Influence of dental occlusion on postural control and plantar pressure distribution.

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Scharnweber, Benjamin; Adjami, Frederic; Schuster, Gabriele; Kopp, Stefan; Natrup, Jörg; Erbe, Christina; Ohlendorf, Daniela

2017-11-01

The number of studies investigating correlations between the temporomandibular system and body posture, postural control or plantar pressure distribution is continuously increasing. If a connection can be found, it is often of minor influence or for only a single parameter. However, small subject groups are critical. This study was conducted to define correlations between dental parameters, postural control and plantar pressure distribution in healthy males. In this study, 87 male subjects with an average age of 25.23 ± 3.5 years (ranging from 18 to 35 years) were examined. Dental casts of the subjects were analyzed. Postural control and plantar pressure distribution were recorded by a force platform. Possible orthodontic and orthopedic factors of influence were determined by either an anamnesis or a questionnaire. All tests performed were randomized and repeated three times each for intercuspal position (ICP) and blocked occlusion (BO). For a statistical analysis of the results, non-parametric tests (Wilcoxon-Matched-Pairs-Test, Kruskall-Wallis-Test) were used. A revision of the results via Bonferroni-Holm correction was considered. ICP increases body sway in the frontal (p ≤ 0.01) and sagittal planes (p ≤ 0.03) compared to BO, whereas all other 29 correlations were independent of the occlusion position. For both of the ICP or BO cases, Angle-class, midline-displacement, crossbite, or orthodontic therapy were found to have no influence on postural control or plantar pressure distribution (p > 0.05). However, the contact time of the left foot decreased (p ≤ 0.001) while detecting the plantar pressure distribution in each position. Persistent dental parameters have no effect on postural sway. In addition, postural control and plantar pressure distribution have been found to be independent postural criteria.

Redistribution of joint moments is associated with changed plantar pressure in diabetic polyneuropathy

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Willems Paul JB

2009-02-01

Full Text Available Abstract Background Patients with diabetic polyneuropathy (DPN are often confronted with ulceration of foot soles. Increased plantar pressure under the forefoot has been identified as a major risk factor for ulceration. This study sets out to test the hypothesis that changes in gait characteristics induced by DPN related muscle weakness are the origin of the elevated plantar pressures. Methods Three groups of subjects participated: people diagnosed with diabetes without polyneuropathy (DC, people diagnosed with diabetic polyneuropathy (DPN and healthy, age-matched controls (HC. In all subjects isometric strength of plantar and dorsal flexors was assessed. Moreover, joint moments at ankle, knee and hip joints were determined while walking barefoot at a velocity of 1.4 m/s. Simultaneously plantar pressure patterns were measured. Results Compared to HC-subjects, DPN-participants walked with a significantly increased internal plantar flexor moment at the first half of the stance phase. Also in DPN-subjects the maximal braking and propelling force applied to the floor was decreased. Moreover, in DPN-subjects the ratio of forefoot-to-rear foot plantar pressures was increased. Body-mass normalized strength of dorsal flexors showed a trend to be reduced in people with diabetes, both DC and DPN, compared to HC-subjects. Plantar flexors tended to be less weak in DC compared to HC and in DPN relative to DC. Conclusion The results of this study suggest that adverse plantar pressure patterns are associated with redistribution of joint moments, and a consequent reduced capacity to control forward velocity at heel strike.

Hardness and posting of foot orthoses modify plantar contact area, plantar pressure, and perceived comfort when cycling.

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Bousie, Jaquelin A; Blanch, Peter; McPoil, Thomas G; Vicenzino, Bill

2018-07-01

To evaluate the effects of hardness and posting of orthoses on plantar profile and perceived comfort and support during cycling. A repeated measures study with randomised order of orthoses, hardness, and posting conditions. Twenty-three cyclists cycled at a cadence of 90rpm and a perceived exertion rating of twelve. Contoured soft and hard orthoses with or without a medial forefoot or lateral forefoot post were evaluated. Plantar contact area, mean pressure and peak pressure were measured for nine plantar regions using the pedar ® -X system and represented as a percentage of the total (CA%, MP%, and PP% respectively). Perceived comfort and support was rated on a visual analogue scale. The softer orthosis significantly increased CA% (p=0.014) across the midfoot and heel with a decrease in the toe region and forefoot. MP% (p=0.034) and PP% (p=0.012) were significantly increased at the mid and lateral forefoot with reductions in MP% at the midfoot and in PP% at the hallux and toes. Forefoot posting significantly increased CA% (p=0.018) at the toes and forefoot and decreased it at the heel. PP% was significantly altered (p=0.013) based on posting position. Lateral forefoot posting significantly decreased heel comfort (p=0.036). When cycling, a soft, contoured orthosis increased contact across the midfoot and heel, modulating forefoot and midfoot plantar pressures but not altering comfort or support. Forefoot postings significantly modified contact areas and plantar pressures and reduced comfort at the heel. Copyright © 2017. Published by Elsevier Ltd.

Innovations in plantar pressure and foot temperature measurements in diabetes

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Bus, S. A.

2016-01-01

Plantar pressure and temperature measurements in the diabetic foot primarily contribute to identifying abnormal values that increase risk for foot ulceration, and they are becoming increasingly more integrated in clinical practice and daily life of the patient. While plantar pressure measurements

Variability and repeatability analysis of plantar pressure during gait in older people.

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Franco, Pedro S; Silva, Caio Borella P da; Rocha, Emmanuel S da; Carpes, Felipe P

2015-01-01

Repeatability and variability of the plantar pressure during walking are important components in the clinical assessment of the elderly. However, there is a lack of information on the uniformity of plantar pressure patterns in the elderly. To analyze the repeatability and variability in plantar pressure considering mean, peak and asymmetries during aged gait. Plantar pressure was monitored in four different days for ten elderly subjects (5 female), with mean±standard-deviation age of 73±6 years, walking barefoot at preferred speed. Data were compared between steps for each day and between different days. Mean and peak plantar pressure values were similar between the different days of evaluation. Asymmetry indexes were similar between the different days evaluated. Plantar pressure presented a consistent pattern in the elderly. However, the asymmetry indexes observed suggest that the elderly are exposed to repetitive asymmetric loading during locomotion. Such result requires further investigation, especially concerning the role of these asymmetries for development of articular injuries. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

Nordic Walking Practice Might Improve Plantar Pressure Distribution

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Perez-Soriano, Pedro; Llana-Belloch, Salvador; Martinez-Nova, Alfonso; Morey-Klapsing, G.; Encarnacion-Martinez, Alberto

2011-01-01

Nordic walking (NW), characterized by the use of two walking poles, is becoming increasingly popular (Morgulec-Adamowicz, Marszalek, & Jagustyn, 2011). We studied walking pressure patterns of 20 experienced and 30 beginner Nordic walkers. Plantar pressures from nine foot zones were measured during trials performed at two walking speeds (preferred…

Froude number fractions to increase walking pattern dynamic similarities: application to plantar pressure study in healthy subjects.

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Moretto, P; Bisiaux, M; Lafortune, M A

2007-01-01

The purpose of this study was to determine if using similar walking velocities obtained from fractions of the Froude number (N(Fr)) and leg length can lead to kinematic and kinetic similarities and lower variability. Fifteen male subjects walked on a treadmill at 0.83 (VS(1)) and 1.16ms(-1) (VS(2)) and then at two similar velocities (V(Sim27) and V(Sim37)) determined from two fractions of the N(Fr) (0.27 and 0.37) so that the average group velocity remained unchanged in both conditions (VS(1)=V (Sim27)andVS(2)=V (Sim37)). N(Fr) can theoretically be used to determine walking velocities proportional to leg lengths and to establish dynamic similarities between subjects. This study represents the first attempt at using this approach to examine plantar pressure. The ankle and knee joint angles were studied in the sagittal plane and the plantar pressure distribution was assessed with an in-shoe measurement device. The similarity ratios were computed from anthropometric parameters and plantar pressure peaks. Dynamically similar conditions caused a 25% reduction in leg joint angles variation and a 10% significant decrease in dimensionless pressure peak variability on average of five footprint locations. It also lead to heel and under-midfoot pressure peaks proportional to body mass and to an increase in the number of under-forefoot plantar pressure peaks proportional to body mass and/or leg length. The use of walking velocities derived from N(Fr) allows kinematic and plantar pressure similarities between subjects to be observed and leads to a lower inter-subject variability. In-shoe pressure measurements have proven to be valuable for the understanding of lower extremity function. Set walking velocities used for clinical assessment mask the effects of body size and individual gait mechanics. The anthropometric scaling of walking velocities (fraction of N(Fr)) should improve identification of unique walking strategies and pathological foot functions.

An exploratory study on differences in cumulative plantar tissue stress between healing and non-healing plantar neuropathic diabetic foot ulcers

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van Netten, Jaap J.; van Baal, Jeff G.; Bril, Adriaan; Wissink, Marieke; Bus, Sicco A.

2018-01-01

Mechanical stress is important in causing and healing plantar diabetic foot ulcers, but almost always studied as peak pressure only. Measuring cumulative plantar tissue stress combines plantar pressure and ambulatory activity, and better defines the load on ulcers. Our aim was to explore differences

Diabetic foot ulcer incidence in relation to plantar pressure magnitude and measurement location.

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Ledoux, William R; Shofer, Jane B; Cowley, Matthew S; Ahroni, Jessie H; Cohen, Victoria; Boyko, Edward J

2013-01-01

We prospectively examined the relationship between site-specific peak plantar pressure (PPP) and ulcer risk. Researchers have previously reported associations between diabetic foot ulcer and elevated plantar foot pressure, but the effect of location-specific pressures has not been studied. Diabetic subjects (n=591) were enrolled from a single VA hospital. Five measurements of in-shoe plantar pressure were collected using F-Scan. Pressures were measured at 8 areas: heel, lateral midfoot, medial midfoot, first metatarsal, second through fourth metatarsal, fifth metatarsal, hallux, and other toes. The relationship between incident plantar foot ulcer and PPP or pressure-time integral (PTI) was assessed using Cox regression. During follow-up (2.4years), 47 subjects developed plantar ulcers (10 heel, 12 metatarsal, 19 hallux, 6 other). Overall mean PPP was higher for ulcer subjects (219 vs. 194kPa), but the relationship differed by site (the metatarsals with ulcers had higher pressure, while the opposite was true for the hallux and heel). A statistical analysis was not performed on the means, but hazard ratios from a Cox survival analysis were nonsignificant for PPP across all sites and when adjusted for location. However, when the metatarsals were considered separately, higher baseline PPP was significantly associated with greater ulcer risk; at other sites, this relationship was nonsignificant. Hazard ratios for all PTI data were nonsignificant. Location must be considered when assessing the relationship between PPP and plantar ulceration. © 2013.

Plantar pressure in diabetic peripheral neuropathy patients with active foot ulceration, previous ulceration and no history of ulceration: a meta-analysis of observational studies.

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Fernando, Malindu Eranga; Crowther, Robert George; Pappas, Elise; Lazzarini, Peter Anthony; Cunningham, Margaret; Sangla, Kunwarjit Singh; Buttner, Petra; Golledge, Jonathan

2014-01-01

Elevated dynamic plantar pressures are a consistent finding in diabetes patients with peripheral neuropathy with implications for plantar foot ulceration. This meta-analysis aimed to compare the plantar pressures of diabetes patients that had peripheral neuropathy and those with neuropathy with active or previous foot ulcers. Published articles were identified from Medline via OVID, CINAHL, SCOPUS, INFORMIT, Cochrane Central EMBASE via OVID and Web of Science via ISI Web of Knowledge bibliographic databases. Observational studies reporting barefoot dynamic plantar pressure in adults with diabetic peripheral neuropathy, where at least one group had a history of plantar foot ulcers were included. Interventional studies, shod plantar pressure studies and studies not published in English were excluded. Overall mean peak plantar pressure (MPP) and pressure time integral (PTI) were primary outcomes. The six secondary outcomes were MPP and PTI at the rear foot, mid foot and fore foot. The protocol of the meta-analysis was published with PROPSERO, (registration number CRD42013004310). Eight observational studies were included. Overall MPP and PTI were greater in diabetic peripheral neuropathy patients with foot ulceration compared to those without ulceration (standardised mean difference 0.551, 95% CI 0.290-0.811, pdiabetic peripheral neuropathy with a history of foot ulceration compared to those with diabetic neuropathy without a history of ulceration. More homogenous data is needed to confirm these findings.

Plantar pressures in children with and without sever's disease.

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Becerro de Bengoa Vallejo, Ricardo; Losa Iglesias, Marta Elena; Rodríguez Sanz, David; Prados Frutos, Juan Carlos; Salvadores Fuentes, Paloma; Chicharro, José López

2011-01-01

a case-control study was conducted to compare static plantar pressures and distribution of body weight across the two lower limbs, as well as the prevalence of gastrocnemius soleus equinus, in children with and without calcaneal apophysitis (Sever's disease). the participants were 54 boys enrolled in a soccer academy, of which eight were lost to follow-up. Twenty-two boys with unilateral Sever's disease comprised the Sever's disease group and 24 healthy boys constituted a control group. Plantar pressure data were collected using pedobarography, and gastrocnemius soleus equinus was assessed. peak pressure and percentage of body weight supported were significantly higher in the symptomatic feet of the Sever's disease group than in the asymptomatic feet of the Sever's disease group and the control group. Every child in the Sever's disease group had bilateral gastrocnemius equinus, while nearly all children in the control group had no equinus. high plantar foot pressures are associated with Sever's disease, although it is unclear whether they are a predisposing factor or a result of the condition. Gastrocnemius equinus may be a predisposing factor for Sever's disease. Further research is needed to identify other factors involved in the disease and to better understand the factors that contribute to abnormal distribution of body weight in the lower limbs.

Higher plantar pressure on the medial side in four soccer-related movements.

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Wong, Pui-lam; Chamari, Karim; Mao, De Wei; Wisløff, Ulrik; Hong, Youlian

2007-02-01

To measure the plantar pressure in four soccer-related movements in 15 male soccer players (mean (SD) age 20.9 (1.3) years, height 173 (4) cm, weight 61.7 (3.6) kg). To record plantar pressure distribution, the players wore soccer boots with 12 circular studs and with an insole pressure recorder device equipped with 99 sensors. Plantar pressure was recorded in five successful trials in each of the four soccer-related movements: running, sideward cutting, 45 degrees cutting and landing from a vertical jump. Each footprint was divided into 10 recorded areas for analysis. Compared with running at 3.3 m/s, maximal speed sideward cutting and 45 degrees cutting induced higher peak pressure (pplantar surface as compared with the lateral side. These data suggest that the medial side of the plantar surface may be more prone to injuries, and that foot orthosis adoption, improved soccer boot design and specific muscle training could be considered to reduce pressure and the subsequent risk of injury.

[Spasticity and dynamic plantar pressure distribution measurements in hemiplegic spastic children].

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Femery, V; Moretto, P; Renaut, H; Thévenon, A

2001-02-01

The aim of this study was to analyse the plantar pressure distribution in nine hemiplegic spastic children to illustrate the dynamic alteration during stance phase linked spasticity grade. The graduation of the lower limbs muscle tone related to the Aschworth spasticity scale enabled us to identify two groups of hemiplegics subjects. The groups Asch 1 and Asch 3 have respectively presented a low and a strong spasticity. The peak pressures during consecutive gait cycles were determined under the feet of 30 healthy subjects and two cerebral palsy groups using a wearable footprint analysis system. A statistical study showed a similarity between the two disabled groups. Peak pressures under the midfoot were significantly higher compared to the control group. While the plantar pressure distribution profile was specific for each group under all other anatomical structures. The significant alterations were observed under the forefoot and hallux. Spasticity modifies the foot contact to ground and leads to a specific plantar pressure distribution profile linked to the spasticity grade. The equinovarus with clawed toes deformity due to higher spasticity seems to be an important factor in terminal stance phase perturbations. However spastic hemiplegic subjects seem to adopt a gait pattern in agreement with stability optimization criteria.

Quantifying dynamic changes in plantar pressure gradient in diabetics with peripheral neuropathy

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Chi-Wen Lung

2016-07-01

Full Text Available Diabetic foot ulcers remain one of the most serious complications of diabetes. Peak plantar pressure (PPP and peak pressure gradient (PPG during walking have been shown to be associated with the development of diabetic foot ulcers. To gain further insight into the mechanical etiology of diabetic foot ulcers, examination of the pressure gradient angle (PGA has been recently proposed. The PGA quantifies directional variation or orientation of the pressure gradient during walking, and provides a measure of whether pressure gradient patterns are concentrated or dispersed along the plantar surface. We hypothesized that diabetics at risk of foot ulceration would have smaller PGA in key plantar regions, suggesting less movement of the pressure gradient over time. A total of 27 participants were studied, including 19 diabetics with peripheral neuropathy and 8 non-diabetic control subjects. A foot pressure measurement system was used to measure plantar pressures during walking. PPP, PPG and PGA were calculated for four foot regions - 1st toe (T1, 1st metatarsal head (M1, 2nd metatarsal head (M2, and heel (HL. Consistent with prior studies, PPP and PPG were significantly larger in the diabetic group compared to non-diabetic controls in the T1 and M1 regions, but not M2 or HL. For example, PPP was 165% (P=0.02 and PPG was 214% (P<0.001 larger in T1. PGA was found to be significantly smaller in the diabetic group in T1 (46%, P=0.04, suggesting a more concentrated pressure gradient pattern under the toe. The proposed PGA may improve our understanding of the role of pressure gradient on the risk of diabetic foot ulcers.

Comparison of Plantar Pressure Distribution in Dominant & Non-dominant leg of female Kata and Kumite National Team

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Elnaz Dizaji

2016-09-01

Full Text Available Objective: The aim of this study was to compare the plantar pressure distribution of dominant and non-dominant legs of females who were participated in the kata and kumite national team. Methods: Twelve kumite and 8 kata female athletes of the Karate national team participated in this study. Plantar pressure was measured using emed platform during barefoot walking. After dividing the foot into 10 masks, peak pressure, pressure-time integral, maximum force and force-time integral were calculated. Wilcoxon and U-Mann-Witney tests were used to analyze parameters at a significance level of p ≤ 0.05. Results: In comparison of kata and kumite teams it was found that, kata plantar pressure parameters in Metatarsal-2 (p=0.05 and Metatarsals-3, 4, 5 (p=0.04 were significantly less than those in kumite. Also, in comparison of dominant and non-dominant leg, plantar pressure parameters of dominant leg were less in Metatarsal-2 (p=0.04 and more in Bigtoe (p=0.04 and Toes-3, 4, 5 (p=0.03 than those in the non-dominant leg. Conclusion: Results may be indicative different of natures of the two athletic fields in that Kumite has a higher impact on plantar pressure due to higher mechanical loads. Furthermore, the unequal use of the legs may affect plantar pressure because of leg dominance. Thus, further and more comprehensive studies are necessary to prevent exercise-induced adaptations in professional levels and their treatments.

Higher plantar pressure on the medial side in four soccer‐related movements

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Wong, Pui‐lam; Chamari, Karim; De Wei Mao; Wisløff, Ulrik; Hong, Youlian

2007-01-01

Objective To measure the plantar pressure in four soccer‐related movements in 15 male soccer players (mean (SD) age 20.9 (1.3) years, height 173 (4) cm, weight 61.7 (3.6) kg). Design To record plantar pressure distribution, the players wore soccer boots with 12 circular studs and with an insole pressure recorder device equipped with 99 sensors. Plantar pressure was recorded in five successful trials in each of the four soccer‐related movements: running, sideward cutting, 45° cutting and landing from a vertical jump. Each footprint was divided into 10 recorded areas for analysis. Results Compared with running at 3.3 m/s, maximal speed sideward cutting and 45° cutting induced higher peak pressure (pplantar surface as compared with the lateral side. Conclusions These data suggest that the medial side of the plantar surface may be more prone to injuries, and that foot orthosis adoption, improved soccer boot design and specific muscle training could be considered to reduce pressure and the subsequent risk of injury. PMID:17178776

Plantar pressures are higher in cases with diabetic foot ulcers compared to controls despite a longer stance phase duration.

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Fernando, Malindu E; Crowther, Robert G; Lazzarini, Peter A; Sangla, Kunwarjit S; Wearing, Scott; Buttner, Petra; Golledge, Jonathan

2016-09-15

Current international guidelines advocate achieving at least a 30 % reduction in maximum plantar pressure to reduce the risk of foot ulcers in people with diabetes. However, whether plantar pressures differ in cases with foot ulcers to controls without ulcers is not clear. The aim of this study was to assess if plantar pressures were higher in patients with active plantar diabetic foot ulcers (cases) compared to patients with diabetes without a foot ulcer history (diabetes controls) and people without diabetes or a foot ulcer history (healthy controls). Twenty-one cases with diabetic foot ulcers, 69 diabetes controls and 56 healthy controls were recruited for this case-control study. Plantar pressures at ten sites on both feet and stance phase duration were measured using a pre-established protocol. Primary outcomes were mean peak plantar pressure, pressure-time integral and stance phase duration. Non-parametric analyses were used with Holm's correction to correct for multiple testing. Binary logistic regression models were used to adjust outcomes for age, sex and body mass index. Median differences with 95 % confidence intervals and Cohen's d values (standardised mean difference) were reported for all significant outcomes. The majority of ulcers were located on the plantar surface of the hallux and toes. When adjusted for age, sex and body mass index, the mean peak plantar pressure and pressure-time integral of toes and the mid-foot were significantly higher in cases compared to diabetes and healthy controls (p diabetic foot ulcers despite having a longer stance phase duration which would be expected to lower plantar pressure. Whether plantar pressure changes can predict ulcer healing should be the focus of future research. These results highlight the importance of offloading feet during active ulceration in addition to before ulceration.

Reduction of peak plantar pressure in people with diabetes-related peripheral neuropathy: an evaluation of the DH Pressure Relief Shoe™

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Raspovic Anita

2012-10-01

Full Text Available Abstract Background Offloading plantar pressure is a key strategy for the prevention or healing of neuropathic plantar ulcers in diabetes. Non-removable walking casts, such as total contact casts, are currently considered the gold-standard for offloading this type of wound. However, alternative methods for offloading that are more cost effective and easier to use are continually being sought. The aim of this study was to evaluate the capacity of the DH Pressure Relief Shoe™ to offload high pressure areas under the neuropathic foot in diabetes. Methods A within-subjects, repeated measures design was used. Sixteen participants with diabetic peripheral neuropathy were recruited and three footwear conditions were evaluated in a randomised order: a canvas shoe (the control, the participants’ own standard shoe, and the DH Pressure Relief Shoe™. The primary outcome was peak plantar pressure, measured using the pedar-X® mobile in-shoe system between the three conditions. Results Data analysis was conducted on 14 out of the 16 participants because two participants could not complete data collection. The mean peak pressure values in kPa (±SD for each condition were: control shoe 315.9 (±140.7, participants’ standard shoe 273.0 (±127.1 and DH Pressure Relief Shoe™ 155.4 (±89.9. There was a statistically significant difference in peak plantar pressure between the DH Pressure Relief Shoe™ compared to both the control shoe (p = 0.002 and participants’ standard shoe (p = 0.001. The DH Pressure Relief Shoe™ decreased plantar pressures by 51% compared to the control shoe and by 43% compared to participants’ standard shoe. Importantly, for a couple of study participants, the DH Pressure Relief Shoe™ appeared unsuitable for day-to-day wearing. Conclusions The DH Pressure Relief Shoe™ reduced plantar pressures more than the other two shoe conditions. The DH Pressure Relief Shoe™ may be a useful alternative to current offloading

Does obesity influence foot structure and plantar pressure patterns in prepubescent children?

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Dowling, A M; Steele, J R; Baur, L A

2001-06-01

This study examined the effects of obesity on plantar pressure distributions in prepubescent children. Field-based, experimental data on BMI (body mass index), foot structure and plantar pressures were collected for 13 consenting obese children and 13 non-obese controls. Thirteen obese (age 8.1+/-1.2 y; BMI 25.5+/-2.9 kg/m(2)) and 13 non-obese (age 8.4+/-0.9 y; BMI 16.9+/-1.2 kg/m(2)) prepubescent children, matched to the obese children for gender, age and height. Height and weight were measured to calculate BMI. Static weight-bearing footprints for the right and left foot of each subject were recorded using a pedograph to calculate the footprint angle and the Chippaux-Smirak index as representative measures of the surface area of the foot in contact with the ground. Right and left foot plantar pressures were then obtained using a mini-emed(R) pressure platform to calculate the force and pressure experienced under each child's foot during static and dynamic loaded and unloaded conditions. Obese subjects displayed significantly lower footprint angle (t=4.107; P=plantar pressures between the two subject groups. That is, although rearfoot dynamic forces generated by the obese subjects were significantly higher than those generated by the non-obese subjects, these forces were experienced over significantly higher mean peak areas of contact with the mini-emed(R) system. Therefore, rearfoot pressures experienced by the two subject groups did not differ. However, the mean peak dynamic forefoot pressures generated by the obese subjects (39.3+/-15.7 N.cm(-2); q=3.969) were significantly higher than those generated by the non-obese subjects (32.3+/-9.2 N.cm(-2)). It is postulated that foot discomfort-associated structural changes and increased forefoot plantar pressures in the obese foot may hinder obese children from participating in physical activity and therefore warrants immediate further investigation.

Integrated kinematics-kinetics-plantar pressure data analysis: a useful tool for characterizing diabetic foot biomechanics.

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Sawacha, Zimi; Guarneri, Gabriella; Cristoferi, Giuseppe; Guiotto, Annamaria; Avogaro, Angelo; Cobelli, Claudio

2012-05-01

The fundamental cause of lower-extremity complications in diabetes is chronic hyperglycemia leading to diabetic foot ulcer pathology. While the relationship between abnormal plantar pressure distribution and plantar ulcers has been widely investigated, little is known about the role of shear stress. Moreover, the mutual relationship among plantar pressure, shear stress, and abnormal kinematics in the etiology of diabetic foot has not been established. This lack of knowledge is determined by the lack of commercially available instruments which allow such a complex analysis. This study aims to develop a method for the simultaneous assessment of kinematics, kinetics, and plantar pressure on foot subareas of diabetic subjects by means of combining three commercial systems. Data were collected during gait on 24 patients (12 controls and 12 diabetic neuropathics) with a motion capture system synchronized with two force plates and two baropodometric systems. A four segment three-dimensional foot kinematics model was adopted for the subsegment angles estimation together with a three segment model for the plantar sub-area definition during gait. The neuropathic group exhibited significantly excessive plantar pressure, ground reaction forces on each direction, and a reduced loading surface on the midfoot subsegment (pfoot ulcerations, and help planning prevention programs. Copyright © 2011 Elsevier B.V. All rights reserved.

Research on Normal Human Plantar Pressure Test

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Liu Xi Yang

2016-01-01

Full Text Available FSR400 pressure sensor, nRF905 wireless transceiver and MSP40 SCM are used to design the insole pressure collection system, LabVIEW is used to make HMI of data acquisition, collecting a certain amount of normal human foot pressure data, statistical analysis of pressure distribution relations about five stages of swing phase during walking, using the grid closeness degree to identify plantar pressure distribution pattern recognition, and the algorithm simulation, experimental results demonstrated this method feasible.

Characteristics of Plantar Pressures and Related Pain Profiles in Elite Sprinters and Recreational Runners.

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Chow, Tong-Hsien; Chen, Yih-Shyuan; Wang, Jia-Chang

2018-01-01

Plantar pressure measurement is effective for assessing plantar loading and can be applied to evaluating foot performance. We sought to explore the characteristics of plantar pressures in elite sprinters and recreational runners during static standing and walking. Arch index (AI) values, regional plantar pressure distributions (PPDs), and footprint characteristics were examined in 80 elite sprinters and 90 recreational runners using an optical plantar pressure measurement system. Elite sprinters' pain profiles were examined to evaluate their most common pain areas. In recreational runners, AI values in males were in the normal range and in females were high arch type. The AI values were significantly lower in elite sprinters than in recreational runners. In elite sprinters, particularly males, the static PPD of both feet was higher at the medial metatarsal bone and the lateral heel and lower at the medial and lateral longitudinal arches. Elite male sprinters' PPD of both feet was mainly transferred to the medial metatarsal bone and decreased at the lateral longitudinal arch and the medial heel during the midstance phase of walking. The lateral knee joint and biceps femoris were the most common sites of musculoskeletal pain in elite sprinters. Elite sprinters' AI values could be classified as high arches, and their PPD tended to parallel the features of runners and high-arched runners. These findings correspond to the profile of patellofemoral pain syndrome (PFPS)-related plantar pressure. The pain profiles seemed to resonate with the symptoms of high-arched runners and PFPS. A possible link between high-arched runners and PFPS warrants further study.

Assessment of the Medial Longitudinal Arch in children with Flexible Pes Planus by Plantar Pressure Mapping.

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Elmoatasem, E M; Eid, M A

2016-12-01

Plantar Pressure mapping was introduced as a new modality for assessment of the height of the medial longitudinal arch of the foot. Therefore, the aim of this study is to correlate the plantar pressure mapping readings of arch index contact force ratio (AICFR) in children with flexible pes planus with radiographic measurements and static plantar footprints in order to determine the reliability of pressure mapping as a modality for the assessment and follow up of the flat foot deformity. Radiographic measurements, foot prints, and pressure mapping scans were recorded for each foot at initial presentation and at latest follow up in 28 children (56 feet) with flexible pes planus. A positive correlation of pressure mapping results was found with the talo-first metatarsal angle, the calcaneal pitch angle, as well as the footprint scans (P plantar pressure mapping is a reliable and effective tool in screening, diagnosis, and follow up of children with flexible pes planus.

Effect of variable body mass on plantar foot pressure and off-loading device efficacy.

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Pirozzi, Kelly; McGuire, James; Meyr, Andrew J

2014-01-01

An increasing body of evidence has implicated obesity as having a negative effect on the development, treatment, and outcome of lower extremity pathologic entities, including diabetic foot disease. The objective of the present study was to increase the body of knowledge with respect to the effects of obesity on foot function. Specifically, we attempted to (1) describe the relationship between an increasing body mass index (BMI) on plantar foot pressures during gait, and (2) evaluate the efficacy of commonly prescribed off-loading devices with an increasing BMI. A repeated measures design was used to compare the peak plantar foot pressures under multiple test conditions, with the volunteers acting as their own controls. The primary outcome measure was the mean peak plantar pressure in the heel, midfoot, forefoot, and first metatarsal, and the 2 variables were modification of patient weight (from "normal" BMI to "overweight," "obese," and "morbidly obese") and footwear (from an athletic sneaker to a surgical shoe, controlled ankle motion walker, and total contact cast). Statistically significant increases in the peak plantar pressures were observed with increasing volunteer BMI weight class, regardless of the off-loading device used. The present investigation has provided unique and specific data with respect to the changes that occur in the peak plantar pressures with variable BMIs across different anatomic levels and with commonly used off-loading devices. From our results, we have concluded that although the plantar pressures increase with increasing weight, it appears that at least some reduction in pressure can be achieved with an off-loading device, most effectively with the total contact cast, regardless of the patient's BMI. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Inter- and intra-observer reliability of masking in plantar pressure measurement analysis.

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Deschamps, K; Birch, I; Mc Innes, J; Desloovere, K; Matricali, G A

2009-10-01

Plantar pressure measurement is an important tool in gait analysis. Manual placement of small masks (masking) is increasingly used to calculate plantar pressure characteristics. Little is known concerning the reliability of manual masking. The aim of this study was to determine the reliability of masking on 2D plantar pressure footprints, in a population with forefoot deformity (i.e. hallux valgus). Using a random repeated-measure design, four observers identified the third metatarsal head on a peak-pressure barefoot footprint, using a small mask. Subsequently, the location of all five metatarsal heads was identified, using the same size of masks and the same protocol. The 2D positional variation of the masks and the peak pressure (PP) and pressure time integral (PTI) values of each mask were calculated. For single-masking the lowest inter-observer reliability was found for the distal-proximal direction, causing a clear, adverse impact on the reliability of the pressure characteristics (PP and PTI). In the medial-lateral direction the inter-observer reliability could be scored as high. Intra-observer reliability was better and could be scored as high or good for both directions, with a correlated improved reliability of the pressure characteristics. Reliability of multi-masking showed a similar pattern, but overall values tended to be lower. Therefore, small sized masking in order to define pressure characteristics in the forefoot should be done with care.

Comparison of plantar pressure distribution in subjects with normal and flat feet during gait

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Aluisio Otavio Vargas Avila

2010-06-01

Full Text Available The aim of this study was to determine the possible relationship between loss of thenormal medial longitudinal arch measured by the height of the navicular bone in a static situationand variables related to plantar pressure distribution measured in a dynamic situation. Elevenmen (21 ± 3 years, 74 ± 10 kg and 175 ± 4 cm participated in the study. The Novel Emed-ATSystem was used for the acquisition of plantar pressure distribution data (peak pressure, meanpressure, contact area, and relative load at a sampling rate of 50 Hz. The navicular drop testproposed by Brody (1982 was used to assess the height of the navicular bone for classificationof the subjects. The results were compared by the Mann-Whitney U test, with the level of significanceset at p ≤ 0.05. Differences were observed between the two groups in the mid-foot regionfor all variables studied, with the observation of higher mean values in subjects with flat feet.There were also significant differences in contact area, relative load, peak pressure, and meanpressure between groups. The present study demonstrates the importance of paying attentionto subjects with flat feet because changes in plantar pressure distribution are associated withdiscomfort and injuries.

The effect of low-Dye taping on plantar pressures, during gait, in subjects with navicular drop exceeding 10 mm.

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Lange, Belinda; Chipchase, Lucy; Evans, Angela

2004-04-01

A preintervention and postintervention, repeated-measures experimental design. To investigate the immediate effect of low-Dye taping on peak and mean plantar pressures during gait in subjects with navicular drop exceeding 10 mm. Low-Dye taping is commonly used to support the longitudinal and transverse arches of the foot in an attempt to reduce the effects of symptoms associated with excessive pronation. Plantar pressure measurement has been used as an indirect indicator of pronation during gait. METHOD AND MEASURES: The right foot of 60 subjects was tested using the Emed-AT system to obtain plantar pressure values. Subjects performed 6 barefoot walks over the Emed pressure platform while taped and a further 6 walks while untaped. Plantar pressures were recorded. Each footprint obtained was divided into 10 sections or 'masks.' Average peak and mean plantar pressure values (N/cm2) were calculated for both taped and untaped walks for each mask. Paired t tests demonstrated significant changes in peak plantar pressure in 8 of the 10 areas of the foot and significant changes in mean plantar pressure in 9 of the 10 areas of the foot. Low-Dye taping significantly decreased pressure under the heel and the medial and middle forefoot, while increasing pressure under the lateral midfoot and under the toes. A significant decrease in mean plantar pressure was observed under the lateral forefoot, while no significant difference was demonstrated in peak plantar pressure under this area. The area under the medial midfoot demonstrated no significant change in either peak or mean pressure. Low-Dye taping significantly altered peak and mean plantar pressure values in subjects with navicular drop exceeding 10 mm. In particular, peak and mean plantar pressure increased under the lateral midfoot and under the toes, and decreased under the heel and forefoot, suggesting that a decrease in the amount of pronation occurred.

Effect of arch support insole on plantar pressure distribution in females with mild and moderate hallux valgus

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Maedeh Farzadi

2013-10-01

Full Text Available Objective: Hallux Valgus is one of the most foot deformities which increase plantar pressure beneath big toe and first metatarsal. The aim of this study was to assess the effect of foot orthosis on plantar pressure distribution in subjects with mild and moderate Hallux Valgus. Materials & Methods: in this quasi-experimental study, females 16 with Hallux Valgus were recruited. Plantar pressure in 8 area of foot was measured by Pedar-X insole when wearing standard shoe only shoe with foot orthosis and shoe with foot orthosis after a month of using orthosis. Data were analyzed by repeated measure analysis of variance test. Results: using foot orthosis for a month leaded to decrease pressure in the big toe (P<0/019 first metatarsal and 3-5 metatarsals (P<0.001 and also increased pressure in medial mid foot (P<0.001. Conclusion: Foot orthosis decreased peak pressure in fore foot and increased it in medial mid foot. Therefore redistribute plantar pressure to the more normal pattern in Hallux Valgus subjects. So it could be one of the effective methods to prevent the progression of this deformity in its initial steps of formation.

Spatiotemporal and plantar pressure patterns of 1000 healthy individuals aged 3-101 years.

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McKay, Marnee J; Baldwin, Jennifer N; Ferreira, Paulo; Simic, Milena; Vanicek, Natalie; Wojciechowski, Elizabeth; Mudge, Anita; Burns, Joshua

2017-10-01

The purpose of this study was to establish normative reference values for spatiotemporal and plantar pressure parameters, and to investigate the influence of demographic, anthropometric and physical characteristics. In 1000 healthy males and females aged 3-101 years, spatiotemporal and plantar pressure data were collected barefoot with the Zeno™ walkway and Emed ® platform. Correlograms were developed to visualise the relationships between widely reported spatiotemporal and pressure variables with demographic (age, gender), anthropometric (height, mass, waist circumference) and physical characteristics (ankle strength, ankle range of motion, vibration perception) in children aged 3-9 years, adolescents aged 10-19 years, adults aged 20-59 years and older adults aged over 60 years. A comprehensive catalogue of 31 spatiotemporal and pressure variables were generated from 1000 healthy individuals. The key findings were that gait velocity was stable during adolescence and adulthood, while children and older adults walked at a comparable slower speed. Peak pressures increased during childhood to older adulthood. Children demonstrated highest peak pressures beneath the rearfoot whilst adolescents, adults and older adults demonstrated highest pressures at the forefoot. Main factors influencing spatiotemporal and pressure parameters were: increased age, height, body mass and waist circumference, as well as ankle dorsiflexion and plantarflexion strength. This study has established whole of life normative reference values of widely used spatiotemporal and plantar pressure parameters, and revealed changes to be expected across the lifespan. Copyright © 2017 Elsevier B.V. All rights reserved.

The Influence of Running on Foot Posture and In-Shoe Plantar Pressures.

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Bravo-Aguilar, María; Gijón-Noguerón, Gabriel; Luque-Suarez, Alejandro; Abian-Vicen, Javier

2016-03-01

Running can be considered a high-impact practice, and most people practicing continuous running experience lower-limb injuries. The aim of this study was to determine the influence of 45 min of running on foot posture and plantar pressures. The sample comprised 116 healthy adults (92 men and 24 women) with no foot-related injuries. The mean ± SD age of the participants was 28.31 ± 6.01 years; body mass index, 23.45 ± 1.96; and training time, 11.02 ± 4.22 h/wk. Outcome measures were collected before and after 45 min of running at an average speed of 12 km/h, and included the Foot Posture Index (FPI) and a baropodometric analysis. The results show that foot posture can be modified after 45 min of running. The mean ± SD FPI changed from 6.15 ± 2.61 to 4.86 ± 2.65 (P running. Peak plantar pressures in the forefoot decreased after running. The pressure-time integral decreased during the heel strike phase in the internal edge of the foot. In addition, a decrease was found in the pressure-time integral during the heel-off phase in the internal and rearfoot edges. The findings suggest that after 45 min of running, a pronated foot tends to change into a more neutral position, and decreased plantar pressures were found after the run.

Evaluation and Optimization of Therapeutic Footwear for Neuropathic Diabetic Foot Patients Using In-Shoe Plantar Pressure Analysis

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Bus, Sicco A.; Haspels, Rob; Busch-Westbroek, Tessa E.

2011-01-01

OBJECTIVE Therapeutic footwear for diabetic foot patients aims to reduce the risk of ulceration by relieving mechanical pressure on the foot. However, footwear efficacy is generally not assessed in clinical practice. The purpose of this study was to assess the value of in-shoe plantar pressure analysis to evaluate and optimize the pressure-reducing effects of diabetic therapeutic footwear. RESEARCH DESIGN AND METHODS Dynamic in-shoe plantar pressure distribution was measured in 23 neuropathic diabetic foot patients wearing fully customized footwear. Regions of interest (with peak pressure >200 kPa) were selected and targeted for pressure optimization by modifying the shoe or insole. After each of a maximum of three rounds of modifications, the effect on in-shoe plantar pressure was measured. Successful optimization was achieved with a peak pressure reduction of >25% (criterion A) or below an absolute level of 200 kPa (criterion B). RESULTS In 35 defined regions, mean peak pressure was significantly reduced from 303 (SD 77) to 208 (46) kPa after an average 1.6 rounds of footwear modifications (P diabetic foot. This result provides an objective approach to instantly improve footwear quality, which should reduce the risk for pressure-related plantar foot ulcers. PMID:21610125

MEMS Technology Sensors as a More Advantageous Technique for Measuring Foot Plantar Pressure and Balance in Humans

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Clara Sanz Morère

2016-01-01

Full Text Available Locomotor activities are part and parcel of daily human life. During walking or running, feet are subjected to high plantar pressure, leading sometimes to limb problems, pain, or foot ulceration. A current objective in foot plantar pressure measurements is developing sensors that are small in size, lightweight, and energy efficient, while enabling high mobility, particularly for wearable applications. Moreover, improvements in spatial resolution, accuracy, and sensitivity are of interest. Sensors with improved sensing techniques can be applied to a variety of research problems: diagnosing limb problems, footwear design, or injury prevention. This paper reviews commercially available sensors used in foot plantar pressure measurements and proposes the utilization of pressure sensors based on the MEMS (microelectromechanical systems technique. Pressure sensors based on this technique have the capacity to measure pressure with high accuracy and linearity up to high pressure levels. Moreover, being small in size, they are highly suitable for this type of measurement. We present two MEMS sensor models and study their suitability for the intended purpose by performing several experiments. Preliminary results indicate that the sensors are indeed suitable for measuring foot plantar pressure. Importantly, by measuring pressure continuously, they can also be utilized for body balance measurements.

Impact of foot progression angle on the distribution of plantar pressure in normal children.

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Lai, Yu-Cheng; Lin, Huey-Shyan; Pan, Hui-Fen; Chang, Wei-Ning; Hsu, Chien-Jen; Renn, Jenn-Huei

2014-02-01

Plantar pressure distribution during walking is affected by several gait factors, most especially the foot progression angle which has been studied in children with neuromuscular diseases. However, this relationship in normal children has only been reported in limited studies. The purpose of this study is to clarify the correlation between foot progression angle and plantar pressure distribution in normal children, as well as the impacts of age and sex on this correlation. This study retrospectively reviewed dynamic pedobarographic data that were included in the gait laboratory database of our institution. In total, 77 normally developed children aged 5-16 years who were treated between 2004 and 2009 were included. Each child's footprint was divided into 5 segments: lateral forefoot, medial forefoot, lateral midfoot, medial midfoot, and heel. The percentages of impulse exerted at the medial foot, forefoot, midfoot, and heel were calculated. The average foot progression angle was 5.03° toe-out. Most of the total impulse was exerted on the forefoot (52.0%). Toe-out gait was positively correlated with high medial (r = 0.274; P plantar pressure as part of the treatment of various foot pathologies. Copyright © 2013 Elsevier Ltd. All rights reserved.

Plantar pressure cartography reconstruction from 3 sensors.

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Abou Ghaida, Hussein; Mottet, Serge; Goujon, Jean-Marc

2014-01-01

Foot problem diagnosis is often made by using pressure mapping systems, unfortunately located and used in the laboratories. In the context of e-health and telemedicine for home monitoring of patients having foot problems, our focus is to present an acceptable system for daily use. We developed an ambulatory instrumented insole using 3 pressures sensors to visualize plantar pressure cartographies. We show that a standard insole with fixed sensor position could be used for different foot sizes. The results show an average error measured at each pixel of 0.01 daN, with a standard deviation of 0.005 daN.

Selected plantar pressure characteristics associated with the skating performance of national in-line speed skaters.

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Wu, Wen-Lan; Hsu, Hsiu-Tao; Chu, I-Hua; Tsai, Feng-Hua; Liang, Jing-Min

2017-06-01

In order to help coaches analyse the techniques of professional in-line speed skaters for making the required fine adjustments and corrections in their push-off work, this study analysed the specific plantar pressure characteristics during a 300-m time-trial test. Fourteen elite in-line speed skaters from the national team were recruited in this study. The total completion time of the 300-m time-trial test, duration of each skating phase, and plantar pressure distribution were measured. The correlation between plantar pressure distribution and skating performance was assessed using Pearson correlation analyses. The results showed that the contact time of the total foot and force-time integral (FTI) in the medial forefoot were significantly correlated with the duration of the start phase, and the FTIs in the medial forefoot of the gliding (left) leg and lateral forefoot of the pushing (right) leg were significantly correlated with the duration of the turning phase. The maximum force in the medial heel, medial forefoot, and median forefoot and the FTI in the medial heel and medial forefoot were significantly correlated with the duration of the linear acceleration phase. The results suggest that a correct plantar loading area and push-off strategy can enhance the skating performance.

A new method to normalize plantar pressure measurements for foot size and foot progression angle.

NARCIS (Netherlands)

Keijsers, N.L.; Stolwijk, N.M.; Nienhuis, B.; Duysens, J.E.J.

2009-01-01

Plantar pressure measurement provides important information about the structure and function of the foot and is a helpful tool to evaluate patients with foot complaints. In general, average and maximum plantar pressure of 6-11 areas under the foot are used to compare groups of subjects. However,

The Symmetry in the Selected Plantar Pressure Distribution Parameters of the Elderly Subject With Lower Limb Discrepancy (LLD

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Raghad Memar

2012-10-01

Full Text Available Objectives: lower leg discrepancy is a common problem which causes the changes in the plantar pressure distribution pattern during gait. Therefore, the purpose of this study was to study the symmetry in the various plantar pressure distribution parameters in the elderly subject with leg discrepancy. Methods & Materials: Twenty-one elderly from Esfehan with leg discrepancy (1.5 to 3 cm participated in this study. Plantar pressure distribution and other related parameters were measured in the five discrete steps for each limb by “emed 2” platforms. Three successful steps from five were selected and averaged, and the plantar areas were divided into 11 marks. For each mark peak force (BW%, peak pressure (Kpa, contact area, contact time, pressure time integral and force time integral were calculated. Descriptive statistics (mean and SD to report the plantar pressure pattern, dependent sample t- test for comparison pressure data between long and short limb (P≤0.05 and symmetry index (SI% for the symmetrical status in the selected plantar pressure data of the elderly subject with LLD were used. Results: The consequence of dependent t-test showed that regardless of contact area in the forefoot region and 3th, 4th and 5th toes, there were no significant differences between long and short limb. Symmetry index (SI% also revealed that the contact time in the short limbs heel was less than long limb and peak force and peak pressure in the short limb was less in mid foot region and was greater in forefoot region than long limb. Conclusion: Given The Result Of This Study Showed That In The Short Limb, Initial Contact Time And Weight Acceptance Was Reduced, Which Cause The Increase Of The Pressure In The Forefoot And Also Which Causes The Increase Of Stress Fracture Risk In The Metatarsal Region. Therefore, It Is Suggested That LLD Subject Use Orthotic Or Shoes That Can Increase Their Heel Height And Balancing The Contact Time In The Short Limb To Resolve

Global body posture and plantar pressure distribution in individuals with and without temporomandibular disorder: a preliminary study.

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Souza, Juliana A; Pasinato, Fernanda; Corrêa, Eliane C R; da Silva, Ana Maria T

2014-01-01

The aim of this study was to evaluate body posture and the distribution of plantar pressure at physiologic rest of the mandible and during maximal intercuspal positions in subjects with and without temporomandibular disorder (TMD). Fifty-one subjects were assessed by the Diagnostic Criteria for Research on Temporomandibular Disorders and divided into a symptomatic group (21) and an asymptomatic group (30). Postural analysis for both groups was conducted using photogrammetry (SAPo version 0.68; University of São Paulo, São Paulo, Brazil). The distribution of plantar pressures was evaluated by means of baropodometry (Footwork software), at physiologic rest and maximal intercuspal positions. Of 18 angular measurements, 3 (17%) were statistically different between the groups in photogrammetric evaluation. The symptomatic group showed more pronounced cervical distance (P = .0002), valgus of the right calcaneus (P = .0122), and lower pelvic tilt (P = .0124). The baropodometry results showed the TMD subjects presented significantly higher rearfoot and lower forefoot distribution than those in the asymptomatic group. No differences were verified in maximal intercuspal position in the between-group analysis and between the 2 mandibular positions in the within-group analysis. Subjects with and without TMD presented with global body posture misalignment. Postural changes were more pronounced in the subjects with TMD. In addition, symptomatic subjects presented with abnormal plantar pressure distribution, suggesting that TMD may have an influence on the postural system. Copyright © 2014 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

Enhanced spatio-temporal alignment of plantar pressure image sequences using B-splines.

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Oliveira, Francisco P M; Tavares, João Manuel R S

2013-03-01

This article presents an enhanced methodology to align plantar pressure image sequences simultaneously in time and space. The temporal alignment of the sequences is accomplished using B-splines in the time modeling, and the spatial alignment can be attained using several geometric transformation models. The methodology was tested on a dataset of 156 real plantar pressure image sequences (3 sequences for each foot of the 26 subjects) that was acquired using a common commercial plate during barefoot walking. In the alignment of image sequences that were synthetically deformed both in time and space, an outstanding accuracy was achieved with the cubic B-splines. This accuracy was significantly better (p align real image sequences with unknown transformation involved, the alignment based on cubic B-splines also achieved superior results than our previous methodology (p alignment on the dynamic center of pressure (COP) displacement was also assessed by computing the intraclass correlation coefficients (ICC) before and after the temporal alignment of the three image sequence trials of each foot of the associated subject at six time instants. The results showed that, generally, the ICCs related to the medio-lateral COP displacement were greater when the sequences were temporally aligned than the ICCs of the original sequences. Based on the experimental findings, one can conclude that the cubic B-splines are a remarkable solution for the temporal alignment of plantar pressure image sequences. These findings also show that the temporal alignment can increase the consistency of the COP displacement on related acquired plantar pressure image sequences.

Basketball lay-up - foot loading characteristics and the number of trials necessary to obtain stable plantar pressure variables.

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Chua, YaoHui K; Quek, Raymond K K; Kong, Pui W

2017-03-01

This study aimed (1) to profile the plantar loading characteristics when performing the basketball lay-up in a realistic setting and (2) to determine the number of trials necessary to establish a stable mean for plantar loading variables during the lay-up. Thirteen university male basketball players [age: 23.0 (1.4) years, height: 1.75 (0.05) m, mass: 68.4 (8.6) kg] performed ten successful basketball lay-ups from a stationary position. Plantar loading variables were recorded using the Novel Pedar-X in-shoe system. Loading variables including peak force, peak pressure, and pressure-time integral were extracted from eight foot regions. Performance stability of plantar loading variables during the take-off and landing steps were assessed using the sequential averaging technique and intra-class correlation coefficient (ICC). High plantar loadings were experienced at the heel during the take-off steps, and both the heel and forefoot regions upon landing. The sequential estimation technique revealed a five-eight trial range to achieve a stable mean across all plantar loading variables, whereas ICC analysis was insensitive to inter-trial differences of repeated lay-up performances. Future studies and performance evaluation protocols on plantar loading during basketball lay-ups should include at least eight trials to ensure that the measurements obtained are sufficiently stable.

