Effects of human variation on foot and ankle pain in rural Madagascar.

OBJECTIVES: Foot and ankle dysfunction in barefoot/minimally shod populations remains understudied. Although factors affecting musculoskeletal pain in Western populations are well-studied, little is known about how types of work, gender, and body shape influence bone and joint health in non-Western and minimally shod communities. This study examines the effect of human variation on locomotor disability in an agrarian community in Madagascar. MATERIALS AND METHODS: Foot measurements were collected along with height, weight, age, and self-report data on daily activity and foot and ankle pain from 41 male and 48 female adults. A short form revised foot function index (FFI-R), that measures functional disability related to foot pain, was calculated. Raw and normalized foot measurements were compared by gender and used in a multiple linear regression model to determine predictors of FFI-R. RESULTS: Compared to men, women reported higher FFI-R scores (p = 0.014), spent more time on their feet (p = 0.019), and had higher BMIs (p = 0.0001). For their weight, women had significantly smaller and narrower feet than men. Bimalleolar breadth (p = 0.0005) and foot length (p = 0.0223) standardized by height, time spent on feet (p = 0.0102), ankle circumference standardized by weight (p = 0.0316), and age (p = 0.0090) were significant predictors of FFI-R score. DISCUSSION: Our findings suggest that human variation in anatomical and behavioral patterns serve as significant explanations for increased foot and ankle pain in women in this non-Western rural population. Foot and ankle pain were prevalent at similar levels to those in industrialized populations, indicating that research should continue to examine its effect on similar barefoot/minimally shod communities.

Foot health among the Roma population of southern Spain according to the foot health status questionnaire.

BACKGROUND: Foot health of the Roma population is a challenge for the health professionals where this minority is significant, as is the case in Spain. At present, little is known about foot health of the Roma population and their knowledge would promote the training of these professionals at the community level. Foot pain is common and a reason for consulting podiatry services. The purpose of this study was to determine foot health among the Roma population according to the Foot Health Status Questionnaire. METHOD: An observational, cross-sectional and quantitative study conducted at the Roma population living in Spain in 2018. Self-reported data and the Foot Health Status Questionnaire were recorded. Examining the general health and foot health (foot pain, foot function, footwear and general health) and general (general health, social capacity, physical activity and vigour). This questionnaire is recommended as a valid and reliable patient-reported outcome. The obtained scores were compared. RESULTS: A sample made up of 624 men and women from the Roma population took part in this study. 45% were Roma men and 55% Roma women. In the first section of the FHSQ, a lower score of values was recorded in the footwear domain (62.5) and in the general foot health domain (60). Gypsy women obtained lower scores in all the domains. In the second section, lower scores were obtained in the vigour (56) domain and in the general health (60) domain. A large effect size (r-Rosenthal) was found by gender in the footwear domain (0.334) and in the vigour domain (0.195). Roma women showed higher values in cardiac disorders, serious illnesses, doctor visits and foot problems. 67.8% reported that they had never been assisted by a podiatrist. CONCLUSIONS: The studied Roma population has foot health problems, and these are more pronounced among women. They show lower values in the footwear and vigour domains. More professional training is required for health workers in this field to avoid cultural diversity stereotypes.

Foot Problems in Patients in Acute Care: A Point-Prevalence Survey.

