiable potential risk factors. RESEARCH QUESTION: what are the associations between foot and ankle functional and structural characteristics with falls in community-dwelling older adults? METHOD: One hundred eighty-seven community-dwelling older adults (106 females) aged 62-90 years (mean 70.5 ±â€¯5.2) from Isfahan, Iran were recruited. Foot and ankle structure and function (including foot posture, range of motion, muscle strength, deformity, pain and plantar loading patterns during walking) were measured. Fall history was documented in the preceding year. Univariate analyses compared fallers and non-fallers on all variables to determine significant differences and logistic regression analysis identified variables independently associated with falls. RESULTS: Seventy-four participants (39.9 %) had experienced a fall in the previous year. Logistic regression analysis revealed that less first metatarsophalangeal joint extension (odds ratio 0.82, 95 % CI 0.73-0.91), less plantarflexor muscle strength (odds ratio 0.29, 95 % CI 0.15-0.55), greater pressure-time integral in the medial forefoot (odds ratio 2.65, 95 %CI 1.10-6.38), greater center of pressure velocity in the forefoot (odds ratio 1.27, 95 % CI 1.07-1.49) and greater foot pain (odds ratio 1.09, 95 % CI 1.02-1.16) were significantly and independently associated with falls after accounting for physiological falls risk factors. SIGNIFICANCE: We have identified several structural and functional foot and ankle characteristics associated with falling in older people. Future development of interventions to help prevent or treat these potentially modifiable risk factors may help decrease the risk of falling in this population.

Effects of metatarsal domes on plantar pressures in older people with a history of forefoot pain.

BACKGROUND: Forefoot pads such as metatarsal domes are commonly used in clinical practice for the treatment of pressure-related forefoot pain, however evidence for their effects is inconsistent. This study aimed to evaluate the effects on plantar pressures of metatarsal domes in different positions relative to the metatarsal heads. METHODS: Participants in this study included 36 community-dwelling adults aged 65 or older with a history of forefoot pain. Standardised footwear was used and plantar pressures were measured using the pedar®-X in-shoe plantar pressure measurement system. Peak pressure, maximum force and contact area were analysed using an anatomically-based masking protocol that included three forefoot mask sub-areas (proximal to, beneath, and distal to the metatarsal heads). Data were collected for two different types of prefabricated metatarsal domes of different densities (Emsold metatarsal dome and Langer PPT metatarsal pad) in three different positions relative to the metatarsal heads. Seven conditions were tested in this study: (i) control (no pad) condition, (ii) Emsold metatarsal dome positioned 5 mm proximal to the metatarsal heads, (iii) Emsold metatarsal dome positioned in-line with the metatarsal heads, (iv), Emsold metatarsal dome positioned 5 mm distal to the metatarsal heads, (v) Langer PPT metatarsal pad positioned 5 mm proximal to the metatarsal heads, (vi) Langer PPT metatarsal pad positioned in-line with the metatarsal heads, and (vii) Langer PPT metatarsal pad positioned 5 mm distal to the metatarsal heads. RESULTS: When analysed with the mask that was distal to the metatarsal heads, where the plantar pressure readings were at their highest, all metatarsal dome conditions led to significant reductions in plantar pressure at the forefoot compared to the control (no pad) condition (F3.9, 135.6 = 8.125, p < 0.001). The reductions in plantar pressure were in the order of 45-60 kPa. Both the Emsold metatarsal dome and the Langer PPT metatarsal pad, when positioned proximal to the metatarsal heads, managed to achieve this without adversely increasing plantar pressure proximally where the pad was positioned, however the Emsold metatarsal dome was most effective. CONCLUSIONS: Metatarsal domes reduce plantar pressure in the forefoot in older people with a history of forefoot pain. All metatarsal dome conditions significantly reduced peak pressure in the forefoot, however metatarsal domes that were positioned 5 mm proximal to the metatarsal heads provided the best balance of reducing plantar pressure distal to the metatarsal heads, where the pressure is at its greatest, but not adversely increasing plantar pressure proximally, where the bulk of the pad is positioned. In this proximal position, the Emsold metatarsal dome was more effective than the Langer PPT metatarsal pad and we cautiously recommend this forefoot pad for alleviating forefoot pressure in older people with forefoot pain.

