Foot Morphology in Chinese Adolescents Aged Between 13 to 18 Years Varies by Gender and Age.

BACKGROUND We recently reported age and gender differences in foot shape and size in Chinese school children aged between 7-12 years. This study aimed to analyze age and gender differences in foot shape and size in Chinese adolescents aged between 13-18 years. MATERIAL AND METHODS The study included 1,252 adolescent boys and 1274 adolescent girls from seven regions in China. Twelve measurements of foot shape were recorded using a video filming system. One-way analysis of variance (ANOVA) compared the changes in the measurements with age. An independent t-test was used to analyze gender-associated differences in foot size and shape. RESULTS In adolescent boys, foot length and width increased significantly at 13-14 years and heel width, arch height, and fifth metatarsal head height increased until 18 years (P<0.05). In adolescent girls, most foot measurements ceased to increase after 15 years, except for arch height. Adolescent boys showed significantly larger foot length, width, height, and girth compared with adolescent girls (P<0.05) (Cohen's d effect size >0.8). Adolescent boys showed a significant increase in ball width and girth, and instep length and height compared with adolescent girls, who had a longer medial foot length and higher fifth metatarsal head height compared with adolescent boys (P<0.05) (Cohen's d effect size >0.5). CONCLUSIONS Age and gender associated differences were found in foot measurements in Chinese adolescents, aged between 13-18 years. These differences should be considered by shoe manufacturers and when making clinical decisions about normal foot development.

The effect of Tai Chi practice on brain white matter structure: a diffusion tensor magnetic resonance imaging study.

Diffusion tensor imaging (DTI) measures the displacement of water molecules across tissue components and thus provides information on the microstructure of brain white matter. This study examined the effect of Tai Chi and the relation of Tai Chi experiences and skills with brain white matter. Fractional anisotropy (FA) was obtained from the DTI magnetic resonance images of two group participants, namely, the long-term Tai Chi practitioners and sedentary counterparts. Whole-brain voxel-based analysis showed that the Tai Chi group had higher FA in the splenium of corpus callosum (p = 0.015) than the control group. Rank correlation analysis revealed that in the Tai Chi group, the FA value of the splenium of corpus callosum was moderately related with exercise duration (r = 0.45, p = 0.045) but highly related with skill level (r = 0.699, p = 0.001). Long-term Tai Chi practice could benefit to the brain white matter, and these impacts were correlated with exercise duration and skill level.

Foot Morphology in Chinese School Children Varies by Sex and Age.

BACKGROUND Knowledge of children's foot shape is essential for podiatric healthcare and footwear design. Differences in foot shapes relative to sex and age were demonstrated among white children; however, no study has examined the foot characteristics of Asian children according to sex and age. This study aimed to analyze the age- and sex-associated differences in foot measurements in Chinese children. MATERIAL AND METHODS We recruited 1240 boys and 1303 girls from China as participants for the present study. Foot dimensions were recorded by a video filming system, and 12 foot-shape measurements were acquired. One-way ANOVA was used to calculated the changes in measurements with age for boys and girls. Scores were analyzed as raw and normalized to foot length using the independent-samples t test. RESULTS Most measurements increased significantly at 7-8 and 8-9 years for girls and 8-9 and 10-11 years for boys. Arch height, instep length, and heel width showed greatest increases for both sexes ages 7-12 years (P<0.05). Sex differences in measurements mainly occurred at 8, 9, and 11 years. When we analyzed the normalized measurements of the same age children, instep length, heel width, ball girth, and instep girth were significantly different between boys and girls (P<0.05). CONCLUSIONS Sex- and age-associated differences were identified in the foot morphology of the Chinese school-aged children in this study. These differences should be considered when making clinical decisions about normal foot development and manufacturing shoes for Chinese school children.

Effects of different periods of Tai Chi exercise on the kinesthesia of the lower limb joints of elderly women.