The effect of different depths of medial heel skive on plantar pressures

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Bonanno Daniel R

2012-08-01

Full Text Available Abstract Background Foot orthoses are often used to treat lower limb injuries associated with excessive pronation. There are many orthotic modifications available for this purpose, with one being the medial heel skive. However, empirical evidence for the mechanical effects of the medial heel skive modification is limited. This study aimed to evaluate the effect that different depths of medial heel skive have on plantar pressures. Methods Thirty healthy adults (mean age 24 years, range 18–46 with a flat-arched or pronated foot posture and no current foot pain or deformity participated in this study. Using the in-shoe pedar-X® system, plantar pressure data were collected for the rearfoot, midfoot and forefoot while participants walked along an 8 metre walkway wearing a standardised shoe. Experimental conditions included a customised foot orthosis with the following 4 orthotic modifications: (i no medial heel skive, (ii a 2 mm medial heel skive, (iii a 4 mm medial heel skive and (iv a 6 mm medial heel skive. Results Compared to the foot orthosis with no medial heel skive, statistically significant increases in peak pressure were observed at the medial rearfoot – there was a 15% increase (p = 0.001 with the 4 mm skive and a 29% increase (p  Conclusions This study found that a medial heel skive of 4 mm or 6 mm increases peak pressure under the medial rearfoot in asymptomatic adults with a flat-arched or pronated foot posture. Plantar pressures at the midfoot and forefoot were not altered by a medial heel skive of 2, 4 or 6 mm. These findings provide some evidence for the effects of the medial heel skive orthotic modification.

Plantar pressure and EMG activity of simulated and actual ski jumping take-off.

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Virmavirta, M; Komi, P V

2001-10-01

Plantar pressures and activation of the four muscles (VL - vastus lateralis, GL - gluteus, TA - tibialis anterior and GA - lat. gastrocnemius) were measured from ten ski jumpers under simulated laboratory conditions with training shoes (Lab TS) and with jumping boots (Lab JB) as well as in actual hill jumping conditions (Hill). The most significant differences between measured conditions were found in muscle activation patterns and plantar pressures prior to take-off. The centrifugal force due to the curvature of the inrun under actual hill jumping conditions caused extra pressure under the fore and rear parts of the feet (Pknee and hip extensor muscles.

The effect of medial arch support over the plantar pressure and triceps surae muscle strength after prolonged standing

OpenAIRE

Hindun Saadah; Deswaty Furqonita; Angela Tulaar

2015-01-01

Background: The activity with prolonged standing position is one of the causes of abnormalities in the lower leg and foot. The aim of this study is to discover the effect of medial arch support over the distribution of plantar pressure when standing and walking.Methods: This was an experimental study with pre- and post-design the strength of triceps surae muscle after prolonged standing, was also evaluated in an experimental study with pre- and post-design. Variables of plantar pressure measu...

Criterion-related validity of the foot health status questionnaire regarding strength and plantar pressure measurements in elderly people.

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Cuesta-Vargas, Antonio I; Galan-Mercant, Alejandro; Martín-Borras, Maria Carmen; González-Sánchez, Manuel

2012-12-01

Criterion-related validity of a self-administered questionnaire listed as gold standard requires objective testing. The aim of this study was to analyze the Foot Health Status Questionnaire (FHSQ) using functional variable measures (dynamic plantar pressure and foot strength). A total of 22 elderly healthy participants (13 women and 9 men) were screened by interview and physical examination for foot or gait abnormalities. Foot strength, footprint pressure, and foot health status were measured. All the items of the FHSQ show significant correlation with functional variables, but general foot health shows the highest correlation with the 4 physical variables related to plantar pressure (R2 = 0.741), followed by foot pain (R2 = 0.652). A set of different, directly measured physical variables related to foot strength and plantar pressure significantly correlate with the FHSQ dimensions. Cross-sectional trial.

Are Pressure Time Integral and Cumulative Plantar Stress Related to First Metatarsophalangeal Joint Pain? Results From a Community-Based Study.

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Rao, Smita; Douglas Gross, K; Niu, Jingbo; Nevitt, Michael C; Lewis, Cora E; Torner, James C; Hietpas, Jean; Felson, David; Hillstrom, Howard J

2016-09-01

To examine the relationship between plantar stress over a step, cumulative plantar stress over a day, and first metatarsophalangeal (MTP) joint pain among older adults. Plantar stress and first MTP pain were assessed within the Multicenter Osteoarthritis Study. All included participants were asked if they had pain, aching, or stiffness at the first MTP joint on most days for the past 30 days. Pressure time integral (PTI) was quantified as participants walked on a pedobarograph, and mean steps per day were obtained using an accelerometer. Cumulative plantar stress was calculated as the product of regional PTI and mean steps per day. Quintiles of hallucal and second metatarsal PTI and cumulative plantar stress were generated. The relationship between predictors and the odds ratio of first MTP pain was assessed using a logistic regression model. Feet in the quintile with the lowest hallux PTI had 2.14 times increased odds of first MTP pain (95% confidence interval [95% CI] 1.42-3.25, P pain (95% CI 1.01-2.23, P = 0.042). Cumulative plantar stress was unassociated with first MTP pain. Lower PTI was modestly associated with increased prevalence of frequent first MTP pain at both the hallux and second metatarsal. Lower plantar loading may indicate the presence of an antalgic gait strategy and may reflect an attempt at pain avoidance. The lack of association with cumulative plantar stress may suggest that patients do not limit their walking as a pain-avoidance mechanism. © 2016, American College of Rheumatology.

High lateral plantar pressure is related to an increased tibialis anterior/fibularis longus activity ratio in patients with recurrent lateral ankle sprain

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Mineta S

2017-06-01

Full Text Available Shinshiro Mineta,1 Takayuki Inami,2 Raldy Mariano,3 Norikazu Hirose4 1Graduate School of Sport Sciences, 2Institute of Physical Education, Keio University, Hiyoshi, Yokohama, 3Graduate School of Asia-Pacific Studies, Waseda University, Shinjuku, Tokyo, 4Faculty of Sport Sciences, Waseda University, Higashifushimi, Nishitokyo, Japan Introduction: Center of pressure (COP is a sudden displacement at the time of a lateral ankle sprain (LAS. It has been suggested that the distribution of plantar pressure and the quantity of COP displacement are important for assessing the risk of LAS. Therefore, we evaluated the plantar pressure during a single-leg balance test with eyes closed (SLB-C to identify the factors and characteristics of plantar pressure in people with repeated cases of LAS.Methods: We recruited 22 collegiate athletes and divided them into an instability group (IG; n=11 and a control group (CG; n=11. We measured the distribution of plantar pressure and lower extremity muscle activity during a SLB-C along with static alignment and isometric ankle strength.Results: The fibularis longus (FL activity was significantly lower in the IG than in the CG. The lateral plantar pressure (LPP/medial plantar pressure (MPP ratio was also higher in the IG than in the CG. In addition, the LPP/MPP ratio was correlated with the tibialis anterior (TA/FL ratio.Conclusion: These results suggest that increased lateral plantar pressure is related to decreased FL activity and increased TA/FL ratio. Keywords: chronic ankle instability, ankle sprain, postural stability, soccer, prevention

Dynamic plantar pressure proles of South African university students ...

African Journals Online (AJOL)

Background. Footscan technology allows for assessment of injury risk and walking mechanics, yet there is a dearth of normative data pertaining to the normal, injury-free foot in a South African (SA) context. Objective. To generate normative tables from plantar pressure prole data gathered from students at an SA university.

Efficacy measures associated to a plantar pressure based classification system in diabetic foot medicine.

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Deschamps, Kevin; Matricali, Giovanni Arnoldo; Desmet, Dirk; Roosen, Philip; Keijsers, Noel; Nobels, Frank; Bruyninckx, Herman; Staes, Filip

2016-09-01

The concept of 'classification' has, similar to many other diseases, been found to be fundamental in the field of diabetic medicine. In the current study, we aimed at determining efficacy measures of a recently published plantar pressure based classification system. Technical efficacy of the classification system was investigated by applying a high resolution, pixel-level analysis on the normalized plantar pressure pedobarographic fields of the original experimental dataset consisting of 97 patients with diabetes and 33 persons without diabetes. Clinical efficacy was assessed by considering the occurence of foot ulcers at the plantar aspect of the forefoot in this dataset. Classification efficacy was assessed by determining the classification recognition rate as well as its sensitivity and specificity using cross-validation subsets of the experimental dataset together with a novel cohort of 12 patients with diabetes. Pixel-level comparison of the four groups associated to the classification system highlighted distinct regional differences. Retrospective analysis showed the occurence of eleven foot ulcers in the experimental dataset since their gait analysis. Eight out of the eleven ulcers developed in a region of the foot which had the highest forces. Overall classification recognition rate exceeded 90% for all cross-validation subsets. Sensitivity and specificity of the four groups associated to the classification system exceeded respectively the 0.7 and 0.8 level in all cross-validation subsets. The results of the current study support the use of the novel plantar pressure based classification system in diabetic foot medicine. It may particularly serve in communication, diagnosis and clinical decision making. Copyright © 2016 Elsevier B.V. All rights reserved.

Impact of the difference in the plantar flexor strength of the ankle joint in the affected side among hemiplegic patients on the plantar pressure and walking asymmetry.

Science.gov (United States)

You, Young Youl; Chung, Sin Ho; Lee, Hyung Jin

2016-11-01

[Purpose] This study was to examine the changes in the gait lines and plantar pressures in static and dynamic circumstances, according to the differences in the strengths of the plantar flexors in the ankle joints on the affected sides of hemiplegic patients, and to determine their impacts on walking symmetry. [Subjects and Methods] A total of thirty hospitalized stroke patients suffering from hemiplegia were selected in this study. The subjects had ankylosing patterns in the ankle joints of the affected sides. Fifteen of the patients had plantar flexor manual muscle testing scores between poor and fair, while fifteen of the patients had zero and trace. [Results] The contact pattern of the plantar surface with the ground is a reliable method for walking analysis, which is an important index for understanding the ankle mechanism and the relationship between the plantar surface and the ground. [Conclusion] The functional improvement of patients with stroke could be supported through a verification of the analysis methods of the therapy strategy and walking pattern.

Hallux valgus and plantar pressure loading: the Framingham foot study

Science.gov (United States)

2013-01-01

Background Hallux valgus (HV), a common structural foot deformity, can cause foot pain and lead to limited mobility. The purpose of this study was to evaluate differences in plantar pressure and force during gait by HV status in a large population-based cohort of men and women. Methods A trained examiner performed a validated physical examination on participants’ feet and recorded the presence of hallux valgus and other specific foot disorders. Each foot was classified into one of four mutually exclusive groups based on the foot examination. Foot groups were: (i) HV only, (ii) HV and at least one additional foot disorder (FD), (iii) no HV but at least one other FD, and (iv) neither HV nor FD (referent). Biomechanical data for both feet were collected using Tekscan Matscan. Foot posture during quiet standing, using modified arch index (MAI), and foot function during gait, using center of pressure excursion index (CPEI), were calculated per foot. Further, walking scans were masked into eight sub-regions using Novel Automask, and peak pressure and maximum force exerted in each region were calculated. Results There were 3205 participants, contributing 6393 feet with complete foot exam data and valid biomechanical measurements. Participants with HV had lower hallucal loading and higher forces at lesser toes as well as higher MAI and lower CPEI values compared to the referent. Participants with HV and other FDs were also noted to have aberrant rearfoot forces and pressures. Conclusions These results suggest that HV alters foot loading patterns and pressure profiles. Future work should investigate how these changes affect the risk of other foot and lower extremity ailments. PMID:24138804

Prevention of recurrent foot ulcers with plantar pressure-based in-shoe orthoses: the CareFUL prevention multicenter randomized controlled trial.

Science.gov (United States)

Ulbrecht, Jan S; Hurley, Timothy; Mauger, David T; Cavanagh, Peter R

2014-07-01

To assess the efficacy of in-shoe orthoses that were designed based on shape and barefoot plantar pressure in reducing the incidence of submetatarsal head plantar ulcers in people with diabetes, peripheral neuropathy, and a history of similar prior ulceration. Single-blinded multicenter randomized controlled trial with subjects randomized to wear shape- and pressure-based orthoses (experimental, n = 66) or standard-of-care A5513 orthoses (control, n = 64). Patients were followed for 15 months, until a study end point (forefoot plantar ulcer or nonulcerative plantar forefoot lesion) or to study termination. Proportional hazards regression was used for analysis. There was a trend in the composite primary end point (both ulcers and nonulcerative lesions) across the full follow-up period (P = 0.13) in favor of the experimental orthoses. This trend was due to a marked difference in ulcer occurrence (P = 0.007) but no difference in the rate of nonulcerative lesions (P = 0.76). At 180 days, the ulcer prevention effect of the experimental orthoses was already significant (P = 0.003) when compared with control, and the benefit of the experimental orthoses with respect to the composite end point was also significant (P = 0.042). The hazard ratio was 3.4 (95% CI 1.3-8.7) for the occurrence of a submetatarsal head plantar ulcer in the control compared with experimental arm over the duration of the study. We conclude that shape- and barefoot plantar pressure-based orthoses were more effective in reducing submetatarsal head plantar ulcer recurrence than current standard-of-care orthoses, but they did not significantly reduce nonulcerative lesions. © 2014 by the American Diabetes Association.

Development of a high resolution plantar pressure monitoring pad based on fiber Bragg grating (FBG) sensors.

Science.gov (United States)

Suresh, R; Bhalla, S; Hao, J; Singh, C

2015-01-01

High importance is given to plantar pressure monitoring in the field of biomedical engineering for the diagnosis of posture related ailments associated with diseases such as diabetes and gonarthrosis. This paper presents the proof-of-concept development of a new high resolution plantar pressure monitoring pad based on fiber Bragg grating (FBG) sensors. In the proposed configuration, the FBG sensors are embedded within layers of carbon composite material (CCM) in turn conforming to an arc shape. A total of four such arc shaped sensors are instrumented in the pad at the locations of the forefoot and the hind foot. As a test of the pad, static plantar pressure is monitored on normal subjects under various posture conditions. The pad is evaluated both as a standalone platform as well as a pad inserted inside a standard shoe. An average pressure sensitivity of 1.2 pm/kPa and a resolution of approximately 0.8 kPa is obtained in this special configuration. The pad is found to be suitable in both configurations- stand-alone pad as well as an insert inside a standard shoe. The proposed set up offers a cost-effective high resolution and accurate plantar pressure measurement system suitable for clinical deployment. The novelty of the developed pressure pad lies in its ability to be used both as platform type as well as inserted in-sole type sensor system.

Comparison of plantar pressures and contact area between normal and cavus foot.

Science.gov (United States)

Fernández-Seguín, Lourdes M; Diaz Mancha, Juan Antonio; Sánchez Rodríguez, Raquel; Escamilla Martínez, Elena; Gómez Martín, Beatriz; Ramos Ortega, Javier

2014-02-01

In pes cavus, the medial longitudinal arch elevation reduces the contact surface area and consequently increases the corresponding plantar pressure measurements. This poor distribution of loads may produce associated pathology and pain in this or other areas of the body. Normal reference values need to be established in order to determine which patterns are prone to pathology. To compare the plantar pressures and weight-bearing surface in a population with pes cavus to a population with neutral feet. The sample comprised 68 adults, 34 with pes cavus and 34 with neutral feet. The Footscan USB Gait Clinical System(®) was used as a platform to measure the total contact area and plantar pressure under the forefoot, midfoot, hindfoot, each metatarsal head, and the overall metatarsal area. A statistical analysis of the data was performed using Student's t-test for independent samples. The pes cavus subjects showed a significant reduction in their weight-bearing area [neutral feet: 165.04 ( ± 20.68) cm(2); pes cavus: 118.26 ( ± 30.31) cm(2); p contact surface and the load under the first toe. A significant increase is present in the load under the metatarsal areas, but the relative distribution of this load is similar in both groups. Copyright © 2013 Elsevier B.V. All rights reserved.

Comparison of foot orthoses made by podiatrists, pedorthists and orthotists regarding plantar pressure reduction in The Netherlands

Directory of Open Access Journals (Sweden)

Guldemond Nick A

2005-12-01

Full Text Available Abstract Background There is a need for evidence of clinical effectiveness of foot orthosis therapy. This study evaluated the effect of foot orthoses made by ten podiatrists, ten pedorthists and eleven orthotists on plantar pressure and walking convenience for three patients with metatarsalgia. Aims were to assess differences and variability between and within the disciplines. The relationship between the importance of pressure reduction and the effect on peak pressure was also evaluated. Methods Each therapist examined all three patients and was asked to rate the 'importance of pressure reduction' through a visual analogue scale. The orthoses were evaluated twice in two sessions while the patient walked on a treadmill. Plantar pressures were recorded with an in-sole measuring system. Patients scored walking convenience per orthosis. The effects of the orthoses on peak pressure reduction were calculated for the whole plantar surface of the forefoot and six regions: big toe and metatarsal one to five. Results Within each discipline there was an extensive variation in construction of the orthoses and achieved peak pressure reductions. Pedorthists and orthotists achieved greater maximal peak pressure reductions calculated over the whole forefoot than podiatrists: 960, 1020 and 750 kPa, respectively (p Conclusion The large variation for various aspects of foot orthoses therapy raises questions about a consistent use of concepts for pressures management within the professional groups.

Pressure-reduction and preservation in custom-made footwear of patients with diabetes and a history of plantar ulceration

NARCIS (Netherlands)

Waaijman, R.; Arts, M. L. J.; Haspels, R.; Busch-Westbroek, T. E.; Nollet, F.; Bus, S. A.

2012-01-01

Diabet. Med. 29, 15421549 (2012) Abstract Aims To assess the value of using in-shoe plantar pressure analysis to improve and preserve the offloading properties of custom-made footwear in patients with diabetes. Methods Dynamic in-shoe plantar pressures were measured in new custom-made footwear of

[Asymmetries in dynamic plantar pressure distribution measurement in able-bodied gait: application to the study of the gait asymmetries in children with hemiplegic cerebral palsy].

Science.gov (United States)

Femery, V; Moretto, P; Renaut, H; Lensel, G; Thevenon, A

2002-03-01

The aim of this study was to analyse, firstly, the plantar pressure distribution in healthy subjects in order to validate or invalidate the previous studies results on the asymmetrical profile of the stance phase. The studies of asymmetries was based on the identification of a propulsive foot and a loading foot from a concept introduced by Viel. Secondly, the approach was applied to the study of gait asymmetries in two children with hemiplegic cerebral plasy. Thirty healthy control subjects and two hemiplegic children (H1 and H2) performed a walking test at self selected speed. The recordings of dynamic parameters were realized thanks to an in-shoe plantar pressure analysis system (Parotec, by Paromed Medizintechnik, GMBH, Germany). The pressure peaks were determined from the recording of pressures under eight footprint locations. A program calculated the sum of forces under the heel and determined the loading foot. By defect, the second foot is the propulsive foot. The asymmetrical profile of the human normal stance phase was validated. Under the heel, the pressure peaks lower by 28 % were noticed beneath the loading foot compared to the propulsive foot. Inversely, under the metatarsal heads and the hallux, the pressure peaks were greater by 32 % beneath the propulsive foot. For the two hemiplegic children, the plantar pressure profile equally highlighted significant differences between the unaffected and affected feet. The pressure peaks under the affected heel were respectively lower by 21 % and 97 % for H1 and H2. The loading function was found and associated to the affected limb. The propulsive function was not systematically found under the unaffected foot. The analysis of plantar pressure measurements during able-bodied gait showed differences between the two lower limbs. These dynamic asymmetries are the results of a natural functional organization of the supports differentiating a loading foot and a propulsive foot and corroborating the concept proposed by

Pressure-reduction and preservation in custom-made footwear of patients with diabetes and a history of plantar ulceration.

Science.gov (United States)

Waaijman, R; Arts, M L J; Haspels, R; Busch-Westbroek, T E; Nollet, F; Bus, S A

2012-12-01

To assess the value of using in-shoe plantar pressure analysis to improve and preserve the offloading properties of custom-made footwear in patients with diabetes. Dynamic in-shoe plantar pressures were measured in new custom-made footwear of 117 patients with diabetes, neuropathy, and a healed plantar foot ulcer. In 85 of these patients, high peak pressure locations (peak pressure > 200 kPa) were targeted for pressure reduction (goal: > 25% relief or below an absolute level of 200 kPa) by modifying the footwear. After each of a maximum three rounds of modifications, pressures were measured. In a subgroup of 32 patients, pressures were measured and, if needed, footwear was modified at 3-monthly visits for 1 year. Pressures were compared with those measured in 32 control patients who had no footwear modifications based on pressure analysis. At the previous ulcer location and the highest and second highest pressure locations, peak pressures were significantly reduced by 23%, 21% and 15%, respectively, after modification of footwear. These lowered pressures were maintained or further reduced over time and were significantly lower, by 24-28%, compared with pressures in the control group. The offloading capacity of custom-made footwear for high-risk patients can be effectively improved and preserved using in-shoe plantar pressure analysis as guidance tool for footwear modification. This provides a useful approach to obtain better offloading footwear that may reduce the risk for pressure-related diabetic foot ulcers. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

Reliability of Baropodometry on the Evaluation of Plantar Load Distribution: A Transversal Study.

Science.gov (United States)

Baumfeld, Daniel; Baumfeld, Tiago; da Rocha, Romário Lopes; Macedo, Benjamim; Raduan, Fernando; Zambelli, Roberto; Alves Silva, Thiago Alexandre; Nery, Caio

2017-01-01

Introduction . Baropodometry is used to measure the load distribution on feet during rest and walking. The aim of this study was to evaluate changes in plantar foot pressures distribution due to period of working and due to stretching exercises of the posterior muscular chain. Methods . In this transversal study, all participants were submitted to baropodometric evaluation at two different times: before and after the working period and before and after stretching the muscles of the posterior chain. Results . We analyzed a total of 54 feet of 27 participants. After the working period, there was an average increase in the forefoot pressure of 0.16 Kgf/cm 2 and an average decrease in the hindfoot pressure of 0.17 Kgf/cm 2 . After stretching the posterior muscular chain, the average increase in the forefoot pressure was 0.56 Kgf/cm 2 and the hindfoot average pressure decrease was 0.56 Kgf/cm 2 . These changes were not statistically significant. Discussion . It was reported that the strength of the Achilles tendon generates greater forefoot load transferred from the hindfoot. In our study, no significant variation in the distribution of plantar pressure was observed. It can be inferred that baropodometry was a reliable instrument to determine the plantar pressure, regardless of the tension of the posterior chain muscles.

MEMS technology sensors as a more advantageous technique for measuring foot plantar pressure and balance in humans

OpenAIRE

Sanz Morère, C. (Clara); Surażyński, Ł. (Łukasz); Rodrigo Pérez-Tabernero, A. (Ana); Vihriälä, E. (Erkki); Myllylä, T. (Teemu)

2016-01-01

Abstract Locomotor activities are part and parcel of daily human life. During walking or running, feet are subjected to high plantar pressure, leading sometimes to limb problems, pain, or foot ulceration. A current objective in foot plantar pressure measurements is developing sensors that are small in size, lightweight, and energy efficient, while enabling high mobility, particularly for wearable applications. Moreover, improvements in spatial resolution, accuracy, and sensitivity are of i...

Foot Plantar Pressure Estimation Using Artificial Neural Networks

OpenAIRE

Xidias , Elias; Koutkalaki , Zoi; Papagiannis , Panagiotis; Papanikos , Paraskevas; Azariadis , Philip

2015-01-01

Part 1: Smart Products; International audience; In this paper, we present a novel approach to estimate the maximum pressure over the foot plantar surface exerted by a two-layer shoe sole for three distinct phases of the gait cycle. The proposed method is based on Artificial Neural Networks and can be utilized for the determination of the comfort that is related to the sole construction. Input parameters to the proposed neural network are the material properties and the thicknesses of the sole...

Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review.

Science.gov (United States)

Bus, S A; van Deursen, R W; Armstrong, D G; Lewis, J E A; Caravaggi, C F; Cavanagh, P R

2016-01-01

Footwear and offloading techniques are commonly used in clinical practice for preventing and healing of foot ulcers in persons with diabetes. The goal of this systematic review is to assess the medical scientific literature on this topic to better inform clinical practice about effective treatment. We searched the medical scientific literature indexed in PubMed, EMBASE, CINAHL, and the Cochrane database for original research studies published since 1 May 2006 related to four groups of interventions: (1) casting; (2) footwear; (3) surgical offloading; and (4) other offloading interventions. Primary outcomes were ulcer prevention, ulcer healing, and pressure reduction. We reviewed both controlled and non-controlled studies. Controlled studies were assessed for methodological quality, and extracted key data was presented in evidence and risk of bias tables. Uncontrolled studies were assessed and summarized on a narrative basis. Outcomes are presented and discussed in conjunction with data from our previous systematic review covering the literature from before 1 May 2006. We included two systematic reviews and meta-analyses, 32 randomized controlled trials, 15 other controlled studies, and another 127 non-controlled studies. Several randomized controlled trials with low risk of bias show the efficacy of therapeutic footwear that demonstrates to relief plantar pressure and is worn by the patient, in the prevention of plantar foot ulcer recurrence. Two meta-analyses show non-removable offloading to be more effective than removable offloading for healing plantar neuropathic forefoot ulcers. Due to the limited number of controlled studies, clear evidence on the efficacy of surgical offloading and felted foam is not yet available. Interestingly, surgical offloading seems more effective in preventing than in healing ulcers. A number of controlled and uncontrolled studies show that plantar pressure can be reduced by several conservative and surgical approaches. Sufficient

Reliability of in-Shoe Plantar Pressure Measurements in Rheumatoid Arthritis Patients

Science.gov (United States)

Vidmar, Gaj; Novak, Primoz

2009-01-01

Plantar pressures measurement is a frequently used method in rehabilitation and related research. Metric characteristics of the F-Scan system have been assessed from different standpoints and in different patients, but not its reliability in rheumatoid arthritis patients. Therefore, our objective was to assess reliability of the F-Scan plantar…

Comparison of plantar pressure distribution in CAD-CAM and prefabricated foot orthoses in patients with flexible flatfeet.

Science.gov (United States)

Khodaei, Banafsheh; Saeedi, Hassan; Jalali, Maryam; Farzadi, Maede; Norouzi, Ehsan

2017-12-01

The effect of foot orthoses on plantar pressure distribution has been proven by researchers but there are some controversies about advantages of custom-made foot orthoses to less expensive prefabricated foot orthoses. Nineteen flatfeet adults between 18 and 45 participated in this study. CAD-CAM foot orthoses were made for these patients according to their foot scan. Prefabricated foot orthoses were prepared according to their foot size. Plantar pressure, force and contact area were measured using pedar ® -x in-shoe system wearing shoe alone, wearing CAD-CAM foot orthoses and wearing prefabricated foot orthoses. Repeated measures ANOVA model with post-hoc, Bonferroni comparison were used to test differences. CAD-CAM and prefabricated foot orthoses both decreased pressure and force under 2nd, 3-5 metatarsal and heel regions comparing to shoe alone condition. CAD-CAM foot orthosis increased pressure under lateral toe region in comparison to shoe alone and prefabricated foot orthosis. Both foot orthoses increased pressure and contact area in medial midfoot region comparing to shoe alone condition. Increased forces were seen at hallux and lateral toes by prefabricated foot orthoses in comparison with CAD-CAM foot orthoses and control condition, respectively. According to the results, both foot orthoses could decrease the pressure under heel and metatarsal area. It seems that the special design of CAD-CAM foot orthoses could not make great differences in plantar pressure distribution in this sample. Further research is required to determine whether these results are associated with different scan systems or design software. Copyright © 2017 Elsevier Ltd. All rights reserved.

Dynamic plantar pressure distribution, strength capacity and postural control after Lisfranc fracture-dislocation

DEFF Research Database (Denmark)

Mehlhorn, Alexander T; Walther, Markus; Yilmaz, Tayfun

2017-01-01

of life. 17 consecutive patients suffering from a Lisfranc fracture dislocation were registered, underwent open reduction and internal fixation and were followed-up for 50.5±25.7months (Mean±SDM). Biomechanical analysis of muscle strength capacities, postural control and plantar pressure distribution......Substantial progress has been made in the operative treatment of Lisfranc fractures, however, the prognosis remains poor. We hypothesized that Lisfranc injuries change the postural control and muscle strength of the lower limb. Both are suggested to correlate with the clinical outcome and quality...... correlated well with clinical outcome. Altered postural control was evident by a significant reduction in unilateral stance time, from which we calculated a strong correlation between stance time and the isokinetic strength measurement. Plantar pressure measurements revealed a significant reduction in peak...

Integrating computer aided radiography and plantar pressure measurements for complex gait analysis

International Nuclear Information System (INIS)

Gefen, A.; Megido-Ravid, M.; Itzchak, Y.; Arcan, M.

1998-01-01

Radiographic Fluoroscopy (DRF) and Contact Pressure Display (CPD). The CPD method uses a birefiingent integrated optical sandwich for contact stress analysis, e.g. plantar pressure distribution. The DRF method displays and electronically records skeletal motion using X-ray radiation, providing the exact bone and joint positions during gait. Integrating the two techniques, contribution of each segment to the HFS behavior may be studied by applying image processing and analysis techniques. The combined resulted data may be used not only to detect and diagnose gait pathologies but also as a base for development of advanced numerical models of the foot structure

Effectiveness of the Simultaneous Stretching of the Achilles Tendon and Plantar Fascia in Individuals With Plantar Fasciitis.

Science.gov (United States)

Engkananuwat, Phoomchai; Kanlayanaphotporn, Rotsalai; Purepong, Nithima

2018-01-01

Since the plantar fascia and the Achilles tendon are anatomically connected, it is plausible that stretching of both structures simultaneously will result in a better outcome for plantar fasciitis. Fifty participants aged 40 to 60 years with a history of plantar fasciitis greater than 1 month were recruited. They were prospectively randomized into 2 groups. Group 1 was instructed to stretch the Achilles tendon while group 2 simultaneously stretched the Achilles tendon and plantar fascia. After 4 weeks of both stretching protocols, participants in group 2 demonstrated a significantly greater pressure pain threshold than participants in group 1 ( P = .040) with post hoc analysis. No significant differences between groups were demonstrated in other variables ( P > .05). Concerning within-group comparisons, both interventions resulted in significant reductions in pain at first step in the morning and average pain at the medial plantar calcaneal region over the past 24 hours, while there were increases in the pressure pain threshold, visual analog scale-foot and ankle score, and range of motion in ankle dorsiflexion ( P plantar fascia for 4 weeks was a more effective intervention for plantar fasciitis. Patients who reported complete relief from symptoms at the end of the 4-week intervention in the simultaneous stretching group (n = 14; 56%) were double that of the stretching of the Achilles tendon-only group (n = 7; 28%). II, lesser quality RCT or prospective comparative study.

The effect of medial arch support over the plantar pressure and triceps surae muscle strength after prolonged standing

Directory of Open Access Journals (Sweden)

Hindun Saadah

2015-11-01

Full Text Available Background: The activity with prolonged standing position is one of the causes of abnormalities in the lower leg and foot. The aim of this study is to discover the effect of medial arch support over the distribution of plantar pressure when standing and walking.Methods: This was an experimental study with pre- and post-design the strength of triceps surae muscle after prolonged standing, was also evaluated in an experimental study with pre- and post-design. Variables of plantar pressure measurement are the contact area and pressure peak were measured by using the Mat-scan tool. The measurement of the triceps surae muscle strength was done with a hand-held dynamometer, before and after using the medial arch support. Measurement was performed before and after working with prolonged standing position which took place about seven hours using the medial arch support inserted in the shoes. Data was analyzed using paired T-test.Results: There was a significant difference of peak pressure between standing (p = 0.041 and walking (p = 0.001. Whereas the contact area showed a significant decrease in the width of the contact area when standing (104.12 ± 12.42 vs 99.08 ± 10.21 p = 0.023. Whereas, the triceps surae muscle strength pre- and post-standing prolonged did not indicate a significant difference.Conclusion: There was decrease in peak pressure when standing and walking and decrease in contact area when standing on plantar after used of the medial arch support after prolonged standing.

The effect of foot orthoses with forefoot cushioning or metatarsal pad on forefoot peak plantar pressure in running

Directory of Open Access Journals (Sweden)

Michaela Hähni

2016-11-01

Full Text Available Abstract Background Foot orthoses are frequently used in sports for the treatment of overuse complaints with sufficient evidence available for certain foot-related overuse pathologies like plantar fasciitis, rheumatoid arthritis and foot pain (e.g., metatarsalgia. One important aim is to reduce plantar pressure under prominent areas like metatarsal heads. For the forefoot region, mainly two common strategies exist: metatarsal pad (MP and forefoot cushioning (FC. The aim of this study was to evaluate which of these orthosis concepts is superior in reducing plantar pressure in the forefoot during running. Methods Twenty-three (13 female, 10 male asymptomatic runners participated in this cross-sectional experimental trial. Participants ran in a randomised order under the two experimental (MP, FC conditions and a control (C condition on a treadmill (2.78 ms−1 for 2 min, respectively. Plantar pressure was measured with the in-shoe plantar pressure measurement device pedar-x®-System and mean peak pressure averaged from ten steps in the forefoot (primary outcome and total foot was analysed. Insole comfort was measured with the Insole Comfort Index (ICI, sum score 0–100 after each running trial. The primary outcome was tested using the Friedman test (α = 0.05. Secondary outcomes were analysed descriptively (mean ± SD, lower & upper 95%-CI, median and interquartile-range (IQR. Results Peak pressure [kPa] in the forefoot was significantly lower wearing FC (281 ± 80, 95%-CI: 246–315 compared to both C (313 ± 69, 95%-CI: 283–343; p = .003 and MP (315 ± 80, 95%-CI: 280–350; p = .001. No significant difference was found between C and MP (p = .858. Peak pressures under the total foot were: C: 364 ± 82, 95%-CI: 328–399; MP: 357 ± 80, 95%-CI: 326–387; FC: 333 ± 81 95%-CI: 298–368. Median ICI sum scores were: C 50, MP 49, FC 64. Conclusions In contrast to the metatarsal pad orthosis, the

Assessment of plantar pressure in forefoot relief shoes of different designs.

Science.gov (United States)

Carl, Hans-Dieter; Pfander, David; Swoboda, Bernd

2006-02-01

After reconstructive forefoot surgery, patients require complete or partial forefoot relief, which can be obtained with a variety of shoe designs. The aim of this study was to evaluate the effectiveness of two different types of forefoot-relief shoes frequently used after surgery, especially their safety against unintentional forefoot load. Ten healthy volunteers were asked to perform five trials on a treadmill at self-selected speeds. In the first trial, mean peak pressure values in mass-produced shoes and insoles were evaluated and considered as 100%. Two different shoe designs (short heel-short sole, ii: short heel-complete sole) were compared in two trials each with appropriate and inappropriate use (attempting to put weight on the forefoot) gait pattern. Plantar pressure values were obtained using the Pedar cable system (Novel Inc., Munich, Germany). For analysis, pedobarographic pictures were subdivided into midfoot (31% to 60% of the total insole length) and forefoot (61% to 100% of the total insole length). ANOVA was used for statistical analysis, and p values less than 0.01 were considered significant. With the short-soled shoe, forefoot and midfoot relief was 100% in both compliant and in noncompliant use. With wearing a complete sole, compliant use led to a significant reduction (p shoe produced mean peak pressure values significantly higher (p shoes under the forefoot, but not under the midfoot. Forefoot-relief shoes are effective in reducing both mean and peak plantar pressures. Shoes with a nonsupported midfoot and forefoot may be safer with inappropriate use than shoes with a complete sole. The kind of forefoot shoe should be carefully chosen to regulate weightbearing after reconstructive forefoot surgery.

Influence of slope steepness, foot position and turn phase on plantar pressure distribution during giant slalom alpine ski racing.

Directory of Open Access Journals (Sweden)

Thomas Falda-Buscaiot

Full Text Available The purpose of this study was to investigate the evolution of ground reaction force during alpine skiing turns. Specifically, this study investigated how turn phases and slope steepness affected the whole foot normal GRF pattern while performing giant slalom turns in a race-like setting. Moreover, the outside foot was divided into different plantar regions to see whether those parameters affected the plantar pressure distribution. Eleven skiers performed one giant slalom course at race intensity. Runs were recorded synchronously using a video camera in the frontal plane and pressure insoles under both feet's plantar surface. Turns were divided according to kinematic criteria into four consecutive phases: initiation, steering1, steering2 and completion; both steering phases being separated by the gate passage. Component of the averaged Ground Reaction Force normal to the ski's surface([Formula: see text], /BW, and Pressure Time Integral relative to the entire foot surface (relPTI, % parameters were calculated for each turn phases based on plantar pressure data. Results indicated that [Formula: see text] under the total foot surface differed significantly depending on the slope (higher in steep sections vs. flat sections, and the turn phase (higher during steering2 vs. three other phases, although such modifications were observable only on the outside foot. Moreover, [Formula: see text] under the outside foot was significantly greater than under the inside foot.RelPTI under different foot regions of the outside foot revealed a global shift from forefoot loading during initiation phase, toward heel loading during steering2 phase, but this was dependent on the slope studied. These results suggest a differentiated role played by each foot in alpine skiing turns: the outside foot has an active role in the turning process, while the inside foot may only play a role in stability.

Integrated pressure-force-kinematics measuring system for the characterisation of plantar foot loading during locomotion.

Science.gov (United States)

Giacomozzi, C; Macellari, V; Leardini, A; Benedetti, M G

2000-03-01

Plantar pressure, ground reaction force and body-segment kinematics measurements are largely used in gait analysis to characterise normal and abnormal function of the human foot. The combination of all these data together provides a more exhaustive, detailed and accurate view of foot loading during activities than traditional measurement systems alone do. A prototype system is presented that integrates a pressure platform, a force platform and a 3D anatomical tracking system to acquire combined information about foot function and loading. A stereophotogrammetric system and an anatomically based protocol for foot segment kinematics is included in a previously devised piezo-dynamometric system that combines pressure and force measurements. Experimental validation tests are carried out to check for both spatial and time synchronisation. Misalignment of the three systems is found to be within 6.0, 5.0 and 1.5 mm for the stereophotogrammetric system, force platform and pressure platform, respectively. The combination of position and pressure data allows for a more accurate selection of plantar foot subareas on the footprint. Measurements are also taken on five healthy volunteers during level walking to verify the feasibility of the overall experimental protocol. Four main subareas are defined and identified, and the relevant vertical and shear force data are computed. The integrated system is effective when there is a need for loading measurements in specific plantar foot subareas. This is attractive both in clinical assessment and in biomechanics research.

Blood pressure and calf muscle oxygen extraction during plantar flexion exercise in peripheral artery disease.

Science.gov (United States)

Luck, J Carter; Miller, Amanda J; Aziz, Faisal; Radtka, John F; Proctor, David N; Leuenberger, Urs A; Sinoway, Lawrence I; Muller, Matthew D

2017-07-01

Peripheral artery disease (PAD) is an atherosclerotic vascular disease that affects 200 million people worldwide. Although PAD primarily affects large arteries, it is also associated with microvascular dysfunction, an exaggerated blood pressure (BP) response to exercise, and high cardiovascular mortality. We hypothesized that fatiguing plantar flexion exercise that evokes claudication elicits a greater reduction in skeletal muscle oxygenation (SmO 2 ) and a higher rise in BP in PAD compared with age-matched healthy subjects, but low-intensity steady-state plantar flexion elicits similar responses between groups. In the first experiment, eight patients with PAD and eight healthy controls performed fatiguing plantar flexion exercise (from 0.5 to 7 kg for up to 14 min). In the second experiment, seven patients with PAD and seven healthy controls performed low-intensity plantar flexion exercise (2.0 kg for 14 min). BP, heart rate (HR), and SmO 2 were measured continuously using near-infrared spectroscopy (NIRS). SmO 2 is the ratio of oxygenated hemoglobin to total hemoglobin, expressed as a percent. At fatigue, patients with PAD had a greater increase in mean arterial BP (18 ± 2 vs. vs. 10 ± 2 mmHg, P = 0.029) and HR (14 ± 2 vs. 6 ± 2 beats/min, P = 0.033) and a greater reduction in SmO 2 (-54 ± 10 vs. -12 ± 4%, P = 0.001). However, both groups had similar physiological responses to low-intensity, nonpainful plantar flexion exercise. These data suggest that patients with PAD have altered oxygen uptake and/or utilization during fatiguing exercise coincident with an augmented BP response. NEW & NOTEWORTHY In this laboratory study, patients with peripheral artery disease performed plantar flexion exercise in the supine posture until symptoms of claudication occurred. Relative to age- and sex-matched healthy subjects we found that patients had a higher blood pressure response, a higher heart rate response, and a greater reduction in skeletal muscle oxygenation as

Surface effects on in-shoe plantar pressure and tibial impact during running

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Weijie Fu

2015-12-01

Conclusion: There may not be an inevitable relationship between the surface and the lower-limb impact in runners. It is, however, still noteworthy that the effects of different treadmill surfaces should be considered in the interpretation of plantar pressure performance and translation of such results to overground running.

The Characteristics of Static Plantar Loading in the First-Division College Sprint Athletes

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Tong-Hsien Chow

2016-01-01

Background: Plantar pressure measurement is an effective method for assessing plantar loading and can be applied to evaluating movement performance of the foot. The purpose of this study is to explore the sprint athletes' plantar loading characteristics and pain profiles in static standing. Methods: Experiments were undertaken on 80 first-division college sprint athletes and 85 healthy non-sprinters. 'JC Mat', the optical plantar pressure measurement was applied to examining the differences b...

Effect of medial arch support foot orthosis on plantar pressure distribution in females with mild-to-moderate hallux valgus after one month of follow-up.

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Farzadi, Maede; Safaeepour, Zahra; Mousavi, Mohammad E; Saeedi, Hassan

2015-04-01

Higher plantar pressures at the medial forefoot are reported in hallux valgus. Foot orthoses with medial arch support are considered as an intervention in this pathology. However, little is known about the effect of foot orthoses on plantar pressure distribution in hallux valgus. To investigate the effect of a foot orthosis with medial arch support on pressure distribution in females with mild-to-moderate hallux valgus. Quasi-experimental. Sixteen female volunteers with mild-to-moderate hallux valgus participated in this study and used a medial arch support foot orthosis for 4 weeks. Plantar pressure for each participant was assessed using the Pedar-X(®) in-shoe system in four conditions including shoe-only and foot orthosis before and after the intervention. The use of the foot orthosis for 1 month led to a decrease in peak pressure and maximum force under the hallux, first metatarsal, and metatarsals 3-5 (p hallux and the first metatarsal head by transferring the load to the other regions. It would appear that this type of foot orthosis can be an effective method of intervention in this pathology. Findings of this study will improve the clinical knowledge about the effect of the medial arch support foot orthosis used on plantar pressure distribution in hallux valgus pathology. © The International Society for Prosthetics and Orthotics 2014.

Plantar pressure with and without custom insoles in patients with common foot complaints.

NARCIS (Netherlands)

Stolwijk, N.M.; Louwerens, J.W.; Nienhuis, B.; Duysens, J.E.J.; Keijsers, N.L.

2011-01-01

BACKGROUND: Although many patients with foot complaints receive customized insoles, the choice for an insole design can vary largely among foot experts. To investigate the variety of insole designs used in daily practice, the insole design and its effect on plantar pressure distribution were

Selective plantar fascia release for nonhealing diabetic plantar ulcerations.

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Kim, J Young; Hwang, Seungkeun; Lee, Yoonjung

2012-07-18

Achilles tendon lengthening can decrease plantar pressures, leading to resolution of forefoot ulceration in patients with diabetes mellitus. However, this procedure has been reported to have a complication rate of 10% to 30% and can require a long period of postoperative immobilization. We have developed a new technique, selective plantar fascia release, as an alternative to Achilles tendon lengthening for managing these forefoot ulcers. We evaluated sixty patients with diabetes for a mean of 23.5 months after selective plantar fascia release for the treatment of nonhealing diabetic neuropathic ulcers in the forefoot. Preoperative and postoperative dorsiflexion range of motion of the affected metatarsophalangeal joint and wound-healing data were used to evaluate the effectiveness of the procedure and to determine the relationship between plantar fascia release and ulcer healing. Complications were recorded. Thirty-six (56%) of the ulcers healed within six weeks, including twenty-nine (60%) of the plantar toe ulcers and seven (44%) of the metatarsophalangeal joint ulcers. The mean range of motion of the affected metatarsophalangeal joint increased from 15.3° ± 7.8° to 30.6° ± 14.1° postoperatively (p plantar fascia release. Our results suggest that selective plantar fascia release can lead to healing of neuropathic plantar forefoot ulcers in diabetic patients. Ulcers in patients in whom the preoperative dorsiflexion angle of the affected metatarsophalangeal joint is between 5° and 30° and in whom the increase in range of motion is ≥13° postoperatively have the greatest chance of being cured. Therapeutic level IV. See Instructions for Authors for a complete description of the levels of evidence.

Biomechanical analysis of the support in race walking. Relationship between footprint, subtalar joint angles, and plantar pressures Análisis biomecánico del apoyo plantar en la marcha atlética. Relación entre la huella plantar, ángulos de la articulación subastragalina y presiones plantares

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M. Meana

2010-09-01

Full Text Available

The aims were to describe the behavior of the subtalar joint and foot in the race walk, and seek for correlations between them and the footprint. 12 race walkers participated in the study. The arch index was calculated on their footprints. Plantar pressures were measured and 3D photogrammetry used on a single support while they race walked at their own competitive speed. Maximum pressures were calculated in each region of the foot and also the maximum and minimum values of the three angles that describe the subtalar joint. The maximum pronation was higher than that described in the walking gait and similar to that of the running gait (-13.6 ± 3.90. In the beginning of the support the subtalar joint was between the walking and the running gaits. This suggests that the cushioning mechanism of this joint is adjusted according to the type of locomotion. The region of the foot that registered higher pressures was the external rearfoot (21.02 kPa/kg followed by the internal forefoot (13.12 kPa/kg, showing a different behaviour to that of the running gait, in which both present similar maximum pressures. The subjects with lower arches tended to support with the internal face of the foot (r=-0.713 and with the leg inclined medially (r=0.874. Likewise, the racewalkers with higher arches registered higher pressures in the external part of the rearfoot, whereas the lowest ones did it in the internal part of the midfoot.
Key Words: Biomechanics, race walk, footprint, subtalar joint, plantar pressure.

Los objetivos fueron describir el comportamiento de la articulación subastragalina y el pie en la marcha atlética y buscar correlaciones entre estos y la huella plantar. Participaron 12 marchadores. Se calculó el índice del arco sobre sus huellas plantares. Se registraron presiones plantares y se aplicó fotogrametría 3D durante un apoyo

The Analysis of Plantar Pressure Data Based on Multimodel Method in Patients with Anterior Cruciate Ligament Deficiency during Walking

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Xiaoli Li

2016-01-01

Full Text Available The movement information of the human body can be recorded in the plantar pressure data, and the analysis of plantar pressure data can be used to judge whether the human body motion function is normal or not. A two-meter footscan® system was used to collect the plantar pressure data, and the kinetic and dynamic gait characteristics were extracted. According to the different description of gait characteristics, a set of models was established according to various people to present the movement of lower limbs. By the introduction of algorithm in machine learning, the FCM clustering algorithm is used to cluster the sample set and create a set of models, and then the SVM algorithm was used to identify the new samples, so as to complete the normal and abnormal motion function identification. The multimodel presented in this paper was carried out into the analysis of the anterior cruciate ligament deficiency. This method demonstrated being effective and can provide auxiliary analysis for clinical diagnosis.

The effect of moderate running on foot posture index and plantar pressure distribution in male recreational runners.

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Escamilla-Martínez, Elena; Martínez-Nova, Alfonso; Gómez-Martín, Beatriz; Sánchez-Rodríguez, Raquel; Fernández-Seguín, Lourdes María

2013-01-01

Fatigue due to running has been shown to contribute to changes in plantar pressure distribution. However, little is known about changes in foot posture after running. We sought to compare the foot posture index before and after moderate exercise and to relate any changes to plantar pressure patterns. A baropodometric evaluation was made, using the FootScan platform (RSscan International, Olen, Belgium), of 30 men who were regular runners and their foot posture was examined using the Foot Posture Index before and after a 60-min continuous run at a moderate pace (3.3 m/sec). Foot posture showed a tendency toward pronation after the 60-min run, gaining 2 points in the foot posture index. The total support and medial heel contact areas increased, as did pressures under the second metatarsal head and medial heel. Continuous running at a moderate speed (3.3 m/sec) induced changes in heel strike related to enhanced pronation posture, indicative of greater stress on that zone after physical activity. This observation may help us understand the functioning of the foot, prevent injuries, and design effective plantar orthoses in sport.

Comparison of plantar pressure distribution in subjects with normal and flat feet during gait DOI: 10.5007/1980-0037.2010v12n4p290

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Patrik Felipe Nazario

2010-01-01

Full Text Available The aim of this study was to determine the possible relationship between loss of the normal medial longitudinal arch measured by the height of the navicular bone in a static situation and variables related to plantar pressure distribution measured in a dynamic situation. Eleven men (21 ± 3 years, 74 ± 10 kg and 175 ± 4 cm participated in the study. The Novel Emed-AT System was used for the acquisition of plantar pressure distribution data (peak pressure, mean pressure, contact area, and relative load at a sampling rate of 50 Hz. The navicular drop test proposed by Brody (1982 was used to assess the height of the navicular bone for classification of the subjects. The results were compared by the Mann-Whitney U test, with the level of significance set at p ≤ 0.05. Differences were observed between the two groups in the mid-foot region for all variables studied, with the observation of higher mean values in subjects with flat feet. There were also significant differences in contact area, relative load, peak pressure, and mean pressure between groups. The present study demonstrates the importance of paying attention to subjects with flat feet because changes in plantar pressure distribution are associated with discomfort and injuries.

Battery-Free Smart Sock for Abnormal Relative Plantar Pressure Monitoring.

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Lin, Xiaoyou; Seet, Boon-Chong

2017-04-01

This paper presents a new design of a wearable plantar pressure monitoring system in the form of a smart sock for sensing abnormal relative pressure changes. One advantage of this approach is that with a battery-free design, this system can be powered solely by radio frequency (RF) energy harvested from a radio frequency identification (RFID) reader unit hosted on a smartphone of the wearer. At the same time, this RFID reader can read foot pressure values from an embedded sensor-tag in the sock. A pressure sensing matrix made of conductive fabric and flexible piezo-resistive material is integrated into the sock during the knitting process. Sensed foot pressures are digitized and stored in the memory of a sensor-tag, thus allowing relative foot pressure values to be tracked. The control unit of the smart sock is assembled on a flexible printed circuit board (FPC) that can be strapped to the lower limb and detached easily when it is not in use. Experiments show that the system can operate reliably in both tasks of RF energy harvesting and pressure measurement.

Plantar Pressures After Nonoperative Treatment for Clubfoot: Intermediate Follow-up at Age 5 Years.

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Jeans, Kelly A; Erdman, Ashley L; Karol, Lori A

2017-01-01

Worldwide, a nonoperative approach in the treatment of idiopathic clubfoot has been taken in an attempt to reduce the incidence of surgical outcomes. Although both the Ponseti casting (Ponseti) and the French physiotherapy (PT) methods have shown gait and pedobarograph differences at age 2 years, improved gait results have been reported by age 5 years. The purpose of this study was to assess plantar pressures in feet treated with the Ponseti versus the PT methods at this intermediate stage. Clubfoot patients treated nonoperatively (Ponseti or PT) underwent pedobarograph data collection at age 5 years. The foot was subdivided into the medial/lateral hindfoot, midfoot, and forefoot regions. Variables included Peak Pressure, Maximum Force, Contact Area%, Contact Time%, Pressure Time Integral, the hindfoot-forefoot angle, and displacement of the center of pressure (COP) line. Twenty controls were used for comparison. Pedobarograph data from 164 patients (238 feet; 122 Ponseti and 116 PT) showed no significant differences between the Ponseti and the PT feet, except the PT feet had a significantly less medial movement of the COP than the Ponseti feet (P=0.0379). Compared with controls, both groups had decreased plantar pressures in the hindfoot and first metatarsal regions, whereas the midfoot and lateral forefoot experienced significant increases compared with controls. This lateralization was also reflected in the hindfoot-forefoot angle and the COP. Feet that remain nonoperative and avoid surgical intervention are considered a good clinical result. However, pedobarograph results indicate mild residual deformity in these feet despite clinically successful outcomes. Level II-therapeutic.