Lower limb kinematics in individuals with chronic low back pain during walking.

Several investigators have suggested the presence of a link between Chronic Low Back Pain (CLBP) and lower limbs kinematics that can contribute to functional limitations and disability. Moreover, CLBP has been connected to postural and structural asymmetry. Understanding the movement pattern of lower extremities and its asymmetry during walking can provide a basis for examination and rehabilitation in people with CLBP. The present study focuses on lower limbs kinematics in individuals with CLBP during walking. Three-dimensional movements of the pelvic, hip, knee and ankle joints were tracked using a seven-camera Qualysis motion capture system. Functional dada analysis (FDA) was applied for the statistical analysis of pelvic and lower limbs motion patterns in 40 participants (20 CLBP and 20 controls). The CLBP group showed significantly different hip motion pattern in the transvers plane, altered knee and ankle motion pattern in the sagittal plane on the dominant side and different hip motion pattern in the transvers and frontal planes on the non-dominant side in comparison with the control group over the stance phase. In terms of symmetry, in the CLBP group, hip and knee moved through a significantly different motion patterns in the transvers plane on the dominant side in comparison with the non-dominant side. In the control group, knee moved through a significantly different motion pattern in the transvers plane on the dominant side in comparison with the non-dominant side. In conclusion, low back pain lead to altered movement patterns of the main joints of lower limbs especially on the dominant side during stance phase. Therefore, care should be taken to examine dominant lower limb movement pattern in CLBP to make a better clinical decision.

The Effect of Three Different Insoles on Ankle Movement Variability during Walking in Athletes with Functional Ankle Instability.

BACKGROUND: Increased ankle movement variability has been reported in people with functional ankle instability (FAI). The purpose of this study was to investigate the effect of textured insole, lateral wedge, and textured lateral wedge insole on ankle movement variability during walking in athletes with FAI. MATERIALS AND METHODS: Twenty-one athletes diagnosed with FAI participated in this before-after study. Kinematic data were collected during four conditions (5 repeated trials per condition): (1) flat ethylene-vinyl acetate (EVA) insole, (2) textured flat EVA insole, (3) prefabricated lateral heel and sole wedge insole, and (4) textured lateral heel and sole wedge. The analysis of ankle movement variability was conducted during stance phase and 200 ms before initial contact to 200 ms after initial contact. The coefficient of multiple correlations (CMC) was calculated to investigate pattern variability and intraclass correlation (ICC) was used to investigate variability at the points of interest. RESULTS: In terms of pattern variability, wearing textured lateral wedge increased CMC compared to other insoles. However, statistically significant differences were observed only in the frontal plane during stance phase (P < 0.05). In terms of variability at the points of interest, in the frontal plane and in all points of interest, wearing textured lateral wedge increased ICC compared to other insoles. The effects of other insoles on ankle movement variability were inconsistent. CONCLUSIONS: The results of this study showed that textured insole has the potential to decrease variability and the use of texture with lateral wedge may more improve variability in athletes with FAI.

An anatomically-based masking protocol for the assessment of in-shoe plantar pressure measurement of the forefoot.