This study investigated the effects of different periods of Tai Chi exercise on knee and ankle joint kinesthesia. A total of 20 Tai Chi practitioners and 19 controls completed the final test. Customized devices were used to measure the kinesthesia of the knee and ankle joints at the start, after 24 weeks and after 48 weeks of the intervention. Results showed that the 24-week Tai Chi intervention considerably improved the kinesthesia of the knee flexion and extension and ankle dorsiflexion. The 48-week Tai Chi intervention improved the kinesthesia towards knee flexion and extension, ankle dorsiflexion and plantar flexion. Moreover, the 48-week Tai Chi intervention had better kinesthesia towards knee extension and ankle dorsiflexion compared with the 24-week Tai Chi intervention. Our results suggest that long-term (48 weeks versus 24 weeks) Tai Chi exercise benefits the knee and ankle kinesthesia of elderly women.

Effects of 24-week Tai Chi exercise on the knee and ankle proprioception of older women.

This study examined the effects of regular Tai Chi (TC) exercise on the kinaesthesia of the knee and ankle joints of older women. A total of 43 women aged 55-68 years participated in this study. In a 24-week study period, the TC group (n = 22) underwent an organized TC exercise, whereas the control group (n = 21) maintained a sedentary lifestyle. Customized instruments were used to measure the threshold for the detection of the passive motion of the knee and ankle joints. After 24 weeks, the TC group showed a significantly smaller threshold for the detection of passive motion of knee extension (31.4%, p = 0.009), knee flexion (27.0%, p = 0.044), and ankle dorsal flexion (28.9%, p = 0.014) than the control group. Other comparisons showed no significant differences. The 24-week TC exercise benefited the lower-limb kinaesthesia of the knee joint flexion and extension and ankle dorsal flexion.

Effect of 1-year regular Tai Chi on neuromuscular reaction in elderly women: a randomized controlled study.

This study assessed the effect of 1-year regular Tai Chi (TC) on neuromuscular reaction in elderly women. A total of 41 elderly women (55 years-68 years) completed the study. The TC group (n = 21) performed the 24-form TC, while the control group (C, n = 20) was instructed to read newspapers or watch television when the TC group practised. Electromyogram measurements were conducted before and after intervention. After a year-long intervention, the post-test results of between-group neuromuscular reaction time showed significant differences in the rectus femoris (t = 3.607, p = 0.001), semitendinosus (t = 2.678, p = 0.011), anterior tibialis (t = 3.455, p = 0.001), and gastrocnemius muscles (t = 4.061, p = 0.000). Within-group results showed that the TC group had significantly shorter neuromuscular reaction time compared to its baseline value in the rectus femoris (t = 3.066, p = 0.006), semitendinosus (t = 2.485, p = 0.022), anterior tibialis (t = 2.311, p = 0.032), and gastrocnemius muscles (t = 2.462, p = 0.023). Results suggested that year-long regular TC can improve neuromuscular reaction function in elderly women.

Effects of 24 weeks of Tai Chi Exercise on Postural Control among Elderly Women.

This study examined the effects of 24 weeks of Tai Chi Quan on the postural control of elderly women. A total of 43 women aged 55-68 years participated in the study. A Tai Chi group (n = 22) underwent an organized Tai Chi exercise, whereas the control group (n = 21) maintained a habitual, no-regular-exercise lifestyle. A Good Balance tester (Metitur, Finland) was used to measure the time, paths and velocity of the center of pressure (COP) of subjects during stance while shifting COP to targeted positions shown on a monitor. After 24 weeks, the Tai Chi group showed significantly shorter total (18.6%, p = 0.005), mediolateral (21.9%, p = 0.002) and anteroposterior (18.3%, p = 0.002) COP sway paths than the control group. The results indicate that 24 weeks of the Tai Chi exercise improved the efficiency of postural control for elderly women.

Kinetics of badminton lunges in four directions.