Laterality and Plantar Pressure Distribution During Gait in Healthy Children: Comment on Mayolas Pi, Arrese, Aparicio, and Masià (2015).

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Zverev, Yury

2016-08-01

In a recent paper, Mayolas Pi, Arrese, Aparicio, and Masià reported the absence of significant bilateral differences between legs in the average plantar pressure during walking in six- to seven-year-old children. However, the authors demonstrated bilateral differences in the distribution of plantar pressure during walking independent of foot preference in three tests: kicking a ball with precision, balancing on one foot, and jumping on one foot. From the results, Mayolas Pi et al. proposed that this asymmetric pattern of plantar pressure distribution is not caused by laterality. This paper suggests that the selected age range of participants and methods of diagnosing of laterality and data analysis could have significant effects on the results. Indeed, according to the literature, laterality in humans is a multidimensional trait with poor stabilization and conformity between different dimensions in preschool and younger school children. © The Author(s) 2016.

Plantar pressure relief under the metatarsal heads: therapeutic insole design using three-dimensional finite element model of the foot.

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Chen, Wen-Ming; Lee, Sung-Jae; Lee, Peter Vee Sin

2015-02-26

Therapeutic footwear with specially-made insoles is often used in people with diabetes and rheumatoid arthritis to relieve ulcer risks and pain due to high pressures from areas beneath bony prominences of the foot, in particular to the metatarsal heads (MTHs). In a three-dimensional finite element study of the foot and footwear with sensitivity analysis, effects of geometrical variations of a therapeutic insole, in terms of insole thicknesses and metatarsal pad (MP) placements, on local peak plantar pressure under MTHs and stress/strain states within various forefoot tissues, were determined. A validated musculoskeletal finite element model of the human foot was employed. Analyses were performed in a simulated muscle-demanding instant in gait. For many design combinations, increasing insole thicknesses consistently reduce peak pressures and internal tissue strain under MTHs, but the effects reach a plateau when insole becomes very thick (e.g., a value of 12.7mm or greater). Altering MP placements, however, showed a proximally- and a distally-placed MP could result in reverse effects on MTH pressure-relief. The unsuccessful outcome due to a distally-placed MP may attribute to the way it interacts with plantar tissue (e.g., plantar fascia) adjacent to the MTH. A uniform pattern of tissue compression under metatarsal shaft is necessary for a most favorable pressure-relief under MTHs. The designated functions of an insole design can best be achieved when the insole is very thick, and when the MP can achieve a uniform tissue compression pattern adjacent to the MTH. Copyright © 2015 Elsevier Ltd. All rights reserved.

In-Shoe Plantar Pressures and Ground Reaction Forces during Overweight Adults' Overground Walking

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de Castro, Marcelo P.; Abreu, Sofia C.; Sousa, Helena; Machado, Leandro; Santos, Rubim; Vilas-Boas, João Paulo

2014-01-01

Purpose: Because walking is highly recommended for prevention and treatment of obesity and some of its biomechanical aspects are not clearly understood for overweight people, we compared the absolute and normalized ground reaction forces (GRF), plantar pressures, and temporal parameters of normal-weight and overweight participants during…

Using an optimization approach to design an insole for lowering plantar fascia stress--a finite element study.

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Hsu, Yu-Chun; Gung, Yih-Wen; Shih, Shih-Liang; Feng, Chi-Kuang; Wei, Shun-Hwa; Yu, Chung-Huang; Chen, Chen-Sheng

2008-08-01

Plantar heel pain is a commonly encountered orthopedic problem and is most often caused by plantar fasciitis. In recent years, different shapes of insole have been used to treat plantar fasciitis. However, little research has been focused on the junction stress between the plantar fascia and the calcaneus when wearing different shapes of insole. Therefore, this study aimed to employ a finite element (FE) method to investigate the relationship between different shapes of insole and the junction stress, and accordingly design an optimal insole to lower fascia stress.A detailed 3D foot FE model was created using ANSYS 9.0 software. The FE model calculation was compared to the Pedar device measurements to validate the FE model. After the FE model validation, this study conducted parametric analysis of six different insoles and used optimization analysis to determine the optimal insole which minimized the junction stress between plantar fascia and calcaneus. This FE analysis found that the plantar fascia stress and peak pressure when using the optimal insole were lower by 14% and 38.9%, respectively, than those when using the flat insole. In addition, the stress variation in plantar fascia was associated with the different shapes of insole.

Plantar fasciitis (fasciosis) treatment outcome study: plantar fascia thickness measured by ultrasound and correlated with patient self-reported improvement.

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Fabrikant, Jerry M; Park, Tae Soon

2011-06-01

Ultrasound, well recognized as an effective diagnostic tool, reveals a thickening of the plantar fascia in patients with plantar fasciitis/fasciosis disease. The authors hypothesized that ultrasound would also reveal a decrease in the plantar fascia thickness for patients undergoing treatment for the disease, a hypothesis that, heretofore, had been only tested on a limited number of subjects. They conducted a more statistically significant study that found that clinical treatment with injection and biomechanical correction does indeed diminish plantar fascia thickness as shown on ultrasound. The study also revealed that patients experience the most heightened plantar fascia tenderness toward the end of the day, and improvement in their symptomatic complaints were associated with a reduction in plantar fascia thickness. As a result, the authors conclude that office-based ultrasound can help diagnose and confirm plantar fasciitis/fasciosis through the measurement of the plantar fascia thickness. Because of the advantages of ultrasound--that it is non-invasive with greater patient acceptance, cost effective and radiation-free--the imaging tool should be considered and implemented early in the diagnosis and treatment of plantar fasciitis/fasciosis. Copyright © 2011 Elsevier Ltd. All rights reserved.

Influence of different safety shoes on gait and plantar pressure: a standardized examination of workers in the automotive industry.

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Ochsmann, Elke; Noll, Ulrike; Ellegast, Rolf; Hermanns, Ingo; Kraus, Thomas

2016-09-30

Working conditions, such as walking and standing on hard surfaces, can increase the development of musculoskeletal complaints. At the interface between flooring and musculoskeletal system, safety shoes may play an important role in the well-being of employees. The aim of this study was to evaluate the effects of different safety shoes on gait and plantar pressure distributions on industrial flooring. Twenty automotive workers were individually fitted out with three different pairs of safety shoes ( "normal" shoes, cushioned shoes, and midfoot bearing shoes). They walked at a given speed of 1.5 m/s. The CUELA measuring system and shoe insoles were used for gait analysis and plantar pressure measurements, respectively. Statistical analysis was conducted by ANOVA analysis for repeated measures. Walking with cushioned safety shoes or a midfoot bearing safety shoe led to a significant decrease of the average trunk inclination (pshoes as well as midfoot bearing shoes (pshoes. As expected, plantar pressure distributions varied significantly between cushioned or midfoot bearing shoes and shoes without ergonomic components. The overall function of safety shoes is the avoidance of injury in case of an industrial accident, but in addition, safety shoes could be a long-term preventive instrument for maintaining health of the employees' musculoskeletal system, as they are able to affect gait parameters. Further research needs to focus on safety shoes in working situations.

Flat feet, happy feet? Comparison of the dynamic plantar pressure distribution and static medial foot geometry between Malawian and Dutch adults.

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Niki M Stolwijk

Full Text Available In contrast to western countries, foot complaints are rare in Africa. This is remarkable, as many African adults walk many hours each day, often barefoot or with worn-out shoes. The reason why Africans can withstand such loading without developing foot complaints might be related to the way the foot is loaded. Therefore, static foot geometry and dynamic plantar pressure distribution of 77 adults from Malawi were compared to 77 adults from the Netherlands. None of the subjects had a history of foot complaints. The plantar pressure pattern as well as the Arch Index (AI and the trajectory of the center of pressure during the stance phase were calculated and compared between both groups. Standardized pictures were taken from the feet to assess the height of the Medial Longitudinal Arch (MLA. We found that Malawian adults: (1 loaded the midfoot for a longer and the forefoot for a shorter period during roll off, (2 had significantly lower plantar pressures under the heel and a part of the forefoot, and (3 had a larger AI and a lower MLA compared to the Dutch. These findings demonstrate that differences in static foot geometry, foot loading, and roll off technique exist between the two groups. The advantage of the foot loading pattern as shown by the Malawian group is that the plantar pressure is distributed more equally over the foot. This might prevent foot complaints.

Effects of weight-bearing exercise on a mini-trampoline on foot mobility, plantar pressure and sensation of diabetic neuropathic feet; a preliminary study.

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Kanchanasamut, Wararom; Pensri, Praneet

2017-01-01

Objective : Foot and ankle exercise has been advocated as a preventative approach in reducing the risk of foot ulceration. However, knowledge about the appropriate types and intensity of exercise program for diabetic foot ulcer prevention is still limited. The current study aimed to examine the effects of an eight-week mini-trampoline exercise on improving foot mobility, plantar pressure and sensation of diabetic neuropathic feet. Methods : Twenty-one people with diabetic peripheral neuropathy who had impaired sensation perception were divided into two groups. The exercise group received a foot-care education program plus an eight-week home exercise program using the mini-trampoline ( n  = 11); whereas a control group received a foot-care education only ( n  = 10). Measurements were undertaken at the beginning, at the completion of the eight-week program and at a 20-week follow-up. Results : Both groups were similar prior to the study. Subjects in the exercise group significantly increased the range of the first metatarsophalangeal joint in flexion (left: p  = 0.040, right: p  = 0.012) and extension (left: p  = 0.013) of both feet more than controlled subjects. There was a trend for peak plantar pressure at the medial forefoot to decrease in the exercise group ( p  = 0.016), but not in the control group. At week 20, the number of subjects in the exercise group who improved their vibration perception in their feet notably increased when compared to the control group (left: p  = 0.043; right: p  = 0.004). Conclusions : This is a preliminary study to document the improvements in foot mobility, plantar pressure and sensation following weight-bearing exercise on a flexible surface in people with diabetic neuropathic feet. Mini-trampoline exercise may be used as an adjunct to other interventions to reduce risk of foot ulceration. A larger sample size is needed to verify these findings. This trial is registered with COA No. 097.2/55.

Mini-Invasive floating metatarsal osteotomy for resistant or recurrent neuropathic plantar metatarsal head ulcers

OpenAIRE

Tamir, Eran; Finestone, Aharon S.; Avisar, Erez; Agar, Gabriel

2016-01-01

Background Patients with peripheral neuropathy and pressure under a relatively plantar deviated metatarsal head frequently develop plantar foot ulcers. When conservative management with orthotics and shoes does not cure the ulcer, surgical metatarsal osteotomy may be indicated to relieve the pressure and enable the ulcer to heal. The purpose of this study is to evaluate the use of a mini-invasive floating metatarsal osteotomy in treating recalcitrant ulcers or recurrent ulcers plantar to the ...

Comparison of plantar pressure on normal -footed vs. high arch-footed badminton players in two-way lunge

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parvane bazipoor

2017-03-01

Full Text Available Background: Compared to the individuals with a normal arch structure, those with high or low arch can be at an increased risk of overuse injuries. The risk of overuse injury among athletes is high due, in part, to the repeated loading of the lower extremities. The current study aimed to determine if foot type (high-arched or normal results in differences in plantar pressure during two badminton-specific movements (right-reverse lunge and right-lateral lunge. Methods: Twenty badminton players (10 with normal feet and 10 with higharched feet completed five trials in both right-reverse and right-lateral lunge, while in-shoe pressure data were collected at 100 Hz. The peak pressure and mean pressure were analyzed among the subjects for five major anatomical regions of the foot, using the independent t test in SPSS version 20. The foot type was determined by the foot posture index (FPI (α<0.05. Results: Results showed that the plantar pressure characteristics of normal and high-arched feet were different; such that in high-arched feet, as compared to normal subjects, there were significantly fewer pressure strikes in the medial (P=0.010 and lateral (P=0.002 mid-foot in right-reverse lunge and this was significantly higher in forefoot (P=0.003 and toes (P=0.010. However, the peak (P=0.157 and mean (P=0.104 pressure in the heel was higher but not significant. In the right- lateral lunge, we found statistically lower peak pressure stroke for the lateral mid-foot (P=0.010 and forefoot (P=0.011; however, the mean pressure was lower in the lateral (P=0.010 and medial (P=0.040 mid-foot and forefoot (P=0.120, although it was not significant in the forefoot. Conclusion: Results showed that the medial longitudinal arch of the foot might cause pressure differences in the feet among the players with normal and higharched feet. As the results demonstrated, in high-arched feet, there are some regions where plantar pressure is higher and some where it is lower

Development of a wearable plantar force measurement device for gait analysis in remote conditions.

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Hamid, Rawnak; Wijesundara, Suharshani; McMillan, Lachlan; Scott, David; Redoute, Jean-Michel; Ebeling, Peter R; Yuce, Mehmet Rasit

2017-07-01

The pressure field that exists between the foot and the supporting surface is identified as the foot plantar pressure. The information obtained from foot plantar pressure measurements has useful applications that include diagnosis of gait disturbances, optimization of footwear design, sport biomechanics and prevention of injury. Using wearable technology to measure foot plantar pressure continuously allows the collection of comprehensive real-life data sets while interfering minimally with the subject's daily activities. This paper presents the design of a wearable device to measure foot plantar pressure. Mechanical and electrical design considerations as well as data analysis are discussed. A pilot study involving 20 physically fit volunteers (15 males and 5 females, ageing from 20 - 45) performing a variety of physical activities (such as standing, walking, jumping and climbing up and down stairs) illustrate the potential of the device in terms of its wearability, and suitability for unobtrusive long-term monitoring.

Plantar fascia softening in plantar fasciitis with normal B-mode sonography.

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Wu, Chueh-Hung; Chen, Wen-Shiang; Wang, Tyng-Guey

2015-11-01

To investigate plantar fascia elasticity in patients with typical clinical manifestations of plantar fasciitis but normal plantar fascia morphology on B-mode sonography. Twenty patients with plantar fasciitis (10 unilateral and 10 bilateral) and 30 healthy volunteers, all with normal plantar fascia morphology on B-mode sonography, were included in the study. Plantar fascia elasticity was evaluated by sonoelastographic examination. All sonoelastograms were quantitatively analyzed, and less red pixel intensity was representative of softer tissue. Pixel intensity was compared among unilateral plantar fasciitis patients, bilateral plantar fasciitis patients, and healthy volunteers by one-way ANOVA. A post hoc Scheffé's test was used to identify where the differences occurred. Compared to healthy participants (red pixel intensity: 146.9 ± 9.1), there was significantly less red pixel intensity in the asymptomatic sides of unilateral plantar fasciitis (140.4 ± 7.3, p = 0.01), symptomatic sides of unilateral plantar fasciitis (127.1 ± 7.4, p plantar fasciitis (129.4 ± 7.5, p plantar fascia thickness or green or blue pixel intensity among these groups. Sonoelastography revealed that the plantar fascia is softer in patients with typical clinical manifestations of plantar fasciitis, even if they exhibit no abnormalities on B-mode sonography.

EMG activities and plantar pressures during ski jumping take-off on three different sized hills.

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Virmavirta, M; Perttunen, J; Komi, P V

2001-04-01

Different profiles of ski jumping hills have been assumed to make the initiation of take-off difficult especially when moving from one hill to another. Neuromuscular adaptation of ski jumpers to the different jumping hills was examined by measuring muscle activation and plantar pressure of the primary take-off muscles on three different sized hills. Two young ski jumpers volunteered as subjects and they performed several trials from each hill (K-35 m, K-65 m and K-90 m) with the same electromyographic (EMG) electrode and insole pressure transducer set-up. The results showed that the differences in plantar pressure and EMGs between the jumping hills were smaller than expected for both jumpers. The small changes in EMG amplitudes between the hills support the assumption that the take-off was performed with the same intensity on different jumping hills and the timing of the gluteus EMG demonstrates well the similarity of the muscle activation on different hills. On the basis of the results obtained it seems that ski jumping training on small hills does not disturb the movement patterns for bigger hills and can also be helpful for special take-off training with low speed.

The Effect of Landing Surface on the Plantar Kinetics of Chinese Paratroopers Using Half-Squat Landing

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Li, Yi; Wu, Ji; Zheng, Chao; Huang, Rong Rong; Na, Yuhong; Yang, Fan; Wang, Zengshun; Wu, Di

2013-01-01

The objective of the study was to determine the effect of landing surface on plantar kinetics during a half-squat landing. Twenty male elite paratroopers with formal parachute landing training and over 2 years of parachute jumping experience were recruited. The subjects wore parachuting boots in which pressure sensing insoles were placed. Each subject was instructed to jump off a platform with a height of 60 cm, and land on either a hard or soft surface in a half-squat posture. Outcome measures were maximal plantar pressure, time to maximal plantar pressure (T-MPP), and pressure-time integral (PTI) upon landing on 10 plantar regions. Compared to a soft surface, hard surface produced higher maximal plantar pressure in the 1st to 4th metatarsal and mid-foot regions, but lower maximal plantar pressure in the 5th metatarsal region. Shorter T- MPP was found during hard surface landing in the 1st and 2nd metatarsal and medial rear foot. Landing on a hard surface landing resulted in a lower PTI than a soft surface in the 1stphalangeal region. For Chinese paratroopers, specific foot prosthesis should be designed to protect the1st to 4thmetatarsal region for hard surface landing, and the 1stphalangeal and 5thmetatarsal region for soft surface landing. Key Points Understanding plantar kinetics during the half-squat landing used by Chinese paratroopers can assist in the design of protective footwear. Compared to landing on a soft surface, a hard surface produced higher maximal plantar pressure in the 1st to 4th metatarsal and mid-foot regions, but lower maximal plantar pressure in the 5th metatarsal region. A shorter time to maximal plantar pressure was found during a hard surface landing in the 1st and 2nd metatarsals and medial rear foot. Landing on a hard surface resulted in a lower pressure-time integral than landing on a soft surface in the 1st phalangeal region. For Chinese paratroopers, specific foot prosthesis should be designed to protect the 1st to 4th metatarsal

Low Incidence Of Extensor Plantar Reflex In Newborns In An ...

African Journals Online (AJOL)

Healthy term newborns with Apgar score of 8 and above at one minute were recruited into the study consecutively in a maternity hospital in Ibadan, Nigeria. The plantar reflex was elicited by stroking the lateral side of the sole with firm pressure, between 24 - 48 hours after delivery. Results Of 461 newborns, the plantar reflex ...

Whole plantar nerve conduction study with disposable strip electrodes.

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Hemmi, Shoji; Kurokawa, Katsumi; Nagai, Taiji; Okamoto, Toshio; Murakami, Tatsufumi; Sunada, Yoshihide

2016-02-01

A new method to evaluate whole plantar nerve conduction with disposable strip electrodes (DSEs) is described. Whole plantar compound nerve action potentials (CNAPs) were recorded at the ankle. DSEs were attached to the sole for simultaneous stimulation of medial and lateral plantar nerves. We also conducted medial plantar nerve conduction studies using an established method and compared the findings. Whole plantar CNAPs were recorded bilaterally from 32 healthy volunteers. Mean baseline to peak amplitude for CNAPs was 26.9 ± 11.8 μV, and mean maximum conduction velocity was 65.8 ± 8.3 m/s. The mean amplitude of CNAPs obtained by our method was 58.2% higher than that of CNAPs obtained by the Saeed method (26.9 μV vs. 17.0 μV; P < 0.0001). The higher mean amplitude of whole plantar CNAPs obtained by our method suggests that it enables CNAPs to be obtained easily, even in elderly people. © 2015 Wiley Periodicals, Inc.

Can RSScan footscan(®) D3D™ software predict injury in a military population following plantar pressure assessment? A prospective cohort study.

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Franklyn-Miller, Andrew; Bilzon, James; Wilson, Cassie; McCrory, Paul

2014-03-01

Injury in initial military training is common with incidences from 25 to 65% of recruits sustaining musculoskeletal injury. Risk factors for injury include extrinsic factors such as rapid onset of high volume training, but intrinsic factors such as lower limb biomechanics and foot type. Prediction of injury would allow more effective training delivery, reduce manpower wastage and improve duty of care to individuals by addressing potential interventions. Plantar pressure interpretation of footfall has been shown to reflect biomechanical intrinsic abnormality although no quantifiable method of risk stratification exists. To identify if pressure plate assessment of walking gait is predictive of injury in a military population. 200 male subjects commencing Naval Officer training were assessed by plantar pressure plate recording, of foot contact pressures. A software interpretation, D3D™, stratified the interpretation to measure 4 specific areas of potential correction. Participants were graded as to high, medium and low risk of injury and subsequently followed up for injury through their basic training. Seventy two percent of all injuries were attributed to subjects in the high and medium risk of injury as defined by the risk categorization. 47% of all injuries were sustained in the high-risk group. Participants categorized in the high-risk group for injury were significantly more likely to sustain injury than in medium or low groups (penvironment. Copyright © 2013 Elsevier Ltd. All rights reserved.

Total contact cast wall load in patients with a plantar forefoot ulcer and diabetes.

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Begg, Lindy; McLaughlin, Patrick; Vicaretti, Mauro; Fletcher, John; Burns, Joshua

2016-01-01

The total contact cast (TCC) is an effective intervention to reduce plantar pressure in patients with diabetes and a plantar forefoot ulcer. The walls of the TCC have been indirectly shown to bear approximately 30 % of the plantar load. A new direct method to measure inside the TCC walls with capacitance sensors has shown that the anterodistal and posterolateral-distal regions of the lower leg bear the highest load. The objective of this study was to directly measure these two regions in patients with Diabetes and a plantar forefoot ulcer to further understand the mechanism of pressure reduction in the TCC. A TCC was applied to 17 patients with Diabetes and a plantar forefoot ulcer. TCC wall load (contact area, peak pressure and max force) at the anterodistal and posterolateral-distal regions of the lower leg were evaluated with two capacitance sensor strips measuring 90 cm(2) (pliance®, novel GmbH, Germany). Plantar load (contact area, peak pressure and max force) was measured with a capacitance sensor insole (pedar®, novel GmbH, Germany) placed inside the TCC. Both pedar® and pliance® collected data simultaneously at a sampling rate of 50Hz synchronised to heel strike. The magnitude of TCC wall load as a proportion of plantar load was calculated. The TCC walls were then removed to determine the differences in plantar loading between the TCC and the cut down shoe-cast for the whole foot, rearfoot, midfoot and forefoot (region of interest). TCC wall load was substantial. The anterodistal lower leg recorded 48 % and the posterolateral-distal lower leg recorded 34 % of plantar contact area. The anterodistal lower leg recorded 28 % and the posterolateral-distal lower leg recorded 12 % of plantar peak pressure. The anterodistal lower leg recorded 12 % and the posterolateral-distal lower leg recorded 4 % of plantar max force. There were significant differences in plantar load between the TCC and the cut down shoe-cast for the whole foot, rearfoot, midfoot and

Analysis of spatial temporal plantar pressure pattern during gait in Parkinson's disease.

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Okuno, Ryuhei; Fujimoto, Satoshi; Akazawa, Jun; Yokoe, Masaru; Sakoda, Saburo; Akazawa, Kenzo

2008-01-01

Spatial temporal plantar pressure patterns measured with sheet-shaped pressure sensor were investigated to extract features of gait in Parkinson's disease. Both six subjects of Parkinson's disease (PD) and elderly fourteen normal control subjects were asked to execute usual walking on the pressure sensor sheets. Candidate features were step length, step time, gait velocity and transition of center of pressure to foot axis direction. The step length and gait velocity were smaller in PD subjects than those in normal subjects. Time of step cycle in three PD subjects were longer than that in normal subjects while the times of other PD subjects were similar to those of control subjects. The length from heel contact to toe off within one footprint was small in the subjects with short step length. Such possibility was indicated that Parkinson's disease in gait could be separated from normal subjects by these features.

Oscillation of plantar pressure center in athletes and non-athletes with and without ankle sprains

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André Kenzo Saito

2016-08-01

Full Text Available ABSTRACT OBJECTIVE: To assess whether there is any difference in the oscillation of the plantar pressure center in single-leg stance between athletes and non-athletes with and without ankle sprains. METHODS: 54 volunteers performed four static assessments and one dynamic assessment while standing on one foot on a baropodometer, barefoot, for 10 s in each test. The variables of area (cm2, distance (cm, anteroposterior oscillation (cm, mediolateral oscillation (cm and mean velocity (cm/s were analyzed. The items "other symptoms" and "sports and recreation" of the subjective Foot and Ankle Outcome Score (FAOS questionnaire were applied. For the statistical analysis, repeated-measurement ANOVA (ANOVA-MR, multivariate ANOVA (MANOVA, Tukey's post hoc test and partial eta squared were used. RESULTS: ANOVA-MR revealed differences regarding distance, with major effects for eyes (p 0.05; and "sport and recreation", p > 0.05. CONCLUSION: Athletes present higher mean velocity of oscillation of plantar pressure center and generally do not have differences in oscillation amplitude in the sagittal and coronal planes, in comparison with non-athletes.

Plantar pressure measurements. Rational shoe-wear in patients with rheumatoid arthritis.

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Barrett, J P

1976-03-15

Objective measurements of forefoot plantar pressures were taken on 25 patients with rheumatoid arthritis. The Harris mat footprint test and the Brand slipper sock test were used to assess both compressive shearing forces. The Harris mat footprint test is a static used when the patient is unshod. The Brand slipper sock test is a dynamic test used while the shoe is worn. An experimental sandal was designed and used for the treatment of symptomatic forefoot callosities. The Harris mat footprint test results improved dramatically after the patients had worn an experimental sandal for six months. The Brand slipper sock test results showed marked diminution in the pressure profile while the patients wore the experimental sandal. All of the patients improved in their functional abilities while wearing the experimental sandal.

Estimation of Foot Plantar Center of Pressure Trajectories with Low-Cost Instrumented Insoles Using an Individual-Specific Nonlinear Model

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Xinyao Hu

2018-02-01

Full Text Available Postural control is a complex skill based on the interaction of dynamic sensorimotor processes, and can be challenging for people with deficits in sensory functions. The foot plantar center of pressure (COP has often been used for quantitative assessment of postural control. Previously, the foot plantar COP was mainly measured by force plates or complicated and expensive insole-based measurement systems. Although some low-cost instrumented insoles have been developed, their ability to accurately estimate the foot plantar COP trajectory was not robust. In this study, a novel individual-specific nonlinear model was proposed to estimate the foot plantar COP trajectories with an instrumented insole based on low-cost force sensitive resistors (FSRs. The model coefficients were determined by a least square error approximation algorithm. Model validation was carried out by comparing the estimated COP data with the reference data in a variety of postural control assessment tasks. We also compared our data with the COP trajectories estimated by the previously well accepted weighted mean approach. Comparing with the reference measurements, the average root mean square errors of the COP trajectories of both feet were 2.23 mm (±0.64 (left foot and 2.72 mm (±0.83 (right foot along the medial–lateral direction, and 9.17 mm (±1.98 (left foot and 11.19 mm (±2.98 (right foot along the anterior–posterior direction. The results are superior to those reported in previous relevant studies, and demonstrate that our proposed approach can be used for accurate foot plantar COP trajectory estimation. This study could provide an inexpensive solution to fall risk assessment in home settings or community healthcare center for the elderly. It has the potential to help prevent future falls in the elderly.

Estimation of Foot Plantar Center of Pressure Trajectories with Low-Cost Instrumented Insoles Using an Individual-Specific Nonlinear Model.

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Hu, Xinyao; Zhao, Jun; Peng, Dongsheng; Sun, Zhenglong; Qu, Xingda

2018-02-01

Postural control is a complex skill based on the interaction of dynamic sensorimotor processes, and can be challenging for people with deficits in sensory functions. The foot plantar center of pressure (COP) has often been used for quantitative assessment of postural control. Previously, the foot plantar COP was mainly measured by force plates or complicated and expensive insole-based measurement systems. Although some low-cost instrumented insoles have been developed, their ability to accurately estimate the foot plantar COP trajectory was not robust. In this study, a novel individual-specific nonlinear model was proposed to estimate the foot plantar COP trajectories with an instrumented insole based on low-cost force sensitive resistors (FSRs). The model coefficients were determined by a least square error approximation algorithm. Model validation was carried out by comparing the estimated COP data with the reference data in a variety of postural control assessment tasks. We also compared our data with the COP trajectories estimated by the previously well accepted weighted mean approach. Comparing with the reference measurements, the average root mean square errors of the COP trajectories of both feet were 2.23 mm (±0.64) (left foot) and 2.72 mm (±0.83) (right foot) along the medial-lateral direction, and 9.17 mm (±1.98) (left foot) and 11.19 mm (±2.98) (right foot) along the anterior-posterior direction. The results are superior to those reported in previous relevant studies, and demonstrate that our proposed approach can be used for accurate foot plantar COP trajectory estimation. This study could provide an inexpensive solution to fall risk assessment in home settings or community healthcare center for the elderly. It has the potential to help prevent future falls in the elderly.

Combined application of FBG and PZT sensors for plantar pressure monitoring at low and high speed walking.

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Suresh, R; Bhalla, S; Singh, C; Kaur, N; Hao, J; Anand, S

2015-01-01

Clinical monitoring of planar pressure is vital in several pathological conditions, such as diabetes, where excess pressure might have serious repercussions on health of the patient, even to the extent of amputation. The main objective of this paper is to experimentally evaluate the combined application of the Fibre Bragg Grating (FBG) and the lead zirconate titanate (PZT) piezoceramic sensors for plantar pressure monitoring during walk at low and high speeds. For fabrication of the pressure sensors, the FBGs are embedded within layers of carbon composite material and stacked in an arc shape. From this embedding technique, average pressure sensitivity of 1.3 pm/kPa and resolution of nearly 0.8 kPa is obtained. These sensors are found to be suitable for measuring the static and the low-speed walk generated foot pressure. Simultaneously, PZT patches of size 10 × 10 × 0.3 mm were used as sensors, utilizing the d_{33} (thickness) coupling mode. A sensitivity of 7.06 mV/kPa and a pressure resolution of 0.14 kPa is obtained from these sensors, which are found to be suitable for foot pressure measurement during high speed walking and running. Both types of sensors are attached to the underside of the sole of commercially available shoes. In the experiments, a healthy male subject walks/runs over the treadmill wearing the fabricated shoes at various speeds and the peak pressure is measured using both the sensors. Commercially available low-cost hardware is used for interrogation of the two sensor types. The test results clearly show the feasibility of the FBG and the PZT sensors for measurement of plantar pressure. The PZT sensors are more accurate for measurement of pressure during walking at high speeds. The FBG sensors, on the other hand, are found to be suitable for static and quasi-dynamic (slow walking) conditions. Typically, the measured pressure varied from 400 to 600 kPa below the forefoot and 100 to 1000 kPa below the heel as the walking speed varied from 1

Range of Motion and Plantar Pressure Evaluation for the Effects of Self-Care Foot Exercises on Diabetic Patients with and Without Neuropathy.

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Cerrahoglu, Lale; Koşan, Umut; Sirin, Tuba Cerrahoglu; Ulusoy, Aslihan

2016-05-01

We aimed to investigate whether a home exercise for self-care program that consists of range of motion (ROM), stretching, and strengthening exercises could improve ROM for foot joints and plantar pressure distribution during walking in diabetic patients to prevent diabetic foot complications. Seventy-six diabetic patients were recruited (38 with neuropathy and 38 without neuropathy). Neuropathy and nonneuropathy groups were randomly divided into a home exercise group (n = 19) and a control group (n = 19). Exercise groups performed their own respective training programs for 4 weeks, whereas no training was done in the control group. Total contact area and plantar pressure under six foot areas before and after the exercise program were measured. Ankle and first metatarsophalangeal joint ROM were measured before and after the exercise program. In the exercise group, there were significant improvements in ROM for the ankle and first metatarsophalangeal joints (P .05). A home exercise program could be an effective preventive method for improving ROM for foot joints and plantar pressure distribution in diabetic patients independent of the presence of neuropathy.

Anatomy and biomechanical properties of the plantar aponeurosis: a cadaveric study.

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Da-wei Chen

Full Text Available OBJECTIVES: To explore the anatomy of the plantar aponeurosis (PA and its biomechanical effects on the first metatarsophalangeal (MTP joint and foot arch. METHODS: Anatomic parameters (length, width and thickness of each central PA bundle and the main body of the central part were measured in 8 cadaveric specimens. The ratios of the length and width of each bundle to the length and width of the central part were used to describe these bundles. Six cadaveric specimens were used to measure the range of motion of the first MTP joint before and after releasing the first bundle of the PA. Another 6 specimens were used to evaluate simulated static weight-bearing. Changes in foot arch height and plantar pressure were measured before and after dividing the first bundle. RESULTS: The average width and thickness of the origin of the central part at the calcaneal tubercle were 15.45 mm and 2.79 mm respectively. The ratio of the length of each bundle to the length of the central part was (from medial to lateral 0.29, 0.30, 0.28, 0.25, and 0.27, respectively. Similarly, the ratio of the widths was 0.26, 0.25, 0.23, 0.19 and 0.17. The thickness of each bundle at the bifurcation of the PA into bundles was (from medial to lateral 1.26 mm, 1.04 mm, 0.91 mm, 0.84 mm and 0.72 mm. The average dorsiflexion of the first MTP joint increased 10.16° after the first bundle was divided. Marked acute changes in the foot arch height and the plantar pressure were not observed after division. CONCLUSIONS: The first PA bundle was not the longest, widest, or the thickest bundle. Releasing the first bundle increased the range of motion of the first MTP joint, but did not acutely change foot arch height or plantar pressure during static load testing.

Plantar pressure and foot pain in the last trimester of pregnancy.

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Karadag-Saygi, Evrim; Unlu-Ozkan, Feyza; Basgul, Alin

2010-02-01

Back and foot pain are common complaints during pregnancy. Progression of symptoms is seen especially in the third trimester as the center of gravity (COP) is altered due to weight gain. The aim of the study was to evaluate plantar pressure changes and postural balance differences of pregnant women. Thirty-five last trimester pregnant women with complaints of foot pain were included. The control group consisted of 35 non-pregnant women who were age and body mass index (BMI) matched volunteers. All selected cases were overweight. Foot pain in pregnancy was measured by Visual analogue scale (VAS). Percentages of pressure on forefoot and hindfoot were measured using static pedobarography and peak pressures at forefoot, midfoot and hindfoot were measured using dynamic pedobarography. As a measurement of balance, COP sway length and width were also analyzed. Compared to overweight individuals, pregnant patients had higher forefoot pressure on the right side with standing and walking. Also, significant increases in contact times under the forefoot and longer floor contact times were found. VAS scores were correlated with forefoot contact times during walking. Although the sway length from COP was higher than controls, no significant correlation was found in sway length and weight gain. These data suggest that forefoot pressures increase in the last trimester of pregnancy during standing and walking. There is prominent increased postural sway in anterior-posterior direction in this period. We believe that based on the observed pressure changes, foot pain in pregnancy due to changes in body mass and distribution may be relieved by exercise and shoewear modifications.

Can foot anthropometric measurements predict dynamic plantar surface contact area?

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Collins Natalie

2009-10-01

Full Text Available Abstract Background Previous studies have suggested that increased plantar surface area, associated with pes planus, is a risk factor for the development of lower extremity overuse injuries. The intent of this study was to determine if a single or combination of foot anthropometric measures could be used to predict plantar surface area. Methods Six foot measurements were collected on 155 subjects (97 females, 58 males, mean age 24.5 ± 3.5 years. The measurements as well as one ratio were entered into a stepwise regression analysis to determine the optimal set of measurements associated with total plantar contact area either including or excluding the toe region. The predicted values were used to calculate plantar surface area and were compared to the actual values obtained dynamically using a pressure sensor platform. Results A three variable model was found to describe the relationship between the foot measures/ratio and total plantar contact area (R2 = 0.77, p R2 = 0.76, p Conclusion The results of this study indicate that the clinician can use a combination of simple, reliable, and time efficient foot anthropometric measurements to explain over 75% of the plantar surface contact area, either including or excluding the toe region.

A Comparison of Foot Plantar Pressure in Badminton Players with Normal and High-Arched Feet during the Two-Way Lunge

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Parvane Bazipoor

2017-03-01

Full Text Available Background: Compared to the individuals with a normal arch structure, those with high or low arch can be at an increased risk of overuse injuries. The risk of overuse injury among athletes is high due, in part, to the repeated loading of the lower extremities. The current study aimed to determine if foot type (high-arched or normal results in differences in plantar pressure during two badminton-specific movements (right-reverse lunge and right-lateral lunge. Methods: Twenty badminton players (10 with normal feet and 10 with higharched feet completed five trials in both right-reverse and right-lateral lunge, while in-shoe pressure data were collected at 100 Hz. The peak pressure and mean pressure were analyzed among the subjects for five major anatomical regions of the foot, using the independent t test in SPSS version 20. The foot type was determined by the foot posture index (FPI (α<0.05. Results: Results showed that the plantar pressure characteristics of normal and high-arched feet were different; such that in high-arched feet, as compared to normal subjects, there were significantly fewer pressure strikes in the medial (P=0.010 and lateral (P=0.002 mid-foot in right-reverse lunge and this was significantly higher in forefoot (P=0.003 and toes (P=0.010. However, the peak (P=0.157 and mean (P=0.104 pressure in the heel was higher but not significant. In the right- lateral lunge, we found statistically lower peak pressure stroke for the lateral mid-foot (P=0.010 and forefoot (P=0.011; however, the mean pressure was lower in the lateral (P=0.010 and medial (P=0.040 mid-foot and forefoot (P=0.120, although it was not significant in the forefoot. Conclusion: Results showed that the medial longitudinal arch of the foot might cause pressure differences in the feet among the players with normal and higharched feet. As the results demonstrated, in high-arched feet, there are some regions where plantar pressure is higher and some where it is lower

Relação entre o ângulo quadriciptal (ÂQ e a distribuição da pressão plantar em jogadores de futebol Relationship between quadriceps angle (Q and plantar pressure distribution in football players

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Rafael G. Braz

2010-08-01

Full Text Available OBJETIVOS: Verificar possível associação entre ângulo quadriciptal (ÂQ e distribuição de pressão plantar em jogadores de futebol, comparando-os com indivíduos não praticantes da modalidade. MÉTODOS: Cento e vinte e um participantes do sexo masculino foram selecionados: 50 jogadores de futebol (JF e 71 sujeitos para o grupo controle (GC. Avaliaram-se concomitantemente o ÂQ, por meio do Software para Avaliação Postural (SAPO, e a pressão plantar, pela plataforma F-Scan/F-Mat System. Para verificar correlação entre o ÂQ e os valores de picos de pressão em quatro segmentos do pé (antepé medial e lateral, médio-pé e retropé, utilizou-se o Coeficiente de Pearson (r para análises paramétricas. O teste t independente foi empregado para comparar isoladamente essas mesmas variáveis entre os grupos. A normalidade dos dados foi verificada pelos valores de skewness, adotando nível de significância de 5%. RESULTADOS: Encontrou-se correlação negativa e fraca (r=-0,32 somente entre ÂQ e médio-pé direito. Os grupos diferiram quanto ao ÂQ bilateralmente, sendo que o grupo JF teve média de 11,36º, e GC, de 13,80º à direita e de 11,03º contra 13,96º à esquerda, respectivamente. Em relação à pressão plantar, o JF teve maior média de força nas faces laterais do antepé direito (0,77 contra 0,63 kg/cm² e esquerdo (0,65 e 0,54 kg/cm², enquanto o GC apresentou maior pico de pressão no médio-pé esquerdo (JF: 0,37 e GC: 0,46 kg/cm². CONCLUSÕES: Não houve relação entre os valores de ÂQ na distribuição da pressão plantar nos jogadores de futebol. Os atletas apresentaram, porém, ÂQ diminuído e maiores picos de pressão nas faces laterais de ambos os pés, o que sugere alinhamento em varo dos joelhos e distribuição supinada das bases plantares.OBJECTIVES: To determine whether there is an association between the Q-angle (Q and the distribution of plantar pressure in football players, and to compare the

The correlation between plantar fascia thickness and symptoms of plantar fasciitis.

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Mahowald, Sarah; Legge, Bradford S; Grady, John F

2011-01-01

The purpose of this study was to determine whether changes in plantar fascia thickness are a reliable gauge of efficacy of treatment protocols for plantar fasciitis. Thirty-nine feet (30 patients) with plantar fasciitis received an ultrasound examination to measure the thickness of the medial band of the plantar fascia. Each patient assessed his or her pain using the visual analogue scale. Following various treatments, a second ultrasound examination was performed and the thickness of the plantar fascia was again measured and subjective pain level assessed. Twenty-nine feet (74.4%) showed a decrease in plantar fascia thickness and a decrease in pain. One foot (2.6%) experienced an increase in fascia thickness and reported an increase in pain. Four feet (10.3%) had an increase in thickness of the plantar fascia and reported no change in pain level. Three feet had minor increases in fascia thickness but reported a decrease in pain (7.7%). One foot (2.6%) had no change in fascia thickness but a decrease in pain and one foot (2.6%) had a decrease in the plantar fascia but no change in pain level. The average reduction in fascia thickness was 0.82 mm ± 1.04 mm, correlating with an average improvement in pain of 3.64 ± 2.7 (P plantar fascia is a valid objective measurement to assess effectiveness of new or existing treatment protocols.

Relationships between static foot alignment and dynamic plantar loads in runners with acute and chronic stages of plantar fasciitis: a cross-sectional study

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Ribeiro, Ana P.; Sacco, Isabel C. N.; Dinato, Roberto C.; João, Silvia M. A.

2016-01-01

BACKGROUND: The risk factors for the development of plantar fasciitis (PF) have been associated with the medial longitudinal arch (MLA), rearfoot alignment and calcaneal overload. However, the relationships between the biomechanical variables have yet to be determined. OBJECTIVE: The goal of this study was to investigate the relationships between the MLA, rearfoot alignment, and dynamic plantar loads in runners with unilateral PF in acute and chronic phases. METHOD: Cross-sectional study which thirty-five runners with unilateral PF were evaluated: 20 in the acute phase (with pain) and 15 with previous chronic PF (without pain). The MLA index and rearfoot alignment were calculated using digital images. The contact area, maximum force, peak pressure, and force-time integral over three plantar areas were acquired with Pedar X insoles while running at 12 km/h, and the loading rates were calculated from the vertical forces. RESULTS: The multiple regression analyses indicated that both the force-time integral (R 2=0.15 for acute phase PF; R 2=0.17 for chronic PF) and maximum force (R 2=0.35 for chronic PF) over the forefoot were predicted by an elevated MLA index. The rearfoot valgus alignment predicted the maximum force over the rearfoot in both PF groups: acute (R 2=0.18) and chronic (R 2=0.45). The rearfoot valgus alignment also predicted higher loading rates in the PF groups: acute (R 2=0.19) and chronic (R 2=0.40). CONCLUSION: The MLA index and the rearfoot alignment were good predictors of plantar loads over the forefoot and rearfoot areas in runners with PF. However, rearfoot valgus was demonstrated to be an important clinical measure, since it was able to predict the maximum force and both loading rates over the rearfoot. PMID:26786073

Using Plantar Electrical Stimulation to Improve Postural Balance and Plantar Sensation Among Patients With Diabetic Peripheral Neuropathy: A Randomized Double Blinded Study.

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Najafi, Bijan; Talal, Talal K; Grewal, Gurtej Singh; Menzies, Robert; Armstrong, David G; Lavery, Lawrence A

2017-07-01

People with diabetic peripheral neuropathy (DPN) often exhibit deteriorations in motor-performance mainly due to lack of plantar-sensation. The study explored effectiveness of plantar electrical-stimulation therapy to enhance motor-performance among people with DPN. Using a double-blinded model, 28 volunteers with DPN (age: 57.8 ± 10.2 years) were recruited and randomized to either intervention (IG: n = 17) or control (CG: n = 11) group. Both groups received identical plantar-stimulation devices for six weeks of daily use at home; however, only the IG devices were set to deliver stimulation. Balance (ankle, hip, and center of mass [COM] sway) and gait (stride velocity [SV], stride time [ST], stride length [SL], and cadence) were measured using validated wearable sensors. Outcomes were assessed at baseline and at six-week. Clinical assessment including vascular as measured by ankle-brachial-index (ABI) and plantar-sensation as quantified by vibratory plantar threshold (VPT) were also measured at baseline and six weeks. No difference were observed between groups for baseline characteristics ( P > .050). Posttherapy, ankle and COM sway with eyes open were significantly improved ( P 1.20 ( P = .041, d = 0.99) Conclusion: This study suggests that daily home use of plantar electrical-stimulation may be a practical means to enhance motor-performance and plantar-sensation in people with DPN.

Effect of Achilles tendon loading on plantar fascia tension in the standing foot.

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Cheung, Jason Tak-Man; Zhang, Ming; An, Kai-Nan

2006-02-01

The plantar fascia, which is one of the major arch-supporting structures of the human foot, sustains high tensions during weight-bearing. A positive correlation between Achilles tendon loading and plantar fascia tension has been reported. Excessive stretching and tightness of the Achilles tendon are thought to be the risk factors of plantar fasciitis but their biomechanical effects on the plantar fascia have not been fully addressed. A three-dimensional finite element model of the human foot and ankle, incorporating geometrical and material nonlinearity, was employed to investigate the loading response of the plantar fascia in the standing foot with different magnitudes of Achilles tendon loading. With the total ground reaction forces of one foot maintained at 350 N to represent half body weight, an increase in Achilles tendon load from (0-700 N) resulted in a general increase in total force and peak plantar pressure at the forefoot of up to about 250%. There was a lateral and anterior shift of the centre of pressure and a reduction in the arch height with an increasing Achilles tendon load as a result of the plantar flexion moment on the calcaneus. From the finite element predictions of simulated balanced standing, Achilles tendon forces of 75% of the total weight on the foot (350 N) were found to provide the closest match of the measured centre of pressure of the subject during balanced standing. Both the weight on the foot and Achilles tendon loading resulted in an increase in tension of the plantar fascia with the latter showing a two-times larger straining effect. Increasing tension on the Achilles tendon is coupled with an increasing strain on the plantar fascia. Overstretching of the Achilles tendon resulting from intense muscle contraction and passive stretching of tight Achilles tendon are plausible mechanical factors for overstraining of the plantar fascia.

Influence of different safety shoes on gait and plantar pressure: a standardized examination of workers in the automotive industry

OpenAIRE

Ochsmann, Elke; Noll, Ulrike; Ellegast, Rolf; Hermanns, Ingo; Kraus, Thomas

2016-01-01

Objective: Working conditions, such as walking and standing on hard surfaces, can increase the development of musculoskeletal complaints. At the interface between flooring and musculoskeletal system, safety shoes may play an important role in the well-being of employees. The aim of this study was to evaluate the effects of different safety shoes on gait and plantar pressure distributions on industrial flooring. Methods: Twenty automotive workers were individually fitted out with three differe...

Plantar fibromatosis. Ultrasound assessment; La fibromatosi plantare: risultati ecografici

Energy Technology Data Exchange (ETDEWEB)

Solivetti, F.R.; Luzi, F.; Bucher, S.; Thorel, M.F.; Muscardin, L. [Rome Ospedale Santa Maria e San Gallicano, Rome (Italy)

1999-05-01

In 1998-99, six patients with plantar fibromatosis were submitted to US (ultrasound) with plantar fibromatosis were submitted to US with 13 MHz linear array and 20 MHz mechanical annular array probes. All patients were examined in prone recumbency with the probe positioned on the sole of the foot. Only some of them were subsequently submitted to surgery. Plantar fibromatosis exhibited an almost pathognomonic pattern and US proved to be a quick, noninvasive and cost-effective technique to confirm clinical diagnosis. The nodule is typically single and iso echoic, with maximum diameter of about 1 cm, inhomogeneous internal structure and few thin hyperechoic septa. The nodular fibrous proliferation adheres with the major axis along the plantar fascia; it exhibits clear-cut margins and US beam transmission is good. No calcifications or fluid collections are seen within the nodule. Color and power Doppler show no flow inside. It is demonstrated that US is an adequate tool for the study of plantar fibromatosis. [Italian] Negli anni 1998-99 sono stati osservati ben sei casi di fibromatosi plantare, solo in parte trattati chirurgicamente. Tutti sono stati studiati con ecografia, con apparecchiatura in tempo reale e sonde lineari da 13 MHz e anulari da 20 MHz. Si puo' descrivere un quadro tipico della malattia diagnosticabile con l'ecografia, specie in associazione con sintomi clinici caratteristici.

Numerical simulation of the plantar pressure distribution in the diabetic foot during the push-off stance.

Science.gov (United States)

Actis, Ricardo L; Ventura, Liliana B; Smith, Kirk E; Commean, Paul K; Lott, Donovan J; Pilgram, Thomas K; Mueller, Michael J

2006-08-01

The primary objective of conservative care for the diabetic foot is to protect the foot from excessive pressures. Pressure reduction and redistribution may be achieved by designing and fabricating orthotic devices based on foot structure, tissue mechanics, and external loads on the diabetic foot. The purpose of this paper is to describe the process used for the development of patient-specific mathematical models of the second and third rays of the foot, their solution by the finite element method, and their sensitivity to model parameters and assumptions. We hypothesized that the least complex model to capture the pressure distribution in the region of the metatarsal heads would include the bony structure segmented as toe, metatarsal and support, with cartilage between the bones, plantar fascia and soft tissue. To check the hypothesis, several models were constructed with different levels of details. The process of numerical simulation is comprised of three constituent parts: model definition, numerical solution and prediction. In this paper the main considerations relating model selection and computation of approximate solutions by the finite element method are considered. The fit of forefoot plantar pressures estimated using the FEA models and those explicitly tested were good as evidenced by high Pearson correlations (r=0.70-0.98) and small bias and dispersion. We concluded that incorporating bone support, metatarsal and toes with linear material properties, tendon and fascia with linear material properties, soft tissue with nonlinear material properties, is sufficient for the determination of the pressure distribution in the metatarsal head region in the push-off position, both barefoot and with shoe and total contact insert. Patient-specific examples are presented.

Biomechanical consequences of plantar fascial release or rupture during gait. Part II: alterations in forefoot loading.

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Sharkey, N A; Donahue, S W; Ferris, L

1999-02-01

With a model using feet from cadavers, we tested the hypothesis that plantar fascial release or rupture alters the loading environment of the forefoot during the latter half of the stance phase of gait. The model simulated the position and loading environment of the foot at two instants: early in terminal stance immediately after heel-off and late in terminal stance just preceding contralateral heel strike. Eight feet were loaded at both positions by simulated plantar flexor contraction, and the distribution of plantar pressure was measured before and after progressive release of the plantar fascia. Strain in the diaphysis of the second metatarsal was also measured, from which the bending moments and axial force imposed on the metatarsal were calculated. Cutting the medial half of the central plantar fascial band significantly increased peak pressure under the metatarsal heads but had little effect on pressures in other regions of the forefoot or on second metatarsal strain and loading. Dividing the entire central band or completely releasing the plantar fascia from the calcaneus had a much greater effect and caused significant shifts in plantar pressure and force from the toes to beneath the metatarsal heads. These shifts were accompanied by significantly increased strain and bending in the second metatarsal. Complete fasciotomy increased the magnitude of strain in the dorsal aspect of the second metatarsal by more than 80%, suggesting that plantar fascial release or rupture accelerates the accumulation of fatigue damage in these bones. Altered forefoot loading may be a potential complication of plantar fasciotomy.