BACKGROUND: The area beneath the metatarsal heads is a common location of foot pain, which is often associated with high plantar pressures. Current plantar pressure assessment protocols focus mainly on the gross area of the forefoot with minimal attention paid to specific areas such as the metatarsal heads. The aim of this study was to develop and assess a new anatomically-based masking protocol that is clinically relevant to measure forefoot plantar pressure during shod conditions based on the anatomical positions of the metatarsal heads. METHODS: Initially, we developed a masking protocol to measure forefoot plantar pressure during shod conditions based on the anatomical positions of the metatarsal heads. This new masking protocol divided the forefoot into three sub-areas (proximal, beneath, and distal to the metatarsal heads) as determined by the position of each metatarsal head. Following development of the new masking protocol, we compared the new protocol against a traditional protocol, which defines the forefoot as between 51 and 81% of the foot length. To compare the two masking protocols, we tested two experimental conditions: (i) a control condition (i.e. no metatarsal pad), and (ii) a metatarsal pad condition. We then compared plantar pressure differences between the two experimental conditions for the two masking protocols. Participants for this component of the study included 36 community dwelling older adults (mean age 75.6 years ±5.4) with a history of forefoot pain. Forefoot plantar pressure data were measured while walking using the pedar®-X in-shoe system. Peak pressure, maximum force and contact area at the time of peak pressure were determined and results were compared between the two masking protocols. RESULTS: The traditional masking protocol showed that the metatarsal pad significantly decreased peak pressure and increased contact area in the forefoot area (i.e. within the entire mask area), but maximum force was not significantly different between the two conditions. In contrast, the newly developed anatomically-based masking protocol indicated that the metatarsal pad decreased peak plantar pressures distal to and beneath the metatarsal heads by increasing force and contact area proximal to the metatarsal heads. CONCLUSIONS: An anatomically-based masking protocol that is clinically relevant was developed to assess forefoot plantar pressure during shod conditions based on the anatomical positions of metatarsal heads. We propose that the new forefoot masking protocol will provide greater interpretability of forefoot plantar pressure data, which will aid clinicians and researchers for diagnostic, prognostic and therapeutic purposes.

Foot posture is associated with plantar pressure during gait: A comparison of normal, planus and cavus feet.

BACKGROUND: Variations in foot posture, such as pes planus (low medial longitudinal arch) or pes cavus (high medial longitudinal arch) are associated with some lower limb injuries. However, the mechanism that links foot posture to injury is not clear. Research question The aim of this study was to compare plantar pressure between healthy individuals with normal, planus or cavus feet. METHODS: Ninety-two healthy volunteers (aged 18 to 45) were classified as either normal (n = 35), pes planus (n = 31) or pes cavus (n = 26) based on the Foot Posture Index, Arch Index and normalised navicular height truncated. Barefoot walking trials were conducted using an emed®-x400 plantar pressure system (Novel GmbH, Munich, Germany). An 11 region mask was used that included the medial heel, lateral heel, midfoot, 1st, 2nd, 3rd, 4th and 5th metatarsophalangeal joints, hallux, 2nd toe, and the 3rd, 4th and 5th toes. Peak pressure, pressure-time integral, maximum force, force-time integral and contact area were calculated for each region. One way analyses of variance and effect sizes were used to compare the three foot posture groups. RESULTS: Overall, the largest differences were between the planus and cavus foot groups in forefoot pressure and force. In particular, peak pressures at the 4th and 5th MTPJs in the planus foot group were lower compared to the normal and cavus foot groups, and displayed the largest effect sizes. Significance This study confirms that foot posture does influence plantar pressures, and that each foot posture classification displays unique plantar pressure characteristics.

Centre of pressure characteristics in normal, planus and cavus feet.

BACKGROUND: The aim of this study was to compare centre of pressure (COP) characteristics between healthy adults with normal, planus or cavus feet who were allocated to groups based on reliable foot posture measurement techniques. METHODS: Ninety-two healthy adult participants (aged 18 to 45) were recruited and classified as either normal (n = 35), pes planus (n = 31) or pes cavus (n = 26) based on Foot Posture Index, Arch Index and normalised navicular height truncated measurements. Barefoot walking trials were conducted using an emed®-x 400 plantar pressure system (Novel GmbH, Munich, Germany). Average, maximum, minimum and range (difference between maximum and minimum) values were calculated for COP velocity and lateral-medial force index during loading response, midstance, terminal stance and pre-swing phases of stance. The COP excursion index was also calculated. One-way analyses of variance were used to compare the three foot posture groups. RESULTS: The cavus foot exhibited the slowest average and minimum COP velocity during terminal stance, but this pattern was reversed during pre-swing, when the cavus foot exhibited the fastest maximum COP velocity. The planus foot exhibited the smallest lateral medial force index range during terminal stance. There were no differences between the groups for COP excursion index. CONCLUSION: These findings indicate that there are differences in COP characteristics between foot postures, which may represent different mechanisms for generating force to facilitate forward progression of the body during the propulsive phases of gait.