PURPOSE: Determine the prevalence of foot problems in an inpatient population and to describe demographic data, comorbid conditions, and type of footwear worn. DESIGN: Observational point-prevalence cross-sectional design. SUBJECTS AND SETTING: The study setting was a 722-bed licensed hospital in Western Australia. A convenience sampling was used to include adults hospitalized in the study setting during the period of data collection. METHODS: A subset of foot questions, guided by a literature review, and input from foot, wound, diabetes, and psychometric researchers and clinicians, was incorporated into the hospital point-prevalence survey conducted annually for nursing safety and quality. Trained nurses collected data during the 1-day survey. Data were analyzed using descriptive statistics and 2-tailed tests; associations between study variables were analyzed. RESULTS: Two hundred twenty-one patients participated in the survey; a majority (n = 193, 87%) self-reported at least 1 foot problem. More than half (n = 124) reported 3 foot problems and nearly one-third (n = 67) had 5 or more foot problems. Thick nails, damaged nails, and calluses and corns were the most frequently occurring foot problems. Older participants were more likely to have certain foot problems such as calluses and thick nails. Eleven (5%) participants were admitted to the hospital for a foot-related condition. CONCLUSION: The majority of foot problems in our study were found to be minor and not the primary admitting diagnosis. However, even minor foot problems can pose a risk of worsening, especially in high-risk populations such as those with diabetes. Thus, detection is critical in overall patient assessment, and nurses play a critical role in assessment and management of minor foot problems through the delivery of skin and nail care and through collaboration with other professionals who provide specialized foot care.

Examination of the Effect of Suitable Size of Shoes under the Second Metatarsal Head and Width of Shoes under the Fifth Metatarsal Head for the Prevention of Callus Formation in Healthy Young Women.

Excessive pressure and shear stress while walking cause a risk of callus formation, which eventually causes foot ulcers in patients with diabetes mellitus. Callus under the second metatarsal head (MTH) has been associated with increased shear stress/pressure ratios (SPR). Callus under the fifth MTH has been associated with increased peak shear stress (PSS). The purpose of this study is to examine whether the effect of the suitable size and width of shoes prevents diabetic foot ulcers under the second and fifth MTH. We measured the pressure and shear stress by testing three kinds of sizes and two types of width of shoes. Significant difference was not observed in the SPR under the second MTH among different sizes of shoes. However, the pressure and shear stress were significantly lower when putting on shoes of fit size compared with larger sizes. The PSS under the fifth MTH was significantly smaller when putting on shoes of fit width compared with those of narrow width. Wearing shoes of fit size and width has the potential to prevent callus formation by reducing the pressure and shear stress constituting SPR under the second MTH and PSS under the fifth MTH.

Footwear in the causation and prevention of foot ulcers in diabetes mellitus.

BACKGROUND.: Inappropriate footwear may be a major cause of foot ulceration among patients with diabetic neuropathy in India. No study has specifically examined the types of footwear or its components in patients with diabetes mellitus and their role in causing foot ulcers. We analysed the role of commonly used footwear in India in inducing first foot ulcers (FFU) in people with diabetes. METHODS.: Of 4800 patients with diabetes attending our centre over 1 year, 301 had FFU from different causes. Sixty-six patients with diabetic neuro-/vasculopathy presenting with ulcers due to footwear were included as cases. An equal number of patients with diabetes but without foot ulcers were enrolled as controls. Cases and controls were matched demographically and clinically for type of diabetes, metabolic control, duration of diabetes, comorbid conditions and foot neurovascular status. We did a detailed foot examination for neurological, vascular and wound status. We also evaluated the footwear in both groups. RESULTS.: In one-fifth of 335 limbs (301 patients), the primary cause for the FFU was use of inappropriate footwear. The patients used seven different models of footwear, six of which were found to be inappropriate. The straps of footwear caused over 50% of ulcers. Another one-third were due to penetration of sharp objects through the outer sole of footwear; among these cases, 1 3.6% of ulcers were caused by not using soft inner soles. CONCLUSIONS.: The use of softer insole is least effective in preventing foot ulcers. Similarly, straps contribute to a higher percentage of foot ulcers. Foot ulcers can be prevented by a combination of soft insole, with midsole and hard outsole with proper back counter and adjustable front and back straps.

Can parallel use of different running shoes decrease running-related injury risk?