Plantar fasciitis

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... activities in moderation can also help. Images Plantar fascia Plantar fasciitis References Abu-Laban RB, Rose NGW. Ankle ... Elsevier; 2016:970. Kadakia AR. Heel pain and plantar fasciitis In: Miller MD, ... of tendons and fascia and adolescent and adult pes planus. In: Canale ...

Estimation of ground reaction forces and joint moments on the basis on plantar pressure insoles and wearable sensors for joint angle measurement.

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Ostaszewski, Michal; Pauk, Jolanta

2018-05-16

Gait analysis is a useful tool medical staff use to support clinical decision making. There is still an urgent need to develop low-cost and unobtrusive mobile health monitoring systems. The goal of this study was twofold. Firstly, a wearable sensor system composed of plantar pressure insoles and wearable sensors for joint angle measurement was developed. Secondly, the accuracy of the system in the measurement of ground reaction forces and joint moments was examined. The measurements included joint angles and plantar pressure distribution. To validate the wearable sensor system and examine the effectiveness of the proposed method for gait analysis, an experimental study on ten volunteer subjects was conducted. The accuracy of measurement of ground reaction forces and joint moments was validated against the results obtained from a reference motion capture system. Ground reaction forces and joint moments measured by the wearable sensor system showed a root mean square error of 1% for min. GRF and 27.3% for knee extension moment. The correlation coefficient was over 0.9, in comparison with the stationary motion capture system. The study suggests that the wearable sensor system could be recommended both for research and clinical applications outside a typical gait laboratory.

Endoscopic Plantar Fasciotomy Through Two Medial Portals for the Treatment of Recalcitrant Plantar Fasciopathy.

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Al-Ashhab, Mohamed Ebrahim; Elbegawy, Hossam El-Dein A; Hasan, Hala Ali Abed

Plantar fasciopathy is a common cause of heel pain. Endoscopic plantar fasciotomy has the advantage of less surgical trauma and rapid recovery. The aim of the present prospective study was to delineate the results of endoscopic plantar fascia release through 2 medial portals. The present study included 2 groups. The first group included 27 feet in 25 patients that had undergone endoscopic plantar fascia release followed up for 19.7 (range 12 to 33) months. The second group, the control group, included 20 feet in 16 patients treated conservatively and followed up for 16.4 (range 12 to 24) months. The results of endoscopic plantar fascia release were superior to the conservative methods. The surgically treated group experienced significantly less pain, activity limitations, and gait abnormality. The presence of a calcaneal spur had no effect on the final postoperative score. In conclusion, endoscopic plantar fascia release through 2 medial portals is an effective procedure for treatment of resistant plantar fasciopathy that fails to respond to conservative management options. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

A comparative study of the Podotrack, a simple semiquantitative plantar pressure measuring device, and the optical pedobarograph in the assessment of pressures under the diabetic foot.

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van Schie, C H; Abbott, C A; Vileikyte, L; Shaw, J E; Hollis, S; Boulton, A J

1999-02-01

To test the Podotrack, a simple inexpensive semiquantitative footprint mat, for potential use as a screening tool for high plantar pressures, against the optical pedobarograph (a computerized device). The Podotrack was superimposed on the pedobarograph for simultaneous measurement of pressures from both systems. Three independent observers quantified the pressures of Podotrack footprints from healthy controls and diabetic patients, both before (n=164) and after (n=183) training. The sensitivity of the Podotrack to identify high pressure areas measured by the pedobarograph (> 12.3 kg/cm2) was 78.7%, 45.8% and 44.3% (observer A, B and C) before training, but improved to 96.2%, 92.4% and 91.1% after training (P<0.01). Specificity for all three observers was more than 90% before and after training. Inter-observer agreement improved significantly after training (P<0.001). After a simple training of the observers, the Podotrack identified approximately all high pressure areas, suggesting that the Podotrack could be a useful screening tool to identify areas at risk of ulceration in diabetic patients. We recommend a standard training package for new Podotrack users, to optimize identification of diabetic patients at risk of foot ulceration.

Stresses in the plantar region for long- and short-range throws in women basketball players.

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Pau, Massimiliano; Ciuti, Carla

2013-01-01

This study aimed to assess plantar pressure pattern modifications caused by short- and long-distance shots in women basketball players. To this end, 24 experienced national- and regional-level basketball players performed 3 trials of 4 technical gestures (free throw, jump stop shot, three-point shot and lay-up) barefoot on a pressure platform placed in fixed positions on the court. Raw data were processed to calculate location and magnitude of pressure peaks in three sub-regions (forefoot, midfoot and rearfoot), and the increase ratio was calculated relative to plantar pressure measured during a static bipedal and unipedal upright stance. The results showed significant increases (ptraining and rehabilitation protocols.

Relationship of Plantar Fascia Thickness and Preoperative Pain, Function, and Quality of Life in Recalcitrant Plantar Fasciitis.

Science.gov (United States)

Gamba, Carlo; Sala-Pujals, Aleix; Perez-Prieto, Daniel; Ares-Vidal, Jesus; Solano-Lopez, Alberto; Gonzalez-Lucena, Gemma; Ginés-Caspedosa, Alberto

2018-04-01

The measurement of plantar fascia thickness has been advocated as a diagnostic and prognostic instrument in patients with plantar fasciitis, but there are no data relative to it in recalcitrant plantar fasciitis. The aim of the study is to evaluate the correlation between plantar fascia thickness and pain, functional score, and health perception in patients with this condition. Thirty-eight feet were studied with ultrasound and magnetic resonance imaging to measure plantar fascia thickness. The visual analogue scale (VAS), American Orthopaedic Foot & Ankle Hindfoot Score (AOFAS), and SF-36 were then recorded for each patient. The relationship between the fascia and these scores was analyzed to evaluate the correlation of thickness with pain, functional level, and health perception of patients. In patients with recalcitrant plantar fasciitis, plantar fascia thickness did not correlate with pain (VAS), AOFAS, or any item of the SF-36. The thickness of the plantar fascia in patients with recalcitrant plantar fasciitis did not correlate with its clinical impact, and thus, we believe it should not be used in treatment planning. Level IV, case series.

Endoscopic Plantar Fascia Debridement for Chronic Plantar Fasciitis.

Science.gov (United States)

Cottom, James M; Baker, Joseph S

2016-10-01

When conservative therapy fails for chronic plantar fasciitis, surgical intervention may be an option. Surgical techniques that maintain the integrity of the plantar fascia will have less risk of destabilizing the foot and will retain foot function. Endoscopic debridement of the plantar fascia can be performed reproducibly to reduce pain and maintain function of the foot. Copyright © 2016 Elsevier Inc. All rights reserved.

Anatomical features of plantar aponeurosis: cadaveric study using ultrasonography and magnetic resonance imaging

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Moraes do Carmo, Clarissa Canella; Fonseca de Almeida Melao, Lina Isabel; Valle de Lemos Weber, Marcio Freitas; Trudell, Debra; Resnick, Donald [UCSD, Department of Radiology, San Diego, CA (United States); VA Healthcare System San Diego, La Jolla, CA (United States)

2008-10-15

Abnormalities of the plantar aponeurosis are commonly encountered in patients with subcalcaneal heel pain. Understanding normal anatomy is required to accurately diagnose some disorders of the foot. The purpose of our study was to describe the normal anatomy of the plantar aponeurosis, using ultrasonography and MRI with close anatomic correlation in cadavers. After MRI and ultrasonography of 10 cadaveric foot specimens, the thickness of the central and lateral portions of the plantar aponeurosis displayed by imaging studies was measured by three radiologists. One specimen was sectioned in the transverse plane, one in the coronal plane, one in the sagittal plane, and two in a sagittal oblique plane. Normal anatomy was identified and similar measurements of the plantar aponeurosis were also made. An average value was determined and a statistical analysis was accomplished. The calcaneal insertions of the plantar aponeurosis were better visualized than its distal portions with both MRI and ultrasonography. The measurements of the plantar aponeurosis made by three different radiologists were different, but without statistical significance. The average measurements for the central and lateral portions of the plantar aponeurosis with both imaging methods were different from each other because of differences in the morphology of these structures. The values obtained with ultrasonography and MRI, were also different from each other for both the central and lateral portions of the plantar aponeurosis, but with no statistical significance. We have described the detailed anatomy of the plantar aponeurosis with emphasis on the more distal structures that can be visualized with MRI. There was no statistically significant difference between the accuracy of ultrasonography and MRI regarding the measurements of the thickness of the central and lateral portions of the plantar aponeurosis. Knowledge of the normal anatomy of these structures enables the radiologist to identify early

Characteristics of Plantar Loads in Maximum Forward Lunge Tasks in Badminton.

Science.gov (United States)

Hu, Xiaoyue; Li, Jing Xian; Hong, Youlian; Wang, Lin

2015-01-01

Badminton players often perform powerful and long-distance lunges during such competitive matches. The objective of this study is to compare the plantar loads of three one-step maximum forward lunges in badminton. Fifteen right-handed male badminton players participated in the study. Each participant performed five successful maximum lunges at three directions. For each direction, the participant wore three different shoe brands. Plantar loading, including peak pressure, maximum force, and contact area, was measured by using an insole pressure measurement system. Two-way ANOVA with repeated measures was employed to determine the effects of the different lunge directions and different shoes, as well as the interaction of these two variables, on the measurements. The maximum force (MF) on the lateral midfoot was lower when performing left-forward lunges than when performing front-forward lunges (p = 0.006, 95% CI = -2.88 to -0.04%BW). The MF and peak pressures (PP) on the great toe region were lower for the front-forward lunge than for the right-forward lunge (MF, p = 0.047, 95% CI = -3.62 to -0.02%BW; PP, p = 0.048, 95% CI = -37.63 to -0.16 KPa) and left-forward lunge (MF, p = 0.015, 95% CI = -4.39 to -0.38%BW; PP, p = 0.008, 95% CI = -47.76 to -5.91 KPa). These findings indicate that compared with the front-forward lunge, left and right maximum forward lunges induce greater plantar loads on the great toe region of the dominant leg of badminton players. The differences in the plantar loads of the different lunge directions may be potential risks for injuries to the lower extremities of badminton players.

The plantar plate of the first metatarsophalangeal joint: an anatomical study.

Science.gov (United States)

Lucas, Douglas E; Philbin, Terrence; Hatic, Safet

2014-04-01

The plantar plate of the first metatarsophalangeal (MP) joint is a critical structure of the forefoot that has been identified as a major stabilizer within the capsuloligamentous complex. Many studies have clarified and documented the anatomy of the lesser toe MP plantar plates, but few have looked closely at the anatomy of the first MP joint. Ten cadaveric specimens were examined to identify and document the objective anatomic relationship of the plantar plate, tibial sesamoid, and surrounding osseus structures. The average distance of the plantar plate distal insertion from the joint line into the proximal phalanx was 0.33 mm. The plantar plate was inserted into the metatarsal head on average 17.29 mm proximal from the joint line. The proximal aspect of the sesamoid was 18.55 mm proximal to the distal attachment of the plantar plate to the phalanx. The distal aspect of the sesamoid averaged 4.69 mm away from the distal attachment into the proximal phalanx. The footprint of the distal plate insertion was on average 6.33 mm in length in the sagittal plane. The authors hope that these objective data measures can aid in the understanding and subsequent surgical repair of this important forefoot structure.

Saccadic Eye Movement Improves Plantar Sensation and Postural Balance in Elderly Women.

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Bae, Youngsook

2016-06-01

Vision, proprioception and plantar sensation contribute to the control of postural balance (PB). Reduced plantar sensation alters postural response and is at an increased risk of fall, and eye movements reduce the postural sway. Therefore, the aim of this study was to study the improvement of plantar sensation and PB after saccadic eye movement (SEM) and pursuit eye movement (PEM) in community-dwelling elderly women. Participants (104 females; 75.11 ± 6.25 years) were randomly allocated into the SEM group (n = 52) and PEM groups (n = 52). The SEM group performed eye fixation and SEM for 5 minutes, and the PEM group performed eye fixation and PEM for 5 minutes. The plantar sensation was measured according to the plantar surface area of the feet in contact with the floor surface before and after the intervention. Before and after SEM and PEM with the eyes open and closed, PB was measured as the area (mm(2)), length (cm), and velocity (cm/s) of the fluctuation of the center of pressure (COP). The plantar sensation of both feet improved in both groups (p eye open and close in both groups (p < 0.01). The length and velocity of the COP significantly decreased in the SEM group compared to the PEM group (p < 0.05). In conclusion, SEM and PEM are effective interventions for improving plantar sensation and PB in elderly women, with greater PB improvement after SEM.

A Comparison between the Effects of Aerobic Dance Training on Mini-Trampoline and Hard Wooden Surface on Bone Resorption, Health-Related Physical Fitness, Balance, and Foot Plantar Pressure in Thai Working Women.

Science.gov (United States)

Sukkeaw, Wittawat; Kritpet, Thanomwong; Bunyaratavej, Narong

2015-09-01

To compare the effects of aerobic dance training on mini-trampoline and hard wooden surface on bone resorption, health-related physical fitness, balance, and foot plantar pressure in Thai working women. Sixty-three volunteered females aged 35-45 years old participated in the study and were divided into 3 groups: A) aerobic dance on mini-trampoline (21 females), B) aerobic dance on hard wooden surface (21 females), and C) control group (21 females). All subjects in the aerobic dance groups wore heart rate monitors during exercise. Aerobic dance worked out 3 times a week, 40 minutes a day for 12 weeks. The intensity was set at 60-80% of the maximum heart rate. The control group engaged in routine physical activity. The collected data were bone formation (N-terminal propeptine of procollagen type I: P1NP) bone resorption (Telopeptide cross linked: β-CrossLaps) health-related physical fitness, balance, and foot plantar pressure. The obtained data from pre- and post trainings were compared and analyzed by paired samples t-test and one way analysis of covariance. The significant difference was at 0.05 level. After the 12-week training, the biochemical bone markers of both mini-trampoline and hard wooden surface aerobic dance training subjects decreased in bone resorption (β-CrossLaps) but increased in boneformation (P1NP). Health-related physical fitness, balance, and foot plantar pressure were not only better when comparing to the pre-test result but also significantly different when comparing to the control group (p trampoline showed that leg muscular strength, balance and foot plantar pressure were significantly better than the aerobic dance on hard wooden surface (p trampoline and hard wooden surface had positive effects on biochemical bone markers. However, the aerobic dance on mini-trampoline had more leg muscular strength and balance including less foot plantar pressure. It is considered to be an appropriate exercise programs in working women.

A CLINICAL STUDY OF PLANTAR ULCERS IN LEPROSY

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Lilakumari Subramoniam

2017-06-01

Full Text Available BACKGROUND Deformity prevention is one of the top priorities in leprosy elimination programme. Plantar ulcer and foot deformities are commonly seen in leprosy patients causing considerable physical disability. This can be prevented by early and regular MDT, proper practice of feet care, correction of deformities and management of infections. The study was to assess the above factors contributing to the development and recurrences of plantar ulcers among our leprosy patients. MATERIALS AND METHODS 66 leprosy patients with plantar ulcers were evaluated for delay of treatment, practice of feet care, site of ulcer, concomitant deformities and bone changes. Identification of infective agent is done by culture and sensitivity test. RESULTS Majority of patients belonged to the borderline spectrum. Delay in starting anti-leprosy treatment ranged from 2 months to 12 years. The main reasons for the delay in treatment are the patients ignored the lesions because they are asymptomatic or treatment with other modalities like homeo/ayurvedic drugs. 92% of patients studied were not practicing feet care. Common site of ulcer was beneath the heads of metatarsals and big toe. Foot drop was seen in 15% and claw toes in 33%. Osteomyelitis observed in 20% of patients. Common pathogen isolated was staphylococcus seen in 75% of cases followed by Streptococcus and Klebsiella. 50% of Staphylococci isolated were found to be penicillin resistant. CONCLUSION The occurrence of plantar ulcers and its complications are not an inevitable sequelae of leprosy and is totally preventable if appropriate measures are undertaken.

A COMPARITIVE STUDY ON EFFECTIVENESS OF TAPING WITH IONTOPHORESIS AND TAPING ALONE IN CHRONIC PLANTAR FASCITIS

OpenAIRE

Biju Chetri, U.T. Ifthikar Ali, Madhusmita Koch, Abhijit Dutta

2016-01-01

Background: Plantar fasciitis is a painful condition caused by microtrauma to plantar fascia due to overuse. It is a most common cause of heel pain in runners. Various studies proved taping and Iontophoresis as effective in the treating plantar fasciitis. But there are no studies comparing the combined effect of iontophoresis with taping and taping alone in the treatment of plantar fasciitis. Methods: 50 patients suffering from plantar fasciitis who met the inclusion criteria were selected...

Plantar vein thrombosis: a rare cause of plantar foot pain

International Nuclear Information System (INIS)

Siegal, Daniel S.; Wu, Jim S.; Brennan, Darren D.; Hochman, Mary G.; Challies, Tracy

2008-01-01

Plantar vein thrombosis is a rare condition, with only a handful of cases reported in the literature. The cause is unknown; however, the disease has been attributed to prior surgery, trauma, and paraneoplastic conditions. We present a case of a 32-year-old female runner with plantar vein thrombosis diagnosed on contrast-enhanced MRI and confirmed on ultrasound. The symptoms resolved with conservative treatment and evaluation revealed the presence of a prothrombin gene mutation and use of oral contraceptive pills. To our knowledge, this is the first case of plantar vein thrombosis diagnosed initially by MRI. Moreover, this case suggests that plantar vein thrombosis should be considered in patients with hypercoagulable states and plantar foot pain. (orig.)

Plantar vein thrombosis: a rare cause of plantar foot pain

Energy Technology Data Exchange (ETDEWEB)

Siegal, Daniel S.; Wu, Jim S.; Brennan, Darren D.; Hochman, Mary G. [Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA (United States); Challies, Tracy [Beth Israel Deaconess Medical Center, Department of Pathology, Boston, MA (United States)

2008-03-15

Plantar vein thrombosis is a rare condition, with only a handful of cases reported in the literature. The cause is unknown; however, the disease has been attributed to prior surgery, trauma, and paraneoplastic conditions. We present a case of a 32-year-old female runner with plantar vein thrombosis diagnosed on contrast-enhanced MRI and confirmed on ultrasound. The symptoms resolved with conservative treatment and evaluation revealed the presence of a prothrombin gene mutation and use of oral contraceptive pills. To our knowledge, this is the first case of plantar vein thrombosis diagnosed initially by MRI. Moreover, this case suggests that plantar vein thrombosis should be considered in patients with hypercoagulable states and plantar foot pain. (orig.)

Ultrasound-guided plantar fascia release technique: a retrospective study of 46 feet.

Science.gov (United States)

Vohra, Praveen K; Japour, Christopher J

2009-01-01

Ultrasound-guided plantar fascia release offers the surgeon clear visualization of anatomy at the surgical site. This technique uses small arthroscopic dissecting instruments through a 0.5-cm incision, allowing the surgeon to avoid the larger and more tissue-disruptive incision that is traditionally used for plantar heel spur resection and plantar fascia releases. Forty-one patients (46 feet) were selected for the study. The mean patient age was 47 years. Twenty-nine were considered obese with a body mass index greater than 30 kg/m(2). Patients were functionally and subjectively evaluated 4 weeks after surgery using the American Orthopedic Foot and Ankle Society Ankle and Hindfoot Rating Scale. Results from the study show a significant improvement (P = .05 confidence level) 4 weeks postoperatively for the 41 patients (46 feet), compared to their preoperative condition. The mean pretest score was 33.6 (range 10-52); this score improved to 88.0 (range 50-100), 4 weeks postoperatively. There were no postoperative infections or complications. The ultrasound-guided plantar fascia release technique is a practical surgical procedure for the relief of chronic plantar fascia pain because the surgeon is able to clearly visualize the plantar fascia by ultrasound. In addition, there is minimal disruption to surrounding tissue because small instruments are passed through a small 0.5-cm incision. The traditional open method of heel spur surgery, in contrast, uses a larger skin incision of 3 to 5 cm, followed by larger instruments to dissect to the plantar fascia.

Comparação da pressão plantar e dos sintomas osteomusculares por meio do uso de palmilhas customizadas e pré-fabricadas no ambiente de trabalho Comparison of plantar pressure and musculoskeletal symptoms with the use of custom and prefabricated insoles in the work environment

Directory of Open Access Journals (Sweden)

Josiane S. Almeida

2009-12-01

Full Text Available OBJETIVOS: Comparar os efeitos do uso de dois tipos de palmilhas, customizadas e pré-fabricadas, sobre a descarga plantar de peso e o comportamento de sintomas osteomusculares em trabalhadoras de linha de montagem. MÉTODOS: Ensaio randomizado com 27 mulheres que trabalhavam em postura ortostática estática, com média de idade de 30,3±7,09 e massa de 64,85±13,65 e que apresentavam sintomas osteomusculares. Inicialmente, aplicou-se o Questionário Nórdico de Sintomas Osteomusculares e coletaram-se as pressões plantares pelo sistema de baropodometria computadorizada (FootWork. Posteriormente, a casuística foi dividida em grupo controle (GC, que utilizou palmilha pré-fabricada e grupo intervenção (GI, que usou palmilha customizada de etilvinilacetato (EVA durante oito semanas. Dados baropodométricos foram novamente coletados assim como a reaplicação do questionário. RESULTADOS: Não houve diferença estatística significante na comparação entre grupos e dados baropodométricos. Notou-se, entretanto, mudança de comportamento nas variáveis de descarga em cada momento avaliado, assim como o aumento para as variáveis de média pressão de descarga e pressão plantar máxima (pOBJECTIVES: To compare the effect of the use of custom and prefabricated insoles on the behavior of plantar weight load and musculoskeletal symptoms in assembly line workers. METHODS: A randomized trial was carried out with 27 women who worked in a static standing position and had musculoskeletal symptoms. The mean age was 30.3±7.09 years and the weight 64.85±13.65 Kg. The Nordic Musculoskeletal Questionnaire was administered, and plantar pressure was determined using a computerized baropodometric system (FootWork. The sample was then divided into control group, which wore pre-fabricated insoles, and intervention group, which wore ethylvinylacetate insoles for eight weeks. Baropodometric data were collected and the questionnaire was administered once again

A COMPARITIVE STUDY ON EFFECTIVENESS OF TAPING WITH IONTOPHORESIS AND TAPING ALONE IN CHRONIC PLANTAR FASCITIS

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Biju Chetri

2016-04-01

Full Text Available Background: Plantar fasciitis is a painful condition caused by microtrauma to plantar fascia due to overuse. It is a most common cause of heel pain in runners. Various studies proved taping and Iontophoresis as effective in the treating plantar fasciitis. But there are no studies comparing the combined effect of iontophoresis with taping and taping alone in the treatment of plantar fasciitis. Methods: 50 patients suffering from plantar fasciitis who met the inclusion criteria were selected. The subjects were randomly divided into two groups i.e. Group A and Group B. Group A received taping, iontophoresis with plantar fascia stretching. Group B received taping and plantar fascia stretching. A total of 6 treatment sessions were given on alternate days over a period of two weeks for both the groups. Results: VAS and FFI scores across baseline and post intervention showed a significant improvement statistically in their mean scores between Groups A and B (P<0.05. Between group comparison of VAS and FFI scores, it showed that subject treated with Iontophoresis in combination with taping and plantar fascia stretch (Group A had significant improvement in VAS and functional ability when compared to subjects treated with taping and plantar fascia stretching alone (Group B. Conclusion: Iontophoresis along with Taping and plantar fascia stretching gave an additional benefit when compared with Taping and plantar fascia stretching alone in reducing pain and improving function in plantar fasciitis.

Characteristics of Plantar Loads in Maximum Forward Lunge Tasks in Badminton.

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Xiaoyue Hu

Full Text Available Badminton players often perform powerful and long-distance lunges during such competitive matches. The objective of this study is to compare the plantar loads of three one-step maximum forward lunges in badminton.Fifteen right-handed male badminton players participated in the study. Each participant performed five successful maximum lunges at three directions. For each direction, the participant wore three different shoe brands. Plantar loading, including peak pressure, maximum force, and contact area, was measured by using an insole pressure measurement system. Two-way ANOVA with repeated measures was employed to determine the effects of the different lunge directions and different shoes, as well as the interaction of these two variables, on the measurements.The maximum force (MF on the lateral midfoot was lower when performing left-forward lunges than when performing front-forward lunges (p = 0.006, 95% CI = -2.88 to -0.04%BW. The MF and peak pressures (PP on the great toe region were lower for the front-forward lunge than for the right-forward lunge (MF, p = 0.047, 95% CI = -3.62 to -0.02%BW; PP, p = 0.048, 95% CI = -37.63 to -0.16 KPa and left-forward lunge (MF, p = 0.015, 95% CI = -4.39 to -0.38%BW; PP, p = 0.008, 95% CI = -47.76 to -5.91 KPa.These findings indicate that compared with the front-forward lunge, left and right maximum forward lunges induce greater plantar loads on the great toe region of the dominant leg of badminton players. The differences in the plantar loads of the different lunge directions may be potential risks for injuries to the lower extremities of badminton players.

Plantar pitted keratolysis: a study from non-risk groups

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Asli Feride Kaptanoglu

2012-02-01

Full Text Available Pitted keratolysis is an acquired, superficial bacterial infection of the skin which is characterized by typical malodor and pits in the hyperkeratotic areas of the soles. It is more common in barefooted people in tropical areas, or those who have to wear occlusive shoes, such as soldiers, sailors and athletes. In this study, we evaluated 41 patients who had been diagnosed with plantar pitted keratolysis. The patients were of high socioeconomic status, were office-workers, and most had a university degree. Malodor and plantar hyperhydrosis were the most frequently reported symptoms. The weight-bearing metatarsal parts of the feet were those most affected. Almost half the women in the study gave a history of regular pedicure and foot care in a spa salon. Mean treatment duration was 19 days. All patients were informed about the etiology of the disease, predisposing factors and preventive methods. Recurrences were observed in only 17% of patients during the one year follow-up period. This study emphasizes that even malodorous feet among non-risk city dwellers may be a sign of plantar pitted keratolysis. A study of the real incidence of the disease in a large population-based series is needed.

Sonographic and MRI evaluation of the plantar plate: a prospective study

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Gregg, Julie; Silberstein, Morry; Schneider, Timothy; Marks, Paul

2006-01-01

The purpose of this study was to establish the accuracy of ultrasound in the examination of the plantar plate by comparing it with MRI, or if available, surgical findings. The lesser metatarsophalangeal joint plantar plates of 40 symptomatic and 40 asymptomatic feet (160 asymptomatic and 160 symptomatic plantar plates) were examined with ultrasound and MRI. Patients treated with surgery were chosen on a clinical basis and provided surgical correlation for the imaging techniques. Symptomatic patients with metatatarsalgia and suspected metatarsophalangeal joint instability were referred by an orthopedic foot specialist; asymptomatic feet were obtained either through examination of the contralateral foot of the symptomatic patients or volunteers. Ultrasound detected 75/160 and 139/160 plantar plates torn in the asymptomatic and symptomatic groups, respectively. MRI detected 56/160 and 142/160 tears in the symptomatic and asymptomatic groups, respectively. The sensitivity of MRI and ultrasound with surgical correlation was calculated to be 87 and 96%, respectively, with poor specificity. Ultrasound correlates moderately with MRI in the evaluation of the plantar plate. Surgical correlations, although limited (n=10), indicate ultrasound is superior to MRI with more accurate detection of tears. (orig.)

Plantar pressure distribution of ostrich during locomotion on loose sand and solid ground

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Rui Zhang

2017-07-01

Full Text Available Background The ostrich is a cursorial bird with extraordinary speed and endurance, especially in the desert, and thus is an ideal large-scale animal model for mechanic study of locomotion on granular substrate. Methods The plantar pressure distributions of ostriches walking/running on loose sand/solid ground were recorded using a dynamic pressure plate. Results The center of pressure (COP on loose sand mostly originated from the middle of the 3rd toe, which differed from the J-shaped COP trajectory on solid ground. At mid-stance, a high-pressure region was observed in the middle of the 3rd toe on loose sand, but three high-pressure regions were found on solid ground. The gait mode significantly affected the peak pressures of the 3rd and 4th toes (p = 1.5 × 10−6 and 2.39 × 10−8, respectively, but not that of the claw (p = 0.041. The effects of substrate were similar to those of the gait mode. Discussion Ground reaction force trials of each functional part showed the 3rd toe bore more body loads and the 4th toe undertook less loads. The pressure distributions suggest balance maintenance on loose sand was provided by the 3rd and 4th toes and the angle between their length axes. On loose sand, the middle of the 3rd toe was the first to touch the sand with a smaller attack angle to maximize the ground reaction force, but on solid ground, the lateral part was the first to touch the ground to minimize the transient loading. At push-off, the ostrich used solidification properties of granular sand under the compression of the 3rd toe to generate sufficient traction.

Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers

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Tang, Ulla Hellstrand; Z?gner, Roland; Lisovskaja, Vera; Karlsson, Jon; Hagberg, Kerstin; Tranberg, Roy

2015-01-01

Objective: Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP) and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and ...

Shall We Inject Superficial or Deep to the Plantar Fascia? An Ultrasound Study of the Treatment of Chronic Plantar Fasciitis.

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Gurcay, Eda; Kara, Murat; Karaahmet, Ozgur Zeliha; Ata, Ayşe Merve; Onat, Şule Şahin; Özçakar, Levent

We compared the effectiveness of ultrasound (US)-guided corticosteroid, injected superficial or deep to the fascia, in patients with plantar fasciitis. Thirty patients (24 females [75%] and 6 males [25%]) with unilateral chronic plantar fasciitis were divided into 2 groups according to the corticosteroid injection site: superficial (n = 15) or deep (n = 15) to the plantar fascia. Patient heel pain was measured using a Likert pain scale and the Foot Ankle Outcome Scale (FAOS) for foot disability, evaluated at baseline and repeated in the first and sixth weeks. The plantar fascia and heel pad thicknesses were assessed on US scans at baseline and the sixth week. The groups were similar in age, gender, and body mass index (p > .05 for all). Compared with the baseline values, the Likert pain scale (p plantar fascia thickness had decreased significantly in both groups at the sixth week (p  .05 for both). The difference in the FAOS subscales (pain, p = .002; activities of daily living, p = .003; sports/recreational activities, p = .008; quality of life, p = .009) and plantar fascia thickness (p = .049) showed better improvement in the deep than in the superficial injection group. US-guided corticosteroid injections are safe and effective in the short-term therapeutic outcome of chronic plantar fasciitis. Additionally, injection of corticosteroid deep to the fascia might result in greater reduction in plantar fascia thickness, pain, and disability and improved foot-related quality of life. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Simplified versus geometrically accurate models of forefoot anatomy to predict plantar pressures: A finite element study.

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Telfer, Scott; Erdemir, Ahmet; Woodburn, James; Cavanagh, Peter R

2016-01-25

Integration of patient-specific biomechanical measurements into the design of therapeutic footwear has been shown to improve clinical outcomes in patients with diabetic foot disease. The addition of numerical simulations intended to optimise intervention design may help to build on these advances, however at present the time and labour required to generate and run personalised models of foot anatomy restrict their routine clinical utility. In this study we developed second-generation personalised simple finite element (FE) models of the forefoot with varying geometric fidelities. Plantar pressure predictions from barefoot, shod, and shod with insole simulations using simplified models were compared to those obtained from CT-based FE models incorporating more detailed representations of bone and tissue geometry. A simplified model including representations of metatarsals based on simple geometric shapes, embedded within a contoured soft tissue block with outer geometry acquired from a 3D surface scan was found to provide pressure predictions closest to the more complex model, with mean differences of 13.3kPa (SD 13.4), 12.52kPa (SD 11.9) and 9.6kPa (SD 9.3) for barefoot, shod, and insole conditions respectively. The simplified model design could be produced in 3h in the case of the more detailed model, and solved on average 24% faster. FE models of the forefoot based on simplified geometric representations of the metatarsal bones and soft tissue surface geometry from 3D surface scans may potentially provide a simulation approach with improved clinical utility, however further validity testing around a range of therapeutic footwear types is required. Copyright © 2015 Elsevier Ltd. All rights reserved.

EFFECTS OF COMBINED FOOT/ANKLE ELECTROMYOSTIMULATION AND RESISTANCE TRAINING ON THE IN-SHOE PLANTAR PRESSURE PATTERNS DURING SPRINT IN YOUNG ATHLETES

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François Fourchet

2011-06-01

Full Text Available Several studies have already reported that specific foot/ankle muscle reinforcement strategies induced strength and joint position sense performance enhancement. Nevertheless the effects of such protocols on sprint performance and plantar loading distribution have not been addressed yet. The objective of the study is to investigate the influence of a 5-wk foot/ankle strength training program on plantar loading characteristics during sprinting in adolescent males. Sixteen adolescent male athletes of a national training academy were randomly assigned to either a combined foot/ankle electromyostimulation and resistance training (FAST or a control (C group. FAST consisted of foot medial arch and extrinsic ankle muscles reinforcement exercises, whereas C maintained their usual training routine. Before and after training, in-shoe loading patterns were measured during 30-m running sprints using pressure sensitive insoles (right foot and divided into nine regions for analysis. Although sprint times remained unchanged in both groups from pre- to post- training (3.90 ± 0.32 vs. 3.98 ± 0.46 s in FAST and 3.83 ± 0.42 vs. 3.81 ± 0.44 s in C, changes in force and pressure appeared from heel to forefoot between FAST and C. In FAST, mean pressure and force increased in the lateral heel area from pre- to post- training (67.1 ± 44.1 vs. 82.9 ± 28.6 kPa [p = 0.06]; 25.5 ± 17.8 vs. 34.1 ± 14.3 N [p = 0.05] and did not change in the medial forefoot (151.0 ± 23.2 vs. 146.1 ± 30.0 kPa; 142.1 ± 29.4 vs. 136.0 ± 33.8; NS. Mean area increased in FAST under the lateral heel from pre- to post- (4.5 ± 1.3 vs. 5.7 ± 1.6 cm2 [p < 0.05] and remained unchanged in C (5.5 ± 2.8 vs. 5.0 ± 3.0 cm2. FAST program induced significant promising lateral and unwanted posterior transfer of the plantar loads without affecting significantly sprinting performance

AVALIAÇÃO DAS PRESSÕES PLANTARES EM DIFERENTES SITUAÇÕES POR BAROPODOMETRIA

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Ana Claudia de Souza Fortaleza

2011-06-01

Full Text Available This study aimed to evaluate plantar pressure values obtained in the static, dynamic and during gait in healthy subjects. To this end, we evaluated 43 healthy elderly through a trail running in three situations: static, dynamic and gait. We calculated the mean and standard deviation for variables description and performed univariate analysis of variance (ANOVA to relate the assessment situation. The plantar pressure values obtained were 0.48 ± 0.16 kgf/cm2 for evaluating static, 1.45 ± 0.41 kgf/cm2 for dynamic and 1.48 ± 0.45 for Kgf/cm2 for gait. The results showed an increase in pressure and a significance when compared the pressure in static with the dynamic pressure as well as the static with the march. No differences were found when comparingthe pressures in dynamic and gait. These findings confirm that with this trail running doesn’t have different to the use of the dynamic or gait situation of to get the results.

Plantar-flexion of the ankle joint complex in terminal stance is initiated by subtalar plantar-flexion: A bi-planar fluoroscopy study.

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Koo, Seungbum; Lee, Kyoung Min; Cha, Young Joo

2015-10-01

Gross motion of the ankle joint complex (AJC) is a summation of the ankle and subtalar joints. Although AJC kinematics have been widely used to evaluate the function of the AJC, the coordinated movements of the ankle and subtalar joints are not well understood. The purpose of this study was to accurately quantify the individual kinematics of the ankle and subtalar joints in the intact foot during ground walking by using a bi-planar fluoroscopic system. Bi-planar fluoroscopic images of the foot and ankle during walking and standing were acquired from 10 healthy subjects. The three-dimensional movements of the tibia, talus, and calcaneus were calculated with a three-dimensional/two-dimensional registration method. The skeletal kinematics were quantified from 9% to 86% of the full stance phase because of the limited camera speed of the X-ray system. At the beginning of terminal stance, plantar-flexion of the AJC was initiated in the subtalar joint on average at 75% ranging from 62% to 76% of the stance phase, and plantar-flexion of the ankle joint did not start until 86% of the stance phase. The earlier change to plantar-flexion in the AJC than the ankle joint due to the early plantar-flexion in the subtalar joint was observed in 8 of the 10 subjects. This phenomenon could be explained by the absence of direct muscle insertion on the talus. Preceding subtalar plantar-flexion could contribute to efficient and stable ankle plantar-flexion by locking the midtarsal joint, but this explanation needs further investigation. Copyright © 2015 Elsevier B.V. All rights reserved.

Plantar flaps based on perforators of the plantar metatarsal/common digital arteries.

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Valentin, Georgescu Alexandru; Rodica, Matei Ileana; Manuel, Llusa

2014-09-01

Because of the unique characteristics of its integument, the affirmation "replacing like with like" becomes more than evident in the reconstruction of defects of the ultraspecialized plantar skin. But, the paucity of local resources, and especially in the forefoot, transforms this attempt in a very challenging problem. Many techniques, including skin grafts and various types of flaps were used in the management of defects in the forefoot. We present a new useful flap in the reconstruction of skin defects in the forefoot, based on small perforator vessels originating either from the plantar metatarsal arteries or plantar common digital arteries. Starting with June 2011, this flap was performed, as plantar transposition perforator flap, plantar propeller flap, or plantar propeller perforator plus flap, in seven patients with ulcers over the plantar forefoot. During a follow-up of 7 to 17 months (mean, 9.8 months), the local evolution regarding flap integration, pain, relapse, sensitive recovery, donor site, and footwear quality was analyzed. We registered a 100% survival rate of the flaps, with delayed healing in only one case. The gait resumption was possible after 6 weeks in all cases. This new flap, based on small perforator vessels from the plantar metatarsal or common digital arteries, and which provides a good, stable, and sensory recovery, seems to be a promising method in the reconstruction of plantar skin defects over the metatarsal heads. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comparison of plantar pressure distribution between three different shoes and three common movements in futsal.

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Teymouri, Meghdad; Halabchi, Farzin; Mirshahi, Maryam; Mansournia, Mohammad Ali; Mousavi Ahranjani, Ali; Sadeghi, Amir

2017-01-01

Analysis of in-shoe pressure distribution during sport-specific movements may provide a clue to improve shoe design and prevent injuries. This study compared the mean and the peak pressures over the whole foot and ten separate areas of the foot, wearing different shoes during specific movements. Nine male adult recreational futsal players performed three trials of three sport-specific movements (shuffle, sprint and penalty kick), while they were wearing three brands of futsal shoes (Adidas, Lotto and Tiger). Plantar pressures on dominant feet were collected using the F-SCAN system. Peak and mean pressures for whole foot and each separate area were extracted. For statistical analysis, the mean differences in outcome variables between different shoes and movements were estimated using random-effects regression model using STATA ver.10. In the average calculation of the three movements, the peak pressure on the whole foot in Adidas shoe was less than Lotto [8.8% (CI95%: 4.1-13.6%)] and Tiger shoes [11.8% (CI95%:7-16.7%)], (P<0.001). Also, the recorded peak pressure on the whole foot in penalty kick was 61.1% (CI95%: 56.3-65.9%) and 57.6% (CI95%: 52.8-62.3%) less than Shuffle and Sprint tests, respectively (P<0.001). Areas with the highest peak pressure during all 3 movements were not different between all shoes. This area was medial forefoot in cases of shuffle and sprint movements and medial heel in case of penalty kick.

Comparison of plantar pressure distribution between three different shoes and three common movements in futsal.

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Meghdad Teymouri

Full Text Available Analysis of in-shoe pressure distribution during sport-specific movements may provide a clue to improve shoe design and prevent injuries. This study compared the mean and the peak pressures over the whole foot and ten separate areas of the foot, wearing different shoes during specific movements.Nine male adult recreational futsal players performed three trials of three sport-specific movements (shuffle, sprint and penalty kick, while they were wearing three brands of futsal shoes (Adidas, Lotto and Tiger. Plantar pressures on dominant feet were collected using the F-SCAN system. Peak and mean pressures for whole foot and each separate area were extracted. For statistical analysis, the mean differences in outcome variables between different shoes and movements were estimated using random-effects regression model using STATA ver.10.In the average calculation of the three movements, the peak pressure on the whole foot in Adidas shoe was less than Lotto [8.8% (CI95%: 4.1-13.6%] and Tiger shoes [11.8% (CI95%:7-16.7%], (P<0.001. Also, the recorded peak pressure on the whole foot in penalty kick was 61.1% (CI95%: 56.3-65.9% and 57.6% (CI95%: 52.8-62.3% less than Shuffle and Sprint tests, respectively (P<0.001.Areas with the highest peak pressure during all 3 movements were not different between all shoes. This area was medial forefoot in cases of shuffle and sprint movements and medial heel in case of penalty kick.

Using effect size to quantify plantar pressure asymmetry of gait of nondisabled adults and patients with hemiparesis.

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Potdevin, François J; Femery, Virginie G; Decatoire, Aurélien; Bosquet, Laurent; Coello, Yann; Moretto, Pierre

2007-01-01

In the literature, numerous statistical analyses are used to quantify asymmetry in gait. This study tested the effect size (ES) statistic for quantifying asymmetry in nondisabled and pathological populations. The plantar pressure peaks on eight footprint locations of 27 nondisabled subjects and 18 patients with hemiparesis were bilaterally compared. Asymmetry quantifications were performed with ES and standard statistical tests (index of asymmetry, symmetry index, and ratio index). The results show an advantage in using ES to quantify asymmetry when confidence limits are also calculated. Conversely, traditional asymmetry indexes immediately implied asymmetry without statistical basis. These findings should be considered when one is attempting to diagnose pathological walking patterns or guide rehabilitation processes.

Manual therapy for plantar heel pain.

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Pollack, Yosefa; Shashua, Anat; Kalichman, Leonid

2018-03-01

Manual therapy employed in the treatment of plantar heel pain includes joint or soft tissue mobilizations. Efficacy of these methods is still under debate. To determine whether manual therapy, consisting of deep massage, myofascial release or joint mobilization is effective in treating plantar heel pain. A critical review of all available studies with an emphasis on randomized controlled trials (RCTs) was performed. PubMed, PEDro, and Google Scholar databases were searched for keywords relating to plantar heel pain, joint, and soft tissue mobilizations. There were no search limitations or language restrictions. The reference lists of all retrieved articles were searched. The PEDro score was used to assess the quality of the reviewed papers. A total of six relevant RCTs were found: two examined the effectiveness of joint mobilization on plantar heel pain and four the effectiveness of soft tissue techniques. Five studies showed a positive short-term effect after manual therapy treatment, mostly soft tissue mobilizations, with or without stretching exercises for patients with plantar heel pain, compared to other treatments. One study observed that adding joint mobilization to the treatment of plantar heel pain was not effective. The quality of all studies was moderate to high. According to reviewed moderate and high-quality RCTs, soft tissue mobilization is an effective modality for treating plantar heel pain. Outcomes of joint mobilizations are controversial. Further studies are needed to evaluate the short and long-term effect of different soft tissue mobilization techniques. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effectiveness of Plantar Fascia-Specific Stretching Exercises in Plantar Fasciitis

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Devrim Özer

2015-12-01

Full Text Available Aim: Plantar fasciitis (PF is a painful and disabling disease that affects the quality of life and daily activities of patients and it is the most common cause of heel pain in adults. In primary treatment, conservative treatment is suggested and different conservative options are described in the literature. In our study, we evaluated the efficacy of plantar fascia-specific stretching exercises in the treatment of PF. Methods: Twenty-nine feet - 21 patients with the mean age of 49.3 years were included in the study. The mean length of follow-up was 19.8 months and the mean length of exercise period was 4.94 months. Non-weight bearing plantar fascia-specific stretching exercise was done twice daily, for 10 times at each session. In addition to exercises, silicone heel pad and nonsteroidal anti-inflammatory drugs (NSAID were added. Visual analog scale (VAS was used for pain evaluation. Results: Full recovery detected in 15 feet in 10 patients (52% and a decrease in pain was seen in 10 feet in 8 patients (34%. There was no response in 4 feet in 3 patients (14%. There was statistically significant difference between pre-treatment and post-treatment visual analog scale scores (p=0.0001. Conclusion: Plantar fascia-specific stretching exercise is an effective treatment option in PF.

Effect of plantar cutaneous inputs on center of pressure during quiet stance in older adults

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Yun Wang

2016-06-01

Conclusion: The findings indicate that mechanical facilitation of sensation on the plantar soles enhanced postural stability in older adults. The results show that plantar cutaneous inputs provide information that leads to reduced postural sway in healthy older adults. This could have implications in clinical and rehabilitative areas.

Ultrasound diagnosis and evaluation of plantar heel pain.

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Argerakis, Nicholas G; Positano, Rock G; Positano, Rock C J; Boccio, Ashley K; Adler, Ronald S; Saboeiro, Gregory R; Dines, Joshua S

2015-03-01

One of the most common causes of heel pain is plantar fasciitis; however, there are other pathologic disorders that can mimic the symptoms and clinical presentation of this disorder. The purpose of this study was to retrospectively review the prevalence of various pathologic disorders on ultrasound in patients with proximal plantar heel pain. The medical records and diagnostic ultrasound reports of patients presenting with plantar heel pain between March 1, 2006, and March 31, 2007, were reviewed retrospectively, and the prevalence of various etiologies was collected. The inclusion criteria were based on their clinical presentation of plantar fasciitis or previous diagnosis of plantar fasciitis from an unknown source. Ultrasound evaluation was then performed to confirm the clinical diagnosis. We examined 175 feet of 143 patients (62 males and 81 females; age range, 16-79 years). Plantar fibromas were present in 90 feet (51%). Plantar fasciitis was diagnosed in 128 feet (73%). Coexistent plantar fibroma and plantar fascial thickening was found in 63 feet (36%). Of the 47 feet that were negative for plantar fasciitis on ultrasound, 27 (57%) revealed the presence of plantar fibroma. Diagnostic ultrasound can effectively and safely identify the prevalence of various etiologies of heel pain. The high prevalence of plantar fibromas and plantar fascial tears cannot be determined by clinical examination alone, and, therefore, ultrasound evaluation should be performed for confirmation of diagnosis.

Classification of Forefoot Plantar Pressure Distribution in Persons with Diabetes: A Novel Perspective for the Mechanical Management of Diabetic Foot?

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Deschamps, Kevin; Matricali, Giovanni Arnoldo; Roosen, Philip; Desloovere, Kaat; Bruyninckx, Herman; Spaepen, Pieter; Nobels, Frank; Tits, Jos; Flour, Mieke; Staes, Filip

2013-01-01

Background The aim of this study was to identify groups of subjects with similar patterns of forefoot loading and verify if specific groups of patients with diabetes could be isolated from non-diabetics. Methodology/Principal Findings Ninety-seven patients with diabetes and 33 control participants between 45 and 70 years were prospectively recruited in two Belgian Diabetic Foot Clinics. Barefoot plantar pressure measurements were recorded and subsequently analysed using a semi-automatic total mapping technique. Kmeans cluster analysis was applied on relative regional impulses of six forefoot segments in order to pursue a classification for the control group separately, the diabetic group separately and both groups together. Cluster analysis led to identification of three distinct groups when considering only the control group. For the diabetic group, and the computation considering both groups together, four distinct groups were isolated. Compared to the cluster analysis of the control group an additional forefoot loading pattern was identified. This group comprised diabetic feet only. The relevance of the reported clusters was supported by ANOVA statistics indicating significant differences between different regions of interest and different clusters. Conclusion/s Significance There seems to emerge a new era in diabetic foot medicine which embraces the classification of diabetic patients according to their biomechanical profile. Classification of the plantar pressure distribution has the potential to provide a means to determine mechanical interventions for the prevention and/or treatment of the diabetic foot. PMID:24278219

Plantar fascia-specific stretching versus radial shock-wave therapy as initial treatment of plantar fasciopathy.

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Rompe, Jan D; Cacchio, Angelo; Weil, Lowell; Furia, John P; Haist, Joachim; Reiners, Volker; Schmitz, Christoph; Maffulli, Nicola

2010-11-03

Whether plantar fascia-specific stretching or shock-wave therapy is effective as an initial treatment for proximal plantar fasciopathy remains unclear. The aim of this study was to test the null hypothesis of no difference in the effectiveness of these two forms of treatment for patients who had unilateral plantar fasciopathy for a maximum duration of six weeks and which had not been treated previously. One hundred and two patients with acute plantar fasciopathy were randomly assigned to perform an eight-week plantar fascia-specific stretching program (Group I, n = 54) or to receive repetitive low-energy radial shock-wave therapy without local anesthesia, administered weekly for three weeks (Group II, n = 48). All patients completed the seven-item pain subscale of the validated Foot Function Index and a patient-relevant outcome questionnaire. Patients were evaluated at baseline and at two, four, and fifteen months after baseline. The primary outcome measures were a mean change in the Foot Function Index sum score at two months after baseline, a mean change in item 2 (pain during the first few steps of walking in the morning) on this index, and satisfaction with treatment. No difference in mean age, sex, weight, or duration of symptoms was found between the groups at baseline. At two months after baseline, the Foot Function Index sum score showed significantly greater changes for the patients managed with plantar fascia-specific stretching than for those managed with shock-wave therapy (p plantar fascia is superior to repetitive low-energy radial shock-wave therapy for the treatment of acute symptoms of proximal plantar fasciopathy.

Effects of plantar-flexor muscle fatigue on the magnitude and regularity of center-of-pressure fluctuations

NARCIS (Netherlands)

Roerdink, M.; Hlavackova, P.; Vuillerme, N.