The lunge is the most fundamental skill in badminton competitions. Fifteen university-level male badminton players performed lunge maneuvers in four directions, namely, right-forward, left-forward, right-backward, and left-backward, while wearing two different brands of badminton shoes. The test compared the kinetics of badminton shoes in performing typical lunge maneuvers. A force plate and an insole measurement system measured the ground reaction forces and plantar pressures. These measurements were compared across all lunge maneuvers. The left-forward lunge generated significantly higher first vertical impact force (2.34 ± 0.52 BW) than that of the right-backward (2.06 ± 0.60 BW) and left-backward lunges (1.78 ± 0.44 BW); higher second vertical impact force (2.44 ± 0.51 BW) than that of the left-backward lunge (2.07 ± 0.38 BW); and higher maximum anterior-posterior shear force (1.48 ± 0.36 BW) than that of the left-backward lunge (1.18 ± 0.38 BW). Compared with other lunge directions, the left-forward lunge showed higher mean maximum vertical impact anterior-posterior shear forces and their respective maximum loading rates, and the plantar pressure at the total foot and heel regions. Therefore, the left-forward lunge is a critical maneuver for badminton biomechanics and related footwear research because of the high loading magnitude generated during heel impact.

Foot forces induced through Tai Chi push-hand exercises.

The low impact forces of Tai Chi push-hand exercises may be particularly suited for older people and for those with arthritis; however, the biomechanics of push-hand exercises have not previously been reported. This paper examines the ground reaction forces (GRFs) and plantar force distributions during Tai Chi push-hand exercises in a stationary stance with and without an opponent. Ten male Tai Chi practitioners participated in the study. The GRFs of each foot were measured in three perpendicular directions using two force plates (Kistler). The plantar force distribution of each foot was measured concurrently using an insole sensor system (Novel). The results showed that the average maximum vertical GRF of each foot was not more than 88% ± 6.1% of the body weight and the sum of the vertical forces (103% ± 1.4%) generated by the two feet approximately equals the body weight at any one time. The horizontal GRFs generated by the two feet were in the opposite directions and the measured mean peak values were not more than 12% ± 2.8% and 17% ± 4.3% of the body weight in the medio-lateral and antero-posterior directions respectively. Among the nine plantar areas, the toes sustained the greatest plantar force. This study indicates that push-hand exercises generate lower vertical forces than those induced by walking, bouncing, jumping and Tai Chi gait, and that the greatest plantar force is located in the toe area, which may have an important application in balance training particularly for older adults.

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.

Comparison of plantar loads during running on different overground surfaces.

The objective of this study is to compare plantar loads during running on different overground surfaces. Fifteen heel-to-toe runners participated in the study. Plantar load data were collected and analyzed using an insole sensor system during running on concrete, synthetic rubber, and grass surfaces at a running speed of 3.8 m/s. Compared with running on concrete surface, running on natural grass showed a lower magnitude of maximum plantar pressure at the total foot (451.8 kPa vs. 401.7 kPa, p = 0.016), lateral midfoot (175.3 kPa vs. 148.0 kPa, p = 0.004), central forefoot (366.3 kPa vs. 336.8 kPa, p = 0.003), and lateral forefoot (290.2 kPa vs. 257.9 kPa, p = 0.004). Moreover, running on natural grass showed a longer relative contact time compared with running on a concrete surface at the central forefoot (81.9% vs. 78.8%, p = 0.017) and lateral forefoot (75.2% vs. 73.1%, p = 0.007). No significant difference was observed in other multiple comparisons. Different surfaces affected the plantar loads while running. The differences may help us to understand potential injury mechanisms.

Changes in running mechanics using conventional shoelace versus elastic shoe cover.

The purpose of this study was to determine whether there are differences in the perceived comfort, plantar pressure, and rearfoot motion between laced running shoes and elastic-covered running shoes. Fifteen male amateur runners participated in the study. Each participant was assigned laced running shoes and elastic-covered running shoes for use during the study. The perceived comfort, plantar loading, and rearfoot motion control of each type of shoes during running were recorded. When the laced running shoes and elastic-covered running shoes were compared, the elastic-covered running shoes were given a lower perceived comfort rating in terms of shoe length, width, heel cup fitting, and forefoot cushioning. The elastic-covered running shoes also recorded higher peak plantar pressure in the lateral side of the forefoot, as well as larger maximum rearfoot pronation. Overall, shoelaces can help runners obtain better foot-shoe fit. They increase the perceived comfort, and decrease the maximum pronation and plantar pressure. Moreover, shoelaces may help prevent injury in running by allowing better control of the aforementioned factors.