The aim of this study was to determine if runners who use concomitantly different pairs of running shoes are at a lower risk of running-related injury (RRI). Recreational runners (n = 264) participated in this 22-week prospective follow-up and reported all information about their running session characteristics, other sport participation and injuries on a dedicated Internet platform. A RRI was defined as a physical pain or complaint located at the lower limbs or lower back region, sustained during or as a result of running practice and impeding planned running activity for at least 1 day. One-third of the participants (n = 87) experienced at least one RRI during the observation period. The adjusted Cox regression analysis revealed that the parallel use of more than one pair of running shoes was a protective factor [hazard ratio (HR) = 0.614; 95% confidence interval (CI) = 0.389-0.969], while previous injury was a risk factor (HR = 1.722; 95%CI = 1.114-2.661). Additionally, increased mean session distance (km; HR = 0.795; 95%CI = 0.725-0.872) and increased weekly volume of other sports (h/week; HR = 0.848; 95%CI = 0.732-0.982) were associated with lower RRI risk. Multiple shoe use and participation in other sports are strategies potentially leading to a variation of the load applied to the musculoskeletal system. They could be advised to recreational runners to prevent RRI.

Primitive running: a survey analysis of runners' interest, participation, and implementation.

Running is a sport that has continued to see growth in numbers over the years. Recently, there has been a movement promoting running barefoot and in light, "minimalist" shoes. Advocates of barefoot running believe that a more primitive style of running may result in fewer running-related injuries and even possibly improve performance. To identify the current interest level and participation in barefoot or minimalist shod running, an electronic survey was developed and dispersed to 6,082 runners. The survey instrument examined demographics, motivating factors, used resources, perceived barriers, and expectations in runners who add barefoot or in minimalist shod running to their training. Seven hundred eighty-five (13%) runners completed the survey. Six hundred and thirty (75.7%) indicated they were at least somewhat interested in running barefoot or in minimalist shoes. One hundred seventy-two (21.9%) runners had previously tried barefoot running, whereas 239 (30.4%) had previously tried minimalist shoes. The primary motivating factor for those running barefoot or in minimalist shoes (n = 283) was to prevent future injury (n = 97, 34.3%). Advice from friends (n = 68, 24.5%) or books (n = 68, 24.5%) was the most commonly used resource in transitioning to barefoot or minimalist shod running. Fear of possible injury (n = 424, 54%) was the most prevalent perceived barrier in transitioning to barefoot or minimalist shod running. An overwhelming 671 (85.5%) indicated that they were at least somewhat likely to continue with or to add barefoot or minimalist shod running if provided sufficient instruction. Runners who are men, of younger age, and who consider themselves elite runners are somewhat more likely to be interested in barefoot or minimalist shod running.

Anthropometric characteristics of feet of soldiers in the New Zealand Army.

Lower limb and lower back injuries are prevalent within the New Zealand (NZ) Army: independently collected data shows these to be most prevalent, with on average 10% of military personnel affected by such an injury at any time. To improve the quality and appropriateness of footwear, it is essential that normative foot anthropometric data is collected from NZ Army personnel. NZ Army personnel (n = 807) were included in this study; data on foot length, circumference, width, and arch heights were collected. It was found that the NZ Army personnel had notable differences in feet anthropometry compared to an exemplary model for the NZ general population, specifically in terms of arch height. It was also found that a substantial proportion (approximately 50%) of personnel tested could not be provided with a boot that fit (mainly Maori and Pacific Island soldiers) because of a limited width range of the currently issued boot.

Women Walk in High Heels: Lumbar Curvature, Dynamic Motion Stimuli and Attractiveness.