2011-01-01

Control of bipedal posture is highly automatized but requires attentional investment, the amount of which varies between participants and with postural constraints, such as plantar-flexor muscle fatigue. Elevated attentional demands for standing with fatigued plantar flexors have been demonstrated

Análise da pressão plantar e do equilíbrio postural em diferentes fases da gestação Analysis of plantar pressure and postural balance during different phases of pregnancy

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SI Ribas

2007-10-01

Full Text Available OBJETIVO: Analisar a pressão plantar e o equilíbrio postural nos três trimestres de gravidez, bem como a correlação com as características antropométricas. METODOLOGIA: 60 voluntárias com idade média de 23,3 ± 5,5 anos, sendo 15 mulheres em cada grupo: não-gestantes (C, primeiro (1T, segundo (2T e terceiro trimestre (3T. A avaliação foi efetuada por meio de plataforma de pressão na posição bipodal com os olhos abertos. As variáveis analisadas nos pés direito e esquerdo foram: pico de pressão em todo o pé (PT, no antepé (PA e no retropé (PR; distância entre a borda medial dos pés (largura da base de suporte; distância do centro de força ao limite anterior (CFF e posterior (CFC dos pés; deslocamento ântero-posterior (AP e médio--lateral (ML do centro de força; e área de contato (AC. RESULTADOS: Não houve diferença no pico de pressão de contato e na distância CFF e CFC entre os grupos. O deslocamento AP foi maior (p 0,05 entre os grupos para o deslocamento ML. Houve correlação positiva entre peso ganho durante a gestação com AC para o grupo 2T e com PT no pé direito do grupo 1T. CONCLUSÃO: Os resultados demonstram a influência das mudanças anatômicas e fisiológicas inerentes à gestação na pressão plantar, além de sugerir uma redução do equilíbrio postural no 3T, relacionada ao maior deslocamento AP nessa fase.OBJECTIVE: To analyze plantar pressure and postural balance during the three trimesters of pregnancy, and also to correlate these with anthropometric characteristics. METHOD: Sixty volunteers participated in this study, with a mean age of 23.3 ± 5.5 years. There were 15 subjects in each group: non-pregnant (C, first trimester (1T, second trimester (2T and third trimester (3T. Evaluations were performed in bipedal stance with open eyes, using a pressure platform. The following variables were analyzed in the right and left feet: peak pressures in the whole foot (WFP, forefoot (FFP and

Prevention of Recurrent Foot Ulcers With Plantar Pressure–Based In-Shoe Orthoses: The CareFUL Prevention Multicenter Randomized Controlled Trial

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Ulbrecht, Jan S.; Hurley, Timothy; Mauger, David T.

2014-01-01

OBJECTIVE To assess the efficacy of in-shoe orthoses that were designed based on shape and barefoot plantar pressure in reducing the incidence of submetatarsal head plantar ulcers in people with diabetes, peripheral neuropathy, and a history of similar prior ulceration. RESEARCH DESIGN AND METHODS Single-blinded multicenter randomized controlled trial with subjects randomized to wear shape- and pressure-based orthoses (experimental, n = 66) or standard-of-care A5513 orthoses (control, n = 64). Patients were followed for 15 months, until a study end point (forefoot plantar ulcer or nonulcerative plantar forefoot lesion) or to study termination. Proportional hazards regression was used for analysis. RESULTS There was a trend in the composite primary end point (both ulcers and nonulcerative lesions) across the full follow-up period (P = 0.13) in favor of the experimental orthoses. This trend was due to a marked difference in ulcer occurrence (P = 0.007) but no difference in the rate of nonulcerative lesions (P = 0.76). At 180 days, the ulcer prevention effect of the experimental orthoses was already significant (P = 0.003) when compared with control, and the benefit of the experimental orthoses with respect to the composite end point was also significant (P = 0.042). The hazard ratio was 3.4 (95% CI 1.3–8.7) for the occurrence of a submetatarsal head plantar ulcer in the control compared with experimental arm over the duration of the study. CONCLUSIONS We conclude that shape- and barefoot plantar pressure–based orthoses were more effective in reducing submetatarsal head plantar ulcer recurrence than current standard-of-care orthoses, but they did not significantly reduce nonulcerative lesions. PMID:24760263

Comparison of plantar pressure in three types of insole given to patients with diabetes at risk of developing foot ulcers – A two-year, randomized trial

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Ulla Hellstrand Tang

2014-12-01

Conclusions: Custom-made insoles used in combination with stable walking shoes gave lower pressures at the heel region. The variation makes it difficult to detect a systematic difference in plantar pressure for the 6 ROI, if such a difference indeed exists. The levels of satisfaction and usage for all the insoles tested were high. The insoles maintained their pressure redistribution properties over long periods, and few adjustments were needed.

Mechanical Information of Plantar Fascia during Normal Gait

Science.gov (United States)

Gu, Yaodong; Li, Zhiyong

The plantar fascia is an important foot tissue in stabilizing the longitudinal arch of human foot. Direct measurement to monitor the mechanical situation of plantar fascia at human locomotion is difficult. The purpose of this study was to construct a three-dimensional finite element model of the foot to calculate the internal stress/strain value of plantar fascia during different stage of gait. The simulated stress distribution of plantar fascia was the lowest at heel-strike, which concentrated on the medial side of calcaneal tubercle. The peak stress of plantar fascia was appeared at push-off, and the value is more than 5 times of the heel-strike position. Current FE model was able to explore the plantar fascia tension trend at the main sub-phases of foot. More detailed fascia model and intrinsic muscle forces could be developed in the further study.

Diabetic Foot Prevention: Repeatability of the Loran Platform Plantar Pressure and Load Distribution Measurements in Nondiabetic Subjects during Bipedal Standing—A Pilot Study

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Martha Zequera

2011-01-01

Full Text Available This study was designed to assess the repeatability of the Loran Platform and evaluate the variability of plantar pressure and postural balance, during barefoot standing in nondiabetic subjects, for future diabetic foot clinical evaluation. Measurements were taken for eight nondiabetic subjects (4 females, 4 males, aged 47±7.2 years who had no musculoskeletal symptoms. Five variables were measured with the platform in the barefoot standing position. Ten measurements were taken using two different techniques for feet and posture positioning, during three sessions, once a week. For most measurements, no significant effect over time was found with Student's t-test (P<.000125. The ANOVA test of statistical significance confirmed that measurement differences between subjects showed higher variations than measurements taken from the same subject (P<.001. The measurements taken by the Loran Platform system were found to be repeatable.

Comparative study between cryotherapy and salicylic acid in the treatment of plantar warts in Erbil - Iraq

OpenAIRE

Naz Hoshyar Muhamad Tahir; Alaa Abdulrahman Sulaiman

2018-01-01

Background and objective: Plantar warts are hard, grainy growths that usually appear on the heels or balls of feet. Plantar warts are caused by the human papillomavirus, usually self-limiting, but treatment is generally recommended to lessen symptoms, decrease duration, and reduce transmission. The study aimed to evaluate the clinical effectiveness of topical 40% salicylic acid in comparison to cryotherapy in the treatment of plantar wart. Methods: This study was conducted from March 2...

Effects of Wearing Different Personal Equipment on Force Distribution at the Plantar Surface of the Foot

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Christoph Schulze

2013-01-01

Full Text Available Background. The wearing of personal equipment can cause specific changes in muscle activity and posture. In the present study, we investigated the influence of differences in equipment related weight loading and load distribution on plantar pressure. In addition, we studied functional effects of wearing different equipment with a particular focus on relevant changes in foot shape. Methods. Static and dynamic pedobarography were performed on 31 male soldiers carrying increasing weights consisting of different items of equipment. Results. The pressure acting on the plantar surface of the foot increased with higher loading, both under static and dynamic conditions (p < 0.05. We observed an increase in the contact area (p < 0.05 and an influence of load distribution through different ways to carry the rifle. Conclusions. The wearing of heavier weights leads to an increase in plantar pressure and contact area. This may be caused by flattening of the transverse and longitudinal arches. The effects are more evident in subjects with flat feet deformities which seem to flatten at an earlier load condition with a greater amount compared to subjects with normal arches. Improving load distribution should be a main goal in the development of military equipment in order to prevent injuries or functional disorders of the lower extremity.

Association between plantar fascia vascularity and morphology and foot dysfunction in individuals with chronic plantar fasciitis.

Science.gov (United States)

Chen, Hongying; Ho, Hok-Ming; Ying, Michael; Fu, Siu Ngor

2013-10-01

Single-cohort laboratory-based study. To identify whether plantar fascia vascularity and thickness are associated with foot pain and dysfunction in individuals with chronic plantar fasciitis. Background Altered plantar fascia vascularity and thickening of the fascia have been identified in individuals with chronic plantar fasciitis. Thirty-eight patients with chronic unilateral plantar fasciitis and 21 controls participated in this study. Proximal plantar fascia vascularization and thickness were assessed using ultrasound imaging, and pain and foot dysfunction were quantified with a visual analog scale and the Chinese version of the Foot Function Index, respectively. Paired t tests were used to assess the side-to-side differences in fascia thickness and vascularity index (VI) in the control and patient groups, and an unpaired t test was used to make comparisons with the patient group. Multiple regression analysis was performed to identify whether the VI and fascia thickness were associated with pain and foot dysfunction. There were significantly higher VI (mean ± SD, 2.4% ± 1.4%) and fascia thickness (5.0 ± 1.3 mm) values in the affected feet when compared with the unaffected feet in the patient group (VI, 1.4% ± 0.5%; fascia thickness, 3.3 ± 0.7 mm) and with the dominant side of the controls (VI, 1.6% ± 0.4%; fascia thickness, 2.9 ± 0.6 mm). After accounting for age, gender, body mass index, and duration of symptoms, the VI explained 13% and 33% of the variance in pain scores measured with a visual analog scale and the pain subscale of the Foot Function Index, respectively; the VI and fascia thickness explained 42% of the variance in the Foot Function Index. Individuals with unilateral chronic plantar fasciitis demonstrated significantly greater vascularity and thickened fascia on the affected side compared to the unaffected side and also to healthy controls. Fascia vascularity was associated independently with self-perceived pain, and both fascia

Plantar fascia coronal length: a new parameter for plantar fascia assessment.

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Sari, Ahmet Sinan; Demircay, Emre; Cakmak, Gokhan; Sahin, M Sukru; Tuncay, I Cengiz; Altun, Suleyman

2015-01-01

The effects of gender and various anthropometric variables were previously reported as significant predictors of plantar fascia thickness. Although a strong correlation between either the body weight or body mass index (BMI) and plantar fascia thickness were not demonstrated, a moderate relation was stated. We retrospectively investigated the role of gender, height, weight, and body mass index on plantar fascia thickness at the calcaneal origin (PFCO) and 1 cm distal from the calcaneal origin (PF1cm) and the coronal length of the plantar fascia at the calcaneal origin (CLPF) in healthy subjects. The PFCO, PF1cm, and CLPF were retrospectively measured from magnetic resonance images of 100 healthy subjects. The gender, height, weight, and body mass index of the participants were also noted. Gender was a predictive factor for the length of the CLPF. The subjects with a BMI >25 kg/m(2) had a significantly greater PFCO, PF1cm, and CLPF. Height was mildly and BMI and weight were moderately related to the PFCO. However the CLPF showed a better correlation with height, BMI, and weight than that of plantar fascia thickness. CLPF better reflected the role of weight, BMI, and height than its thickness. It is a new parameter that could be valuable in the evaluation of plantar fascia disorders. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Metatarsophalangeal joint extension changes ultrasound measurements for plantar fascia thickness.

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Granado, Michael J; Lohman, Everett B; Gordon, Keith E; Daher, Noha S

2018-01-01

Ultrasound is an inexpensive method for quantifying plantar fascia thickness, especially in those with plantar fasciitis. Ultrasound has also been used to assess the effectiveness of various treatments for plantar fasciitis by comparing plantar fascia thickness before and after an intervention period. While a plantar fascia thickness over 4 mm via ultrasound has been proposed to be consistent with plantar fasciitis, some researchers believe the 4 mm plantar fascia thickness level to be a dubious guideline for diagnosing plantar fasciitis due to the lack of standardization of the measurement process for plantar fascia thickness. In particular, no universal guidelines exist on the positioning of the metatarsophalangeal (MTP) joints during the procedure and the literature also has inconsistent protocols. The purpose of this study is to investigate and compare the influence of MTP joint extension on plantar fascia thickness in healthy participants and those with unilateral plantar fasciitis. The plantar fascia thickness of forty participants (20 with unilateral plantar fasciitis and 20 control) was measured via ultrasound three times at three different MTP joint positions: 1) at rest, 2) 30° of extension from the plantar surface, and 3) maximal extension possible. The plantar fascia became significantly thinner as MTP joint extension increased in both the plantar fasciitis group ( p  plantar fasciitis group, the involved plantar fascia was 1.2 to 1.3 mm thicker (p plantar fascia thickness between the two sides was less than 0.1 mm ( p  plantar fascia thickness. It is recommended that plantar fascia thickness measurements be performed with the toes at rest. If MTP joints must be extended, then the toes should be extended maximally and then noted to ensure subsequent ultrasound procedures are repeated. Standardizing the position of the MTP joints is not only important for attaining the most accurate thickness measurement of the plantar fascia, but is also

A preliminary study of the effect of restricted gastrocnemius length on foot kinematics and plantar pressure patterns during gait in children with Cerebral Palsy

DEFF Research Database (Denmark)

Curtis, Derek

2008-01-01

  Summary/conclusion Kinematic foot modelling and pedobarography are complementary measurement methods for measuring foot biomechanics in children with cerebral palsy (CP). Pedobarography appears to be the most sensitive instrument measuring significantly decreased hindfoot and increased lateral......, range, 9-18 yrs) was tested twice using an EMED pedobarograph and a Vicon motion analysis system using the Oxford kinematic foot model to test the repeatability of the measurement methods and generate normal data. 8 children (4 girls, 4 boys, mean ± SD, 12 ± 2 yrs, range 8-15yr) with spastic CP...... forefoot mean plantar pressure and force in the children with gastrocnemius contracture, whilst the corresponding changes in foot kinematics were non-significant.   Introduction Foot deformity is common in CP and is often due to hypertonia and contracture in spastic muscles. The aim of this study...

Mini-Invasive floating metatarsal osteotomy for resistant or recurrent neuropathic plantar metatarsal head ulcers.

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Tamir, Eran; Finestone, Aharon S; Avisar, Erez; Agar, Gabriel

2016-07-11

Patients with peripheral neuropathy and pressure under a relatively plantar deviated metatarsal head frequently develop plantar foot ulcers. When conservative management with orthotics and shoes does not cure the ulcer, surgical metatarsal osteotomy may be indicated to relieve the pressure and enable the ulcer to heal. The purpose of this study is to evaluate the use of a mini-invasive floating metatarsal osteotomy in treating recalcitrant ulcers or recurrent ulcers plantar to the metatarsal heads in patients with diabetes mellitus (DM) related neuropathy. Computerized medical files of patients with diabetic neuropathy treated with an osteotomy during 2013 and 2014 were retrospectively reviewed. There were 20 osteotomies performed on 17 patients (mean age 58 years). The patients had a diagnosis of DM for a mean of 17 years. All ulcers were University of Texas grade 1A; mean ulcer age was 19 months. After 17/20 operations, the ulcer completely resolved after 6 weeks and did not recur after a mean follow-up of 11.5 months. One patient developed an early post-operative infection with osteomyelitis at the osteotomy site (proximal shaft of the fifth metatarsal) that needed debridement and IV antibiotics. In the other 19 cases, the surgical wound healed within 1 week. Asymptomatic radiological non-union developed in six cases (30 %). Mini-invasive floating metatarsal osteotomy can cure resistant and recurrent University of Texas grade 1A ulcerations plantar to the metatarsal heads in neuropathic patients.

Risk factors affecting chronic rupture of the plantar fascia.

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Lee, Ho Seong; Choi, Young Rak; Kim, Sang Woo; Lee, Jin Yong; Seo, Jeong Ho; Jeong, Jae Jung

2014-03-01

Prior to 1994, plantar fascia ruptures were considered as an acute injury that occurred primarily in athletes. However, plantar fascia ruptures have recently been reported in the setting of preexisting plantar fasciitis. We analyzed risk factors causing plantar fascia rupture in the presence of preexisting plantar fasciitis. We retrospectively reviewed 286 patients with plantar fasciitis who were referred from private clinics between March 2004 and February 2008. Patients were divided into those with or without a plantar fascia rupture. There were 35 patients in the rupture group and 251 in the nonrupture group. The clinical characteristics and risk factors for plantar fascia rupture were compared between the 2 groups. We compared age, gender, the affected site, visual analog scale pain score, previous treatment regimen, body mass index, degree of ankle dorsiflexion, the use of steroid injections, the extent of activity, calcaneal pitch angle, the presence of a calcaneal spur, and heel alignment between the 2 groups. Of the assessed risk factors, only steroid injection was associated with the occurrence of a plantar fascia rupture. Among the 35 patients with a rupture, 33 had received steroid injections. The odds ratio of steroid injection was 33. Steroid injections for plantar fasciitis should be cautiously administered because of the higher risk for plantar fascia rupture. Level III, retrospective comparative study.

Influence of patellofemoral pain syndrome on plantar pressure in the foot rollover process during gait

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Sandra Aliberti

2011-01-01

Full Text Available BACKGROUND: Patellofemoral Pain Syndrome is one of the most common knee disorders among physically active young women. Despite its high incidence, the multifactorial etiology of this disorder is not fully understood. OBJECTIVES: To investigate the influence of Patellofemoral Pain Syndrome on plantar pressure distribution during the foot rollover process (i.e., the initial heel contact, midstance and propulsion phases of the gait. MATERIALS AND METHODS: Fifty-seven young adults, including 22 subjects with Patellofemoral Pain Syndrome (30 ± 7 years, 165 ± 9 cm, 63 ± 12 kg and 35 control subjects (29 ± 7 years, 164 ± 8 cm, 60 ± 11 kg, volunteered for the study. The contact area and peak pressure were evaluated using the Pedar-X system (Novel, Germany synchronized with ankle sagittal kinematics. RESULTS: Subjects with Patellofemoral Pain Syndrome showed a larger contact area over the medial (p = 0.004 and central (p = 0.002 rearfoot at the initial contact phase and a lower peak pressure over the medial forefoot (p = 0.033 during propulsion when compared with control subjects. CONCLUSIONS: Patellofemoral Pain Syndrome is related to a foot rollover pattern that is medially directed at the rearfoot during initial heel contact and laterally directed at the forefoot during propulsion. These detected alterations in the foot rollover process during gait may be used to develop clinical interventions using insoles, taping and therapeutic exercise to rehabilitate this dysfunction.

Sonoelastography of the plantar fascia.

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Wu, Chueh-Hung; Chang, Ke-Vin; Mio, Sun; Chen, Wen-Shiang; Wang, Tyng-Guey

2011-05-01

To compare the stiffness of the plantar fascia by using sonoelastography in healthy subjects of different ages, as well as patients with plantar fasciitis. The study protocol was approved by the Research Ethics Committee of the hospital, and all of the subjects gave their informed consent. Bilateral feet of 40 healthy subjects and 13 subjects with plantar fasciitis (fasciitis group) were examined by using color-coded sonoelastography. Healthy subjects were divided into younger (18-50 years) and older (> 50 years) groups. The color scheme was red (hard), green (medium stiffness), and blue (soft). The color histogram was subsequently analyzed. Each pixel of the image was separated into red, green, and blue components (color intensity range, 0-255). The color histogram then computed the mean intensity of each color component of the pixels within a standardized area. Mixed model for repeated measurements was used for comparison of the plantar fascia thickness and the intensity of the color components on sonoelastogram. Quantitative analysis of the color histogram revealed a significantly greater intensity of blue in older healthy subjects than in younger (94.5 ± 5.6 [± standard deviation] vs 90.0 ± 4.6, P = .002) subjects. The intensity of red and green was the same between younger and older healthy subjects (P = .68 and 0.12). The intensity of red was significantly greater in older healthy subjects than in the fasciitis group (147.8 ± 10.3 vs 133.7 ± 13.4, P plantar fascia softens with age and in subjects with plantar fasciitis. RSNA, 2011

Factors Associated With Callus in Patients with Diabetes, Focused on Plantar Shear Stress During Gait.

Science.gov (United States)

Hamatani, Masako; Mori, Taketoshi; Oe, Makoto; Noguchi, Hiroshi; Takehara, Kimie; Amemiya, Ayumi; Ohashi, Yumiko; Ueki, Kohjiro; Kadowaki, Takashi; Sanada, Hiromi

2016-11-01

The aim of this study is to identify whether plantar shear stress in neuropathic patients with diabetes with callus is increased compared with those without callus. The differences in foot deformity, limited joint mobility, repetitive stress of walking, and ill-fitting shoes between patients with callus and those without callus were also determined. Subjects were recruited from the Diabetic Foot Outpatient Clinic. A newly developed in-shoe measurement system, which has flexible and thin insoles, enabled measurement of both plantar pressure and shear stress simultaneously when subjects walked as usual on a 10 m walkway. It was found that plantar shear stress adjusted for weight during the push-off phase was increased by 1.32 times in patients with callus compared with those without callus (mean ± SD: 0.0500 ± 0.0160 vs 0.0380 ± 0.0144, P = .031). Moreover, hallux valgus deformity, reduction in dorsiflexion of the ankle joint and increase in plantar flexion were showed in feet with callus. Increased plantar shear stress may be caused by gait change that patients having callus push off with the metatarsal head instead of the toe as a result of foot deformity and limited joint mobility. It was found that plantar shear stress adjusted for weight during the push-off phase was increased in patients with callus compared with those without callus by using the newly developed measurement system. These results suggest that reduction of plantar shear stress during the push-off phase can prevent callus formation in neuropathic patients with diabetes. © 2016 Diabetes Technology Society.

Application of a system for measuring foot plantar pressure for evaluation of human mobility

Science.gov (United States)

Klimiec, Ewa; Jasiewicz, Barbara; Zaraska, Krzysztof; Piekarski, Jacek; Guzdek, Piotr; Kołaszczyński, Grzegorz

2016-11-01

The paper presents evaluation of human mobility by gait analysis, carried out in natural conditions (outside laboratory). Foot plantar pressure is measured using a shoe insole with 8 sensors placed in different anatomical zones of the foot, and placed inside a sports footwear. Polarized PVDF foil is used as a sensor material. A wireless transmission system is used to transmit voltage values to the computer. Due to linear relationship between force and transducer voltage, energy released during walking in arbitrary units can be calculated as integral of the square of transducer voltage over time. Gait measurements have been done over the next few days on healthy person during normal walking and slow walking. Performed measurements allow determination of walking speed (number of steps per second), gait rhythm and manner of walking (applying force to inside versus outside part of the sole). It is found that switching from normal to slow walk increases gait energy by 25% while the pressure distribution across the anatomical regions of the foot remains unchanged. The results will be used for developing a programme for evaluation of patients with cardiac failure and future integration of actimetry with pulse and spirometry measurements.

Effects of wearing different personal equipment on force distribution at the plantar surface of the foot.

Science.gov (United States)

Schulze, Christoph; Lindner, Tobias; Woitge, Sandra; Finze, Susanne; Mittelmeier, Wolfram; Bader, Rainer

2013-01-01

The wearing of personal equipment can cause specific changes in muscle activity and posture. In the present study, we investigated the influence of differences in equipment related weight loading and load distribution on plantar pressure. In addition, we studied functional effects of wearing different equipment with a particular focus on relevant changes in foot shape. Static and dynamic pedobarography were performed on 31 male soldiers carrying increasing weights consisting of different items of equipment. The pressure acting on the plantar surface of the foot increased with higher loading, both under static and dynamic conditions (p feet deformities which seem to flatten at an earlier load condition with a greater amount compared to subjects with normal arches. Improving load distribution should be a main goal in the development of military equipment in order to prevent injuries or functional disorders of the lower extremity.

Additional diagnostic value of digital radiology in plantar fasciitis diagnosis

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Marcel Prasetyo

2017-08-01

Full Text Available Background: Ultrasonography (USG is regarded as the gold standard to differentiate normal plantar fascia and plantar fasciitis. Conventional radiography or plain X-ray is typically used to exclude differential diagnosis. Lately, conventional radiography has been digitalized and leads to better visualization of the soft tissue. However, it is not known whether digital radiography evaluation for calcaneus area, both qualitative and quantitative, has a similar diagnostic value as USG findings. Therefore, this study aimed to evaluate whether there is a strong correlation between digital radiographic and USG findings for diagnosing plantar fasciitis.Methods: This is a cross sectional study examining adult patients (>18 years old presenting with inferior heel pain. Plantar aponeurosis thickness was measured by digital radiography and ultrasonography; measurement was performed three times in each modality, and the average value was recorded. Fat stranding, presence of calcaneal enthesophyte, and microfracture were also evaluated in digital radiography. Measurement results were classified into plantar fasciitis diagnosis using the cut-off value 4 mm.Results: There was no significant correlation between plantar aponeurosis thickness measured by digital radiography and by ultrasonography (r=0.069, p=0.688. There was no significant association between plantar fasciitis diagnosis by digital radiography and ultrasonography (p=0.162. However, digital radiography showed good sensitivity to detect plantar fasciitis using a cut-off value of >4 mm plantar fascia thickness.Conclusion: Digital radiography might be used to aid definitive diagnosis for plantar fasciitis.

Plantar fascia: imaging diagnosis and guided treatment.

Science.gov (United States)

McNally, Eugene G; Shetty, Shilpa

2010-09-01

Plantar fasciopathy is a common cause of heel pain. This article covers the imaging anatomy of the hindfoot, the imaging findings on ultrasound and magnetic resonance imaging (MRI) of plantar fasciopathy, plantar fibromas, trauma, Achilles tendonopathy, neural compression, stress fractures of the os calcis and other heel pad lesions. Thickening of the plantar fascia insertion more than 5 mm either on ultrasound or MRI is suggestive of plantar fasciopathy. Ultrasound is superior to MRI for diagnosis of plantar fibroma as small low signal lesions on MRI are similar to the normal plantar fascia signal. Ultrasound demonstrates low echogenicity compared with the echogenic plantar fascia. Penetrating injuries can appear bizarre due to associated foreign body impaction and infection. Achilles tendonopathy can cause heel pain and should be considered as a possible diagnosis. Treatment options include physical therapy, ECSWT, corticosteroid injection, and dry needling. Percutaneous US guided treatment methods will be described. Thieme Medical Publishers.

Efficacy and Tolerability of Topical Green Tea Extract (Polyphenon E) Application in a “Therapy-Resistant” Plantar Wart

OpenAIRE

Giancarlo Meloni; Massimo Milani

2018-01-01

Plantar warts account for 30% of all cutaneous warts. These lesions could be very painful, especially if the lesion is located over pressure sites such as the metatarsal head. Plantar wart treatment remains a challenging therapeutic problem. A 67-year-old immunocompetent nonsmoking man presented with a large mosaic plantar wart on his right foot. The lesion had been present for 5 years. Several cryotherapy sessions (a total of 6 procedures) had been performed with no success. The lesion was t...

Optimisation of rocker sole footwear for prevention of first plantar ulcer: comparison of group-optimised and individually-selected footwear designs.

Science.gov (United States)

Preece, Stephen J; Chapman, Jonathan D; Braunstein, Bjoern; Brüggemann, Gert-Peter; Nester, Christopher J

2017-01-01

Appropriate footwear for individuals with diabetes but no ulceration history could reduce the risk of first ulceration. However, individuals who deem themselves at low risk are unlikely to seek out bespoke footwear which is personalised. Therefore, our primary aim was to investigate whether group-optimised footwear designs, which could be prefabricated and delivered in a retail setting, could achieve appropriate pressure reduction, or whether footwear selection must be on a patient-by-patient basis. A second aim was to compare responses to footwear design between healthy participants and people with diabetes in order to understand the transferability of previous footwear research, performed in healthy populations. Plantar pressures were recorded from 102 individuals with diabetes, considered at low risk of ulceration. This cohort included 17 individuals with peripheral neuropathy. We also collected data from 66 healthy controls. Each participant walked in 8 rocker shoe designs (4 apex positions × 2 rocker angles). ANOVA analysis was then used to understand the effect of two design features and descriptive statistics used to identify the group-optimised design. Using 200 kPa as a target, this group-optimised design was then compared to the design identified as the best for each participant (using plantar pressure data). Peak plantar pressure increased significantly as apex position was moved distally and rocker angle reduced ( p  footwear which was individually selected. In terms of optimised footwear designs, healthy participants demonstrated the same response as participants with diabetes, despite having lower plantar pressures. This is the first study demonstrating that a group-optimised, generic rocker shoe might perform almost as well as footwear selected on a patient by patient basis in a low risk patient group. This work provides a starting point for clinical evaluation of generic versus personalised pressure reducing footwear.

Sonographic evaluation of plantar fasciitis and relation to body mass index

Energy Technology Data Exchange (ETDEWEB)

Ozdemir, Huseyin [Department of Radiology Firat University, Faculty of Medicine, Elazig 23119 (Turkey)]. E-mail: ozdemir@firat.edu.tr; Yilmaz, Erhan [Department Orthopedic Firat University, Faculty of Medicine, Elazig (Turkey); Murat, Ayse [Department of Radiology Firat University, Faculty of Medicine, Elazig 23119 (Turkey); Karakurt, Lokman [Department Orthopedic Firat University, Faculty of Medicine, Elazig (Turkey); Poyraz, A. Kursad [Department of Radiology Firat University, Faculty of Medicine, Elazig 23119 (Turkey); Ogur, Erkin [Department of Radiology Firat University, Faculty of Medicine, Elazig 23119 (Turkey)

2005-06-01

Purpose: We have investigated the role of sonography in the diagnosis of plantar fasciitis. Materials and methods: This study evaluates 39 patients with plantar fasciitis and control group of 22 healthy volunteers. The plantar fascia thickness was measured 5 mm distal to the insertion of the calcaneus of plantar aponeurosis. Qualitative parameters such as decreased echogenity, biconvexity, perifascial fluid and calcification of plantar fascia were also noted. Results: Mean plantar fascia thickness was measured 2.9 mm in patients with unilateral heel pain, 2.2 mm for contralateral normal heel and 2.5 mm for control group. There was a statistically significant difference between heel with plantar fasciitis, contralateral normal heel and control groups (p = 0.009 and 0.0001, respectively). Mean body mass index was 28 kg/m{sup 2} in patients with heel pain and 25 kg/m{sup 2} in control group. Body mass index measurements were significantly different between plantar fasciitis and control groups. We found reduced plantar fascia echogenity in 16 cases (41%), calcaneal spur in 20 cases (51%), biconvex appearance in two cases (5.1%) and perifascial fluid in one case (2.5%). Conclusion: We conclude that in patients with plantar fasciitis, ultrasound may detect relatively small differences in plantar fascia thickness even in clinically unequivocal plantar fasciitis.

Sonographic evaluation of plantar fasciitis and relation to body mass index

International Nuclear Information System (INIS)

Ozdemir, Huseyin; Yilmaz, Erhan; Murat, Ayse; Karakurt, Lokman; Poyraz, A. Kursad; Ogur, Erkin

2005-01-01

Purpose: We have investigated the role of sonography in the diagnosis of plantar fasciitis. Materials and methods: This study evaluates 39 patients with plantar fasciitis and control group of 22 healthy volunteers. The plantar fascia thickness was measured 5 mm distal to the insertion of the calcaneus of plantar aponeurosis. Qualitative parameters such as decreased echogenity, biconvexity, perifascial fluid and calcification of plantar fascia were also noted. Results: Mean plantar fascia thickness was measured 2.9 mm in patients with unilateral heel pain, 2.2 mm for contralateral normal heel and 2.5 mm for control group. There was a statistically significant difference between heel with plantar fasciitis, contralateral normal heel and control groups (p = 0.009 and 0.0001, respectively). Mean body mass index was 28 kg/m 2 in patients with heel pain and 25 kg/m 2 in control group. Body mass index measurements were significantly different between plantar fasciitis and control groups. We found reduced plantar fascia echogenity in 16 cases (41%), calcaneal spur in 20 cases (51%), biconvex appearance in two cases (5.1%) and perifascial fluid in one case (2.5%). Conclusion: We conclude that in patients with plantar fasciitis, ultrasound may detect relatively small differences in plantar fascia thickness even in clinically unequivocal plantar fasciitis

Application of ultrasound in the assessment of plantar fascia in patients with plantar fasciitis: a systematic review.

Science.gov (United States)

Mohseni-Bandpei, Mohammad Ali; Nakhaee, Masoomeh; Mousavi, Mohammad Ebrahim; Shakourirad, Ali; Safari, Mohammad Reza; Vahab Kashani, Reza

2014-08-01

Plantar fasciitis (PFS) is one of the most common causes of heel pain, estimated to affect 10% of the general population during their lifetime. Ultrasound (US) imaging technique is increasingly being used to assess plantar fascia (PF) thickness, monitor the effect of different interventions and guide therapeutic interventions in patients with PFS. The purpose of the present study was to systematically review previously published studies concerning the application of US in the assessment of PF in patients with PFS. A literature search was performed for the period 2000-2012 using the Science Direct, Scopus, PubMed, CINAHL, Medline, Embase and Springer databases. The key words used were: ultrasound, sonography, imaging techniques, ultrasonography, interventional ultrasonography, plantar fascia and plantar fasciitis. The literature search yielded 34 relevant studies. Sixteen studies evaluated the effect of different interventions on PF thickness in patients with PFS using US; 12 studies compared PF thickness between patients with and without PFS using US; 6 studies investigated the application of US as a guide for therapeutic intervention in patients with PFS. There were variations among studies in terms of methodology used. The results indicated that US can be considered a reliable imaging technique for assessing PF thickness, monitoring the effect of different interventions and guiding therapeutic interventions in patients with PFS. Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Sonographic evaluation of plantar fasciitis

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Yoon, Sook Ja; Choi, Yun Sun; Tien, Kuang Lung; Jung, Hye Jeon; Lee, Kyoung Tae; Yoon, Yong Kyu [Eulji College of Medicine Eulji Hospital, Seoul (Korea, Republic of)

1999-03-01

To evaluate the sonographic findings of plantar fasciitis. Both feet of 30 patients(mean age, 44years) in whom plantar fasciitis had been clinically diagnosed, and those of healthy volunteers(mean age, 34years) were evaluated with ultrasound(US) using a 7.0MHz linear array transducer. Heel pain was unilateral in 26 patients and bilateral in four. Sagittal sonograms were obtained in the prone position, and the thickness of the plantar fascia was measured at its proximal end near its insertion into the calcaneus. We also evaluated hypoechoic fascia, perifascial fluid collection, fiber rupture, calcaneal spur and calcifications. Plantar fascia thickness was significantly greater in the heels of patients with plantar fasciitis(3.2-8mm; mean, 5.1{+-}1.12) than in their asymptomatic heels(1.3-5mm; mean, 3.5{+-}0.78)(p<0.0001), in which it was similar to that of heels of patients in the control group(1.8-5mm; mean, 3.0{+-}0.71)(p<0.0001). The proximal plantar fascia was hypoechoic in 31 symptomatic heels(91.2%), in four asymptomatic heels(15.4%), and in none of the patients in the control group. Calcaneal spurs were identified in sixteen symptomatic heels(47.1%), and in two which were asymptomatic(7.7%). Perifascial fluid collection was identified in only two symptomatic heels(5.9%). In plantar fasciitis, sonography demonstrates that the fascia is thicker as well as hypoechic. For the clinical diagnosis of planter fasciitis, US can therefore be used as an adjunct to clinical diagnosis.

Sonographic evaluation of plantar fasciitis

International Nuclear Information System (INIS)

Yoon, Sook Ja; Choi, Yun Sun; Tien, Kuang Lung; Jung, Hye Jeon; Lee, Kyoung Tae; Yoon, Yong Kyu

1999-01-01

To evaluate the sonographic findings of plantar fasciitis. Both feet of 30 patients(mean age, 44years) in whom plantar fasciitis had been clinically diagnosed, and those of healthy volunteers(mean age, 34years) were evaluated with ultrasound(US) using a 7.0MHz linear array transducer. Heel pain was unilateral in 26 patients and bilateral in four. Sagittal sonograms were obtained in the prone position, and the thickness of the plantar fascia was measured at its proximal end near its insertion into the calcaneus. We also evaluated hypoechoic fascia, perifascial fluid collection, fiber rupture, calcaneal spur and calcifications. Plantar fascia thickness was significantly greater in the heels of patients with plantar fasciitis(3.2-8mm; mean, 5.1±1.12) than in their asymptomatic heels(1.3-5mm; mean, 3.5±0.78)(p<0.0001), in which it was similar to that of heels of patients in the control group(1.8-5mm; mean, 3.0±0.71)(p<0.0001). The proximal plantar fascia was hypoechoic in 31 symptomatic heels(91.2%), in four asymptomatic heels(15.4%), and in none of the patients in the control group. Calcaneal spurs were identified in sixteen symptomatic heels(47.1%), and in two which were asymptomatic(7.7%). Perifascial fluid collection was identified in only two symptomatic heels(5.9%). In plantar fasciitis, sonography demonstrates that the fascia is thicker as well as hypoechic. For the clinical diagnosis of planter fasciitis, US can therefore be used as an adjunct to clinical diagnosis

International scientific consensus on medical plantar pressure measurement devices: technical requirements and performance

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Claudia Giacomozzi

2012-01-01

Full Text Available BACKGROUND: Since 2006, the Italian National Institute of Health (ISS has been conducting independent scientific activities to standardize the technical assessment of plantar pressure measurement devices (PMDs. MATERIAL AND METHODS: On the basis of the ISS results, in 2010 the Pedobarographic Group of the International Foot and Ankle Biomechanics community (i-FAB-PG promoted a consensus activity about the main technical requirements for the appropriate use of PMDs. The activity relied on a moodlebased on-line forum, documents exchange, discussions, reviews, meetings and a final survey. RESULTS: The participation of clinical and technical researchers, users, and manufacturers, contributed to the delivery of the hereby reported recommendations which specifically regard Medical PMDs in the form of platforms. CONCLUSIONS: The i-FAB-PG community reached overall agreement on the recommendations, with a few minor objections which are reported and commented in the document. RELEVANCE: The present document, the highest result achievable within a small scientific community, will hopefully represent the starting point of the wider process of establishing official international guidelines or standards, within scientific communities and standardization organizations.

The Role of Pressure Offloading on Diabetic Foot Ulcer Healing and Prevention of Recurrence.

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Bus, Sicco A

2016-09-01

An increased plantar pressure is a causative factor in the development of plantar foot ulcers in people with diabetes mellitus, and ulcers are a precursor of lower extremity amputation. In this article, the evidence is reviewed that relieving areas of increased plantar pressure (ie, offloading) can heal plantar foot ulcers and prevent their recurrence. Noninfected, nonischemic neuropathic plantar forefoot ulcers should heal in 6 to 8 weeks with adequate offloading. Recent meta-analyses and systematic reviews show that nonremovable knee-high devices are most effective. This is probably because they eliminate the problem of nonadherence with the use of a removable device. Studies show a large discrepancy between evidence-based recommendations on offloading and what is used in clinical practice. Many clinics continue to use methods that are less effective or have not been proven to be effective, while ignoring evidence-based methods. Strategies are proposed to address this issue, notably the adoption and implementation of recent international guidelines by professional societies and a stronger focus of clinicians on expedited healing. For the prevention of plantar foot ulcer recurrence in high-risk patients, 2 recent trials have shown that the incidence of recurrence can be significantly reduced with custom-made footwear that has a demonstrated pressure-relieving effect through guidance by plantar pressure measurements, under the condition that the footwear is worn. This review helps to inform clinicians about effective offloading treatment for healing plantar foot ulcers and preventing their recurrence.

Potential Relationship between Passive Plantar Flexor Stiffness and Running Performance.

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Ueno, Hiromasa; Suga, Tadashi; Takao, Kenji; Tanaka, Takahiro; Misaki, Jun; Miyake, Yuto; Nagano, Akinori; Isaka, Tadao

2018-02-01

The present study aimed to determine the relationship between passive stiffness of the plantar flexors and running performance in endurance runners. Forty-eight well-trained male endurance runners and 24 untrained male control subjects participated in this study. Plantar flexor stiffness during passive dorsiflexion was calculated from the slope of the linear portion of the torque-angle curve. Of the endurance runners included in the present study, running economy in 28 endurance runners was evaluated by measuring energy cost during three 4-min trials (14, 16, and 18 km/h) of submaximal treadmill running. Passive stiffness of the plantar flexors was significantly higher in endurance runners than in untrained subjects. Moreover, passive plantar flexor stiffness in endurance runners was significantly correlated with a personal best 5000-m race time. Furthermore, passive plantar flexor stiffness in endurance runners was significantly correlated with energy cost during submaximal running at 16 km/h and 18 km/h, and a trend towards such significance was observed at 14 km/h. The present findings suggest that stiffer plantar flexors may help achieve better running performance, with greater running economy, in endurance runners. Therefore, in the clinical setting, passive stiffness of the plantar flexors may be a potential parameter for assessing running performance. © Georg Thieme Verlag KG Stuttgart · New York.

Tratamiento de necrosis plantar postsepsis neumocóccica con terapia V.A.C.® Treatment of post-pneumococcal plantar necrosis with VAC® therapy

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E. Guisantes

2011-12-01

Full Text Available La terapia VAC® es un dispositivo que favorece la curación de las heridas mediante un sistema cerrado que aplica presión negativa sobre el lecho. Este tratamiento favorece la cicatrización porque reduce el edema y el líquido intersticial, mejora la microcirculación, disminuye el riesgo de infección y favorece la granulación del tejido. Presentamos un caso clínico de un varón de 31 años con un defecto amplio plantar tras necrosis distal por sepsis neumocóccica. Tras 20 días de terapia VAC® la granulación fue adecuada y permitió la cobertura del defecto con un injerto de piel. La terapia VAC® es una opción útil para la reconstrucción de defectos plantares amplios de forma sencilla.VAC® Therapy is a device that lets promote wound healing through a closed system that applies negative pressure on the wound bed. This treatment promotes healing by reducing edema and interstitial fluid, improving microcirculation, reducing the risk of infection and promoting tissue granulation. We report the case of a 31 year old man with a large plantar defect due to distal necrosis after pneumococcal sepsis. After 20 days of VAC® therapy, the granulation was adequate and allowed the coverage of the defect with a skin graft. VAC® therapy is a useful and simple option for reconstruction of broad plantar defects.

The relationship between the flexible flatfoot and plantar fasciitis: ultrasonographic evaluation.

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Huang, Yu-Chi; Wang, Lin-Yi; Wang, Her-Cherng; Chang, Kai-Lan; Leong, Chau-Peng

2004-06-01

The purpose of this study was to investigate the relationship between flexible flatfoot and plantar fasciitis. Twenty-three subjects with flexible flatfoot and 23 subjects with normal arched feet were enrolled. Footprint analysis was used to evaluate the foot conditions in both groups to calculate the individual arch index. We compared the sonographic images of plantar fascia in the flexible flatfoot group with the normal arch group using high-frequency ultrasound. The analysis results indicated that the thickening of the plantar fascia in the flexible flatfoot group was significantly different from the normal arch group. In the flexible flatfoot group, 10 of 23 patients (43.4%) had plantar fasciitis, but only two subjects (8.7%) in the normal arch group had plantar fasciitis. There was a higher incidence of plantar fasciitis in the flexible flatfoot group than the normal arch control group in this study.

Sonographically guided deep plantar fascia injections: where does the injectate go?

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Maida, Eugene; Presley, James C; Murthy, Naveen; Pawlina, Wojciech; Smith, Jay

2013-08-01

To determine the distribution of sonographically guided deep plantar fascia injections in an unembalmed cadaveric model. A single experienced operator completed 10 sonographically guided deep plantar fascia injections in 10 unembalmed cadaveric specimens (5 right and 5 left) obtained from 6 donors (2 male and 4 female) aged 49 to 95 years (mean, 77.5 years) with a mean body mass index of 23.2 kg/m(2) (range, 18.4-26.3 kg/m(2)). A 12-3-MHz linear array transducer was used to direct a 22-gauge, 38-mm stainless steel needle deep to the plantar fascia at the anterior aspect of the calcaneus using an in-plane, medial-to-lateral approach. In each case, 1.5 mL of 50% diluted colored latex was injected deep to the plantar fascia. After a minimum of 72 hours, study coinvestigators dissected each specimen to assess injectate placement. All 10 injections accurately placed latex adjacent to the deep side of the plantar fascia at the anterior calcaneus. However, the flexor digitorum brevis (FDB) origin from the plantar fascia variably limited direct latex contact with the plantar fascia, and small amounts of latex interdigitated with the FDB origin in 90% (9 of 10). In all 10 specimens, latex also covered the traversing first branch of the lateral plantar nerve (FBLPN, ie, Baxter nerve) between the FDB and quadratus plantae muscles. No latex was found in the plantar fat pad or plantar fascia in any specimen. Sonographically guided deep plantar fascia injections reliably deliver latex deep to the plantar fascia while avoiding intrafascial injection. However, the extent of direct plantar fascia contact is variable due to the intervening FDB. On the contrary, the traversing FBLPN is reliably covered by the injection. Deep plantar fascia injections may have a role in the management of refractory plantar fasciitis, particularly following failed superficial perifascial or intrafascial injections, in cases of preferential deep plantar fascia involvement, or when entrapment

Applicability of contrast-enhanced ultrasound in the diagnosis of plantar fasciitis.

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Broholm, R; Pingel, J; Simonsen, L; Bülow, J; Johannsen, F

2017-12-01

Contrast-enhanced ultrasound (CEUS) is used to visualize the microvascularization in various tissues. The purpose of this study was to investigate whether CEUS could be used to visualize the microvascular volume (MV) in the plantar fascia, and to compare the method to clinical symptoms and B-mode ultrasound (US) in patients with plantar fasciitis (PF). Twenty patients with unilateral PF were included and were divided by US in insertional thickening (10), midsubstance thickening (5), and no US changes (5). The MV was measured simultaneously in both heels. Four areas in the plantar fascia and plantar fat pad were measured independently by two observers. Inter- and intra-observer correlation analyses were performed. The asymptomatic heels showed a constantly low MV, and for the whole group of patients, a significantly higher MV was found in the symptomatic plantar fascia and plantar fat pad. Inter-observer correlation as well as intra-observer agreement was excellent. The MV in the plantar fascia and plantar fat pad can be measured reliably using CEUS, suggesting that it is a reproducible method to examine patients with plantar fasciitis. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Effect of turf toe on foot contact pressures in professional American football players.

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Brophy, Robert H; Gamradt, Seth C; Ellis, Scott J; Barnes, Ronnie P; Rodeo, Scott A; Warren, Russell F; Hillstrom, Howard

2009-05-01

The relationship between turf toe and plantar foot pressures has not been extensively studied. Two hypotheses were tested in a cohort of professional American football players: first, that a history of turf toe is associated with increased peak hallucal and first metatarsophalangeal (MTP) plantar pressures; second, that decreased range of motion (ROM) of the first MTP correlates with increased peak hallucal and first MTP plantar pressures. Forty-four athletes from one National Football League (NFL) team were screened for a history of turf toe during preseason training. Dorsal passive MTP ROM and dynamic plantar pressures were measured in both feet of each player. Anatomical masking was used to assess peak pressure at the first MTP and hallux. First MTP dorsiflexion was significantly lower in halluces with a history of turf toe (40.6 +/- 15.1 degrees versus 48.4 +/- 12.8 degrees, p = 0.04). Peak hallucal pressures were higher in athletes with turf toe (535 +/- 288 kPa versus 414 +/- 202 kPa, p = 0.05) even after normalizing for athlete body mass index (p = 0.0003). Peak MTP pressure was not significantly different between the two groups tested. First MTP dorsiflexion did not correlate with peak hallucal or first MTP pressures. This study showed that turf toe is associated with decreased MTP motion. In addition, increased peak hallucal pressures were found. Further study is warranted to determine whether these pressures correlate with the severity of symptoms or progression of turf toe to first MTP arthritis.

Characteristics of the Foot Static Alignment and the Plantar Pressure Associated with Fifth Metatarsal Stress Fracture History in Male Soccer Players: a Case-Control Study.

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Matsuda, Sho; Fukubayashi, Toru; Hirose, Norikazu

2017-12-01

There is a large amount of information regarding risk factors for fifth metatarsal stress fractures; however, there are few studies involving large numbers of subjects. This study aimed to compare the static foot alignment and distribution of foot pressure of athletes with and without a history of fifth metatarsal stress fractures. The study participants comprised 335 collegiate male soccer players. Twenty-nine with a history of fifth metatarsal stress fractures were in the fracture group and 306 were in the control group (with subgroups as follows: 30 in the fracture foot group and 28 in the non-fracture group). We measured the foot length, arch height, weight-bearing leg-heel alignment, non-weight-bearing leg-heel alignment, forefoot angle relative to the rearfoot, forefoot angle relative to the horizontal axis, and foot pressure. The non-weight-bearing leg-heel alignment was significantly smaller and the forefoot angle relative to the rearfoot was significantly greater in the fracture foot group than in the control foot group (P = 0.049 and P = 0.038, respectively). With regard to plantar pressure, there were no significant differences among the groups. Midfield players had significantly higher rates of fifth metatarsal stress fracture in their histories, whereas defenders had significantly lower rates (chi-square = 13.2, P stress fractures according to the type of foot (kicking foot vs. pivoting foot) or the severity of ankle sprain. Playing the midfield position and having an everted rearfoot and inverted forefoot alignment were associated with fifth metatarsal stress fractures. This information may be helpful for preventing fifth metatarsal stress fracture recurrence. More detailed load evaluations and a prospective study are needed in the future.

Effectiveness of trigger point dry needling for plantar heel pain: study protocol for a randomised controlled trial

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Landorf Karl B

2011-01-01

Full Text Available Abstract Background Plantar heel pain (plantar fasciitis is a common and disabling condition, which has a detrimental impact on health-related quality of life. Despite the high prevalence of plantar heel pain, the optimal treatment for this disorder remains unclear. Consequently, an alternative therapy such as dry needling is increasingly being used as an adjunctive treatment by health practitioners. Only two trials have investigated the effectiveness of dry needling for plantar heel pain, however both trials were of a low methodological quality. This manuscript describes the design of a randomised controlled trial to evaluate the effectiveness of dry needling for plantar heel pain. Methods Eighty community-dwelling men and woman aged over 18 years with plantar heel pain (who satisfy the inclusion and exclusion criteria will be recruited. Eligible participants with plantar heel pain will be randomised to receive either one of two interventions, (i real dry needling or (ii sham dry needling. The protocol (including needling details and treatment regimen was formulated by general consensus (using the Delphi research method using 30 experts worldwide that commonly use dry needling for plantar heel pain. Primary outcome measures will be the pain subscale of the Foot Health Status Questionnaire and "first step" pain as measured on a visual analogue scale. The secondary outcome measures will be health related quality of life (assessed using the Short Form-36 questionnaire - Version Two and depression, anxiety and stress (assessed using the Depression, Anxiety and Stress Scale - short version. Primary outcome measures will be performed at baseline, 2, 4, 6 and 12 weeks and secondary outcome measures will be performed at baseline, 6 and 12 weeks. Data will be analysed using the intention to treat principle. Conclusion This study is the first randomised controlled trial to evaluate the effectiveness of dry needling for plantar heel pain. The trial will

Fascitis plantar

OpenAIRE

López Pérez, Diego

2014-01-01

La fascitis plantar (FP) es una de las causas más frecuentes de dolor en el pie, afectando al talón. Es un síndrome degenerativo de la fascia plantar que se produce como resultado de traumas repetidos en el origen de ésta, en el calcáneo, y es la causa más común de dolor en el talón en las personas adultas. Suele presentarse en atletas y corredores, aunque también aparece en la población general, afectando aproximadamente a un 10% en ambos casos. La función que desempeña la fascia es doble...

Acute Medial Plantar Fascia Tear.

Science.gov (United States)

Pascoe, Stephanie C; Mazzola, Timothy J

2016-06-01

A 32-year-old man who participated in competitive soccer came to physical therapy via direct access for a chief complaint of plantar foot pain. The clinical examination findings and mechanism of injury raised a concern for a plantar fascia tear, so the patient was referred to the physician and magnetic resonance imaging was obtained. The magnetic resonance image confirmed a high-grade, partial-thickness, proximal plantar fascia tear with localized edema at the location of the medial band. J Orthop Sports Phys Ther 2016;46(6):495. doi:10.2519/jospt.2016.0409.

Studies of experimental hosiery in diabetic neuropathic patients with high foot pressures.