The effect of school bag design and load on spinal posture during stair use by children.

Thirteen male children ascending and descending stairs with loads that equalled 0%, 10%, 15% and 20% of their body weight were the subject of our research: the boys were wearing an asymmetrical single-strap athletic bag or a symmetrical double-strap backpack during our experiments with them. The maximum spinal tilt to the loading side and to the support side, and the range of spinal motions, were obtained by using a motion analysis system. Our results showed that symmetry of spinal posture was observed both when they ascended staircase with all loads and descended in a backpack. When carrying an athletic bag with 15% and 20% of their body weight while ascending the staircase, the lateral spinal tilt to the supporting side was significantly increased. We concluded that a symmetrical backpack with a load not exceeding 20% or an asymmetrical single-strap athletic bag with a load not exceeding 10% should be recommended for school children in order to promote safer staircase use. STATEMENT OF RELEVANCE: Children carrying heavy school bags may develop spinal problems. This study suggested that when they are using stairs, a symmetrical backpack with a load within 20% body weight is acceptable for them. When they are carrying an asymmetrical single-strap athletic bag, the bag's weight should not exceed 10% of the body weight in order to avoid excessive spinal tilt.

Gender differences in foot shape: a study of Chinese young adults.

One important extrinsic factor that causes foot deformity and pain in women is footwear. Women's sports shoes are designed as smaller versions of men's shoes. Based on this, the current study aims to identify foot shape in 1,236 Chinese young adult men and 1,085 Chinese young adult women. Three-dimensional foot shape data were collected through video filming. Nineteen foot shape variables were measured, including girth (4 variables), length (4 variables), width (3 variables), height (7 variables), and angle (1 variable). A comparison of foot measures within the range of the common foot length (FL) categories indicates that women showed significantly smaller values of foot measures in width, height, and girth than men. Three foot types were classified, and distributions of different foot shapes within the same FL were found between women and men. Foot width, medial ball length, ball angle, and instep height showed significant differences among foot types in the same FL for both genders. There were differences in the foot shape between Chinese young women and men, which should be considered in the design of Chinese young adults' sports shoes.

Greater toe grip and gentler heel strike are the strategies to adapt to slippery surface.

This study investigated the plantar pressure distribution during gait on wooden surface with different slipperiness in the presence of contaminants. Fifteen Chinese males performed 10 walking trials on a 5-m wooden walkway wearing cloth shoe in four contaminated conditions (dry, sand, water, oil). A pressure insole system was employed to record the plantar pressure data at 50Hz. Peak pressure and time-normalized pressure-time integral were evaluated in nine regions. In comparing walking on slippery to non-slippery surfaces, results showed a 30% increase of peak pressure beneath the hallux (from 195.6 to 254.1kPa), with a dramatic 79% increase in the pressure time integral beneath the hallux (from 63.8 to 114.3kPa) and a 34% increase beneath the lateral toes (from 35.1 to 47.2kPa). In addition, the peak pressure beneath the medial and lateral heel showed significant 20-24% reductions, respectively (from 233.6-253.5 to 204.0-219.0kPa). These findings suggested that greater toe grip and gentler heel strike are the strategies to adapt to slippery surface. Such strategies plantarflexed the ankle and the metatarsals to achieve a flat foot contact with the ground, especially at heel strike, in order to shift the ground reaction force to a more vertical direction. As the vertical ground reaction force component increased, the available ground friction increased and the floor became less slippery. Therefore, human could walk without slip on slippery surfaces with greater toe grip and gentler heel strike as adaptation strategies.

A three-pressure-sensor (3PS) system for monitoring ankle supination torque during sport motions.