Previous studies have demonstrated that the angle of women's lumbar curvature affects men's attractiveness judgments of them. The theoretically optimal angle of lumbar curvature provides better resistance against both hyperlordosis and hypolordosis as biomechanical costs of a bipedal fetal load that could impair a woman's fertility. Since men find this attribute attractive, women aim to emphasize it by wearing high-heeled shoes. The primary objective of the present study was to test this evolutionary hypothesis using short videos presenting women walking by the camera. In line with previous findings based on static stimuli (photographs), dynamic stimuli (videos) presenting women walking in high-heeled shoes were expected to elicit increased attractiveness ratings as compared to women wearing flat shoes, which would be associated with the angle of lumbar curvature. Videos were taken of 52 female models walking in two conditions (i.e., wearing either high-heeled or flat shoes). A total of 108 participants (61 males, 47 females) rated the walking models' physical attractiveness in an online setting. Each model's lumbar curvature was measured both in high heels and in flat shoes using photographs taken of them prior to each video recording. The results showed that wearing high heels consistently increased the models' attractiveness, regardless of whether or not it decreased their natural difference from the theoretically optimal angle of lumbar curvature. Both male and female observers showed this positive effect. Furthermore, a negative correlation was found between the models' body mass index (BMI) and their perceived attractiveness scores in both conditions.

The Design of Individual Orthopedic Insoles for the Patients with Diabetic Foot Using Integral Curves to Describe the Plantar Over-Pressure Areas.

Identification of over-pressure areas in the plantar side of the foot in patients with diabetic foot and reduction of plantar pressure play a major role in clinical practice. The use of individual orthopedic insoles is essential to reduce the over-pressure. The aim of the present study is to mark the over-pressure areas of the plantar part of the foot on a pedogram and describe them with high accuracy using a mathematical research method. The locally over-pressured areas with calluses formed due to repeated injuries were identified on the patients' pedograms. The geometric shapes of the over-pressure areas were described by means of the integral curves of the solutions to Dirichlet singular boundary differential equations. Based on the mathematical algorithm describing those curves, the computer programs were developed. The individual orthopedic insoles were produced on a computer numerical control milling machine considering the locally over-pressured areas. The ethylene vinyl acetate polymers of different degrees of hardness were used to produce the individual orthopedic insoles. For the over-pressure areas, a soft material with a hardness of 20 Shore A was used, which reduces the pressure on the plantar side of the foot and increases the contact area. A relatively hard material with a hardness of 40 Shore A was used as the main frame, which imparts the stability of shape to the insole and increases its wear life. The individual orthopedic insoles produced by means of such technology effectively reduce the pressure on the plantar side of the foot and protect the foot from mechanical damage, which is important for the treatment of the diabetic foot.

Changes in knee adduction moment wearing a variable-stiffness shoe correlate with changes in pain and mechanically stimulated cartilage oligomeric matrix levels.

This study aimed to determine if changes in knee adduction moment (KAM) after 6 months of variable-stiffness shoe wear are associated with changes in symptoms or serum levels of cartilage oligomeric matrix protein (COMP) following a mechanical stimulus in subjects with medial knee osteoarthritis (OA). Twenty-five subjects were enrolled in the study and assigned a variable-stiffness shoe, and 19 subjects completed the 6-month follow-up. At baseline and follow-up subjects underwent gait analysis in control and variable-stiffness shoes, completed Western Ontario and McMaster Universities (WOMAC) questionnaires, and serum COMP concentrations were measured immediately before, 3.5 and 5.5 hours after a 30-minute walking activity. Relationships between changes in KAM (first peak and impulse) and changes in (a) COMP levels in response to the 30-minute walking activity and (b) WOMAC scores from baseline to 6-month follow-up were assessed by Pearson correlation coefficients. Changes in first peak KAM were associated with changes in COMP levels 5.5 hours postactivity from baseline to follow-up (R = .564, P = .045). Subjects with greater reductions in KAM had larger decreases in COMP (expressed as a percent of preactivity levels) at follow-up. Subjects with greater reductions in KAM impulse had significantly greater improvements in WOMAC Pain (R = -.56, P = .015) and Function (R = -.52, P = .028) scores at follow-up. The study results demonstrated the magnitude of reduction in the KAM wearing a variable-stiffness shoe is associated with decreases in mechanically stimulated COMP levels and pain/function. This work suggests that interactions between COMP and joint loading during walking should be further investigated in future studies of treatment outcomes in OA.