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Veves, A; Masson, E A; Fernando, D J; Boulton, A J

1990-05-01

High plantar pressures and painless trauma are associated with the development of foot ulcers in diabetic patients. Padded hosiery has been reported to reduce plantar pressures in patients at risk of ulceration. Using the optical pedobarograph we have studied 10 patients who regularly wore experimental padded hosiery for 6 months. The hosiery continued to provide substantial and significant reduction in peak forefoot pressures at 3 months (mean reduction 15.5%, p less than 0.01) and 6 months (17.6%, p less than 0.01), although the level of reduction was less than that seen at baseline (31.3%, p less than 0.05). In addition, commercially available hosiery designed as sportswear has been tested, and compared with experimental hosiery. Although these socks (with high or medium density padding) provided significant pressure reduction versus barefoot (mean 17.4% and 10.4%, p less than 0.01), this was not as great as that seen with experimental hosiery (27%, p less than 0.05). Thus the use of socks designed to reduce pressure stress on diabetic neuropathic feet is effective, and continues to be so for a considerable period of time. Commercially available sports socks may also have a place in the management of the diabetic insensitive foot.

The influence of foot position on stretching of the plantar fascia.

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Flanigan, Ryan M; Nawoczenski, Deborah A; Chen, Linlin; Wu, Hulin; DiGiovanni, Benedict F

2007-07-01

A recent study found nonweightbearing stretching exercises specific to the plantar fascia to be superior to the standard program of weightbearing Achilles tendon-stretching exercises in patients with chronic plantar fasciitis. The present study used a cadaver model to demonstrate the influence of foot and ankle position on stretching of the plantar fascia. Twelve fresh-frozen lower-leg specimens were tested in 15 different configurations representing various combinations of ankle and metatarsophalangeal (MTP) joint dorsiflexion, midtarsal transverse plane abduction and adduction, and forefoot varus and valgus. Measurements were recorded by a differential variable reluctance transducer (DVRT) implanted into the medial band of the plantar fascia, and primary measurement was a percent deformation of the plantar fascia (stretch) with respect to a reference position (90 degrees ankle dorsiflexion, 0 degrees midtarsal and forefoot orientation, and 0 degrees MTP dorsiflexion). Ankle and MTP joint dorsiflexion produced a significant increase (14.91%) in stretch compared to the position of either ankle dorsiflexion alone (9.31% increase, p plantar fascia tissue-specific stretching exercises and lends support to the use of ankle and MTP joint dorsiflexion when employing stretching protocols for nonoperative treatment in patients with chronic proximal plantar fasciitis.

Differences in plantar loading between training shoes and racing flats at a self-selected running speed

NARCIS (Netherlands)

Wiegerinck, Johannes I.; Boyd, Jennifer; Yoder, Jordan C.; Abbey, Alicia N.; Nunley, James A.; Queen, Robin M.

2009-01-01

The purpose of this study was to examine the difference in plantar loading between two different running shoe types. We hypothesized that a higher maximum force, peak pressure, and contact area would exist beneath the entire foot while running in a racing flat when compared to a training shoe. 37

Long-term sensation in the medial plantar flap: a two-centre study.

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Trevatt, Alexander E J; Filobbos, George; Ul Haq, Ata; Khan, Umraz

2014-09-01

Reconstruction in the foot and ankle region is challenging. This study aimed to quantify objective sensation return when a sensate medial plantar flap is used for like-for-like reconstruction of foot and ankle defects. Two-point discrimination (2PD) was assessed in flap and normal tissue at a minimum of 1 year post-operatively. A paired T-test assessed for significance. 8 patients were included. Mean 2PD in normal tissue and flap was 29 mm (SD: 11.9) and 33 mm (SD: 9.97) respectively with no statistically significant difference between the two (two-tailed p-value: 0.1898). Mean age was 53.2 years (range: 15-84). There was no statistically significant correlation between age and 2PD in flap tissue (r=0.6, p=0.15). This is the largest case series of its kind. Our results suggest that sensation in medial plantar flaps can return to near normal and demonstrate the important role the medial plantar flap plays in soft tissue reconstruction in this region. Copyright © 2014 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Is There a Role for MRI in Plantar Heel Pain.

Science.gov (United States)

Fazal, Muhammad Ali; Tsekes, Demetris; Baloch, Irshad

2018-06-01

There is an increasing trend to investigate plantar heel pain with magnetic resonance imaging (MRI) scan though plantar fasciitis is the most common cause. The purpose of our study was to evaluate the role of MRI in patients presenting with plantar heel pain. Case notes and MRI scans of 141 patients with a clinical diagnosis of plantar fasciitis were reviewed retrospectively. There were 98 females and 43 males patients. Fourteen patients had bilateral symptoms. Average age for male patients was 51 years (range = 26-78 years), and for female patients the average age was 52 years (range = 29-76 years). A total of 121 feet had MRI features suggestive of plantar fasciitis. MRI was normal in 32 feet. There was one case of stress fracture of calcaneus and another of a heel fibroma diagnosed on MRI scan. In our study, MRI scan was normal in 20.7% of the cases; 1.3% had a diagnosis other than plantar fasciitis but no sinister pathology. We therefore conclude that MRI scan is not routinely indicated and key is careful clinical assessment. Therapeutic, Level IV: Retrospective, Case series.

Spontaneous distal rupture of the plantar fascia.

Science.gov (United States)

Gitto, Salvatore; Draghi, Ferdinando

2018-07-01

Spontaneous ruptures of the plantar fascia are uncommon injuries. They typically occur at its calcaneal insertion and usually represent a complication of plantar fasciitis and local treatment with steroid injections. In contrast, distal ruptures commonly result from traumatic injuries. We describe the case of a spontaneous distal rupture of the plantar fascia in a 48-year-old woman with a low level of physical activity and no history of direct injury to the foot, plantar fasciitis, or steroid injections. © 2017 Wiley Periodicals, Inc.

Incidence of plantar fascia ruptures following corticosteroid injection.

Science.gov (United States)

Kim, Chul; Cashdollar, Michael R; Mendicino, Robert W; Catanzariti, Alan R; Fuge, LaDonna

2010-12-01

Plantar fasciitis is commonly treated with corticosteroid injections to decrease pain and inflammation. Therapeutic benefits often vary in terms of efficacy and duration. Rupture of the plantar fascia has been reported as a possible complication following corticosteroid injection. A retrospective chart review of 120 patients who received corticosteroid injection for plantar fasciitis was performed at the authors' institution to determine the incidence of plantar fascia rupture. The plantar fascia rupture was diagnosed clinically and confirmed with magnetic resonance imaging. Various factors were analyzed, including the number of injections, interval between injections, body mass index (BMI), and activity level. Four patients (2.4%) consequently experienced plantar fascia rupture following an average of 2.67 injections. The average BMI of these patients was 38.6 kg/m². The authors conclude that corticosteroid injection therapy appears to be a safe and effective form of nonoperative treatment with minimal complications and a relatively low incident of plantar fascia rupture.

A Vibrotactile and Plantar Force Measurement-Based Biofeedback System: Paving the Way towards Wearable Balance-Improving Devices

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Christina Zong-Hao Ma

2015-12-01

Full Text Available Although biofeedback systems have been used to improve balance with success, they were confined to hospital training applications. Little attempt has been made to investigate the use of in-shoe plantar force measurement and wireless technology to turn hospital training biofeedback systems into wearable devices. This research developed a wearable biofeedback system which detects body sway by analyzing the plantar force and provides users with the corresponding haptic cues. The effects of this system were evaluated in thirty young and elderly subjects with simulated reduced foot sensation. Subjects performed a Romberg test under three conditions: (1 no socks, system turned-off; (2 wearing five layers of socks, system turned-off; (3 wearing five layers of socks, and system turned-on. Degree of body sway was investigated by computing the center of pressure (COP movement measured by a floor-mounted force platform. Plantar tactile sensation was evaluated using a monofilament test. Wearing multiple socks significantly decreased the plantar tactile sensory input (p < 0.05, and increased the COP parameters (p < 0.017, indicating increased postural sway. After turning on the biofeedback system, the COP parameters decreased significantly (p < 0.017. The positive results of this study should inspire future development of wearable plantar force-based biofeedback systems for improving balance in people with sensory deficits.

Does the thickening of Achilles tendon and plantar fascia contribute to the alteration of diabetic foot loading?

Science.gov (United States)

Giacomozzi, C; D'Ambrogi, E; Uccioli, L; Macellari, V

2005-06-01

The diabetic foot often undergoes abnormal plantar pressures, changing in walking strategy, ulcerative processes. The present study focuses on the effects that diabetes-induced alterations of Achilles tendon, plantar fascia and first metatarso-phalangeal joint-both anatomical and functional-may have on foot loading. Sixty-one diabetic patients, with or without neuropathy, and 21 healthy volunteers were recruited. Thickness of Achilles tendon and plantar fascia was measured by ultrasound. Flexion-extension of the first metatarso-phalangeal joint was measured passively. Main biomechanic parameters of foot-floor interaction during gait were acquired and related to the above measurements. Plantar fascia and Achilles tendon were significantly (Pplantar fascia, respectively, and 4.0 mm (0.5), 4.6 mm (1.0) and 4.9 mm (1.7) for Achilles tendon, respectively. Flexion-extension of the first metatarso-phalangeal joint was significantly (Pplantar fascia and Achilles tendon in diabetics, more evident in the presence of neuropathy, concurs to develop a rigid foot, which poorly absorbs shock during landing (performs the physiological impact force absorption during landing). More generally, an overall alteration of the foot-ankle complex motion likely occurs throughout the whole gait cycle, which partly explains the abnormal loading under the forefoot.

[Assessment of plantar fasciitis using shear wave elastography].

Science.gov (United States)

Zhang, Lining; Wan, Wenbo; Zhang, Lihai; Xiao, Hongyu; Luo, Yukun; Fei, Xiang; Zheng, Zhixin; Tang, Peifu

2014-02-01

To assess the stiffness and thickness of the plantar fascia using shear wave elastography (SWE) in healthy volunteers of different ages and in patients with plantar fasciitis. The bilateral feet of 30 healthy volunteers and 23 patients with plantar fasciitis were examined with SWE. The plantar fascia thickness and elasticity modulus value were measured at the insertion of the calcaneus and at 1 cm from the insertion. The elderly volunteers had a significantly greater plantar fascia thickness measured using conventional ultrasound (P=0.005) and a significantly lower elasticity modulus value than the young volunteers (P=0.000). The patients with fasciitis had a significantly greater plantar fascia thickness (P=0.001) and a lower elasticity modulus value than the elderly volunteers (P=0.000). The elasticity modulus value was significantly lower at the calcaneus insertion than at 1 cm from the insertion in patients with fasciitis (P=0.000) but showed no significantly difference between the two points in the elderly or young volunteers (P=0.172, P=0.126). SWE allows quantitative assessment of the stiffness of the plantar fascia, which decreases with aging and in patients with plantar fasciitis.

The Role of Pressure Offloading on Diabetic Foot Ulcer Healing and Prevention of Recurrence

NARCIS (Netherlands)

Bus, Sicco A.

2016-01-01

An increased plantar pressure is a causative factor in the development of plantar foot ulcers in people with diabetes mellitus, and ulcers are a precursor of lower extremity amputation. In this article, the evidence is reviewed that relieving areas of increased plantar pressure (ie, offloading) can

Effect of Gender on Mechanical Properties of the Plantar Fascia and Heel Fat Pad.

Science.gov (United States)

Taş, Serkan

2017-10-01

The purpose of the study was to investigate the plantar fascia and heel fat pad stiffness and thickness parameters in females and compare these values with those of males. This study was carried out in 60 healthy sedentary participants (30 female, 30 male) between the ages of 19 and 50 years. Shear wave velocity (SWV) and thickness of the plantar fascia and heel fat pad were measured with an ultrasonography device. Males had a higher plantar fascia ( P = .037) and heel fat pad ( P = .001) thickness compared with females, but SWV of the plantar fascia ( P = .673), heel fat pad microchamber layer ( P = .240), and heel fat pad macrochamber layer ( P = .636) were similar in both groups. Body mass had a strong correlation with the plantar fascia ( r = 0.64, P plantar fascia ( r = 0.44, P Plantar fascia and heel fat pad stiffness were similar in both genders; however, females had a lower plantar fascia and heel fat pad thickness compared with males. Correlation analysis results suggest that higher plantar fascia and heel fat pad thickness in males may be related to higher body mass and height. Level III, Retrospective comparative study.

[Study of the foot ground pressure pattern in children (author's transl)].

Science.gov (United States)

Huguenin, P; Themar-Noel, C; Bensahel, H

1981-01-01

The use of a new apparatus has enabled the authors to study the distribution to the ground of the plantar pressures by the way of ciphering each support area. This procedure is valuable and very precise as 500 pressure pick-up are used which give reliable, numerous and regularly distributed informations. The normal footprint has first been evaluated. Then, a comparison was possible with pathologic foot, so it was possible to estimate the result of a functional or surgical treatment on the morphology of the foot.

Getting to the heel of the problem: plantar fascia lesions

International Nuclear Information System (INIS)

Jeswani, T.; Morlese, J.; McNally, E.G.

2009-01-01

Heel pain is a frequent disabling symptom. Clinical diagnosis is often difficult with a large range of possible diagnoses. Lesions of the plantar fascia form an important group. We present a review describing the common lesions of the plantar fascia, including plantar fasciitis, plantar fascia rupture, plantar fibromatosis, and plantar xanthoma, and illustrate them with appropriate magnetic resonance imaging (MRI) and ultrasound imaging. We also address foreign-body reactions, enthesopathy, and diabetic fascial disease.

Getting to the heel of the problem: plantar fascia lesions

Energy Technology Data Exchange (ETDEWEB)

Jeswani, T. [Department of Radiology, Worthing and Southlands Hospitals, West Sussex (United Kingdom); Morlese, J. [Department of Radiology, Royal Free Hospital, Pond street, London, NW3 2QG (United Kingdom); McNally, E.G. [Department of Radiology, Nuffield Orthopaedic Centre, Oxford (United Kingdom)], E-mail: eugene.mcnally@gmail.com

2009-09-15

Heel pain is a frequent disabling symptom. Clinical diagnosis is often difficult with a large range of possible diagnoses. Lesions of the plantar fascia form an important group. We present a review describing the common lesions of the plantar fascia, including plantar fasciitis, plantar fascia rupture, plantar fibromatosis, and plantar xanthoma, and illustrate them with appropriate magnetic resonance imaging (MRI) and ultrasound imaging. We also address foreign-body reactions, enthesopathy, and diabetic fascial disease.

Getting to the heel of the problem: plantar fascia lesions.

Science.gov (United States)

Jeswani, T; Morlese, J; McNally, E G

2009-09-01

Heel pain is a frequent disabling symptom. Clinical diagnosis is often difficult with a large range of possible diagnoses. Lesions of the plantar fascia form an important group. We present a review describing the common lesions of the plantar fascia, including plantar fasciitis, plantar fascia rupture, plantar fibromatosis, and plantar xanthoma, and illustrate them with appropriate magnetic resonance imaging (MRI) and ultrasound imaging. We also address foreign-body reactions, enthesopathy, and diabetic fascial disease.

Management of plantar fasciitis in the outpatient setting

Science.gov (United States)

Lim, Ang Tee; How, Choon How; Tan, Benedict

2016-01-01

Plantar fasciitis is a very common cause of inferior heel pain that can be triggered and aggravated by prolonged standing, walking, running and obesity, among other factors. Treatments are largely noninvasive and efficacious. Supportive treatments, including the plantar fascia-specific stretch, calf stretching, appropriate orthotics and night dorsiflexion splinting, can alleviate plantar fascia pain. While local injections of corticosteroids can help with pain relief, the effects are short-lived and must be weighed against the risk of fat pad atrophy and plantar fascia rupture. Ultrasonography-guided focal extracorporeal shock wave therapy is useful for patients with chronic plantar fasciitis and referrals for this treatment can be made in recalcitrant cases. Activity modification to decrease cyclical repetitive loading of the plantar fascia should be advised during the treatment phase regardless of the chosen treatment modality. PMID:27075037

Targeting the Plantar Fascia for Corticosteroid Injection.

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Salvi, Andrea Emilio

2015-01-01

Plantar fasciitis is often a difficult condition to treat. It is related to repetitive strain of the fascia at its attachment to the heel bone. This condition quite often appears with the concomitant presence of a plantar calcaneal heel spur. Corticosteroid injection is a popular treatment choice for plantar fasciitis, and accurate localization of the injected medication is essential for successful resolution of symptoms after the injection. In the present brief technical communication, a method for targeting the attachment of the plantar fascia to the medial tubercle of the tuberosity of the calcaneus is described. The targeting method uses the lateral radiograph of the foot to aid in localization of the proximal attachment of the plantar fascia to the calcaneus. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Determinants of footwear difficulties in people with plantar heel pain.

Science.gov (United States)

Sullivan, Justin; Pappas, Evangelos; Adams, Roger; Crosbie, Jack; Burns, Joshua

2015-01-01

Plantar heel pain is a common foot disorder aggravated by weight-bearing activity. Despite considerable focus on therapeutic interventions such as orthoses, there has been limited investigation of footwear-related issues in people with plantar heel pain. The aim of this study was to investigate whether people with plantar heel pain experience footwear-related difficulties compared to asymptomatic individuals, as well as identifying factors associated with footwear comfort, fit and choice. The footwear domain of the Foot Health Status Questionnaire (FHSQ) was assessed in 192 people with plantar heel pain and 69 asymptomatic controls. The plantar heel pain group was also assessed on a variety of measures including: foot posture, foot strength and flexibility, pedobarography and pain level. A univariate analysis of covariance, with age as the covariate, was used to compare the heel pain and control groups on the FHSQ footwear domain score. A multiple regression model was then constructed to investigate factors associated with footwear scores among participants with plantar heel pain. When compared to asymptomatic participants, people with plantar heel pain reported lower FHSQ footwear domain scores (mean difference -24.4; p footwear scores were associated with maximum force beneath the postero-lateral heel during barefoot walking, toe flexor strength and gender. People with plantar heel pain experience difficulty with footwear comfort, fit and choice. Reduced heel loading during barefoot walking, toe flexor weakness and female gender are all independently associated with reports of footwear difficulties in people with heel pain. Increased focus, in both clinical and research settings, is needed to address footwear-related issues in people with plantar heel pain.

Prognostic Value of Diagnostic Sonography in Patients With Plantar Fasciitis.

Science.gov (United States)

Fleischer, Adam E; Albright, Rachel H; Crews, Ryan T; Kelil, Tatiana; Wrobel, James S

2015-10-01

The primary objective of this study was to determine whether the sonographic appearance of the plantar fascia is predictive of the treatment (ie, pain) response in patients receiving supportive therapy for proximal plantar fasciitis. This study was a secondary analysis of data obtained from a randomized controlled trial of ambulatory adults, which examined the efficacy of 3 different foot supports for plantar fasciitis. Participants underwent diagnostic sonographic examinations of their heel at baseline and again at 3 months by a single experienced foot and ankle surgeon. Quantitative (eg, thickness) and qualitative (eg, biconvexity) characteristics of the fascia were recorded according to a standard protocol. Logistic regression models were used to identify predictors of the pain response. Seventy patients completed a baseline evaluation, and 63 patients completed a 3-month follow-up assessment. The pain response was not associated with the type of foot support (P> .05). The only significant indicator of an unfavorable response in the univariate and multivariate analyses was biconvexity of the plantar fascia on sonography at presentation (multivariate odds ratio, 4.76 [95% confidence interval, 1.16-19.5; P= .030). Furthermore, changes in self-reported pain over the 3-month study period were not accompanied by alterations in plantar fascia thickness over this time (r = .056; P = .671). We conclude that patients who present with biconvexity of the plantar fascia may be less responsive to tier 1 treatment regimens that center around mechanical support of the plantar fascia. Furthermore, follow-up measurements of the fascia in this population should not weigh heavily in decisions such as return to play. © 2015 by the American Institute of Ultrasound in Medicine.

Depression, Anxiety, and Stress in People With and Without Plantar Heel Pain.

Science.gov (United States)

Cotchett, Matthew; Munteanu, Shannon E; Landorf, Karl B

2016-08-01

Depression, anxiety, and stress are prevalent in patients with musculoskeletal pain, but the impact of these emotional states has not been evaluated in people with plantar heel pain. The aim of this study was to evaluate the association between depression, anxiety, and stress with plantar heel pain. Forty-five participants with plantar heel pain were matched by sex and age (±2 years) to 45 participants without plantar heel pain. Levels of depression, anxiety, and stress were measured using the Depression, Anxiety and Stress Scale (short version) in participants with and without plantar heel pain. Logistic regression was conducted to determine if levels of depression, anxiety, or stress were associated with having plantar heel pain. Univariate analysis indicated that participants with plantar heel pain had greater levels of depression (mean difference = 4.4, 95% CI 2.3 to 6.5), anxiety (mean difference = 2.6, 95% CI 0.9 to 4.3), and stress (mean difference = 4.8, 95% CI 1.9 to 7.8). After adjusting for age, sex, BMI, and education, for every 1 unit increase in depression, anxiety, or stress (in the DASS subscales), the odds ratios for having plantar heel pain were increased by 1.3 (95% CI 1.1 to 1.6), 1.3 (95% CI 1.1 to 1.5), and 1.2 (95% CI 1.1 to 1.3), respectively. Symptoms of depression, anxiety, and stress were independently associated with plantar heel pain. Larger prospective studies are necessary to evaluate the temporal association between these emotional states and plantar heel pain. Level III, cross sectional, observational. © The Author(s) 2016.

Talalgia: plantar fasciitis

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Ricardo Cardenuto Ferreira

2014-06-01

Full Text Available Plantar fasciitis is a very common painful syndrome, but its exact etiology still remains obscure. The diagnosis is essentially clinical, based on history-taking and physical examination. Complementary laboratory tests and imaging examinations may be useful for differential diagnoses. The treatment is essentially conservative, with a high success rate (around 90%. The essence of the conservative treatment is the home-based program of exercises to stretch the plantar fascia. Indications for surgical treatment are only made when the symptoms persist without significant improvement, after at least six months of conservative treatment supervised directly by the doctor.

Talalgia: plantar fasciitis☆

Science.gov (United States)

Cardenuto Ferreira, Ricardo

2014-01-01

Plantar fasciitis is a very common painful syndrome, but its exact etiology still remains obscure. The diagnosis is essentially clinical, based on history-taking and physical examination. Complementary laboratory tests and imaging examinations may be useful for differential diagnoses. The treatment is essentially conservative, with a high success rate (around 90%). The essence of the conservative treatment is the home-based program of exercises to stretch the plantar fascia. Indications for surgical treatment are only made when the symptoms persist without significant improvement, after at least six months of conservative treatment supervised directly by the doctor. PMID:26229803

Plantar loading changes with alterations in foot strike patterns during a single session in habitual rear foot strike female runners.

Science.gov (United States)

Kernozek, Thomas W; Vannatta, Charles N; Gheidi, Naghmeh; Kraus, Sydnie; Aminaka, Naoko

2016-03-01

Characterize plantar loading parameters when habitually rear foot strike (RFS) runners change their pattern to a non-rear foot strike (NRFS). Experimental. University biomechanics laboratory. Twenty three healthy female runners (Age: 22.17 ± 1.64 yrs; Height: 168.91 ± 5.46 cm; Mass: 64.29 ± 7.11 kg). Plantar loading was measured using an in-sole pressure sensor while running down a 20-m runway restricted to a range of 3.52-3.89 m/s under two conditions, using the runner's typical RFS, and an adapted NRFS pattern. Repeated measures multivariate analysis of variance was performed to detect differences in loading between these two conditions. Force and pressure variables were greater in the forefoot and phalanx in NRFS and greater in the heel and mid foot in RFS pattern, but the total force imposed upon the whole foot and contact time remained similar between conditions. Total peak pressure was higher and contact area was lower during NRFS running. The primary finding of this investigation is that there are distinctly different plantar loads when changing from a RFS to NRFS during running. So, during a transition from RFS to a NRFS pattern; a period of acclimation should be considered to allow for adaptations to these novel loads incurred on plantar regions of the foot. Copyright © 2015 Elsevier Ltd. All rights reserved.

Compressive neuropathy of the first branch of the lateral plantar nerve: a study by magnetic resonance imaging

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Rogéria Nobre Rodrigues

2015-12-01

Full Text Available Abstract Objective: To assess the prevalence of isolated findings of abnormalities leading to entrapment of the lateral plantar nerve and respective branches in patients complaining of chronic heel pain, whose magnetic resonance imaging exams have showed complete selective fatty atrophy of the abductor digiti quinti muscle. Materials and Methods: Retrospective, analytical, and cross-sectional study. The authors selected magnetic resonance imaging of hindfoot of 90 patients with grade IV abductor digiti quinti muscle atrophy according to Goutallier and Bernageau classification. Patients presenting with minor degrees of fatty muscle degeneration (below grade IV and those who had been operated on for nerve decompression were excluded. Results: A female prevalence (78.8% was observed, and a strong correlation was found between fatty muscle atrophy and plantar fasciitis in 21.2%, and ankle varices, in 16.8% of the patients. Conclusion: Fatty atrophy of the abductor digiti quinti muscle is strongly associated with neuropathic alterations of the first branch of the lateral plantar nerve. The present study showed a significant association between plantar fasciitis and ankle varices with grade IV atrophy of the abductor digiti quinti muscle.

Ultrasound evaluation of a spontaneous plantar fascia rupture.

Science.gov (United States)

Louwers, Michael J; Sabb, Brian; Pangilinan, Percival H

2010-11-01

Plantar fascia rupture is an occasional complication in patients with chronic plantar fasciitis or in patients with plantar fasciitis treated with steroid injection. Very few cases of spontaneous plantar fascia rupture have been reported in the literature (Herrick and Herrick, Am J Sports Med 1983;11:95; Lun et al, Clin J Sports Med 1999;9:48-9; Rolf et al, J Foot Ankle Surg 1997;36:112-4; Saxena and Fullem, Am J Sports Med 2004;32:662-5). Spontaneous medial plantar fascia rupture in a 37-yr-old man with no preceding symptoms or steroid injections was confirmed with diagnostic ultrasound, which revealed severe fasciitis at the calcaneal insertion with partial tearing. After conservative treatment, the patient returned to full activities. We discuss the anatomy, risk factors, examination findings, and treatment for this condition, as well as the unique benefits that ultrasound offers over magnetic resonance imaging. It is important to consider plantar fascia rupture in patients with hindfoot pain and medioplantar ecchymosis, particularly if an injury occurred during acceleration maneuvers. Ultrasound in these cases can be used to diagnose a plantar fascia tear quickly, accurately, and cost-effectively.

Endoscopic plantar fascia release via a suprafascial approach is effective for intractable plantar fasciitis.

Science.gov (United States)

Miyamoto, Wataru; Yasui, Youichi; Miki, Shinya; Kawano, Hirotaka; Takao, Masato

2017-10-14

To evaluate the medium-term clinical results of endoscopic plantar fascia release (EPFR) using a suprafascial approach for recalcitrant plantar fasciitis. Twenty-four feet of twenty-three patients who underwent EPFR using a suprafascial approach were followed up for more than 2 years using the American Orthopedic Foot and Ankle Society (AOFAS) score. The AOFAS score at final follow-up was compared between patients who participated in athletic activity (group A) and those who were sedentary (group S) and between those with and those without calcaneal spur (group with CS and group without CS, respectively). The ability of patients to return to athletic activity, and if so, the time interval between surgery and return to athletic activity, were investigated in group A. Complications were recorded. The median follow-up duration was 48 months. The mean AOFAS score in all patients increased significantly between before surgery and final follow-up (P plantar nerve occurred in three feet. EPFR using a suprafascial approach was effective for recalcitrant plantar fasciitis. However, the prognosis of sedentary patients was inferior to that of patients engaged in athletic activity. IV.

Multiple linear regression approach for the analysis of the relationships between joints mobility and regional pressure-based parameters in the normal-arched foot.

Science.gov (United States)

Caravaggi, Paolo; Leardini, Alberto; Giacomozzi, Claudia

2016-10-03

Plantar load can be considered as a measure of the foot ability to transmit forces at the foot/ground, or foot/footwear interface during ambulatory activities via the lower limb kinematic chain. While morphological and functional measures have been shown to be correlated with plantar load, no exhaustive data are currently available on the possible relationships between range of motion of foot joints and plantar load regional parameters. Joints' kinematics from a validated multi-segmental foot model were recorded together with plantar pressure parameters in 21 normal-arched healthy subjects during three barefoot walking trials. Plantar pressure maps were divided into six anatomically-based regions of interest associated to corresponding foot segments. A stepwise multiple regression analysis was performed to determine the relationships between pressure-based parameters, joints range of motion and normalized walking speed (speed/subject height). Sagittal- and frontal-plane joint motion were those most correlated to plantar load. Foot joints' range of motion and normalized walking speed explained between 6% and 43% of the model variance (adjusted R 2 ) for pressure-based parameters. In general, those joints' presenting lower mobility during stance were associated to lower vertical force at forefoot and to larger mean and peak pressure at hindfoot and forefoot. Normalized walking speed was always positively correlated to mean and peak pressure at hindfoot and forefoot. While a large variance in plantar pressure data is still not accounted for by the present models, this study provides statistical corroboration of the close relationship between joint mobility and plantar pressure during stance in the normal healthy foot. Copyright © 2016 Elsevier Ltd. All rights reserved.

Percutaneous release of the plantar fascia. New surgical procedure.

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Oliva, Francesco; Piccirilli, Eleonora; Tarantino, Umberto; Maffulli, Nicola

2017-01-01

Plantar fasciopathy presents with pain at the plantar and medial aspect of the heel. If chronic, it can negatively impact on quality of life. Plantar fasciopathy is not always self-limiting, and can be debilitating. Surgical management involves different procedures. We describe a percutaneous plantar fascia release. A minimally invasive access to the plantar tuberosity of the calcaneus is performed, and a small scalpel blade is used to release the fascia. With this procedure, skin healing problems, nerve injuries, infection and prolonged recovery time are minimised, allowing early return to normal activities. V.

Ultrasound-assisted endoscopic partial plantar fascia release.

Science.gov (United States)

Ohuchi, Hiroshi; Ichikawa, Ken; Shinga, Kotaro; Hattori, Soichi; Yamada, Shin; Takahashi, Kazuhisa

2013-01-01

Various surgical treatment procedures for plantar fasciitis, such as open surgery, percutaneous release, and endoscopic surgery, exist. Skin trouble, nerve disturbance, infection, and persistent pain associated with prolonged recovery time are complications of open surgery. Endoscopic partial plantar fascia release offers the surgeon clear visualization of the anatomy at the surgical site. However, the primary medial portal and portal tract used for this technique have been shown to be in close proximity to the posterior tibial nerves and their branches, and there is always the risk of nerve damage by introducing the endoscope deep to the plantar fascia. By performing endoscopic partial plantar fascia release under ultrasound assistance, we could dynamically visualize the direction of the endoscope and instrument introduction, thus preventing nerve damage from inadvertent insertion deep to the fascia. Full-thickness release of the plantar fascia at the ideal position could also be confirmed under ultrasound imaging. We discuss the technique for this new procedure.

OA03.12. Herbal socks an effective medication against plantar hyperkeratosis

OpenAIRE

Geethadevi, C; Rajendran, R; Radhai, R

2013-01-01

Purpose: Plantar hyperkeratosis commonly called cracked heel is a common condition among adults. Causes for plantar hyperkeratosis are many and include genetic defects reflected in skin structure, allergic dermatoses, and paraneoplastic syndromes seen with particular forms of internal malignancy. Treatment for this condition could be possibly done using traditional herbs. The current study throws light on the cure of plantar hyperkeratosis using socks worn daily. Method: Solanum xanthocarpum ...

Development of an E-Health App for Lower Limb Postoperative Rehabilitation Based on Plantar Pressure Analysis

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Xiao Cheng

2018-05-01

Full Text Available The traditional postoperative rehabilitation training mode of lower limbs is mostly confined to hospitals or nursing sites. With the increase of postoperative patients, the current shortage of medical resources is obviously not satisfactory, and the medical costs are high, thus it is difficult to apply widely. A new mobile phone application (app based on plantar pressure analysis is developed to fulfill the requirements of remote postoperative rehabilitation. It is designed, implemented, tested, and used for pilot experiment in conjunction with the system design methodology of the waterfall model. Preliminary testing and a pilot experiment showed that the app has realized basic functions and can achieve patient rehabilitation out of hospitals. The development of the app can shorten the hospitalization time of patients, reduce medical costs, and make up for the current shortage of medical resources. In the future, more experiments will be done to verify the effectiveness of the app.

Subcalcaneal Bursitis With Plantar Fasciitis Treated by Arthroscopy

Science.gov (United States)

Yamakado, Kotaro

2013-01-01

We report the successful arthroscopic treatment of a case of subcalcaneal bursitis with plantar fasciitis. To our knowledge, this is the first report on arthroscopic excision of a subcalcaneal bursa. Right heel pain developed in a 50-year-old woman, without any obvious cause. She reported that the heel pain occurred immediately after waking and that the heel ached when she walked. Magnetic resonance imaging showed an extra-articular, homogeneous, high-intensity lesion in the fat pad adjacent to the calcaneal tubercle on T2-weighted sagittal and coronal images and thickening of the plantar fascia on T2-weighted sagittal images. A diagnosis of a recalcitrant subcalcaneal bursitis with plantar fasciitis was made, and surgery was performed. The arthroscope was placed between the calcaneus and the plantar fascia. With the surgeon viewing from the lateral portal and working from the medial portal, the dorsal surface of the degenerative plantar fascia was debrided and the medial half of the plantar fascia was released, followed by debridement of the subcalcaneal bursal cavity through the incised plantar fascia. Full weight bearing and gait were allowed immediately after the operation. At the latest follow-up, the patient had achieved complete resolution of heel pain without a recurrence of the mass, confirmed by magnetic resonance imaging. PMID:23875139

Plantar Fascia Rupture: Ultrasound to Facilitate Recognition.

Science.gov (United States)

Servey, Jessica T; Jonas, Christopher

2018-01-01

Plantar fascia rupture in the absence of previous diagnosis of plantar fasciitis, corticosteroid injection, or injury is a rare occurrence with only 7 case reports in the literature since 1978. This is a case of spontaneous plantar fascia rupture in a 38-year-old active-duty US military member with current considerations in musculoskeletal ultrasound, other radiologic imaging, treatment, and followup of this diagnosis. © Copyright 2018 by the American Board of Family Medicine.

Calcaneal attachment of the plantar fascia: MR findings in asymptomatic volunteers.

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Ehrmann, Christine; Maier, Matthias; Mengiardi, Bernard; Pfirrmann, Christian W A; Sutter, Reto

2014-09-01

To determine the spectrum of magnetic resonance (MR) imaging findings at the calcaneal attachment of the plantar fascia in asymptomatic volunteers. The study was approved by the institutional review board, and informed consent was obtained from all subjects. MR imaging was performed in 77 asymptomatic volunteers (mean age, 48.0 years; age range, 23-83 years) with use of a 1.5-T system. There were 40 women (mean age, 49.0 years; age range, 24-83 years) and 37 men (mean age, 48.0 years; age range, 23-83 years). Signal intensity characteristics and thickness of the medial, central, and lateral fascicles of the plantar fascia were assessed independently by two radiologists. The presence of soft-tissue edema, bone marrow edema, and bone spur formation at the attachment of the plantar fascia was noted. Datasets were analyzed with inferential statistic procedures. The mean thickness of the plantar fascia was 0.6 mm (medial fascicle), 4.0 mm (central fascicle), and 2.3 mm (lateral fascicle). Increased signal intensity in the plantar fascia was seen with the T1-weighted sequence in 16 of the 77 volunteers (21%), the T2-weighted sequence in six (7.8%), and the short inversion time inversion-recovery sequence in six (7.8%). Soft-tissue edema was seen deep to the plantar fascia in five of the 77 volunteers (6.5%) and superficial to the plantar fascia in 16 (21%). A calcaneal spur was detected in 15 of the 77 volunteers (19%). Calcaneal bone marrow edema was present in four volunteers (5.2%). T1-weighted signal intensity changes in the plantar fascia, soft-tissue edema superficial to the plantar fascia, and calcaneal spurs are common findings in asymptomatic volunteers and should be used with caution in the diagnosis of plantar fasciitis. Increased signal intensity within the plantar fascia with fluid-sensitive sequences is uncommon in asymptomatic volunteers.

Fascitis plantar

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Dinorah Artidiello Bustio

2015-04-01

Full Text Available Introducción: la fascitis plantar es la inflamación del tejido denso que ocupa la parte anterior del tubérculo interno del calcáneo y constituye la causa más frecuente de dolor en la planta de los pies y dificulta en gran medida el desempeño laboral del individuo. Objetivo: caracterizar la fascitis plantar en pacientes asistidos en los servicios del Hospital General Docente "Abel Santamaría Cuadrado" en Pinar del Río. Material y método: estudio descriptivo, longitudinal y aplicado en el Departamento de Medicina Física y Rehabilitación del Hospital "Abel Santamaría Cuadrado", en el periodo comprendido desde abril del 2013 hasta abril del 2014, a los pacientes con diagnóstico de fascitis plantar. El universo coincidió con la muestra (60 pacientes. Resultados: de la muestra distribuida según ocupación laboral, 53 permanecen el mayor tiempo de pie, siendo el sexo femenino más predominante que el masculino y la edad promedio más afectada es de 40 a 49 años. El 70,0% de los pacientes mostraron dolor en las categorías de moderado a severo. Conclusiones: el sobrepeso y la obesidad crean un estrés adicional. Otro de los factores a considerar, son las neuropatías, el abuso del alcohol y el factor hereditario.

Finite element analysis of plantar fascia during walking: a quasi-static simulation.

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Chen, Yen-Nien; Chang, Chih-Wei; Li, Chun-Ting; Chang, Chih-Han; Lin, Cheng-Feng

2015-01-01

The plantar fascia is a primary arch supporting structure of the foot and is often stressed with high tension during ambulation. When the loading on the plantar fascia exceeds its capacity, the inflammatory reaction known as plantar fasciitis may occur. Mechanical overload has been identified as the primary causative factor of plantar fasciitis. However, a knowledge gap exists between how the internal mechanical responses of the plantar fascia react to simple daily activities. Therefore, this study investigated the biomechanical responses of the plantar fascia during loaded stance phase by use of the finite element (FE) modeling. A 3-dimensional (3-D) FE foot model comprising bones, cartilage, ligaments, and a complex-shaped plantar fascia was constructed. During the stance phase, the kinematics of the foot movement was reproduced and Achilles tendon force was applied to the insertion site on the calcaneus. All the calculations were made on a single healthy subject. The results indicated that the plantar fascia underwent peak tension at preswing (83.3% of the stance phase) at approximately 493 N (0.7 body weight). Stress concentrated near the medial calcaneal tubercle. The peak von Mises stress of the fascia increased 2.3 times between the midstance and preswing. The fascia tension increased 66% because of the windlass mechanism. Because of the membrane element used in the ligament tissue, this FE model was able to simulate the mechanical structure of the foot. After prescribing kinematics of the distal tibia, the proposed model indicated the internal fascia was stressed in response to the loaded stance phase. Based on the findings of this study, adjustment of gait pattern to reduce heel rise and Achilles tendon force may lower the fascia loading and may further reduce pain in patients with plantar fasciitis. © The Author(s) 2014.

Finite element modelling of Plantar Fascia response during running on different surface types

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Razak, A. H. A.; Basaruddin, K. S.; Salleh, A. F.; Rusli, W. M. R.; Hashim, M. S. M.; Daud, R.

2017-10-01

Plantar fascia is a ligament found in human foot structure located beneath the skin of human foot that functioning to stabilize longitudinal arch of human foot during standing and normal gait. To perform direct experiment on plantar fascia seems very difficult since the structure located underneath the soft tissue. The aim of this study is to develop a finite element (FE) model of foot with plantar fascia and investigate the effect of the surface hardness on biomechanical response of plantar fascia during running. The plantar fascia model was developed using Solidworks 2015 according to the bone structure of foot model that was obtained from Turbosquid database. Boundary conditions were set out based on the data obtained from experiment of ground reaction force response during running on different surface hardness. The finite element analysis was performed using Ansys 14. The results found that the peak of stress and strain distribution were occur on the insertion of plantar fascia to bone especially on calcaneal area. Plantar fascia became stiffer with increment of Young’s modulus value and was able to resist more loads. Strain of plantar fascia was decreased when Young’s modulus increased with the same amount of loading.

Differences Between Men and Women in Balance and Tremor in Relation to Plantar Fascia Laxity During the Menstrual Cycle.

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Lee, Haneul; Petrofsky, Jerrold

2018-03-01

  Although much attention has been paid to the effect of estrogen on the knee ligaments, little has been done to examine the ligaments in the foot, such as the plantar fascia, and how they may be altered during the menstrual cycle.   To (1) examine sex differences in plantar fascia thickness and laxity and postural sway and (2) identify any menstrual cycle effects on plantar fascia laxity, postural sway, and neuromuscular tremor between menstruation and the ovulation phase.   Case-control study.   Research laboratory.   Fifteen healthy women (age = 25.9 ± 1.8 years) and 15 healthy men (age = 27.3 ± 2.0 years) volunteered to participate in this study.   We asked participants to perform 8 balance tasks on a force platform while we assessed postural sway and tremor.   Plantar fascia length and thickness unloaded and loaded with body weight were measured via ultrasound. Postural sway and tremor were measured using a force platform.   Plantar fascia length and thickness with pressure were greater in ovulating women compared with men ( P women during menstruation and men. Postural sway and tremor were greater at ovulation than during menstruation ( P men had less sway than ovulating women on the 3 most difficult balance tasks ( P women. Postural sway and tremor in men were the same as in women during menstruation. These findings support the need to be aware of the effect of sex hormones on balance to prevent lower extremity injuries during sport activities.

Effects of plantar fascia stiffness on the biomechanical responses of the ankle-foot complex.

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Cheung, Jason Tak-Man; Zhang, Ming; An, Kai-Nan

2004-10-01

The plantar fascia is one of the major stabilizing structures of the longitudinal arch of human foot, especially during midstance of the gait cycle. Knowledge of its functional biomechanics is important for establishing the biomechanical rationale behind different rehabilitation, orthotic and surgical treatment of plantar fasciitis. This study aims at quantifying the biomechanical responses of the ankle-foot complex with different plantar fascia stiffness. A geometrical detailed three-dimensional finite element model of the human foot and ankle, incorporating geometric and contact nonlinearities was constructed by 3D reconstruction of MR images. A sensitivity study was conducted to evaluate the effects of varying elastic modulus (0-700 MPa) of the plantar fascia on the stress/strain distribution of the bony, ligamentous and encapsulated soft tissue structures. The results showed that decreasing the Young's modulus of plantar fascia would increase the strains of the long and short plantar and spring ligaments significantly. With zero fascia Young's modulus to simulate the plantar fascia release, there was a shift in peak von Mises stresses from the third to the second metatarsal bones and increased stresses at the plantar ligament attachment area of the cuboid bone. Decrease in arch height and midfoot pronation were predicted but did not lead to the total collapse of foot arch. Surgical dissection of the plantar fascia may induce excessive strains or stresses in the ligamentous and bony structures. Surgical release of plantar fascia should be well-planned to minimise the effect on its structural integrity to reduce the risk of developing arch instability and subsequent painful foot syndrome.

A Vibrotactile and Plantar Force Measurement-Based Biofeedback System: Paving the Way towards Wearable Balance-Improving Devices.

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Ma, Christina Zong-Hao; Wan, Anson Hong-Ping; Wong, Duo Wai-Chi; Zheng, Yong-Ping; Lee, Winson Chiu-Chun

2015-12-15

Although biofeedback systems have been used to improve balance with success, they were confined to hospital training applications. Little attempt has been made to investigate the use of in-shoe plantar force measurement and wireless technology to turn hospital training biofeedback systems into wearable devices. This research developed a wearable biofeedback system which detects body sway by analyzing the plantar force and provides users with the corresponding haptic cues. The effects of this system were evaluated in thirty young and elderly subjects with simulated reduced foot sensation. Subjects performed a Romberg test under three conditions: (1) no socks, system turned-off; (2) wearing five layers of socks, system turned-off; (3) wearing five layers of socks, and system turned-on. Degree of body sway was investigated by computing the center of pressure (COP) movement measured by a floor-mounted force platform. Plantar tactile sensation was evaluated using a monofilament test. Wearing multiple socks significantly decreased the plantar tactile sensory input (p biofeedback system, the COP parameters decreased significantly (p biofeedback systems for improving balance in people with sensory deficits.

A Review in Detection and Monitoring Gait Disorders Using In-Shoe Plantar Measurement Systems.

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Ramirez-Bautista, Julian Andres; Huerta-Ruelas, Jorge Adalberto; Chaparro-Cardenas, Silvia Liliana; Hernandez-Zavala, Antonio

2017-01-01

Gait is an important part of our life, as it affects many daily activities. Special footwear is fundamental to obtain an ergonomic gait and to extract data for analysis. The plantar foot pressure can be employed to detect many kinds of disorders, suggest improvements in treatments, rehabilitation tasks, patient monitoring, development of orthopedic devices, and other applications. In recent years, attention to this topic has grown and is reflected in many works issued in both commercial and academic groups, and has focused on the development of devices for foot plantar pressure measurement with applications in medicine, sports, and research. First works on this subject appeared around 1963 and have continuously evolved with emerging technologies. This paper reviews the reported developments in the field of footwear-embedded sensors for gait measurement, monitoring, diagnosis, and analysis in rehabilitation. Future work is proposed to improve the field of measurement of the footprint with electronic devices.

Magnetic resonance imaging of plantar aponeurosis lesions

International Nuclear Information System (INIS)

Roger, B.; Christel, P.; Poux, D.

1987-01-01

Exploration of sporting injuries to plantar aponeurosis (PA) has up to now been based mainly on clinical examination, from which the diagnosis was established. Imaging technics such as standard radiography and ultrasound scanning have limitations allowing diagnosis to be made usually only by elimination, the lesion being very rarely visualized directly. Ten patients with hyperalgic lesion of plantar arch and functional impotence were explored by MR imaging, and in all cases this examination provided superior data confirmed at operation. The examination is painless and little invasive and can be carried out during the acute phase. The plantar aponeurosis is visualized directly between the muscle mass of the plantar arch and the fatty cushion. All three spatial planes can be investigated, most interesting data being obtained from the sagittal (in the PA axis) and frontal (comparative) planes [fr

Foot kinematics in patients with two patterns of pathological plantar hyperkeratosis

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Bowker Peter

2011-02-01

Full Text Available Abstract Background The Root paradigm of foot function continues to underpin the majority of clinical foot biomechanics practice and foot orthotic therapy. There are great number of assumptions in this popular paradigm, most of which have not been thoroughly tested. One component supposes that patterns of plantar pressure and associated hyperkeratosis lesions should be associated with distinct rearfoot, mid foot, first metatarsal and hallux kinematic patterns. Our aim was to investigate the extent to which this was true. Methods Twenty-seven subjects with planter pathological hyperkeratosis were recruited into one of two groups. Group 1 displayed pathological plantar hyperkeratosis only under metatarsal heads 2, 3 and 4 (n = 14. Group 2 displayed pathological plantar hyperkeratosis only under the 1st and 5th metatarsal heads (n = 13. Foot kinematics were measured using reflective markers on the leg, heel, midfoot, first metatarsal and hallux. Results The kinematic data failed to identify distinct differences between these two groups of subjects, however there were several subtle (generally Conclusions There was some evidence of small differences between planter pathological hyperkeratosis groups. Nevertheless, there was too much similarity between the kinematic data displayed in each group to classify them as distinct foot types as the current clinical paradigm proposes.

Plantar fascia evaluation with a dedicated magnetic resonance scanner in weight-bearing position: our experience in patients with plantar fasciitis and in healthy volunteers.

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Sutera, R; Iovane, A; Sorrentino, F; Candela, F; Mularo, V; La Tona, G; Midiri, M

2010-03-01

This study assessed the usefulness of upright weight-bearing examination of the ankle/hind foot performed with a dedicated magnetic resonance (MR) imaging scanner in the evaluation of the plantar fascia in healthy volunteers and in patients with clinical evidence of plantar fasciitis. Between January and March 2009, 20 patients with clinical evidence of plantar fasciitis (group A) and a similar number of healthy volunteers (group B) underwent MR imaging of the ankle/hind foot in the upright weight-bearing and conventional supine position. A 0.25-Tesla MR scanner (G-Scan, Esaote SpA, Genoa, Italy) was used with a dedicated receiving coil for the ankle/hind foot. Three radiologists, blinded to patients' history and clinical findings, assessed in consensus morphological and dimensional changes and signal intensity alterations on images acquired in both positions, in different sequences and in different planes. In group A, MR imaging confirmed the diagnosis in 15/20 cases; in 4/15 cases, a partial tear of the plantar fascia was identified in the upright weight-bearing position alone. In the remaining 5/20 cases in group A and in all cases in group B, the plantar fascia showed no abnormal signal intensity. Because of the increased stretching of the plantar fascia, in all cases in group A and B, thickness in the proximal third was significantly reduced (pplantar fascia, which could be overlooked in the supine position.

A preliminary study of patient-specific mechanical properties of diabetic and healthy plantar soft tissue from gated magnetic resonance imaging.

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Williams, Evan D; Stebbins, Michael J; Cavanagh, Peter R; Haynor, David R; Chu, Baocheng; Fassbind, Michael J; Isvilanonda, Vara; Ledoux, William R

2017-07-01

Foot loading rate, load magnitude, and the presence of diseases such as diabetes can all affect the mechanical properties of the plantar soft tissues of the human foot. The hydraulic plantar soft tissue reducer instrument was designed to gain insight into which variables are the most significant in determining these properties. It was used with gated magnetic resonance imaging to capture three-dimensional images of feet under dynamic loading conditions. Custom electronics controlled by LabVIEW software simultaneously recorded system pressure, which was then translated to applied force values based on calibration curves. Data were collected for two subjects, one without diabetes (Subject A) and one with diabetes (Subject B). For a 0.2-Hz loading rate, and strains 0.16, 0.18, 0.20, and 0.22, Subject A's average tangential heel pad stiffness was 10 N/mm and Subject B's was 24 N/mm. Maximum test loads were approximately 200 N. Loading rate and load magnitude limitations (both were lower than physiologic values) will continue to be addressed in the next version of the instrument. However, the current hydraulic plantar soft tissue reducer did produce a data set for healthy versus diabetic tissue stiffness that agrees with previous trends. These data are also being used to improve finite element analysis models of the foot as part of a related project.

Plantar tendons of the foot: MR imaging and US.

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Donovan, Andrea; Rosenberg, Zehava Sadka; Bencardino, Jenny T; Velez, Zoraida Restrepo; Blonder, David B; Ciavarra, Gina A; Adler, Ronald Steven

2013-01-01

Tendon disorders along the plantar aspect of the foot may lead to significant symptoms but are often clinically misdiagnosed. Familiarity with the normal anatomy of the plantar tendons and its appearance at magnetic resonance (MR) imaging and ultrasonography (US) is essential for recognizing plantar tendon disorders. At MR imaging, the course of the plantar tendons is optimally visualized with dedicated imaging of the midfoot and forefoot. This imaging should include short-axis images obtained perpendicular to the long axis of the metatarsal shafts, which allows true cross-sectional evaluation of the plantar tendons. Normal plantar tendons appear as low-signal-intensity structures with all MR sequences. At US, accurate evaluation of the tendons requires that the ultrasound beam be perpendicular to the tendon. The normal tendon appears as a compact linear band of echogenic tissue that contains a fine, mixed hypoechoic and hyperechoic internal fibrillar pattern. Tendon injuries can be grouped into six major categories: tendinosis, peritendinosis, tenosynovitis, entrapment, rupture, and instability (subluxation or dislocation) and can be well assessed with both MR imaging and US. The radiologist plays an important role in the diagnosis of plantar tendon disorders, and recognizing their imaging appearances at MR imaging and US is essential.