The influence of staff training and education on prosthetic and orthotic service quality: A scoping review.

BACKGROUND: Education and training in prosthetics and orthotics typically comply with International Society for Prosthetics and Orthotics standards based on three categories of prosthetic and orthotic professionals. OBJECTIVE: This scoping study sought to describe the evidence base available to answer the question, How are prosthetic and orthotic services influenced by the training of staff providing them? STUDY DESIGN: Scoping review. METHODS: A structured search of the peer-reviewed literature catalogued in major electronic databases yielded 3039 papers. Following review of title and abstract, 93 articles were considered relevant. Full-text review reduced this number to 25. RESULTS: Only two articles were identified as providing direct evidence of the effects of training and education on service provision. While both suggested that there was an impact, it is difficult to see how the more specific conclusions of either could be generalised. The other 23 articles provide a useful background to a range of issues including the specification of competencies that training programmes should deliver (3 articles), descriptions of a range of training programmes and the effects of training and education on student knowledge and skills. CONCLUSION: Although it is considered axiomatic, the service quality is dependent on practitioner education and training. There is insufficient evidence to establish whether levels of training and education in prosthetics and orthotics have an effect on the quality of prosthetic and orthotic services. Clinical relevance There is very little evidence about the effects of training and education of prosthetists and orthotists on service quality. While this is a somewhat negative finding, we feel that it is important to bring this to the attention of the prosthetics and orthotics community.

The influence of standards and clinical guidelines on prosthetic and orthotic service quality: a scoping review.

OBJECTIVES: Standards and guidelines are an integral part of prosthetic and orthotic service delivery in the developed world underpinned by an assumption that they lead to improved services. Implementing them has a cost, however, and that cost needs to be justified, particularly in resource-limited environments. This scoping review thus asks the question, "What is the evidence of the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics?" MATERIALS AND METHODS: A structured search of three electronic databases (Medline, Scopus and Web of Science) followed by manual searching of title, abstract and full text, yielded 29 articles. RESULTS: Four categories of papers were identified: Descriptions and Commentaries (17 papers), Guideline Development (7), Guideline Testing (2) and Standards implementation (3). No articles were explicitly designed to assess the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics. DISCUSSION AND CONCLUSION: Studies tended to be commentaries on or descriptions of guideline development, testing or implementation of standards. The literature is not sufficiently well developed to warrant the cost and effort of a systematic review. Future primary research should seek to demonstrate whether and how guidelines and standards improve the outcomes for people that require prostheses, orthoses and other assistive devices. Implications for Rehabilitation International Standards and Clinical Guidelines are now an integral part of clinical service provision in prosthetics and orthotics in the developed world. Complying with standards and guidelines has a cost and, particularly in resource-limited environments, it should be possible to justify this in terms of the resulting benefits. This scoping review concludes that there have been no previous studies designed to directly quantify the effects of implementing standards and guidelines on service delivery.

The effect of dual tasking on foot kinematics in people with functional ankle instability.