This study presented a three-pressure-sensor (3PS) system for monitoring ankle supination torque during sport motions. Five male subjects wore a pair of cloth sport shoes and performed 10 trials of walking, running, cutting, vertical jump-landing and stepping-down motions in a random sequence. A pair of pressure insoles (Novel Pedar model W, Germany) was inserted in the shoes for the measurement of plantar pressure at 100Hz. The ankle joint torque was calculated by a standard lower extremity inverse dynamic calculation procedure with the data obtained by a motion capture system (VICON, UK) and a force plate (AMTI, USA), and was presented in a supination/pronation plane with an oblique axis of rotation at the ankle joint. Stepwise linear regression analysis suggested that pressure data at three locations beneath the foot were essential for reconstructing the ankle supination torque. Another group of five male subjects participated in a validation test with the same procedure, but with the pressure insoles replaced by the 3PS system. Estimated ankle supination torque was calculated from the equation developed by the regression analysis. Results suggested that the correlation between the standard and estimated data was high (R=0.938). The overall root mean square error was 6.91Nm, which was about 6% of the peak values recorded in the five sport motions (113Nm). With the good estimation accuracy, tiny size and inexpensive cost, the 3PS system is readily available to be implanted in sport shoe for the estimation and monitoring of ankle supination torque during dynamic sport motions.

Estimating the complete ground reaction forces with pressure insoles in walking.

This study presented a method to estimate the complete ground reaction forces from pressure insoles in walking. Five male subjects performed 10 walking trials in a laboratory. The complete ground reaction forces were collected during a right foot stride by a force plate at 1000Hz. Simultaneous plantar pressure data were collected at 100Hz by a pressure insole system with 99 sensors covering the whole plantar area. Stepwise linear regressions were performed to individually reconstruct the complete ground reaction forces in three directions from the 99 individual pressure data until redundancy among the predictors occurred. An additional linear regression was performed to reconstruct the vertical ground reaction force by the sum of the value of the 99 pressure sensors. Five other subjects performed the same walking test for validation. Estimated ground reaction forces in three directions were calculated with the developed regression models, and were compared with the real data recorded from force plate. Accuracy was represented by the correlation coefficient and the root mean square error. Results showed very good correlation in anterior-posterior (0.928) and vertical (0.989) directions, and reasonable correlation in medial-lateral direction (0.719). The root mean square error was about 12%, 5% and 28% of the peak recorded value. Future studies should aim to generalize the methods or to establish specific methods to other subjects, patients, motions, footwear and floor conditions. The method gives an extra option to study an estimation of the complete ground reaction forces in any environment without the constraints from the number and location of force plates.

Effect of prolonged walking with backpack loads on trunk muscle activity and fatigue in children.

This study investigated the effect of prolonged walking with load carriage on muscle activity and fatigue in children. Fifteen Chinese male children (age=6 years, height=120.0+/-5.4 cm, mass=22.9+/-2.6 kg) performed 20-min walking trials on treadmill (speed=1.1 ms(-1)) with different backpack loads (0%, 10%, 15% and 20% body weight). Electromyography (EMG) signals from upper trapezius (UT), lower trapezius (LT) and rectus abdominis (RA) were recorded at several time intervals (0, 5, 10, 15 and 20 min), and were normalized to the signals collected during maximum voluntary contraction. Integrated EMG signal (IEMG) was calculated to evaluate the muscle activity. Power spectral frequency analysis was applied to evaluate muscle fatigue by the shift of median power frequency (MPF). Results showed that a 15% body weight (BW) load significantly increased muscle activity at lower trapezius when the walking time reached 15 min. When a 20% BW load was being carried, increase in muscle activity was found from 5 min, and muscle fatigue was found from 15 min. In upper trapezius, increase of muscle activity was not found within the 20-min period, however, muscle fatigue was found from 10 min. No increased muscle activity or muscle fatigue was found in rectus abdominis. It is suggested that backpack loads for children should be restricted to no more than 15% body weight for walks of up to 20 min duration to avoid muscle fatigue.