Modified uniportal endoscopic plantar fasciotomy: a technical report.

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Angthong, Chayanin; Charoenthamruksa, Chatchavan; Chumchuen, Sukanis; Kanitnate, Supakit; Khadsongkram, Anuwat; Angthong, Wirana

2012-10-01

Several authors have reported the benefits of the recent procedure of the dual portal endoscopic plantar fasciotomy (EPF). However, very little is known concerning its potential capability via the single portal EPF without special cutting device. The present study aimed to demonstrate the effectiveness of uniportal EPF in a patient with severe intractable plantar fasciitis following a failure of several conservative treatments. The recent technique; uniportal EPF under modified method, without a special cutting device, was reviewed in an effort to improve its capability for plantar release and to provide information for the avoidance of this procedure's complications. A patient, with the recalcitrant conditions and the progression of the severe plantar fasciitis of bilateral feet after a failure of the conservative treatments for 13-month period, was included in this report. All data of the preoperative and each successive postoperative period (1, 6 months and last follow-up) were prospectively collected including American Orthopedic Foot and Ankle Society (AOFAS) score, Visual Analogue Scale-Foot and Ankle (VAS-FA) score and any related complications. The operations were carried out by a single surgeon with the modified uniportal EPF via a simple hooked soft-tissue blade, without a special cutting device, on both feet simultaneously. All feet had uniportal EPF with transection of the medial 50% of the plantar fascia. Postoperatively, a patient was instructed to have partial-weight bearing for the first 2 weeks with wearing of full-length silicone insoles. Then, she is allowed to start to fully weightbear with the insoles. She is advised to cautiously return to daily activities and works at 2nd week after the operation. In regard to the EPF in two feet, there were clearly improvements in the comparison between preoperative and last follow-up period in terms of the increasing AOFAS scores, and VAS-FA scores. There were no significant iatrogenic-related complications

Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers.

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Tang, Ulla Hellstrand; Zügner, Roland; Lisovskaja, Vera; Karlsson, Jon; Hagberg, Kerstin; Tranberg, Roy

2015-01-01

Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP) and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and high plantar pressure. Patients diagnosed with type 1 (n=27) or type 2 (n=47) diabetes (mean age 60.0±15.0 years) were included in this cross-sectional study. Assessments included the registration of foot deformities; test of gross function at the hip, knee, and ankle joints; a stratification of the risk of developing foot ulcers according to the Swedish National Diabetes Register; a walking test; and self-reported questionnaires including the SF-36 health survey. In-shoe PP was measured in seven regions of interests on the sole of the foot using F-Scan(®). An exploratory analysis of the association of risk factors with PP was performed. Neuropathy was present in 28 (38%), and 39 (53%) had callosities in the heel region. Low forefoot arch was present in 57 (77%). Gait-related parameters, such as the ability to walk on the forefoot or heel, were normal in all patients. Eighty percent had normal function at the hip and ankle joints. Gait velocity was 1.2±0.2 m/s. All patients were stratified to risk group 3. Hallux valgus and hallux rigidus were associated with an increase in the PP in the medial forefoot. A higher body mass index (BMI) was found to increase the PP at metatarsal heads 4 and 5. Pes planus was associated with a decrease in PP at metatarsal head 1. Neuropathy did not have a high association with PP. This study identified several potential risk factors for the onset of diabetic foot ulcers (DFU). Hallux valgus and hallux rigidus appeared to increase the PP under the medial

Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers

Directory of Open Access Journals (Sweden)

Ulla Hellstrand Tang

2015-06-01

Full Text Available Objective: Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and high plantar pressure. Patients and methods: Patients diagnosed with type 1 (n=27 or type 2 (n=47 diabetes (mean age 60.0±15.0 years were included in this cross-sectional study. Assessments included the registration of foot deformities; test of gross function at the hip, knee, and ankle joints; a stratification of the risk of developing foot ulcers according to the Swedish National Diabetes Register; a walking test; and self-reported questionnaires including the SF-36 health survey. In-shoe PP was measured in seven regions of interests on the sole of the foot using F-Scan®. An exploratory analysis of the association of risk factors with PP was performed. Results: Neuropathy was present in 28 (38%, and 39 (53% had callosities in the heel region. Low forefoot arch was present in 57 (77%. Gait-related parameters, such as the ability to walk on the forefoot or heel, were normal in all patients. Eighty percent had normal function at the hip and ankle joints. Gait velocity was 1.2±0.2 m/s. All patients were stratified to risk group 3. Hallux valgus and hallux rigidus were associated with an increase in the PP in the medial forefoot. A higher body mass index (BMI was found to increase the PP at metatarsal heads 4 and 5. Pes planus was associated with a decrease in PP at metatarsal head 1. Neuropathy did not have a high association with PP. Conclusions: This study identified several potential risk factors for the onset of diabetic foot ulcers (DFU. Hallux valgus

Diagnostic imaging for chronic plantar heel pain: a systematic review and meta-analysis

Science.gov (United States)

2009-01-01

Background Chronic plantar heel pain (CPHP) is a generalised term used to describe a range of undifferentiated conditions affecting the plantar heel. Plantar fasciitis is reported as the most common cause and the terms are frequently used interchangeably in the literature. Diagnostic imaging has been used by many researchers and practitioners to investigate the involvement of specific anatomical structures in CPHP. These observations help to explain the underlying pathology of the disorder, and are of benefit in forming an accurate diagnosis and targeted treatment plan. The purpose of this systematic review was to investigate the diagnostic imaging features associated with CPHP, and evaluate study findings by meta-analysis where appropriate. Methods Bibliographic databases including Medline, Embase, CINAHL, SportDiscus and The Cochrane Library were searched electronically on March 25, 2009. Eligible articles were required to report imaging findings in participants with CPHP unrelated to inflammatory arthritis, and to compare these findings with a control group. Methodological quality was evaluated by use of the Quality Index as described by Downs and Black. Meta-analysis of study data was conducted where appropriate. Results Plantar fascia thickness as measured by ultrasonography was the most widely reported imaging feature. Meta-analysis revealed that the plantar fascia of CPHP participants was 2.16 mm thicker than control participants (95% CI = 1.60 to 2.71 mm, P plantar fascia thickness values greater than 4.0 mm (OR = 105.11, 95% CI = 3.09 to 3577.28, P = 0.01). CPHP participants were also more likely to show radiographic evidence of subcalcaneal spur than control participants (OR = 8.52, 95% CI = 4.08 to 17.77, P plantar fascia and inferior calcaneum in people with CPHP. Analysis of these studies found that people with CPHP are likely to have a thickened plantar fascia with associated fluid collection, and that thickness values >4.0 mm are diagnostic of

In-shoe plantar tri-axial stress profiles during maximum-effort cutting maneuvers.

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Cong, Yan; Lam, Wing Kai; Cheung, Jason Tak-Man; Zhang, Ming

2014-12-18

Soft tissue injuries, such as anterior cruciate ligament rupture, ankle sprain and foot skin problems, frequently occur during cutting maneuvers. These injuries are often regarded as associated with abnormal joint torque and interfacial friction caused by excessive external and in-shoe shear forces. This study simultaneously investigated the dynamic in-shoe localized plantar pressure and shear stress during lateral shuffling and 45° sidestep cutting maneuvers. Tri-axial force transducers were affixed at the first and second metatarsal heads, lateral forefoot, and heel regions in the midsole of a basketball shoe. Seventeen basketball players executed both cutting maneuvers with maximum efforts. Lateral shuffling cutting had a larger mediolateral braking force than 45° sidestep cutting. This large braking force was concentrated at the first metatarsal head, as indicated by its maximum medial shear stress (312.2 ± 157.0 kPa). During propulsion phase, peak shear stress occurred at the second metatarsal head (271.3 ± 124.3 kPa). Compared with lateral shuffling cutting, 45° sidestep cutting produced larger peak propulsion shear stress (463.0 ± 272.6 kPa) but smaller peak braking shear stress (184.8 ± 181.7 kPa), of which both were found at the first metatarsal head. During both cutting maneuvers, maximum medial and posterior shear stress occurred at the first metatarsal head, whereas maximum pressure occurred at the second metatarsal head. The first and second metatarsal heads sustained relatively high pressure and shear stress and were expected to be susceptible to plantar tissue discomfort or injury. Due to different stress distribution, distinct pressure and shear cushioning mechanisms in basketball footwear might be considered over different foot regions. Copyright © 2014 Elsevier Ltd. All rights reserved.

Contributions of foot muscles and plantar fascia morphology to foot posture.

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Angin, Salih; Mickle, Karen J; Nester, Christopher J

2018-03-01

The plantar foot muscles and plantar fascia differ between different foot postures. However, how each individual plantar structure contribute to foot posture has not been explored. The purpose of this study was to investigate the associations between static foot posture and morphology of plantar foot muscles and plantar fascia and thus the contributions of these structures to static foot posture. A total of 111 participants were recruited, 43 were classified as having pes planus and 68 as having normal foot posture using Foot Posture Index assessment tool. Images from the flexor digitorum longus (FDL), flexor hallucis longus (FHL), peroneus longus and brevis (PER), flexor hallucis brevis (FHB), flexor digitorum brevis (FDB) and abductor hallucis (AbH) muscles, and the calcaneal (PF1), middle (PF2) and metatarsal (PF3) regions of the plantar fascia were obtained using a Venue 40 ultrasound system with a 5-13 MHz transducer. In order of decreasing contribution, PF3 > FHB > FHL > PER > FDB were all associated with FPI and able to explain 69% of the change in FPI scores. PF3 was the highest contributor explaining 52% of increases in FPI score. Decreased thickness was associated with increased FPI score. Smaller cross sectional area (CSA) in FHB and PER muscles explained 20% and 8% of increase in FPI score. Larger CSA of FDB and FHL muscles explained 4% and 14% increase in FPI score respectively. The medial plantar structures and the plantar fascia appear to be the major contributors to static foot posture. Elucidating the individual contribution of multiple muscles of the foot could provide insight about their role in the foot posture. Copyright © 2018. Published by Elsevier B.V.

Effects of Body Mass Index on Mechanical Properties of the Plantar Fascia and Heel Pad in Asymptomatic Participants.

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Taş, Serkan; Bek, Nilgün; Ruhi Onur, Mehmet; Korkusuz, Feza

2017-07-01

Musculoskeletal foot disorders have a high incidence among overweight and obese individuals. One of the important factors causing this high incidence may be plantar fascia and heel pad (HP)-related mechanical changes occurring in these individuals. The aim of the present study was to investigate the plantar fascia and HP stiffness and thickness parameters in overweight and obese individuals and compare these values with those of normal-weight individuals. This study was carried out in 87 (52 female, 35 male) healthy sedentary individuals between the ages of 19 and 58 years (34 ± 11 years). Participants were subsequently categorized according to body mass index (BMI) as normal weight (18.5 kg/m 2 Plantar fascia and HP thickness and stiffness were measured with an ultrasonography device using a linear ultrasonography probe. Overweight and obese individuals had higher HP thickness ( P plantar fascia thickness ( P = .001), heel pad microchamber layer (MIC) stiffness ( P plantar fascia stiffness ( P plantar fascia thickness ( P = .001, r = 0.536), MIC stiffness ( P plantar fascia stiffness ( P plantar fascia and an increase in the thickness of the plantar fascia as well as the thickness and stiffness of HP. Increased body mass could cause changes in the mechanical properties of HP and plantar fascia. Level 3, comparative study.

Radial shock wave treatment alone is less efficient than radial shock wave treatment combined with tissue-specific plantar fascia-stretching in patients with chronic plantar heel pain.

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Rompe, Jan D; Furia, John; Cacchio, Angelo; Schmitz, Christoph; Maffulli, Nicola

2015-12-01

Whether shock wave therapy or shock wave therapy combined with plantar fascia-specific stretching is more efficient in treating chronic plantar heel pain remains unclear. The aim of the study was to test the null hypothesis of no difference of these two forms of management for patients who had unilateral plantar fasciopathy for a minimum duration of twelve months and which had failed at least three other forms of treatment. One hundred and fifty-two patients with chronic plantar fasciopathy were assigned to receive repetitive low-energy radial shock-wave therapy without local anesthesia, administered weekly for three weeks (Group 1, n = 73) or to receive the identical shock wave treatment and to perform an eight-week plantar fascia-specific stretching program (Group 2, n = 79). All patients completed the nine-item pain subscale of the validated Foot Function Index and a subject-relevant outcome questionnaire. Patients were evaluated at baseline, and at two, four, and twenty-four months after baseline. The primary outcome measures were a mean change in the Foot Function Index sum score at two months after baseline, a mean change in item 2 (pain during the first steps of walking in the morning) on this Index, and satisfaction with treatment. No difference in mean age, sex, weight or duration of symptoms was found between the groups at baseline. At two months after baseline, the Foot Function Index sum score showed significantly greater changes for the patients managed with shock-wave therapy plus plantar fascia-specific stretching than those managed with shock-wave therapy alone (p plantar fascia in combination with repetitive low-energy radial shock-wave therapy is more efficient than repetitive low-energy radial shock-wave therapy alone for the treatment of chronic symptoms of proximal plantar fasciopathy. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Ultrasonographic examination of plantar fasciitis: a comparison of patient positions during examination.

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Ahn, Jae Hoon; Lee, Choong Woo; Park, ChanJoo; Kim, Yoon-Chung

2016-01-01

Musculoskeletal ultrasound is a non-invasive and low-cost modality for real-time visualisation of the plantar fascia. Ultrasound examination for plantar fasciitis is generally performed with the patient in a prone position, although the rational for using a prone position has not been validated. The aim of the study was to investigate if ultrasound examination in a supine position, which is more comfortable than the prone position, is valid. We conducted a prospective study of 30 participants with plantar fasciitis, 8 men (27 %) and 22 women (73 %), with a mean age of 53.9 ± 12.6 (range, 32 to 77) years, and an equal distribution of left and right feet. The plantar heel was divided into three portions for ultrasound examination: medial, central and lateral. Two measurements of plantar fascia thickness were obtained for each portion, with participants in 2 positions (supine and prone) and for 2 ankle postures (neutral and 15° of plantarflexion). Mean measurements of plantar fascia thickness were compared between the two positions (Wilcoxon signed rank tests for non-normally distributed data and paired t-tests for normally distributed data). Participants were asked to report their preferred position for examination, supine or prone. The measured thickness was comparable for both supine and prone positions, for both ankle postures, neutral and 15° of plantarflexion (p > 0.05). A specific self-reported preferred position was not identified. Ultrasound examination of plantar fasciitis can be performed in the supine position without any significant difference in measurement compared to examination in the conventional prone position. The Catholic Medical Center Office of Human Research Protection Program (CMC-OHRP)/Institutional Review Board approved the current study (Approval No. KC12DISI0338), and all participants provided their written informed consent for participation and publication.

Association of footprint measurements with plantar kinetics: a linear regression model.

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Fascione, Jeanna M; Crews, Ryan T; Wrobel, James S

2014-03-01

The use of foot measurements to classify morphology and interpret foot function remains one of the focal concepts of lower-extremity biomechanics. However, only 27% to 55% of midfoot variance in foot pressures has been determined in the most comprehensive models. We investigated whether dynamic walking footprint measurements are associated with inter-individual foot loading variability. Thirty individuals (15 men and 15 women; mean ± SD age, 27.17 ± 2.21 years) walked at a self-selected speed over an electronic pedography platform using the midgait technique. Kinetic variables (contact time, peak pressure, pressure-time integral, and force-time integral) were collected for six masked regions. Footprints were digitized for area and linear boundaries using digital photo planimetry software. Six footprint measurements were determined: contact area, footprint index, arch index, truncated arch index, Chippaux-Smirak index, and Staheli index. Linear regression analysis with a Bonferroni adjustment was performed to determine the association between the footprint measurements and each of the kinetic variables. The findings demonstrate that a relationship exists between increased midfoot contact and increased kinetic values in respective locations. Many of these variables produced large effect sizes while describing 38% to 71% of the common variance of select plantar kinetic variables in the medial midfoot region. In addition, larger footprints were associated with larger kinetic values at the medial heel region and both masked forefoot regions. Dynamic footprint measurements are associated with dynamic plantar loading kinetics, with emphasis on the midfoot region.

Comparison between extracorporeal shockwave therapy, placebo ESWT and endoscopic plantar fasciotomy for the treatment of chronic plantar heel pain in the athlete.

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Saxena, Amol; Fournier, Magali; Gerdesmeyer, Ludger; Gollwitzer, Hans

2012-10-01

Plantar fasciitis can be a chronic and debilitating condition affecting athletes of all levels. The aim of this study is to compare treatment outcomes for the treatment of chronic plantar fasciitis in athletes, comparing focused extra corporeal sound wave therapy (ESWT) and the surgical endoscopic plantar fasciotomy (EPF). A total of 37 eligible patients were enrolled in the study between May 2006 and December 2008 at a single institution. Patients were either enrolled in the surgical group, or to the ESWT group which included a placebo controlled, randomized group (P-ESWT). Pre and post Visual Analog Scores (VAS) and Roles and Maudlsey (RM) scores were recorded and compared between the three groups. The patient's return to activity (RTA) was also documented. The results showed statistical improvement within the EPF and ESWT groups with both VAS & RM scores, with EPF being significantly better than both ESWT and P-ESWT in terms of treatment outcomes. Patients enrolled in the ESWT were able though to continue with their exercise regimen, while the EPF group was able to return to their athletic activity in an average of 2.8 months. In conclusion, EPF and ESWT are both effective forms of treatment for chronic plantar fasciitis; EPF being superior in outcomes yet ESWT treatment could be preferable since the athlete can remain active during treatment. II.

Achilles tendon and plantar fascia in recently diagnosed type II diabetes: role of body mass index.

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Abate, Michele; Schiavone, Cosima; Di Carlo, Luigi; Salini, Vincenzo

2012-07-01

Previous research has shown that plantar fascia and Achilles tendon thickness is increased in diabetes. The aims of present study were to assess whether tendon changes can occur in the early stages of the disease and to evaluate the extent of the influence of body mass index (BMI). The study population included 51 recent-onset type II diabetic subjects, who were free from diabetic complications, divided according to BMI into three groups (normal weight, overweight, and obese). Eighteen non-diabetic, normal-weight subjects served as controls. Plantar fascia and Achilles tendon thickness was measured by means of sonography. The groups were well balanced for age and sex. In all the diabetic subjects, plantar fascia and Achilles tendon thickness was increased compared to the controls (p plantar fascia thickness and BMI values (r = 0.749, p plantar fascia and Achilles tendon thickness is increased in the early stages of type II diabetes and that BMI is related more to plantar fascia than Achilles tendon thickness. Further longitudinal studies are needed to evaluate whether these early changes can overload the metatarsal heads and increase the stress transmitted to plantar soft tissues, thus representing an additional risk factor for foot ulcer development.

Diagnostic imaging for chronic plantar heel pain: a systematic review and meta-analysis

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Barrett Joanna T

2009-11-01

Full Text Available Abstract Background Chronic plantar heel pain (CPHP is a generalised term used to describe a range of undifferentiated conditions affecting the plantar heel. Plantar fasciitis is reported as the most common cause and the terms are frequently used interchangeably in the literature. Diagnostic imaging has been used by many researchers and practitioners to investigate the involvement of specific anatomical structures in CPHP. These observations help to explain the underlying pathology of the disorder, and are of benefit in forming an accurate diagnosis and targeted treatment plan. The purpose of this systematic review was to investigate the diagnostic imaging features associated with CPHP, and evaluate study findings by meta-analysis where appropriate. Methods Bibliographic databases including Medline, Embase, CINAHL, SportDiscus and The Cochrane Library were searched electronically on March 25, 2009. Eligible articles were required to report imaging findings in participants with CPHP unrelated to inflammatory arthritis, and to compare these findings with a control group. Methodological quality was evaluated by use of the Quality Index as described by Downs and Black. Meta-analysis of study data was conducted where appropriate. Results Plantar fascia thickness as measured by ultrasonography was the most widely reported imaging feature. Meta-analysis revealed that the plantar fascia of CPHP participants was 2.16 mm thicker than control participants (95% CI = 1.60 to 2.71 mm, P P = 0.01. CPHP participants were also more likely to show radiographic evidence of subcalcaneal spur than control participants (OR = 8.52, 95% CI = 4.08 to 17.77, P Conclusion This systematic review has identified 23 studies investigating the diagnostic imaging appearance of the plantar fascia and inferior calcaneum in people with CPHP. Analysis of these studies found that people with CPHP are likely to have a thickened plantar fascia with associated fluid collection, and that

Applicability of contrast-enhanced ultrasound in the diagnosis of plantar fasciitis

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Broholm, Rikke; Pingel, Jessica; Simonsen, Lene

2017-01-01

-mode ultrasound (US) in patients with plantar fasciitis (PF). 20 patients with unilateral PF were included and were divided by US in insertional thickening (10), midsubstance thickening (5) and no US changes (5). The MV was measured simultaneously in both heels. Four areas in the plantar fascia and plantar fat...... pad were measured independently by two observers. Inter- and intra-observer correlation analyses were performed. The asymptomatic heels showed a constantly low MV, and for the whole group of patients a significantly higher MV was found in the symptomatic plantar fascia and plantar fat pad. Inter...

Effect of gender, age and anthropometric variables on plantar fascia thickness at different locations in asymptomatic subjects.

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Pascual Huerta, Javier; Alarcón García, Juan María

2007-06-01

The study was aimed to investigate plantar fascia thickness at different locations in healthy asymptomatic subjects and its relationship to the following variables: weight, height, sex and age. The study evaluates 96 feet of healthy asymptomatic volunteers. The plantar fascia thickness was measured at four different locations: 1cm proximal to the insertion of the plantar fascia, at the insertion of the plantar fascia on the calcaneus and separate out 1 cm + 2 cm distal to the insertion. A 10 MHz linear-array transducer was used. There were statistically significant differences in plantar fascia thickness at the four different locations (pplantar fascia thickness at 1cm proximal to the insertion. At origin and 1cm distal to insertion weight was an independent predictor of plantar fascia thickness. There are differences of thickness at different locations of plantar fascia measured by ultrasonography. Thickness at 1cm proximal to the insertion is influenced by sex and thickness at origin and at 1cm distal to the insertion has a direct relationship with body weight. This could be attributed to the overloading effect that weight has on plantar fascia in healthy symptomatic subjects at these two locations. Height and age did not seem to influence as independent variables in plantar fascia thickness among non-painful subjects.

Quantitative tissue parameters of Achilles tendon and plantar fascia in healthy subjects using a handheld myotonometer.

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Orner, Sarah; Kratzer, Wolfgang; Schmidberger, Julian; Grüner, Beate

2018-01-01

The aim of the study was to examine the quantitative tissue properties of the Achilles tendon and plantar fascia using a handheld, non-invasive MyotonPRO device, in order to generate normal values and examine the biomechanical relationship of both structures. Prospective study of a large, healthy sample population. The study sample included 207 healthy subjects (87 males and 120 females) for the Achilles tendon and 176 healthy subjects (73 males and 103 females) for the plantar fascia. For the correlations of the tissue parameters of the Achilles tendon and plantar fascia an intersection of both groups was formed which included 150 healthy subjects (65 males and 85 females). All participants were measured in a prone position. Consecutive measurements of the Achilles tendon and plantar fascia were performed by MyotonPRO device at defined sites. For the left and right Achilles tendons and plantar fasciae all five MyotonPRO parameters (Frequency [Hz], Decrement, Stiffness [N/m], Creep and Relaxation Time [ms]) were calculated of healthy males and females. The correlation of the tissue parameters of the Achilles tendon and plantar fascia showed a significant positive correlation of all parameters on the left as well as on the right side. The MyotonPRO is a feasible device for easy measurement of passive tissue properties of the Achilles tendon and plantar fascia in a clinical setting. The generated normal values of the Achilles tendon and plantar fascia are important for detecting abnormalities in patients with Achilles tendinopathy or plantar fasciitis in the future. Biomechanically, both structures are positively correlated. This may provide new aspects in the diagnostics and therapy of plantar fasciitis and Achilles tendinopathy. Copyright © 2017 Elsevier Ltd. All rights reserved.

Foot Placement Characteristics and Plantar Pressure Distribution Patterns during Stepping on Ground in Neonates

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F. Sylos-Labini

2017-10-01

Full Text Available Stepping on ground can be evoked in human neonates, though it is rather irregular and stereotyped heel-to-toe roll-over pattern is lacking. Such investigations can provide insights into the role of contact- or load-related proprioceptive feedback during early development of locomotion. However, the detailed characteristics of foot placements and their association with motor patterns are still incompletely documented. We elicited stepping in 33 neonates supported on a table. Unilateral limb kinematics, bilateral plantar pressure distribution and EMG activity from up to 11 ipsilateral leg muscles were recorded. Foot placement characteristics in neonates showed a wide variation. In ~25% of steps, the swinging foot stepped onto the contralateral foot due to generally small step width. In the remaining steps with separate foot placements, the stance phase could start with forefoot (28%, midfoot (47%, or heel (25% touchdowns. Despite forefoot or heel initial contacts, the kinematic and loading patterns markedly differed relatively to toe-walking or adult-like two-peaked vertical force profile. Furthermore, while the general stepping parameters (cycle duration, step length, range of motion of proximal joints were similar, the initial foot contact was consistently associated with specific center-of-pressure excursion, range of motion in the ankle joint, and the center-of-activity of extensor muscles (being shifted by ~5% of cycle toward the end of stance in the “heel” relative to “forefoot” condition. In sum, we found a variety of footfall patterns in conjunction with associated changes in motor patterns. These findings suggest the potential contribution of load-related proprioceptive feedback and/or the expression of variations in the locomotor program already during early manifestations of stepping on ground in human babies.

Plantar fibromatosis and Dupuytren’s contracture in an adolescent

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Nikolić Jelena

2011-01-01

Full Text Available Background. Fibromatosis represents a wide group of benign, locally proliferative disorders of fibroblasts. Dupuytren` s disease is a benign proliferative disease of palmar aponeurosis which usually affects adults between 40 and 60 years of age. Ledderhose`s disease or plantar fibromatosis is plantar equivalent of Dupuyten`s disease most often affecting middle- aged and older men, usually bilateral, represented with painless nodule in the medial division of plantar fascia. Case report. We presented a 19-year old adolescent that turned to a plastic surgeon complaining to his small finger contracture. He noticed palmar thickening with nodule over the metacarpophalangeal joint of small finger of his right hand when he was 16 years old. A year later a finger started to band. During physical checkup we noticed plantar nodule that also had his father and grandmother. Magnetic resonance and tumor biopsy confirmed a suspicion on plantar fibromatosis - Ledderhose`s disease. Clinical exam of the hand clearly led to a conclusion that the patient had Dupuytren`s contracture with pretendinous cord over the small finger flexor tendons and lack of extension of proximal interphalangeal (PIP joint. On the extensor side of the PIP joints there were Garrod`s nodes. The patient refused surgical treatment of plantar tumor, but agreed to surgical correction of finger contracture. Conclusion. Despite the fact that Dupuytren`s disease and plantar fibromatosis are diseases of adults, the possibility of conjoint appearance of these forms of fibromatosis in adolescent period of life should be kept in mind especially in patients with strong genetic predisposition.

The effects of extracorporeal shock wave therapy on stroke patients with plantar fasciitis

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Kim, Tae Gon; Bae, Sea Hyun; Kim, Gye Yeop; Kim, Kyung Yoon

2015-01-01

[Purpose] The purpose of this research was to analyze the efficacy of extracorporeal shock wave therapy for the treatment of stroke patients with plantar fasciitis. [Subjects and Methods] This study included 10 stroke patients diagnosed with plantar fasciitis who were administered 3 sessions of extracorporeal shock wave therapy per week. After the last session, they performed stretching exercises for their Achilles tendon and plantar fascia for 30 min/day, 5 times a week for 6 months. The following parameters were measured and compared prior to therapy, 6 weeks after therapy, and 6 months after therapy: thickness of the plantar fascia, using an ultrasonic imaging system; degree of spasticity, using a muscle tension measuring instrument; degree of pain, using the visual analogue scale; and gait ability, using the Functional Gait Assessment. [Results] Decreased plantar fascia thickness, spasticity, and pain and increased gait ability were noted after therapy. These changes were significantly greater at 6 months after therapy than at 6 weeks after therapy. [Conclusion] These results indicated that extracorporeal shock wave therapy reduced tension in the plantar fascia, relieving pain and improving gait ability in stroke patients. PMID:25729207

Plantar calcaneal spurs in older people: longitudinal traction or vertical compression?

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Landorf Karl B

2008-08-01

Full Text Available Abstract Background Plantar calcaneal spurs are common, however their pathophysiology is poorly understood. This study aimed to evaluate the prevalence and correlates of plantar calcaneal spurs in a large sample of older people. Methods Weightbearing lateral foot radiographs of 216 people (140 women and 76 men aged 62 to 94 years (mean age 75.9, SD 6.6 were examined for plantar calcaneal and Achilles tendon spurs. Associations between the presence of spurs and sex, body mass index, radiographic measures of foot posture, self-reported co-morbidities and current or previous heel pain were then explored. Results Of the 216 participants, 119 (55% had at least one plantar calcaneal spur and 103 (48% had at least one Achilles tendon spur. Those with plantar calcaneal spurs were more likely to have Achilles tendon spurs (odds ratio [OR] = 2.0, 95% confidence interval [CI] 1.2 to 3.5. Prevalence of spurs did not differ according to sex. Participants with plantar calcaneal spurs were more likely to be obese (OR = 7.9, 95% CI 3.6 to 17.0, report osteoarthritis (OR = 2.6, 95% CI 1.6 to 4.8 and have current or previous heel pain (OR = 4.6, 95% CI 2.3 to 9.4. No relationship was found between the presence of calcaneal spurs and radiographic measures of foot posture. Conclusion Calcaneal spurs are common in older men and women and are related to obesity, osteoarthritis and current or previous heel pain, but are unrelated to radiographic measurements of foot posture. These findings support the theory that plantar calcaneal spurs may be an adaptive response to vertical compression of the heel rather than longitudinal traction at the calcaneal enthesis.

Relative sensitivity of depth discrimination for ankle inversion and plantar flexion movements.

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Black, Georgia; Waddington, Gordon; Adams, Roger

2014-02-01

25 participants (20 women, 5 men) were tested for sensitivity in discrimination between sets of six movements centered on 8 degrees, 11 degrees, and 14 degrees, and separated by 0.3 degrees. Both inversion and plantar flexion movements were tested. Discrimination of the extent of inversion movement was observed to decline linearly with increasing depth; however, for plantar flexion, the discrimination function for movement extent was found to be non-linear. The relatively better discrimination of plantar flexion movements than inversion movements at around 11 degrees from horizontal is interpreted as an effect arising from differential amounts of practice through use, because this position is associated with the plantar flexion movement made in normal walking. The fact that plantar flexion movements are discriminated better than inversion at one region but not others argues against accounts of superior proprioceptive sensitivity for plantar flexion compared to inversion that are based on general properties of plantar flexion such as the number of muscle fibres on stretch.

Enthesopathy of the lateral cord of the plantar fascia.

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Hoffman, Douglas F; Nazarian, Levon N; Smith, Jay

2014-09-01

The objective of this study was to raise awareness of the diagnosis of enthesopathy of the lateral cord of the plantar fascia (LCPF) and describe its sonographic findings. We conducted a retrospective case series of 13 sonographic examinations with the diagnosis of LCPF enthesopathy. Two cadaver dissections of the plantar foot were performed for anatomic correlation. Sonographic findings of LCPF enthesopathy included generalized or focal hypoechoic thickening, loss of the normal fibrillar echo texture, cortical irregularity of the fifth metatarsal tuberosity, and vascularity on color Doppler imaging. Anatomic dissections of the plantar foot detailed the course of the LCPF and served as a guide for optimal sonographic imaging. Enthesopathy of the LCPF is an important etiology of nontraumatic pain at the base of the fifth metatarsal. Sonographic evaluation can readily show the characteristic findings of LCPF enthesopathy. © 2014 by the American Institute of Ultrasound in Medicine.

Effect of gender, age and anthropometric variables on plantar fascia thickness at different locations in asymptomatic subjects

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Pascual Huerta, Javier [Department of Podiatry, Universidad Europea de Madrid (Spain)]. E-mail: javier.pascual@uem.es; Alarcon Garcia, Juan Maria [Ultrasound Unit, Hospital Nuestra Senora de America, Madrid (Spain)

2007-06-15

Purpose: The study was aimed to investigate plantar fascia thickness at different locations in healthy asymptomatic subjects and its relationship to the following variables: weight, height, sex and age. Material and methods: The study evaluates 96 feet of healthy asymptomatic volunteers. The plantar fascia thickness was measured at four different locations: 1 cm proximal to the insertion of the plantar fascia, at the insertion of the plantar fascia on the calcaneus and separate out 1 cm + 2 cm distal to the insertion. A 10 MHz linear-array transducer was used. Results: There were statistically significant differences in plantar fascia thickness at the four different locations (p < 0.001) although no differences in PF thickness were found between the two distal from insertion locations (1 and 2 cm). Multiple regression analysis showed sex as independent predictor of plantar fascia thickness at 1 cm proximal to the insertion. At origin and 1 cm distal to insertion weight was an independent predictor of plantar fascia thickness. Conclusions: There are differences of thickness at different locations of plantar fascia measured by ultrasonography. Thickness at 1 cm proximal to the insertion is influenced by sex and thickness at origin and at 1 cm distal to the insertion has a direct relationship with body weight. This could be attributed to the overloading effect that weight has on plantar fascia in healthy symptomatic subjects at these two locations. Height and age did not seem to influence as independent variables in plantar fascia thickness among non-painful subjects.

Effect of gender, age and anthropometric variables on plantar fascia thickness at different locations in asymptomatic subjects

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Pascual Huerta, Javier; Alarcon Garcia, Juan Maria

2007-01-01

Purpose: The study was aimed to investigate plantar fascia thickness at different locations in healthy asymptomatic subjects and its relationship to the following variables: weight, height, sex and age. Material and methods: The study evaluates 96 feet of healthy asymptomatic volunteers. The plantar fascia thickness was measured at four different locations: 1 cm proximal to the insertion of the plantar fascia, at the insertion of the plantar fascia on the calcaneus and separate out 1 cm + 2 cm distal to the insertion. A 10 MHz linear-array transducer was used. Results: There were statistically significant differences in plantar fascia thickness at the four different locations (p < 0.001) although no differences in PF thickness were found between the two distal from insertion locations (1 and 2 cm). Multiple regression analysis showed sex as independent predictor of plantar fascia thickness at 1 cm proximal to the insertion. At origin and 1 cm distal to insertion weight was an independent predictor of plantar fascia thickness. Conclusions: There are differences of thickness at different locations of plantar fascia measured by ultrasonography. Thickness at 1 cm proximal to the insertion is influenced by sex and thickness at origin and at 1 cm distal to the insertion has a direct relationship with body weight. This could be attributed to the overloading effect that weight has on plantar fascia in healthy symptomatic subjects at these two locations. Height and age did not seem to influence as independent variables in plantar fascia thickness among non-painful subjects

Ultrasound evaluation of intrinsic plantar muscles and fascia in hallux valgus: A case-control study.

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Lobo, César Calvo; Marín, Alejandro Garrido; Sanz, David Rodríguez; López, Daniel López; López, Patricia Palomo; Morales, Carlos Romero; Corbalán, Irene Sanz

2016-11-01

A cross-sectional area (CSA) and thickness reduction of the abductor hallucis (AbH) is shown in subjects with hallux valgus (HV). To date, other soft-tissue structures have not been researched in relation with HV. The aim of this study was to compare the CSA and thickness of the intrinsic plantar muscles and fascia (PF) between feet with and without HV. Therefore, a cross-sectional and case-control study was performed using B-mode with an iU22 Philips ultrasound system and a 5 to 17-MHz transducer. The CSA and thickness were measured for the AbH, flexor digitorum brevis (FDB) and flexor hallucis brevis (FHB), and also the thickness for the anterior, middle, and posterior PF portions. A convenience sample of 40 feet, 20 with HV and 20 without HV, was recruited from a clinical and research center. A multivariate regression analysis using linear regression was performed to evaluate the ultrasound imaging measurements (α = 0.05). Consequently, statistically significant differences were observed between the groups (P plantar fascia thickness increase in favor of the HV group. On the contrary, the FDB thickness and CSA did not show statistically significant differences (P ≥ 0.05). In conclusion, the CSA and thickness of the AbH and FHB intrinsic plantar muscles are reduced, whereas the thickness of the anterior, middle, and posterior PF portions are increased, in subjects with HV compared with those without HV.

The influence of athletic activity on the plantar fascia in healthy young adults.

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Uzel, Murat; Cetinus, Ercan; Ekerbicer, H Cetin; Karaoguz, Ahmet

2006-01-01

Complaints deriving from the plantar fascia are relatively common in athletes. This study aimed to investigate the changes of thickness of plantar fascia via sonography in healthy young adults with different levels of activity. One hundred ten adults with normal body mass index were separated into three groups according to activity level: sedentary (group 1, n = 50), athletic activity less than 7 hours per week (group 2, n = 30), and athletic activity 7 or more hours per week (group 3, n = 30). The thicknesses of the plantar fascia at origin and at a point 5 mm distal to origin were measured via sonography. The mean values of the thickness of the proximal plantar fascia (PFp) and the distal plantar fascia (PFd) in group 1 were similar to those of groups 2 and 3 (p > 0.05). The mean values of PFp and PFd were significantly higher in men than in women (p 0.05). There were moderate positive correlations between PFp and weight, height, and body mass index but no correlation between PFp and amount of athletic activity. The thickness of the plantar fascia at origin did not change with athletic activity at the amateur level. Copyright 2006 Wiley Periodicals, Inc.

Reproducibility of sonographic measurement of thickness and echogenicity of the plantar fascia.

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Cheng, Ju-Wen; Tsai, Wen-Chung; Yu, Tung-Yang; Huang, Kuo-Yao

2012-01-01

To evaluate the intra- and interrater reliability of ultrasonographic measurements of the thickness and echogenicity of the plantar fascia. Eleven patients (20 feet), who complained of inferior heel pain, and 26 volunteers (52 feet) were enrolled. Two sonographers independently imaged the plantar fascia in both longitudinal and transverse planes. Volunteers were assessed twice to evaluate intrarater reliability. Quantitative evaluation of the echogenicity of the plantar fascia was performed by measuring the mean gray level of the region of interest using Digital Imaging and Communications in Medicine viewer software. Sonographic evaluation of the thickness of the plantar fascia showed high reliability. Sonographic evaluations of the presence or absence of hypoechoic change in the plantar fascia showed surprisingly low agreement. The reliability of gray-scale evaluations appears to be much better than subjective judgments in the evaluation of echogenicity. Transverse scanning did not show any advantage in sonographic evaluation of the plantar fascia. The reliability of sonographic examination of the thickness of the plantar fascia is high. Mean gray-level analysis of quantitative sonography can be used for the evaluation of echogenicity, which could reduce discrepancies in the interpretation of echogenicity by different sonographers. Longitudinal instead of transverse scanning is recommended for imaging the plantar fascia. Copyright © 2011 Wiley Periodicals, Inc.

Extracorporeal shock wave therapy for treatment of plantar fasciitis

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Dastgir, N.

2014-01-01

Objective: To explore the effect of extracorporeal shock wave therapy in patients with chronic plantar faciitis. Methods: The prospective study was conducted at Department of Orhopaedic, Regional Hospital, Limerick, Ireland from January to December 2004 and comprised 70 heels in 62 patients with chronic plantar fasciitis in whom conventional conservative treatment consisting of non-steroidal anti-inflammatory drugs, heel cup, orthoses and/or shoe modifications, local steroid injections had failed, and they were treated with low energy extracorporeal shock wave therapy. Patients were reviewed at 6, 12 and 24 weeks post treatment. Results: At follow-up there was significant decrease in pain on the visual analogue scale (p<0.027), with significant improvement in pain score (p<0.009) and in functional score (p<0.001). The comfortable walking distance had increased significantly and there were no reported side effects. Conclusion: Extracorporeal shock wave therapy is a new modality providing good pain relief and a satisfactory clinical outcome in patients with chronic plantar fasciitis. (author)

The effect of the gastrocnemius on the plantar fascia.

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Pascual Huerta, Javier

2014-12-01

Although anatomic and functional relationship has been established between the gastrocnemius muscle, via the Achilles tendon, and the plantar fascia, the exact role of gastrocnemius tightness in foot and plantar fascia problems is not completely understood. This article summarizes past and current literature linking these 2 structures and gives a mechanical explanation based on functional models of the relationship between gastrocnemius tightness and plantar fascia. The effect of gastrocnemius tightness on the sagittal behavior of the foot is also discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

Plantar reflex excitability is increased in the evening in restless legs syndrome patients.

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Dafkin, Chloe; Green, Andrew; Olivier, Benita; McKinon, Warrick; Kerr, Samantha

2017-11-01

To investigate if diurnal changes in spinal excitability (plantar reflex) occur in restless legs syndrome (RLS) participants compared to healthy matched controls. Thirteen RLS participants and 13 healthy control participants' plantar reflex responses were evaluated in the evening (PM) and the morning (AM). Plantar reflex responses were assessed electromyographically, using motion analysis (kinematically) and by subjective nociception (Visual Analogue Scale). RLS participants showed a circadian variation in plantar reflex responses whilst control participants did not. Evening ankle angle changes were larger and faster in RLS participants compared to morning responses. In addition RLS participants displayed significantly smaller change in ankle angle and significantly slower ankle movements in the evening and the morning as well as significantly lower lateral gastrocnemius maximum amplitude in the compared to control participants. The findings of the current study support the theory of RLS circadian fluctuations in spinal excitability. An unexpected finding was decreased plantar reflex responses in RLS participants compared to healthy control participants. However this finding supports the theory of mechanical hypoesthesia in RLS. The results of this study provide further insight into the pathophysiology of RLS, highlighting that not all sensory processing is affected in the same manner. Copyright © 2017 Elsevier B.V. All rights reserved.

Distribution and correlates of plantar hyperkeratotic lesions in older people

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Menz Hylton B

2009-03-01

Full Text Available Abstract Background Plantar hyperkeratotic lesions are common in older people and are associated with pain, mobility impairment and functional limitations. However, little has been documented in relation to the frequency or distribution of these lesions. The aim of this study was to document the occurrence of plantar hyperkeratotic lesions and the patterns in which they occur in a random sample of older people. Methods A medical history questionnaire was administered to a random sample of 301 people living independently in the community (117 men, 184 women aged between 70 and 95 years (mean 77.2, SD 4.9, who also underwent a clinical assessment of foot problems, including the documentation of plantar lesion locations, toe deformities and the presence and severity of hallux valgus. Results Of the 301 participants, 180 (60% had at least one plantar hyperkeratotic lesion. Those with plantar lesions were more likely to be female (χ2 = 18.75, p 2 = 6.15, p vs 36.3 ± 8.4°; t = 2.68, df = 286, p vs 4.8 ± 1.3 hours, t = -2.46, df = 299, p = 0.01. No associations were found between the presence of plantar lesions and body mass index, obesity, foot posture, dominant foot or forefoot pain. A total of 53 different lesions patterns were observed, with the most common lesion pattern being "roll-off" hyperkeratosis on the medial aspect of the 1st metatarsophalangeal joint (MPJ, accounting for 12% of all lesion patterns. "Roll-off" lesions under the 1st MPJ and interphalangeal joint were significantly associated with moderate to severe hallux valgus (p p Conclusion Plantar hyperkeratotic lesions affect 60% of older people and are associated with female gender, hallux valgus, toe deformity, increased ankle flexibility and time spent on feet, but are not associated with obesity, limb dominance, forefoot pain or foot posture. Although there are a wide range of lesion distribution patterns, most can be classified into medial, central or lateral groups. Further

How plantar exteroceptive efficiency modulates postural and oculomotor control: inter-individual variability

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Arnaud eFoisy

2016-05-01

Full Text Available In a previous experiment, we showed that among young and healthy subjects, thin plantar inserts improve postural control and modify vergence amplitudes. In this experiment, however, significant inter-individual variability was observed. We hypothesize that its origin could be attributed to a different reliance upon feet cutaneous afferents. In order to test this hypothesis, we re-analyzed the data relative to 31 young (age 25,7±3,8 and healthy subjects who participated in the first experiment after having classified them into two groups depending on their Plantar Quotient (PQ = Surface area of CoP foam / Surface area of CoP firm ground x100. Foam decreases the information arising from the feet, normally resulting in a PQ>100. Hence, the PQ provides information on the weight of plantar cutaneous afferents used in postural control. Twelve people were Plantar-Independent Subjects, as indicated by a PQ<100. These individuals did not behave like the Normal Plantar Quotient Subjects: they were almost insensitive to the plantar stimulations in terms of postural control and totally insensitive in terms of oculomotor control. We conclude that the inter-individual variability observed in our first experiment is explained by the subjects’ degree of plantar reliance. We propose that plantar independence is a dysfunctional situation revealing an inefficiency in plantar cutaneous afferents. The latter could be due to a latent somatosensory dysfunction generating a noise which prevents the CNS from correctly processing and using feet somatosensory afferents both for balance and vergence control: Plantar Irritating Stimulus. Considering the non-noxious nature and prevalence of this phenomenon, these results can be of great interest to researchers and clinicians who attempt to trigger postural or oculomotor responses through mechanical stimulation of the foot sole.

Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice

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Malone, Terry R.

2004-01-01

Objective: Plantar fasciitis is a prevalent problem, with limited consensus among clinicians regarding the most effective treatment. The purpose of this literature review is to provide a systematic approach to the treatment of plantar fasciitis based on the windlass mechanism model. Data Sources: We searched MEDLINE, SPORT Discus, and CINAHL from 1966 to 2003 using the key words plantar fasciitis, windlass mechanism, pronation, heel pain, and heel spur. Data Synthesis: We offer a biomechanical application for the evaluation and treatment of plantar fasciitis based on a review of the literature for the windlass mechanism model. This model provides a means for describing plantar fasciitis conditions such that clinicians can formulate a potential causal relationship between the conditions and their treatments. Conclusions/Recommendations: Clinicians' understanding of the biomechanical causes of plantar fasciitis should guide the decision-making process concerning the evaluation and treatment of heel pain. Use of this approach may improve clinical outcomes because intervention does not merely treat physical symptoms but actively addresses the influences that resulted in the condition. Principles from this approach might also provide a basis for future research investigating the efficacy of plantar fascia treatment. PMID:16558682

The Effects of Various Running Inclines on Three-Segment Foot Mechanics and Plantar Fascia Strain

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Sinclair Jonathan

2014-12-01

Full Text Available Purpose. There has yet to be a combined analysis of three-dimensional multi-segment foot kinematics and plantar fascia strain in running gait at various degrees of inclination. The aim of the current study was therefore to investigate the above during treadmill running at different inclines (0°, 5°, 10° and 15°. Methods. Twelve male participants ran at 4.0 m · s-1 in the four different inclinations. Three-dimensional kinematics of the foot segments and plantar fascia strain were quantified for each incline and contrasted using one-way repeated measures ANOVA. Results and conclusions. The results showed that plantar fascia strain increased significantly as a function of running incline. Given the projected association between plantar fascia strain and the aetiology of injury, inclined running may be associated with a greater incidence of injury to the plantar fascia.

The design and validation of a magnetic resonance imaging-compatible device for obtaining mechanical properties of plantar soft tissue via gated acquisition.

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Williams, Evan D; Stebbins, Michael J; Cavanagh, Peter R; Haynor, David R; Chu, Baocheng; Fassbind, Michael J; Isvilanonda, Vara; Ledoux, William R

2015-10-01

Changes in the mechanical properties of the plantar soft tissue in people with diabetes may contribute to the formation of plantar ulcers. Such ulcers have been shown to be in the causal pathway for lower extremity amputation. The hydraulic plantar soft tissue reducer (HyPSTER) was designed to measure in vivo, rate-dependent plantar soft tissue compressive force and three-dimensional deformations to help understand, predict, and prevent ulcer formation. These patient-specific values can then be used in an inverse finite element analysis to determine tissue moduli, and subsequently used in a foot model to show regions of high stress under a wide variety of loading conditions. The HyPSTER uses an actuator to drive a magnetic resonance imaging-compatible hydraulic loading platform. Pressure and actuator position were synchronized with gated magnetic resonance imaging acquisition. Achievable loading rates were slower than those found in normal walking because of a water-hammer effect (pressure wave ringing) in the hydraulic system when the actuator direction was changed rapidly. The subsequent verification tests were, therefore, performed at 0.2 Hz. The unloaded displacement accuracy of the system was within 0.31%. Compliance, presumably in the system's plastic components, caused a displacement loss of 5.7 mm during a 20-mm actuator test at 1354 N. This was accounted for with a target to actual calibration curve. The positional accuracy of the HyPSTER during loaded displacement verification tests from 3 to 9 mm against a silicone backstop was 95.9% with a precision of 98.7%. The HyPSTER generated minimal artifact in the magnetic resonance imaging scanner. Careful analysis of the synchronization of the HyPSTER and the magnetic resonance imaging scanner was performed. With some limitations, the HyPSTER provided key functionality in measuring dynamic, patient-specific plantar soft tissue mechanical properties. © IMechE 2015.

OA03.12. Herbal socks an effective medication against plantar hyperkeratosis

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Geethadevi, C; Rajendran, R; Radhai, R

2013-01-01

Purpose: Plantar hyperkeratosis commonly called cracked heel is a common condition among adults. Causes for plantar hyperkeratosis are many and include genetic defects reflected in skin structure, allergic dermatoses, and paraneoplastic syndromes seen with particular forms of internal malignancy. Treatment for this condition could be possibly done using traditional herbs. The current study throws light on the cure of plantar hyperkeratosis using socks worn daily. Method: Solanum xanthocarpum powder and Aleo vera were subjected to different solvent extracts and its antimicrobial activity against isolated organism was studied. The solvent extract showing highest zone of inhibition was chosen and nanoparticle was synthesized by ionic gelification method and characterized physically and chemically. Synthesized nanoparticles were coated onto the socks using pad dry cure method. The antibacterial activity of the socks was then studied using AATCC 100 and 147. The nanoparticle treated socks was chemically characterized using FTIR analysis. The socks were then analyzed in vivo. Result: The synthesized nanoparticles were characterized using HRTEM analysis and it was spherical. The nanoparticles coated socks showed a better activity against the organisms isolated from patients having plantar hyperkeratosis. The activity of the socks was tested in vivo among 20 patients and this proved to be promising cure. The wash durability of the socks was effective until 20 washes. Conclusion: The results showed that the formulated socks were effective against treatment of cracked heel and it also proves to be antimicrobial in nature. The effective durability of the socks was due the control and sustained release of herbal extracts from nanoparticle. Plantar hyperkeratosis could burden immune compromised patients such as diabetes, these kinds of herbal socks would be a better option for this treatment than the conventionally used time consuming treatments.