BACKGROUND: Some cases of repeated inversion ankle sprains are thought to have a neurological basis and are termed functional ankle instability (FAI). In addition to factors local to the ankle, such as loss of proprioception, cognitive demands have the ability to influence motor control and may increase the risk of repetitive lateral sprains. OBJECTIVE: The purpose of this study was to investigate the effect of cognitive demand on foot kinematics in physically active people with functional ankle instability. METHODS: 21 physically active participants with FAI and 19 matched healthy controls completed trials of normal walking (single task) and normal walking while performing a cognitive task (dual task). Foot motion relative to the shank was recorded. Cognitive performance, ankle kinematics and movement variability in single and dual task conditions was characterized. RESULTS: During normal walking, the ankle joint was significantly more inverted in FAI compared to the control group pre and post initial contact. Under dual task conditions, there was a statistically significant increase in frontal plane foot movement variability during the period 200ms pre and post initial contact in people with FAI compared to the control group (p<0.05). Dual task also significantly increased plantar flexion and inversion during the period 200ms pre and post initial contact in the FAI group (p<0.05). CONCLUSION: participants with FAI demonstrated different ankle movement patterns and increased movement variability during a dual task condition. Cognitive load may increase risk of ankle instability in these people.

The effect of stroke on foot kinematics and the functional consequences.

BACKGROUND: Although approximately one-third of stroke survivors suffer abnormal foot posture and this can influence mobility, there is very little objective information regarding the foot and ankle after stroke. OBJECTIVE: As part of a programme of research examining foot and ankle biomechanics after stroke, we investigated multi-planar kinematics and the relationship with function. METHODS: In a single assessment session, static foot posture (Foot Posture Index); mobility limitations (Walking Handicap Scale) and multi-segment foot and ankle kinematics during stance phase of walking were measured in 20 mobile chronic stroke survivors and 15 sex and age-matched healthy volunteers. RESULTS: Compared to the healthy volunteers, the stroke survivors demonstrated consistently reduced range of motion across most segments and planes, increased pronation and reduced supination, disruption of the rocker and the timing of joint motion. Changes in pronation/supination were associated with limited walking ability. CONCLUSIONS: This study provides evidence of structural and movement deficiencies in the intrinsic foot segments affected by stroke. These would not have been detectable using a single segment foot model. Data do not support common clinical practices that focus on correction of sagittal ankle deformity and assumed excessive foot supination. Some of these abnormalities were associated with limitation in functional ability. Biomechanical abnormalities of foot and ankle are modifiable and there is potential for clinical studies and future developments of interventions to help prevent or treat these abnormalities which may improve functional ability post stroke.

Rollover footwear affects lower limb biomechanics during walking.

AIM: To investigate the effect of rollover footwear on walking speed, metabolic cost of gait, lower limb kinematics, kinetics, EMG muscle activity and plantar pressure. METHODS: Twenty subjects (mean age-33.1 years, height-1.71 m, body mass-68.9 kg, BMI 23.6, 12 male) walked in: a flat control footwear; a flat control footwear weighted to match the mass of a rollover shoe; a rollover shoe; MBT footwear. Data relating to metabolic energy and temporal aspects of gait were collected during 6 min of continuous walking, all other data in a gait laboratory. RESULTS: The rollover footwear moved the contact point under the shoe anteriorly during early stance, increasing midfoot pressures. This changed internal ankle dorsiflexion moments to plantarflexion moments earlier, reducing ankle plantarflexion and tibialis anterior activity after initial contact, and increasing calf EMG activity. In mid stance the rollover footwear resulted in a more dorsiflexed ankle position but less ankle movement. During propulsion, the rollover footwear reduced peak ankle dorsiflexion, peak internal plantarflexor ankle moments and the range of ankle plantarflexion. Vertical ground reaction loading rates were increased by the rollover footwear. There were no effects on temporal or energy cost of gait and no effect of elevated shoe weight. CONCLUSION: Investigating all proposed effects of this footwear concurrently has enabled a more valid investigation of how the footwear effects are interrelated. There were concurrent changes in several aspects of lower limb function, with greatest effects at the foot and ankle, but no change in the metabolic cost of walking.

The effect of rollover footwear on the rollover function of walking.