Longitudinal Analysis of Plantar Pressures with Wear of a Running Shoe.

Running shoes typically have a lifespan of 300-1000 km, and the plantar pressure pattern during running may change as the shoe wears. So, the aim of this study was to determine the variation of plantar pressures with shoe wear, and the runner's subjective sensation. Maximun Plantar Pressures (MMP) were measured from 33 male recreational runners at three times during a training season (beginning, 350 km, and 700 km) using the Biofoot/IBV® in-shoe system (Biofoot/IBV®, Valencia, Spain). All the runners wore the same shoes (New Balance® 738, Boston, MA, USA) during this period, and performed similar training. The zones supporting most pressure at all three study times were the medial (inner) column of the foot and the forefoot. There was a significant increase in pressure on the midfoot over the course of the training season (from 387.8 to 590 kPa, p = 0.003). The runners who felt the worst cushioning under the midfoot were those who had the highest peak pressures in that area (p = 0.002). The New Balance® 738 running shoe effectively maintains the plantar pressure pattern after 700 km of use under all the zones studied except the midfoot, probably due to material fatigue or deficits of the specific cushioning systems in that area.

Effects of the weight of shoes on calf muscle simulation.

The current study investigated the effects of shoes of different weights on calf individual muscle contributions during a running cycle. Twenty male runners ran on a force platform with shoes of four different weights (175 g, 255 g, 335 g, and 415 g). The study evaluated runners' lower extremity muscle forces under the four shoe weight conditions using a musculoskeletal modeling system. The system generates equality and inequality constraint equations to simulate muscle forces. The individual muscle contributions in each calf were determined using these muscle forces. Data were compared using one-way repeated-measure ANOVA. The results revealed significant differences in the contributions of the gastrocnemius lateralis. Post hoc comparisons revealed that running in the 175 g shoes resulted in a larger contribution of the gastrocnemius lateralis than running in the 415 g shoes during the braking phase. Therefore, wearing lightweight shoes while running may promote fatigue in the gastrocnemius muscle during the braking phase. The calf muscle activation results may indicate that an adaptation period is warranted when changing from heavy to lightweight shoes.

Lifetime occupation is not associated with radiographic osteoarthritis of the first metatarsophalangeal joint in a cohort study of UK women.

OBJECTIVE: The study aim was to determine whether lifetime occupation was associated with the presence of radiographic osteoarthritis (ROA) of the first metatarsophalangeal joint (MTPJ) in women. METHOD: Data were collected from the prospective, population-based Chingford 1000 Women study. This cohort of women, aged 45-64 years at inception, was established in 1989 from a single general practice in Chingford, UK. Data has subsequently been collected repeatedly. Data from baseline, year six and year ten was used for the purposes of this cross-sectional study. The primary outcome was the presence of dorsal view ROA of the first MTPJ. The main exposure was lifetime occupation, categorised according to levels of occupation previously defined via international consensus: 1. Sedentary, 2. Light, 3. Light manual, 4. Heavy manual. Logistic regression analyses were conducted to quantify the relationship between lifetime occupation type and the presence of ROA of the first MTPJ, adjusting for age, body mass index and lifetime high-heeled footwear use as potential interactive variables for each decade. RESULTS: Data for 209 women were included within this study. The mean (SD) age was 57 (±5.2) years. Predominant lifetime occupation was reported as sedentary by 51.7%, as light by 0%, as light manual by 33.5% and as heavy manual by 14.8% of participants. There were no statistical associations between lifetime occupation type and the presence of ROA of the first MTPJ in either the unadjusted (OR = 0.99, CI = 0.78-1.26,P = 0.96) partially adjusted (for age and BMI; OR = 1.00, CI = 0.78-1.29, P = 0.99) or fully adjusted models (for age, BMI and lifetime high heel footwear use for each decade of working life (OR = 1.02, CI = 0.79-1.31, P = 0.91); high-heel footwear use up to 20s (OR = 0.83, CI = 0.71-1.31, P = 0.83); high-heel footwear use in 20-30s (OR = 1.00, CI = 0.75-1.3, P = 0.98); high-heel footwear use in 30-40s (OR = 1.00, CI = 0.70-1.42, P = 0.99); high-heel footwear use in 40-50s (OR = 0.90, CI = 0.58-1.40, P = 0.65); high-heel footwear use in 50s (OR = 0.63,CI = 0.36-1.09, P = 0.10). CONCLUSIONS: The findings suggest that lifetime occupation is not associated with the presence of ROA of the fist metatarsophalangeal joint. There does not appear to be any interactive effect between lifetime occupation, lifetime high-heel footwear use, age or BMI and ROA of the first MTPJ. In later life a positive trend towards increased ROA in those who reported lifetime high-heel footwear use was noted and this may be worthy of further research.