BACKGROUND: Rollover footwear is assumed to provide an enhanced surface over which the body can roll more easily. The aim of this study was to investigate the effects of rollover footwear on the rollover function of walking. METHODS: Twenty subjects walked in three conditions: (i) a MBT shoe (Masai Barefoot Technology) characterized by a stiff sole rounded in the anterior-posterior direction; (ii) alternative rollover shoe (a prototype of Scholl STARLIT) characterized by a stiff sole rounded in the anterior-posterior direction; (iii) a flat control shoe. Data on the lower limb kinematics and ground reaction force were collected. The rollover function of walking was characterized using the radii of lower limb rollover shapes and duration of terminal double limb support. These data were compared between the three shoe conditions and the relationship between the radii of the curved shoe sole and the radii of the rollover shapes investigated. RESULTS: The radii of the whole and middle part of foot-shoe, ankle-foot and knee-ankle-foot rollover shapes were significantly smaller (i.e. more curved) for MBT (ranging from 12% to 81% smaller) and the rollover shoe (ranging from 2% to 69% smaller) compared with flat shoe (p < 0.05). Double support time decreased significantly for MBT ~12% and rollover shoe ~7% compared to the flat shoe. For both MBT and rollover shoes, there were positive correlations (r = 0.42-0.60) between the sole radii and radius of foot-shoe rollover shape (p < 0.05). CONCLUSION: Wearing MBT and the rollover shoe resulted in more curved foot-shoe, ankle-foot and knee-ankle-foot rollover shapes and faster weight transfer. However, the results also indicate that static sole curve is not the only factor influencing the gait rocker function.

The formation of friction blisters on the foot: the development of a laboratory-based blister creation model.

BACKGROUND/PURPOSE: Friction blisters on the foot are a debilitating pathology that have an impact on activities of daily living and can severely impair function. The purpose of this study was to test the hypotheses that digital infrared thermographic imaging will reveal: 1) a correlation between load application to the skin and the creation of blisters, and 2) a correlation between thermographic readings and contact thermometric temperatures. METHODS: Apparatus was developed to cause the formation of heel blisters through controlled load application (70 kPa). One foot of each of the 30 healthy volunteers (21 men and 9 women), with an age range of 31 ± 8 years, was subjected to load until a blister formed, after which load application ceased and temperature measurements were taken at set times during the following 5.5 h. Temperature measurements were also taken using a contact thermometer. RESULTS: The majority of the participants (77%) blistered within 18 min of load application. All the blisters created showed significant increases in local temperature compared to baseline during blister creation (P < 0.001) and 30 min post-blister creation (P < 0.001). There was a strong correlation between contact thermometry and thermographic temperature data (r > 8). CONCLUSION: These results suggest that thermographic images may prove useful for the remote assessment of traumatically damaged foot skin.

Foot posture after stroke: frequency, nature and clinical significance.

OBJECTIVES: Clinical convention suggests that foot posture and movements are adversely affected by stroke and cause walking difficulties but there is little objective data to support or refute these beliefs. This study explores static foot posture in people with stroke and their relationship to weakness and spasticity and walking limitations. DESIGN: Cross-sectional survey. SETTING: Stroke services and support groups of two acute hospitals. SUBJECTS: Seventy-two stroke survivors with mobility limitations. MAIN MEASURES: Foot Posture Index; Demographics; Motricity Index (weakness); modified Ashworth Scale (spasticity); Walking Handicap Scale (walking limitations). RESULTS: About one-third of participants had abnormal foot posture on the weak side, which was associated with walking limitations. Most (70%) had a symmetrical foot posture with similar frequencies of supination (13%) and pronation (16%) abnormalities. There was no relationship between foot posture and weakness and spasticity; age was the only independent predictor of foot posture abnormalities. CONCLUSIONS: A minority of people with stroke had abnormal or asymmetrical foot posture and equal numbers suffered pronation and supination abnormalities; these findings challenge the beliefs that underpin the clinical management of stroke-related foot problems.