Prevalence, intensity and associated risk factors of soil-transmitted helminth and schistosome infections in Kenya: Impact assessment after five rounds of mass drug administration in Kenya.

BACKGROUND: In Kenya, over five million school age children (SAC) are estimated to be at risk of parasitic worms causing soil-transmitted helminthiasis (STH) and schistosomiasis. As such, the Government of Kenya launched a National School Based Deworming (NSBD) program in 2012 targeting the at-risk SAC living in endemic regions, with the aim of reducing infections prevalence to a level where they no longer constitute a public health problem. The impact of the program has been consistently monitored from 2012 to 2017 through a robust and extensive monitoring and evaluation (M&E) program. The aim of the current study was to evaluate the parasitological outcomes and additionally investigate water, sanitation and hygiene (WASH) related factors associated with infection prevalence after five rounds of mass drug administration (MDA), to inform the program's next steps. MATERIALS AND METHODS: We utilized a cross-sectional design in a representative, stratified, two-stage sample of school children across six regions in Kenya. A sample size of 100 schools with approximately 108 children per school was purposively selected based on the Year 5 STH infection endemicity prior to the survey. Stool samples were examined for the presence of STH and Schistosoma mansoni eggs using double-slide Kato-Katz technique, urine samples were processed using urine filtration technique for the presence of S. haematobium eggs. Survey questionnaires were administered to all the participating children to collect information on their demographic and individual, household and school level WASH characteristics. PRINCIPAL FINDINGS: Overall, STH prevalence was 12.9% (95%CI: 10.4-16.1) with species prevalence of 9.7% (95%CI: 7.5-12.6) for Ascaris lumbricoides, 3.6% (95%CI: 2.2-5.8) for Trichuris trichiura and 1.0% (95%CI: 0.6-1.5) for hookworm. S. mansoni prevalence was 2.2% (95%CI: 1.2-4.3) and S. haematobium prevalence was 0.3% (95%CI: 0.1-1.0). All the infections showed significant prevalence reductions when compared with the baseline prevalence, except S. mansoni. From multivariable analysis, increased odds of any STH infections were associated with not wearing shoes, adjusted odds ratio (aOR) = 1.36 (95%CI: 1.09-1.69); p = 0.007; high number of household members, aOR = 1.21 (95%CI: 1.04-1.41); p = 0.015; and school absenteeism of more than two days, aOR = 1.33 (95%CI: 1.01-1.80); p = 0.045. Further, children below five years had up to four times higher odds of getting STH infections, aOR = 4.68 (95%CI: 1.49-14.73); p = 0.008. However, no significant factors were identified for schistosomiasis, probably due to low prevalence levels affecting performance of statistical analysis. CONCLUSIONS: After five rounds of MDA, the program shows low prevalence of STH and schistosomiasis, however, not to a level where the infections are not a public health problem. With considerable inter-county infection prevalence heterogeneity, the program should adopt future MDA frequencies based on the county's infection prevalence status. Further, the program should encourage interventions aimed at improving coverage among preschool age children and improving WASH practices as long-term infection control strategies.

Foot disorders and falls in older persons.

BACKGROUND: Fall rates are high among older people even in the healthy population. An aging foot may affect ambulatory function and increase the risk of fall(s). OBJECTIVE: To study foot musculoskeletal disorders, falls and associated factors in healthy elderly subjects. METHODS: Healthy volunteers aged 60-80 years who were independent in self-care and walking were recruited from urban Bangkok. Trained physicians evaluated health status, foot problems, and fall(s) history of all subjects. Walking performance was assessed using the 'Timed Get Up & Go' test and 6-m walking speed. Footprints were taken from the standing position. Foot dimensions and footwear were also measured by certified orthotists. Associated factors of foot disorders and falls were analyzed. RESULTS: There were 213 subjects: 108 men, 105 women with a mean age of 68.6 +/- 5.4 years. Foot deformities presented in 87% and were not significantly associated with walking performance or falls. Foot pain was found in 14% with a male:female sex ratio of 1:4. The causes of pain were plantar fasciitis, hallux valgus, callus, metatarsalgia, and inappropriate footwear. Subjects with foot pain had slower walking speed (1.14 +/- 0.12 vs. 1.19 +/- 0.12 m/s, p = 0.056). Falls were reported in 29.5% of women and 12.9% of men (p = 0.004). Multivariate analyses demonstrated that fall risk factors were female gender (OR = 2.4, 95% CI = 1.13-5.12), plantar fasciitis (OR = 6.8, 95% CI = 1.52-31.02), and knee osteoarthritis (OR = 3.6, 95% CI = 1.71-7.59). Subgroup analyses revealed that visual deficit was associated with falls in women (OR = 4.7, 95% CI = 1.75-12.73), and impaired foot protective sensation was associated with falls in men (OR = 5.1, 95% CI = 1.46-18.38). CONCLUSIONS: Aging foot deformities presented different characteristics among genders and were mostly asymptomatic. Foot pain, especially from plantar fasciitis, increased risk of falls in healthy older persons. Foot assessment, foot pain management, and proper footwear play important roles in fall prevention.

Decreased Vertical Trunk Inclination Angle and Pelvic Inclination as the Result of Mid-High-Heeled Footwear on Static Posture Parameters in Asymptomatic Young Adult Women.

The influence of high-heel footwear on the lumbar lordosis angle, anterior pelvic tilt, and sacral tilt are inconsistently described in the literature. This study aimed to investigate the impact of medium-height heeled footwear on the static posture parameters of homogeneous young adult standing women. Heel geometry, data acquisition process, as well as data analysis and parameter extraction stage, were controlled. Seventy-six healthy young adult women with experience in wearing high-heeled shoes were enrolled. Data of fifty-three subjects were used for analysis due to exclusion criteria (scoliotic posture or missing measurement data). A custom structured light surface topography measurement system was used for posture parameters assessment. Three barefoot measurements were taken as a reference and tested for the reliability of the posture parameters. Two 30-degree wedges were used to imitate high-heel shoes to achieve a repeatable foot position. Our study confirmed the significant (p < 0.001) reduced vertical balance angle and pelvis inclination angle with large and medium-to-large effects, respectively, due to high-heel shoes. No significant differences were found in the kyphosis or lordosis angles. High-heeled shoes of medium height in young asymptomatic women can lead to a straightening effect associated with a reduced vertical balance angle and decreased pelvic inclination.

Local dynamic stability of the lower extremity in novice and trained runners while running intraditional and minimal footwear.

BACKGROUND: Understanding how footwear cushioning influences movement stability may be helpful in reducing injuries related to repetitive loading. RESEARCH QUESTION: The purpose of this study was to identify the relationship between running experience and midsole cushioning on local dynamic stability of the ankle, knee and hip. METHODS: Twenty-four trained and novice runners were recruited to run on a treadmill for five minutes at the same relative intensity. Midsole thickness (thick/thin) and stiffness (soft / hard) were manipulated yielding four unique conditions. Lyapunov exponents were estimated using the Wolf algorithm from sagittal ankle, knee and hip kinematics. RESULTS: Trained runners had increased movement stability in all shoe conditions compared to their novice counterparts. Midsole thickness and stiffness, overall, did not affect movement stability within each of the running groups. Novice runners displayed decreased movement stability at the hip while running in the thick/soft running shoes. It was found that running experience has a greater influence on movement stability in the lower limbs compared to the midsole characteristics that were manipulated in this experiment. The hip was most stable followed by the knee and the ankle highlighting decreased stability in distal joints. CONCLUSIONS: It appears that midsole design within current design ranges do not have the ability to influence movement stability.

Effect of heel base area and walking speed on the utilized coefficient of friction during high-heeled walking.

BACKGROUND: The utilized coefficient of friction (uCOF) and the risk of slipping are known to increase as the heel height of shoes increases. The heel base area of shoes can also affect the uCOF. OBJECTIVE: The purpose of this study is to investigate the effect of the heel base area of high heels and walking speed on the uCOF during walking and their interaction effect. METHODS: The walking experiment was conducted at the speed of 1.0 m/s and 1.25 m/s using four 9-cm high heels having different heel areas (narrow, moderate, wide, and wedge heels). RESULTS: The peak uCOF was significantly lower when wearing the wide heels than when wearing the other heels. Wearing the narrow and moderate heels reduced the vertical ground reaction force (GRF) owing to the early timing of the peak anterior-posterior GRF and increased the peak uCOF. As the walking speed became faster, the peak uCOF became greater with more increases by the interaction effect when wearing the narrow and moderate heels than when wearing the wide and wedge heels. CONCLUSIONS: These results imply that wearing narrow high heels should be considered carefully, as the potential for a slip could be high owing to the increase in the peak uCOF. If it is inevitable to wear narrow high heels, it is critical to walk at a slower speed than usual. It is better to wear high heels with a wide heel area, e.g., 3 cm*3 cm, rather than narrow high heels or even wedge heels to reduce the possibility of slipping.

Stability of Three Different Sanitary Shoes on Healthcare Workers: A Cross-Sectional Study.

BACKGROUND: The main purpose of this research was to determine the stability of three different sanitary shoes on nurses with eyes open and closed with respect to barefoot condition. In addition, the secondary aim was to determine the reliability of stability measurements under these different conditions. METHODS: A crossover quasi-experimental study (NCT03764332) was performed. Twenty-six nurses who wore different sanitary shoes (Eva Plus Ultralight®, Gym Step® and Milan-SCL Liso®) were evaluated with respect to barefoot condition for stability measures on the Podoprint® podobarometric and stabilometry tool and with eyes open and closed. Furthermore, the reliability of stability measurements was determined by the intraclass correlation coefficient (ICC) under these different conditions. RESULTS: Between-groups comparisons of the static and stabilometry podobarometric data with eyes open showed statistically significant differences (p < 0.05). Milan-SCL Liso® sanitary shoes improved podobarometric data of forefoot force and distribution with respect to barefoot condition. Eva Plus Ultralight® and Gym Step® sanitary shoes increased the stroke length mean, stroke surface mean, and anterior speed mean as well as reduced y axis displacement mean with respect to barefoot condition. Similar findings were determined for measurements with eyes closed. ICCs ranged from poor to excellent reliability (ICC = 0.010-0.995). CONCLUSIONS: Sanitary shoes improved podobarometric and stabilometry stability with respect to barefoot condition.