Cálculo do índice do arco plantar de staheli e a prevalência de pés planos: estudo em 100 crianças entre 5 e 9 anos de idade Calculation of staheli's plantar arch index and prevalence of flat feet: a study with 100 children aged 5-9 years

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Arnaldo José Hernandez

2007-01-01

Full Text Available Os autores avaliam 100 crianças normais da população geral de ambos os sexos entre 5 e 9 anos de idade com o objetivo de verificar e avaliar o chamado índice do arco plantar e a ocorrência de pé plano. A avaliação do pé plano o foi feita através da obtenção da impressão plantar e do cálculo do índice do arco plantar (IP que estabelece a relação entre a região central e posterior dessa impressão, determinando-se um IP médio e um limite para esse tipo de pé. Concluem que o índice do arco plantar é facilmente obtido a partir da impressão plantar, não existirem diferenças entre os sexos e faixas etárias, que os valores médios do índice do arco plantar nessa faixa etária são estáveis e estão entre 0,61 e 0,67 e que índices do arco plantar acima de 1,15 devem ser considerados como indicativos de pé plano.The authors studied 100 normal children from the general population of both genders with ages ranging from 5 to 9 years old in order to evaluate the plantar arch index and the flat-feet prevalence. The flat-feet evaluation was obtained by means of the footprint and the plantar arch index (IP, which establishes the ratio between central and posterior regions of this footprint, determining a mean IP and a limit to the flat-foot. They conclude that the plantar arch index is easy to obtain from footprints and that there are no differences in terms of gender or age. The mean values of the plantar arch index within this age group are stable and range from 0.61 to 0.67, with plantar arch indexes greater than 1.15 being regarded as flat feet.

Nonlinear finite element analysis of the plantar fascia due to the windlass mechanism.

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Cheng, Hsin-Yi Kathy; Lin, Chun-Li; Chou, Shih-Wei; Wang, Hsien-Wen

2008-08-01

Tightening of plantar fascia by passively dorsiflexing the toes during walking has functional importance. The purpose of this research was to evaluate the influence of big toe dorsiflexion angles upon plantar fascia tension (the windlass effect) with a nonlinear finite element approach. A two-dimensional finite element model of the first ray was constructed for biomechanical analysis. In order to imitate the windlass effect and to evaluate the mechanical responses of the plantar fascia under various conditions, 12 model simulations--three dorsiflexion angles of the big toe (45 degrees, 30 degrees, and 15 degrees), two plantar fascia properties (linear, nonlinear), and two weightbearing conditions (with body weight, without body weight)--were designed and analyzed. Our results demonstrated that nonlinear modeling of the plantar fascia provides a more sophisticated representation of experimental data than the linear one. Nonlinear plantar fascia setting also predicted a higher stress distribution along the fiber directions especially with larger toe dorsiflexion angles (45 degrees>30 degrees>15 degrees). The plantar fascia stress was found higher near the metatarsal insertion and faded as it moved toward the calcaneal insertion. Passively dorsiflexing the big toe imposes tension onto the plantar fascia. Windlass mechanism also occurs during stance phase of walking while the toes begin to dorsiflex. From a biomechanical standpoint, the plantar fascia tension may help propel the body upon its release at the point of push off. A controlled stretch via dorsiflexing the big toe may have a positive effect on treating plantar fasciitis by providing proper guidance for collagen regeneration. The windlass mechanism is also active during the stance phase of walking when the toes begin to dorsiflex.

Evaluating plantar fascia strain in hyperpronating cadaveric feet following an extra-osseous talotarsal stabilization procedure.

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Graham, Michael E; Jawrani, Nikhil T; Goel, Vijay K

2011-01-01

Abnormal talotarsal joint mechanics leading to hyperpronation is implicated as one of the most common causes of plantar fasciopathy. In patients with hyperpronating feet, the plantar fascia experiences excessive tensile forces during static and dynamic weight-bearing activities because of excessive medial longitudinal arch depression. For the purposes of this study, we hypothesized that plantar fascia strain in hyperpronating cadaveric feet would decrease after intervention with an extra-osseous talotarsal stabilization (EOTTS) device. A miniature differential variable reluctance transducer was used to quantify the plantar fascia strain in 6 fresh-frozen cadaver foot specimens exhibiting flexible instability of the talotarsal joint complex (i.e., hyperpronation). The strain was measured as the foot was moved from its neutral to maximally pronated position, before and after intervention using the HyProCure(®) EOTTS device. The mean plantar fascia elongation was 0.83 ± 0.27 mm (strain 3.62% ± 1.17%) and 0.56 ± 0.2 mm (strain 2.42% ± 0.88%) before and after intervention, respectively (N = 18, variation reported is ± 1 SD). The average plantar fascia strain decreased by 33%, and the difference was statistically significant with p plantar fascia strain suggests that an EOTTS device might be effective in stabilizing the pathologic talotarsal joint complex and the medial longitudinal arch and in eliminating hyperpronation. An EOTTS procedure might offer a possible treatment option for plantar fasciopathy in cases in which the underlying etiology is abnormal talotarsal biomechanics. Copyright © 2011 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Assessment of mechanical strain in the intact plantar fascia.

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Clark, Ross A; Franklyn-Miller, Andrew; Falvey, Eanna; Bryant, Adam L; Bartold, Simon; McCrory, Paul

2009-09-01

A method of measuring tri-axial plantar fascia strain that is minimally affected by external compressive force has not previously been reported. The purpose of this study was to assess the use of micro-strain gauges to examine strain in the different axes of the plantar fascia. Two intact limbs from a thawed, fresh-frozen cadaver were dissected, and a combination of five linear and one three-way rosette gauges were attached to the fascia of the foot and ankle. Strain was assessed during two trials, both consisting of an identical controlled, loaded dorsiflexion. An ICC analysis of the results revealed that the majority of gauge placement sites produced reliable measures (ICC>0.75). Strain mapping of the plantar fascia indicates that the majority of the strain is centrally longitudinal, which provides supportive evidence for finite element model analysis. Although micro-strain gauges do possess the limitation of calibration difficulty, they provide a repeatable measure of fascial strain and may provide benefits in situations that require tri-axial assessment or external compression.

Sonographic evaluation of the plantar fascia in asymptomatic subjects.

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Gadalla, N; Kichouh, M; Boulet, C; Machiels, F; De Mey, J; De Maeseneer, M

2014-01-01

To evaluate the appearance of the plantar fascia in asymptomatic subjects. Thirty-one asymptomatic subjects were examined by 2 musculoskeletal radiologists. The plantar fascia was evaluated for thickness, echogenicity, vascularity on power Doppler, rupture, fluid adjacent to the fascia, andcalcifications. The study included 14 men and 17 women (age, 17-79 years; mean, 45 years). The mean thickness of the plantar fascia in men was 3.7 mm (range 2.5-7 mm), and in women 3.5 mm (range, 1.7-5.1 mm). The thickness was greater than 4 mm in 4 men (bilateral in 2). The mean thickness of fascias thicker than 4 mm in men was 5.4 mm (range, 4.3-7 mm). The thickness was greater than 4 mm in 5 women ( bilateral in 4). The mean thickness of fascias thicker than 4 mm in women was 4.7 mm (range, 4.2-5.1 mm). There was no statistically significant difference between men and women and between both heels. Hypoechogenicity was observed in 3 men (bilateral in 2), and in 5 women (bilateral in 6). Hypervascularity, rupture, fluid adjacent to the fascia, and calcifications were not observed. A thickness greater than 4 mm and hypoechogenicity, are common in the plantar fascia of asymptomatic subjects. Findings that were not seen in asymptomatic subjects include a thickness greater than 7 mm, hypervascularity on power Doppler, rupture, fluid adjacent to the fascia, and calcifications.

Thinner plantar fascia predicts decreased pain after extracorporeal shock wave therapy.

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Liang, Huey-Wen; Wang, Tyng-Guey; Chen, Wen-Shiang; Hou, Sheng-Mou

2007-07-01

Increased plantar fascia thickness is common with chronic plantar fasciitis, and reduction of the thickness after extracorporeal shock wave therapy or steroid injection has been reported. We hypothesized a decrease of plantar fascia thickness was associated with pain reduction after extracorporeal shock wave therapy. Fifty-three eligible patients with 78 symptomatic feet were randomly treated with piezoelectric-type extracorporeal shock wave therapy of two intensity levels (0.12 and 0.56 mJ/mm2). Two thousand shock waves for three consecutive sessions were applied at weekly intervals. A visual analog scale for pain, the Foot Function Index, the Short Form-36 Health Survey, and ultrasonographic measurement of plantar fascia thickness were evaluated at baseline and 3 and 6 months after treatment. We analyzed the association between pain level and plantar fascia thickness with generalized estimating equation analysis and adjusted for demographic and treatment-related variables. Patients with thinner plantar fascia experienced less pain after treatment; high-intensity treatment and regular exercise were associated with lower pain level. The overall success rates were 63% and 60% at the 3- and 6-month followups. High- and low-intensity treatments were associated with similar improvements in pain and function. Receiving high-intensity treatment, although associated with less pain at followup, did not provide a higher success rate.

Plantar Fascia Rupture in a Professional Football Referee

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Gürhan Dönmez

2018-04-01

Full Text Available Painful plantar heel in athletes can cause significant discomfort and limping due to difficulty in weight-bearing. Plantar fasciitis and calcaneal spurs are frequently associated with this condition. Herein, a 33-year-old male football referee with plantar fascia rupture following a local corticosteroid injection for the relief of heel pain due to calcaneal bony spur is presented. The diagnosis was confirmed through ultrasonography (USG of the heel, and platelet-rich plasma (PRP injection was performed under USG guidance. With a well designed rehabilitation program, he returned to his previous activity level on the 10th week of injury, without any complications. This case report is presented to highlight the potential complications of blinded corticosteroid injections amongst professional athletes, and it cautions physicians who prescribe or intervene by using.

[Foot stress simulator for biomechanical in vitro studies of lower leg segments].

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Rosenbaum, D; Schmitt, H; Bertsch, C; Bauer, G; Claes, L

1996-05-01

In this paper we describe a foot-loading simulator that permits in vitro studies on human lower leg and foot specimens. The specimens are fixed in a jig and loaded axially with the aid of a pneumatic cylinder. The resulting transfer of forces through the ankle joint complex and Chopart's articulation (line) can be demonstrated on a pressure-sensitive film. Plantar pressure measurements obtained in patients or normal subjects can be used to ensure the comparability of in vivo and in vitro measurements. The supporting platform can be tilted in such a manner as to provide a range of foot positions up to 20 degrees in plantar- or dorsiflexion, eversion or inversion. The system is used for investigating the effects on the intra-articular pressures and plantar pressure patterns of physiological muscle activity and pathological conditions following fracture of the calcaneum or damage to the lateral ligament. By way of an example, the effects of muscle forces on plantar pressure distribution are presented.

Estudo da impressão plantar obtida durante o teste de Jack em crianças Footprint study in children during the Jack test

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José Antonio Pinto

2011-01-01

obtained for each foot, with and without the orthosis. The exams were analyzed using the Valenti and Volpon methods. Statistical tests were applied. RESULTS: In all cases, both the Valenti and Volpon indexes decreased as the orthosis was applied. Furthermore, the difference between both indexes with and without the orthosis decreased with age. CONCLUSIONS: It is possible to quantify the Jack test using plantar impressions with the Volpon and Valenti methods. The variability observed in plantar shape tended to decrease after 4 years of age. Finally, the Jack test gradually lost its capability to change plantar impression with age, which reduces its accuracy as a parameter for a good prognosis in longitudinal medial arch formation. Level of Evidence: Level IV, observational descriptive study.

Dry cupping for plantar fasciitis: a randomized controlled trial.

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Ge, Weiqing; Leson, Chelsea; Vukovic, Corey

2017-05-01

[Purpose] The purpose of this study was to determine the effects of dry cupping on pain and function of patients with plantar fasciitis. [Subjects and Methods] Twenty-nine subjects (age 15 to 59 years old, 20 females and 9 males), randomly assigned into the two groups (dry cupping therapy and electrical stimulation therapy groups), participated in this study. The research design was a randomized controlled trial (RCT). Treatments were provided to the subjects twice a week for 4 weeks. Outcome measurements included the Visual Analogue Pain Scale (VAS) (at rest, first in the morning, and with activities), the Foot and Ankle Ability Measure (FAAM), the Lower Extremity Functional Scale (LEFS), as well as the pressure pain threshold. [Results]The data indicated that both dry cupping therapy and electrical stimulation therapy could reduce pain and increase function significantly in the population tested, as all the 95% Confidence Intervals (CIs) did not include 0 except for the pressure pain threshold. There was no significant difference between the dry cupping therapy and electrical stimulation groups in all the outcome measurements. [Conclusion] These results support that both dry cupping therapy and electrical stimulation therapy could reduce pain and increase function in the population tested.

Imaging of plantar fascia and Achilles injuries undertaken at the London 2012 Olympics.

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Elias, David A; Carne, Andrew; Bethapudi, Sarath; Engebretsen, Lars; Budgett, Richard; O'Connor, Philip

2013-12-01

Plantar fascia and distal Achilles injuries are common in elite athletes. Acute athletic injuries of the plantar fascia include acute plantar fasciopathy and partial or complete tears. Underlying most acute injuries is a background of underlying chronic plantar fasciopathy. Injuries may affect the central or less commonly lateral portions of the fascia and acute tears are generally proximal. Athletic Achilles injuries may occur at the mid tendon or the distal insertion, and there may be an underlying chronic tendinopathy. Acute or chronic paratendinopathy may occur as a separate entity or combined with Achilles injury. In this article, the spectrum of athletic injuries of the plantar fascia and Achilles is described, illustrated by imaging findings from the London 2012 Olympic games.

[The use of papain in plantar ulcers].

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Otuka, E S; Pedrazzani, E S; Pioto, M P

1996-01-01

This work has as a goal to contribute to decrease the inability in leprosy and continuous recurrence of plantar ulcers, through the use of a treatment method using papaine and actions of health education. This work has been done in a health centre with patients that presented plantar ulcers and agreed to participate in the proposed treatment. Analysing and comparing the obtained data before and after treatment, a greater adhesion of patients to this treatment, a quicker healing in relation to other methods used before and a greater interaction with the patient has been observed.

Can plantar soft tissue mechanics enhance prognosis of diabetic foot ulcer?

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Naemi, R; Chatzistergos, P; Suresh, S; Sundar, L; Chockalingam, N; Ramachandran, A

2017-04-01

To investigate if the assessment of the mechanical properties of plantar soft tissue can increase the accuracy of predicting Diabetic Foot Ulceration (DFU). 40 patients with diabetic neuropathy and no DFU were recruited. Commonly assessed clinical parameters along with plantar soft tissue stiffness and thickness were measured at baseline using ultrasound elastography technique. 7 patients developed foot ulceration during a 12months follow-up. Logistic regression was used to identify parameters that contribute to predicting the DFU incidence. The effect of using parameters related to the mechanical behaviour of plantar soft tissue on the specificity, sensitivity, prediction strength and accuracy of the predicting models for DFU was assessed. Patients with higher plantar soft tissue thickness and lower stiffness at the 1st Metatarsal head area showed an increased risk of DFU. Adding plantar soft tissue stiffness and thickness to the model improved its specificity (by 3%), sensitivity (by 14%), prediction accuracy (by 5%) and prognosis strength (by 1%). The model containing all predictors was able to effectively (χ 2 (8, N=40)=17.55, P<0.05) distinguish between the patients with and without DFU incidence. The mechanical properties of plantar soft tissue can be used to improve the predictability of DFU in moderate/high risk patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Pattern description and reliability parameters of six force-time related indices measured with plantar pressure measurements.

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Deschamps, Kevin; Roosen, Philip; Bruyninckx, Herman; Desloovere, Kaat; Deleu, Paul-Andre; Matricali, Giovanni A; Peeraer, Louis; Staes, Filip

2013-09-01

Functional interpretation of plantar pressure measurements is commonly done through the use of ratios and indices which are preceded by the strategic combination of a subsampling method and selection of physical quantities. However, errors which may arise throughout the determination of these temporal indices/ratio calculations (T-IRC) have not been quantified. The purpose of the current study was therefore to estimate the reliability of T-IRC following semi-automatic total mapping (SATM). Using a repeated-measures design, two experienced therapists performed three subsampling sessions on three left and right pedobarographic footprints of ten healthy participants. Following the subsampling, six T-IRC were calculated: Rearfoot-Forefoot_fti, Rearfoot-Midfoot_fti, Forefoot medial/lateral_fti, First ray_fti, Metatarsal 1-Metatarsal 5_fti, Foot medial-lateral_fti. Patterns of the T-IRC were found to be consistent and in good agreement with corresponding knowledge from the literature. The inter-session errors of both therapists were similar in pattern and magnitude. The lowest peak inter-therapist error was found in the First ray_fti (6.5 a.u.) whereas the highest peak inter-therapist error was observed in the Forefoot medial/lateral_fti (27.0 a.u.) The magnitude of the inter-session and inter-therapist error varied over time, precluding the calculation of a simple numerical value for the error. The difference between both error parameters of all T-IRC was negligible which underscores the repeatability of the SATM protocol. The current study reports consistent patterns for six T-IRC and similar inter-session and inter-therapist error. The proposed SATM protocol and the T-IRC may therefore serve as basis for functional interpretation of footprint data. Copyright © 2013 Elsevier B.V. All rights reserved.

Use of high-resolution ultrasound to measure changes in plantar fascia thickness resulting from tissue creep in runners and walkers.

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Welk, Aaron B; Haun, Daniel W; Clark, Thomas B; Kettner, Norman W

2015-01-01

This study sought to use high-resolution ultrasound to measure changes in plantar fascia thickness as a result of tissue creep generated by walking and running. Independent samples of participants were obtained. Thirty-six walkers and 25 runners walked on a treadmill for 10 minutes or ran for 30 minutes, respectively. Standardized measures of the thickness of the plantar fascia were obtained in both groups using high-resolution ultrasound. The mean thickness of the plantar fascia was measured immediately before and after participation. The mean plantar fascia thickness was decreased by 0.06 ± 0.33 mm SD after running and 0.03 ± 0.22 mm SD after walking. The difference between groups was not significant. Although the parameters of this study did not produce significant changes in the plantar fascia thickness, a slightly higher change in the mean thickness of the plantar fascia in the running group deserves further investigation. Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

[The research in a foot pressure measuring system based on LabVIEW].

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Li, Wei; Qiu, Hong; Xu, Jiang; He, Jiping

2011-01-01

This paper presents a system of foot pressure measuring system based on LabVIEW. The designs of hardware and software system are figured out. LabVIEW is used to design the application interface for displaying plantar pressure. The system can realize the plantar pressure data acquisition, data storage, waveform display, and waveform playback. It was also shown that the testing results of the system were in line with the changing trend of normal gait, which conformed to human system engineering theory. It leads to the demonstration of system reliability. The system gives vivid and visual results, and provides a new method of how to measure foot-pressure and some references for the design of Insole System.

Pathologic and post-operative conditions of the plantar fascia: review of MR imaging appearances

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Yu, J.S. [Ohio State Univ., Columbus (United States). Dept. of Radiology

2000-09-01

Magnetic resonance (MR) imaging has emerged as an important noninvasive diagnostic imaging technique for assessment of foot pathology. This modality, owing to its multiplanar imaging capability and inherent superiority in contrast, has been shown to be more accurate and sensitive for detection of plantar fascia pathology than any other imaging method. One of the most important and recognizable causes of heel pain is plantar fasciitis. With the exception of plantar fasciitis, there has been little emphasis on imaging other conditions that affect this important structure. The objective of this review is to demonstrate, from a perspective of MR imaging, the many different pathologic conditions that affect the plantar fascia. Included in this review will be a discussion of normal anatomy as well as entities such as acute plantar fasciitis, chronic plantar fasciitis, traumatic rupture, normal post-surgical changes, pathologic post-fasciotomy conditions, infection, and fibromatosis. (orig.)

Pathologic and post-operative conditions of the plantar fascia: review of MR imaging appearances

International Nuclear Information System (INIS)

Yu, J.S.

2000-01-01

Magnetic resonance (MR) imaging has emerged as an important noninvasive diagnostic imaging technique for assessment of foot pathology. This modality, owing to its multiplanar imaging capability and inherent superiority in contrast, has been shown to be more accurate and sensitive for detection of plantar fascia pathology than any other imaging method. One of the most important and recognizable causes of heel pain is plantar fasciitis. With the exception of plantar fasciitis, there has been little emphasis on imaging other conditions that affect this important structure. The objective of this review is to demonstrate, from a perspective of MR imaging, the many different pathologic conditions that affect the plantar fascia. Included in this review will be a discussion of normal anatomy as well as entities such as acute plantar fasciitis, chronic plantar fasciitis, traumatic rupture, normal post-surgical changes, pathologic post-fasciotomy conditions, infection, and fibromatosis. (orig.)

A constitutive model for the mechanical characterization of the plantar fascia.

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Natali, Arturo N; Pavan, Piero G; Stecco, Carla

2010-10-01

A constitutive model is proposed to describe the mechanical behavior of the plantar fascia. The mechanical characterization of the plantar fascia regards the role in the foot biomechanics and it is involved in many alterations of its functional behavior, both of mechanical and nonmechanical origin. The structural conformation of the plantar fascia in its middle part is characterized by the presence of collagen fibers reinforcing the tissue along a preferential orientation, which is that supporting the major loading. According to this anatomical evidence, the tissue is described by developing an isotropic fiber-reinforced constitutive model and since the elastic response of the fascia is here considered, the constitutive model is based on the theory of hyperelasticity. The model is consistent with a kinematical description of large strains mechanical behavior, which is typical of soft tissues. A fitting procedure of the constitutive model is implemented making use of experimental curves taken from the literature and referring to specimens of human plantar fascia. A satisfactory fitting of the tensile behavior of the plantar fascia has been performed, showing that the model correctly interprets the mechanical behavior of the tissue in the light of comparison to experimental data at disposal. A critical analysis of the model with respect to the problem of the identification of the constitutive parameters is proposed as the basis for planning a future experimental investigation of mechanical behavior of the plantar fascia.

When does mechanical plantar stimulation promote sensory re-weighing: standing on a firm or compliant surface?

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Preszner-Domjan, Andrea; Nagy, Edit; Szíver, Edit; Feher-Kiss, Anna; Horvath, Gyöngyi; Kranicz, Janos

2012-08-01

The purpose of this study was to investigate the effect of different types of mechanical stimulation of the sole on standing postural stability in healthy, young adults. Fifty subjects (34 women, 16 men; mean age 23 ± 2 (mean ± SE)) stood barefoot on fixed force plates both with open and closed eyes on firm surface and then on compliant surface (foam). A modified clinical test of sensory interaction on balance protocol was employed to assess the center of gravity (COG) excursions along anteroposterior (AP) and mediolateral (ML) axes on each surface and visual condition. After the baseline measurement, a stimulation was applied with an elastic spiked layer topped to the firm and then foam surface, and the COG excursions were measured during the stimulation, and then at least 30 min after the stimulation of the spiked layer, we used 10 min of manual static and glide pressure applied to the plantar surface of both feet. Immediately after manual stimulation, static balance parameters were measured again. Results showed that after manual stimulation, the sway path with closed eyes decreased significantly on the AP and ML directions on firm surface conditions. The spiked layer caused significantly decreased sway path on firm platform in both directions, but it was ineffective on compliant surface. Our results established that the activation of plantar mechanoreceptors by 10-min manual stimulation can partially compensate subjects for the absence of visual input and the lack of accurate pressure information from the supporting surface, too.

Application of Multiscale Entropy in Assessing Plantar Skin Blood Flow Dynamics in Diabetics with Peripheral Neuropathy

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Fuyuan Liao

2018-02-01

Full Text Available Diabetic foot ulcer (DFU is a common complication of diabetes mellitus, while tissue ischemia caused by impaired vasodilatory response to plantar pressure is thought to be a major factor of the development of DFUs, which has been assessed using various measures of skin blood flow (SBF in the time or frequency domain. These measures, however, are incapable of characterizing nonlinear dynamics of SBF, which is an indicator of pathologic alterations of microcirculation in the diabetic foot. This study recruited 18 type 2 diabetics with peripheral neuropathy and eight healthy controls. SBF at the first metatarsal head in response to locally applied pressure and heating was measured using laser Doppler flowmetry. A multiscale entropy algorithm was utilized to quantify the regularity degree of the SBF responses. The results showed that during reactive hyperemia and thermally induced biphasic response, the regularity degree of SBF in diabetics underwent only small changes compared to baseline and significantly differed from that in controls at multiple scales (p < 0.05. On the other hand, the transition of regularity degree of SBF in diabetics distinctively differed from that in controls (p < 0.05. These findings indicated that multiscale entropy could provide a more comprehensive assessment of impaired microvascular reactivity in the diabetic foot compared to other entropy measures based on only a single scale, which strengthens the use of plantar SBF dynamics to assess the risk for DFU.

Does footprint depth correlate with foot motion and pressure?

Science.gov (United States)

Bates, K T; Savage, R; Pataky, T C; Morse, S A; Webster, E; Falkingham, P L; Ren, L; Qian, Z; Collins, D; Bennett, M R; McClymont, J; Crompton, R H

2013-06-06

Footprints are the most direct source of evidence about locomotor biomechanics in extinct vertebrates. One of the principal suppositions underpinning biomechanical inferences is that footprint geometry correlates with dynamic foot pressure, which, in turn, is linked with overall limb motion of the trackmaker. In this study, we perform the first quantitative test of this long-standing assumption, using topological statistical analysis of plantar pressures and experimental and computer-simulated footprints. In computer-simulated footprints, the relative distribution of depth differed from the distribution of both peak and pressure impulse in all simulations. Analysis of footprint samples with common loading inputs and similar depths reveals that only shallow footprints lack significant topological differences between depth and pressure distributions. Topological comparison of plantar pressures and experimental beach footprints demonstrates that geometry is highly dependent on overall print depth; deeper footprints are characterized by greater relative forefoot, and particularly toe, depth than shallow footprints. The highlighted difference between 'shallow' and 'deep' footprints clearly emphasizes the need to understand variation in foot mechanics across different degrees of substrate compliance. Overall, our results indicate that extreme caution is required when applying the 'depth equals pressure' paradigm to hominin footprints, and by extension, those of other extant and extinct tetrapods.

Does footprint depth correlate with foot motion and pressure?

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Bates, K. T.; Savage, R.; Pataky, T. C.; Morse, S. A.; Webster, E.; Falkingham, P. L.; Ren, L.; Qian, Z.; Collins, D.; Bennett, M. R.; McClymont, J.; Crompton, R. H.

2013-01-01

Footprints are the most direct source of evidence about locomotor biomechanics in extinct vertebrates. One of the principal suppositions underpinning biomechanical inferences is that footprint geometry correlates with dynamic foot pressure, which, in turn, is linked with overall limb motion of the trackmaker. In this study, we perform the first quantitative test of this long-standing assumption, using topological statistical analysis of plantar pressures and experimental and computer-simulate...

Role of neuropathy and high foot pressures in diabetic foot ulceration.

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Frykberg, R G; Lavery, L A; Pham, H; Harvey, C; Harkless, L; Veves, A

1998-10-01

High plantar foot pressures in association with peripheral neuropathy have been ascertained to be important risk factors for ulceration in the diabetic foot. Most studies investigating these parameters have been limited by their size and the homogeneity of study subjects. The objective of this study was therefore to ascertain the risk of ulceration associated with high foot pressures and peripheral neuropathy in a large and diverse diabetic population. We studied a cross-sectional group of 251 diabetic patients of Caucasian (group C) (n=121), black (group B) (n=36), and Hispanic (group H) (n=94) racial origins with an overall age of 58.5+/-12.5 years (range 20-83). There was an equal distribution of men and women across the entire study population. All patients underwent a complete medical history and lower extremity evaluation for neuropathy and foot pressures. Neuropathic parameters were dichotomized (0/1) into two high-risk variables: patients with a vibration perception threshold (VPT) > or =25 V were categorized as HiVPT (n=132) and those with Semmes-Weinstein monofilament tests > or =5.07 were classified as HiSWF (n=190). The mean dynamic foot pressures of three footsteps were measured using the F-scan mat system with patients walking without shoes. Maximum plantar pressures were dichotomized into a high-pressure variable (Pmax6) indicating those subjects with pressures > or =6 kg/cm2 (n=96). A total of 99 patients had a current or prior history of ulceration at baseline. Joint mobility was significantly greater in the Hispanic cohort compared with the other groups at the first metatarsal-phalangeal joint (C 67+/-23 degrees, B 69+/-23 degrees, H 82+/-23 degrees, P=0.000), while the subtalar joint mobility was reduced in the Caucasian group (C 21+/-8 degrees, B 26+/-7 degrees, H 27+/-11 degrees, P=0.000). Maximum plantar foot pressures were significantly higher in the Caucasian group (C 6.7+/-2.9 kg/cm2, B 5.7+/-2.8 kg/cm2, H 4.4+/-1.9 kg/cm2, P=0

Foot mobility and plantar fascia elasticity in patients with plantar fasciitis.

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Sahin, Namık; Oztürk, Alpaslan; Atıcı, Teoman

2010-01-01

In this study, we investigated the radiologic changes of feet in sagittal plane under weightbearing either with or without plantar fasciitis. The study includes 64 feet of the 42 subjects with heel pain (Group 1: 32 women, 10 men, mean age 48 years, range 33-57 years) and 80 feet of the 40 patients (Group 2: 30 women, 10 men, mean age 47.2 years, range 35-56 years) without heel pain. Calcaneal inclination angle (CIA), calcaneal-first metatarsal angle (CMA), and plantar fascia length (PFL) were measured in the lateral radiographs of the weightbearing and non-weightbearing foot. The values of Group 1 and Group 2 were compared. The mean CIA was 26° (range 18-35°), CMA was 121° (range 115-133°), and PFL was 131 mm (range 110-158 mm) in non-weightbearing position for Group 1. The mean CIA was 27° (range 17-38°), CMA was 122° (range 110-135°), and PFL was 136 mm (range 120-155 mm) in non-weightbearing position for Group 2. The mean CIA was 13.6° (range 5-25°), CMA was 138° (range 130-153°), and PFU was 143.8 mm (range 118-158 mm) in weightbearing position for Group 1. The mean CIA was 9.9° (range 4-25°), CMA was 145° (range 130-155°), and PFU was 151.4 mm (range 137-167 mm) in weightbearing position for Group 2. The difference between CIA, CMA, and PFL values were -13°, 17°, and 12 mm under condition of weightbearing and nonweightbearing position values for Group 1; and -17°, 23°, and 15 mm for Group 2. The differences were significant between weightbearing and non-weightbearing position values (pplantar fascia elasticity, which may lead to posterior heel pain syndrome.

LOCAL CORTICOSTEROID VS. AUTOLOGOUS BLOOD FOR PLANTAR FASCIITIS

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Syam Sunder B

2017-01-01

Full Text Available BACKGROUND Plantar fasciitis is the most common cause of heel pain for which professional care is sought. Initially thought of as an inflammatory process, plantar fasciitis is a disorder of degenerative changes in the fascia and maybe more accurately termed plantar fasciosis. Traditional therapeutic efforts have been directed at decreasing the presumed inflammation. These treatments include icing, Nonsteroidal Anti-inflammatory Drugs (NSAIDs, rest and activity modification, corticosteroids, botulinum toxin type A, splinting, shoe modifications and orthosis. Other treatment techniques have been directed at resolving the degeneration caused by the disease process. In general, these techniques are designed to create an acute inflammatory reaction with the goal of restarting the healing process. These techniques include autologous blood injection, Platelet-Rich Plasma (PRP injection, nitroglycerin patches, Extracorporeal Shock Wave Therapy (ESWT and surgical procedures. Recently, research has focused on regenerative therapies with high expectations of success. The use of autologous growth factors is thought to heal through collagen regeneration and the stimulation of a well-ordered angiogenesis. These growth factors are administered in the form of autologous whole blood or Platelet-Rich Plasma (PRP. Platelets can be isolated using simple cell-separating systems. The degranulation of the alpha granules in the platelets releases many different growth factors that play a role in tissue regeneration processes. Platelet-derived growth factor, transforming growth factor-P, vascular-derived endothelial growth factor, epithelial growth factor, hepatocyte growth factor and insulin-like growth factor are examples of such growth factors. Injections with autologous growth factors are becoming common in clinical practice. The present study was an attempt to compare the efficacy of autologous blood injection in plantar fasciitis by comparing it with the local

Reconstruction of soft-tissue lesions of the foot with the use of the medial plantar flap

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Jefferson Lessa Soares de Macedo

Full Text Available ABSTRACT OBJECTIVE: To study use of the medial plantar flap for reconstruction of the heel and foot. METHOD: The authors share their clinical experience with the use of the medial plantar artery flap for coverage of tissue defects around the foot and heel after trauma. Twelve cases of medial plantar artery flap performed from January 2001 to December 2013 were included. RESULTS: Of the 12 patients, ten were male and two were female. The indications were traumatic loss of the heel pad in ten cases and the dorsal foot in two cases. All the flaps healed uneventfully without major complications, except one case with partial flap loss. The donor site was covered with a split-thickness skin graft. The flaps had slightly inferior protective sensation compared with the normal side. CONCLUSION: From these results, the authors suggest that the medial plantar artery flap is a good addition to the existing armamentarium for coverage of the foot and heel. It is versatile flap that can cover defects on the heel, over the Achilles tendon and plantar surface, as well as the dorsal foot. It provides tissue to the plantar skin with a similar texture and intact protective sensation.

Effect of two Backpack Designs on Cop Displacement and Plantar Force Distribution in Children during Upright Stance

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Mastalerz Andrzej

2016-09-01

Full Text Available Introduction. Many studies have compared different backpack designs and their influence on the carrier; however, no data referring to school students aged 7-8 years are currently available. Therefore, the aim of the research was to assess the influence of backpack design on centre of pressure (COP displacement and plantar force distribution in children during an upright stance. Material and methods. Nineteen school students (9 males and 10 females volunteered for the study. Two Polish backpacks intended for school use were evaluated: backpack A, which had two main compartments, and backpack B, which had one main compartment. The backpack load was composed of books, binders, and regular school equipment. During the measurements, the subjects were asked to look ahead with the head straight and arms at the sides in a comfortable position and to stand barefoot on the F-Scan® sensors (Tekscan, F-Scan® attached to the force platform (Kistler, carrying a load corresponding to 10% of their body mass. Results. The study found insignificant differences between the two backpack designs. Moreover, COP parameters increased significantly during an upright stance while carrying backpack B in comparison to the empty backpack condition. Additionally, we observed significantly higher values of plantar force distribution in the heel region for the condition without load and insignificantly higher ones for carrying backpack A. Conclusions. The results of the current study suggest that the differences between the two backpack designs are too marginal to be detected through COP displacement. Disturbances in plantar force distribution suggest a lack of posture control and a lower stability of the standing position with a backpack, but these disturbances were significant only when the backpack with one main compartment was used.

Comparison Of Medial Arch-Supporting Insoles And Heel Pads In The Treatment Of Plantar Fasciitis

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Malkoc Melih

2015-03-01

Full Text Available Plantar fasciitis is a disorder caused by inflammation of the insertion point of the plantar fascia over the medial tubercle of the calcaneus. Foot orthotics are used to treat plantar fasciitis. Heel pads medialise the centre of force, whereas medial arch supporting insoles lateralise the force. We assessed the clinical results of the treatment of plantar fasciitis with silicone heel pads and medial arch-supported silicone insoles.

Palmar-plantar erythrodysesthesia secondary to docetaxel chemotherapy: a case report

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Al-Niaimi Amjad

2011-02-01

Full Text Available Abstract Introduction Docetaxel is a chemotherapeutic agent used alone or in combination for the management of many neoplastic conditions. Numerous side effects are well described as a consequence. Palmar-plantar erythrodysesthesia, although a relatively common side effect of some types of chemotherapy, occurs infrequently with docetaxel and is often attributed to other drug agents. Case Presentation We report the case of a 66-year-old Caucasian woman who received adjuvant docetaxel monotherapy for invasive breast cancer. She developed palmar-plantar erythrodysesthesia following her first cycle of treatment, which necessitated a change in management. Conclusion Palmar-plantar erythrodysesthesia is a relatively common side effect of cytotoxic chemotherapy, particularly with drugs such as 5-fluorouracil, capecitabine and liposomal doxorubicin. Docetaxel is commonly used both alone and in combination with a number of these agents for the management of various malignant conditions. We would like to highlight the occurrence of palmar-plantar erythrodysesthesia as a result of docetaxel monotherapy so that it can be considered as a potential cause in patients receiving combination treatment with chemotherapeutic agents better known to cause this toxicity.

Objective assessment of corticosteroid effect in plantar fasciitis: additional utility of ultrasound

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Moustafa, Asmaa Mahmoud Ali; Hassanein, Eshrak; Foti, Calogero

2015-01-01

Summary Background although plantar fascia thickening is well documented as a sonographic criterion for the diagnosis of plantar fasciitis (PF), however it was less evaluated as an objective measure of response to treatment. It is unknown to what extent if any different responses to different treatments are related to the ultrasound (US) morphology changes. We aimed to evaluate changes in US findings in correlation to pain reported. Methods this prospective observational trial included 21 plantar fasciitis patients (26 feet), resistant to conservative treatment for at least 2 months. Plantar fascia thickness and echogenicity were evaluated, compared to asymptomatic feet and correlated with visual analogue scale (VAS) and Heel Tenderness Index (HTI), before and after dexam-ethasone (DXM) iontophoresis in group I, and DXM injection in group II. Results increased thickness and reduced echogenicity were constant in symptomatic feet, with high statistical significant difference compared to asymptomatic side. Correlation between plantar fascia thickness with VAS and HTI before and after treatment showed statistically significant positive correlation (pplantar fascia thickness by US in response to DXM had 100% sensitivity, 65.2% specificity and 69% accuracy, with higher specificity and accuracy than VAS. Conclusion US changes showed concurrent validity correlated with self-reported clinical improvement. Accordingly, ultrasound can be considered an objective useful tool for monitoring response to corticosteroid in patients with plantar fasciitis. PMID:26958538

Detection of normal plantar fascia thickness in adults via the ultrasonographic method.

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Abul, Kadir; Ozer, Devrim; Sakizlioglu, Secil Sezgin; Buyuk, Abdul Fettah; Kaygusuz, Mehmet Akif

2015-01-01

Heel pain is a prevalent concern in orthopedic clinics, and there are numerous pathologic abnormalities that can cause heel pain. Plantar fasciitis is the most common cause of heel pain, and the plantar fascia thickens in this process. It has been found that thickening to greater than 4 mm in ultrasonographic measurements can be accepted as meaningful in diagnoses. Herein, we aimed to measure normal plantar fascia thickness in adults using ultrasonography. We used ultrasonography to measure the plantar fascia thickness of 156 healthy adults in both feet between April 1, 2011, and June 30, 2011. These adults had no previous heel pain. The 156 participants comprised 88 women (56.4%) and 68 men (43.6%) (mean age, 37.9 years; range, 18-65 years). The weight, height, and body mass index of the participants were recorded, and statistical analyses were conducted. The mean ± SD (range) plantar fascia thickness measurements for subgroups of the sample were as follows: 3.284 ± 0.56 mm (2.4-5.1 mm) for male right feet, 3.3 ± 0.55 mm (2.5-5.0 mm) for male left feet, 2.842 ± 0.42 mm (1.8-4.1 mm) for female right feet, and 2.8 ± 0.44 mm (1.8-4.3 mm) for female left feet. The overall mean ± SD (range) thickness for the right foot was 3.035 ± 0.53 mm (1.8-5.1 mm) and for the left foot was 3.053 ± 0.54 mm (1.8-5.0 mm). There was a statistically significant and positive correlation between plantar fascia thickness and participant age, weight, height, and body mass index. The plantar fascia thickness of adults without heel pain was measured to be less than 4 mm in most participants (~92%). There was no statistically significant difference between the thickness of the right and left foot plantar fascia.

The Role of Arch Compression and Metatarsophalangeal Joint Dynamics in Modulating Plantar Fascia Strain in Running

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McDonald, Kirsty A.; Stearne, Sarah M.; Alderson, Jacqueline A.; North, Ian; Pires, Neville J.; Rubenson, Jonas

2016-01-01

Elastic energy returned from passive-elastic structures of the lower limb is fundamental in lowering the mechanical demand on muscles during running. The purpose of this study was to investigate the two length-modulating mechanisms of the plantar fascia, namely medial longitudinal arch compression and metatarsophalangeal joint (MPJ) excursion, and to determine how these mechanisms modulate strain, and thus elastic energy storage/return of the plantar fascia during running. Eighteen runners (9 forefoot and 9 rearfoot strike) performed three treadmill running trials; unrestricted shod, shod with restricted arch compression (via an orthotic-style insert), and barefoot. Three-dimensional motion capture and ground reaction force data were used to calculate lower limb kinematics and kinetics including MPJ angles, moments, powers and work. Estimates of plantar fascia strain due to arch compression and MPJ excursion were derived using a geometric model of the arch and a subject-specific musculoskeletal model of the plantar fascia, respectively. The plantar fascia exhibited a typical elastic stretch-shortening cycle with the majority of strain generated via arch compression. This strategy was similar in fore- and rear-foot strike runners. Restricting arch compression, and hence the elastic-spring function of the arch, was not compensated for by an increase in MPJ-derived strain. In the second half of stance the plantar fascia was found to transfer energy between the MPJ (energy absorption) and the arch (energy production during recoil). This previously unreported energy transfer mechanism reduces the strain required by the plantar fascia in generating useful positive mechanical work at the arch during running. PMID:27054319

The Role of Arch Compression and Metatarsophalangeal Joint Dynamics in Modulating Plantar Fascia Strain in Running.

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Kirsty A McDonald

Full Text Available Elastic energy returned from passive-elastic structures of the lower limb is fundamental in lowering the mechanical demand on muscles during running. The purpose of this study was to investigate the two length-modulating mechanisms of the plantar fascia, namely medial longitudinal arch compression and metatarsophalangeal joint (MPJ excursion, and to determine how these mechanisms modulate strain, and thus elastic energy storage/return of the plantar fascia during running. Eighteen runners (9 forefoot and 9 rearfoot strike performed three treadmill running trials; unrestricted shod, shod with restricted arch compression (via an orthotic-style insert, and barefoot. Three-dimensional motion capture and ground reaction force data were used to calculate lower limb kinematics and kinetics including MPJ angles, moments, powers and work. Estimates of plantar fascia strain due to arch compression and MPJ excursion were derived using a geometric model of the arch and a subject-specific musculoskeletal model of the plantar fascia, respectively. The plantar fascia exhibited a typical elastic stretch-shortening cycle with the majority of strain generated via arch compression. This strategy was similar in fore- and rear-foot strike runners. Restricting arch compression, and hence the elastic-spring function of the arch, was not compensated for by an increase in MPJ-derived strain. In the second half of stance the plantar fascia was found to transfer energy between the MPJ (energy absorption and the arch (energy production during recoil. This previously unreported energy transfer mechanism reduces the strain required by the plantar fascia in generating useful positive mechanical work at the arch during running.

The Role of Arch Compression and Metatarsophalangeal Joint Dynamics in Modulating Plantar Fascia Strain in Running.

Science.gov (United States)

McDonald, Kirsty A; Stearne, Sarah M; Alderson, Jacqueline A; North, Ian; Pires, Neville J; Rubenson, Jonas

2016-01-01

Elastic energy returned from passive-elastic structures of the lower limb is fundamental in lowering the mechanical demand on muscles during running. The purpose of this study was to investigate the two length-modulating mechanisms of the plantar fascia, namely medial longitudinal arch compression and metatarsophalangeal joint (MPJ) excursion, and to determine how these mechanisms modulate strain, and thus elastic energy storage/return of the plantar fascia during running. Eighteen runners (9 forefoot and 9 rearfoot strike) performed three treadmill running trials; unrestricted shod, shod with restricted arch compression (via an orthotic-style insert), and barefoot. Three-dimensional motion capture and ground reaction force data were used to calculate lower limb kinematics and kinetics including MPJ angles, moments, powers and work. Estimates of plantar fascia strain due to arch compression and MPJ excursion were derived using a geometric model of the arch and a subject-specific musculoskeletal model of the plantar fascia, respectively. The plantar fascia exhibited a typical elastic stretch-shortening cycle with the majority of strain generated via arch compression. This strategy was similar in fore- and rear-foot strike runners. Restricting arch compression, and hence the elastic-spring function of the arch, was not compensated for by an increase in MPJ-derived strain. In the second half of stance the plantar fascia was found to transfer energy between the MPJ (energy absorption) and the arch (energy production during recoil). This previously unreported energy transfer mechanism reduces the strain required by the plantar fascia in generating useful positive mechanical work at the arch during running.

The plantar fasciotomy: MR imaging findings in asymptomatic volunteers

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Yu, J.S.; Ashman, C. [Ohio State Univ. Medical Center, Department of Radiology, Columbus, OH (United States); Smith, G.; Kaeding, C. [Ohio State Univ. Medical Center, Department of Surgery, Columbus, OH (United States)

1999-08-01

Objective. To determine the postoperative appearance of the plantar fascia on MR imaging after a fasciotomy has been performed, and to compare the postsurgical appearance of the fascia after an open and endoscopic procedure.< rate at head-abs-p1.lf>Design and patients. Fifteen asymptomatic volunteers (12 women, 3 men; age range 22-49 years, mean age 33 years) with prior fasciotomies for treatment of longstanding plantar fasciitis were studied. Fourteen volunteers had a unilateral release and one volunteer had bilateral releases, allowing for assessment of 16 ankles. Eight fasciotomies were performed through an open incision and eight were performed endoscopically. The average time between surgery and imaging was 24 months (range 11-46 months). The site of surgery was established from the operative reports. Proton density (PD)-weighted and T2-weighted images in three orthogonal planes were obtained on a 1.5-T magnet. In eight studies, T1-weighted sagittal and STIR sagittal images were included. The fascia in each ankle was assessed for morphology and signal intensity. Perifascial soft tissues and bone marrow were assessed for edema. Preoperative MR studies were available in five volunteers.< rate at head-abs-p1.lf>Results. There was no apparent difference in the postoperative appearance of the ankle after an open or endoscopic procedure except for scar formation in the subcutaneous fat which was common after an open procedure (P<0.05). Three ankles had a gap in the fascia (one open, two endoscopic). The plantar fascia measured a mean of 7.0 mm (range 5-10 mm) at the fasciotomy, and 8.3 mm (range 6-12 mm) at the enthesis. At the fasciotomy, 11 of 13 ankles had an indistinct deep contour and 9 of 13 had an indistinct superficial contour. At the enthesis, 13 of 16 ankles had an indistinct deep contour and 6 of 16 had an indistinct superficial contour. Compared with preoperative MR studies there was an average reduction in the fascial thickness at the enthesis of 14

The effectiveness of manual stretching in the treatment of plantar heel pain: a systematic review

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Parish Ben

2011-06-01

Full Text Available Abstract Background Plantar heel pain is a commonly occurring foot complaint. Stretching is frequently utilised as a treatment, yet a systematic review focusing only on its effectiveness has not been published. This review aimed to assess the effectiveness of stretching on pain and function in people with plantar heel pain. Methods Medline, EMBASE, CINAHL, AMED, and The Cochrane Library were searched from inception to July 2010. Studies fulfilling the inclusion criteria were independently assessed, and their quality evaluated using the modified PEDro scale. Results Six studies including 365 symptomatic participants were included. Two compared stretching with a control, one study compared stretching to an alternative intervention, one study compared stretching to both alternative and control interventions, and two compared different stretching techniques and durations. Quality rating on the modified Pedro scale varied from two to eight out of a maximum of ten points. The methodologies and interventions varied significantly between studies, making meta-analysis inappropriate. Most participants improved over the course of the studies, but when stretching was compared to alternative or control interventions, the changes only reached statistical significance in one study that used a combination of calf muscle stretches and plantar fascia stretches in their stretching programme. Another study comparing different stretching techniques, showed a statistically significant reduction in some aspects of pain in favour of plantar fascia stretching over calf stretches in the short term. Conclusions There were too few studies to assess whether stretching is effective compared to control or other interventions, for either pain or function. However, there is some evidence that plantar fascia stretching may be more effective than Achilles tendon stretching alone in the short-term. Appropriately powered randomised controlled trials, utilizing validated outcome

Multi-segment foot kinematics and plantar fascia strain during treadmill and overground running

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Sinclair, Jonathan Kenneth; Taylor, Paul John; Vincent, Hayley

2014-01-01

Although physiologically beneficial, running is known to be associated with a high incidence of chronic injuries. Excessive coronal and transverse plane motions of the foot segments and strain experienced by the plantar fascia are linked to the development of a number of chronic injuries. This study examined differences in multi-segment foot kinematics and plantar fascia strain during treadmill and overground running. Twelve male recreational runners ran at 4.0 m.s-1 in both treadmill and ove...

Long-Term Outcome of Open Plantar Fascia Release.

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MacInnes, Alasdair; Roberts, Sam C; Kimpton, Jessica; Pillai, Anand

2016-01-01

Plantar fasciitis is thought to be a self-limiting condition best treated by conservative measures, but despite this many patients have a prolonged duration of symptoms and surgery may be indicated. Partial plantar fascial release is reported to have a short-term success rate of up to 80%, but anecdotally this was not thought to represent our local experience. An audit of long-term patient-reported outcomes following open partial plantar fascia release was performed. A total of 30 patients (33 feet) were identified over a 10-year period and case notes were reviewed. Patients were contacted by letter and invited to complete 2 validated patient-reported outcome score questionnaires (Visual Analog Scale-Foot and Ankle [VAS-FA] and Manchester Oxford Foot Questionnaire [MOXFQ]). Responses were received from 24 patients (26 feet). The average ages were 42.4 (range 24-61) for male and 46.2 (range 33-60) for female patients, with a female/male ratio of 2.7:1. The average duration of treatment prior to operative intervention was 3.1 years (range 1-5). Preoperatively, our cohort underwent a range of conservative measures. All patients were reviewed postoperatively, and average time from surgery to completion of questionnaires was 80 months (range 14-130). The outcomes were worse in patients who had received preoperative steroid injections and this was found to be statistically significant. The mean MOXFQ score was 33.6 ± 3.9 (0-64). Mean VAS-FA score was 57.8 ± 4.9 (24-100). This study found a negative correlation between duration of follow-up and outcome, in both MOXFQ and VAS-FA, showing that patients continued to improve many years postoperatively. The authors also found worse outcomes with preoperative steroid injections, better outcomes in older patients, and a weak gender bias, suggesting results in men were better than those in women. A prolonged recovery period and generally poor outcomes leads the authors to suggest that open plantar fascia release is of

Distribuição da força plantar e oscilação do centro de pressão em relação ao peso e posicionamento do material escolar Plantar force distribution and pressure center oscillation in relation to the weight and positioning of school supplies and books in student's backpack

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S Rodrigues

2008-02-01

Full Text Available OBJETIVO: Investigou-se a influência da carga e posicionamento do material escolar sobre a distribuição da força plantar (DFP e trajetória do centro de pressão (COP em estudantes. MÉTODOS: Participaram 30 voluntários (10,7 ± 1,35 anos, ambos os gêneros, sem alteração postural. Dados baropodométricos foram coletados em sistema de baropodometria computadorizada (Matscan Research, Teckscanâ, 5.72: sem carga (controle; com carga (mochila de 5, 10 e 15% da massa corporal, posicionada nas regiões anterior e posterior do tronco, ombro direito e esquerdo. RESULTADOS: Sem carga, a DFP foi maior no calcâneo esquerdo comparado ao direito (pOBJECTIVE: The influence of the weight and positioning of school supplies and books in backpacks, on plantar force distribution (PFD and pressure center location, was investigated among students. METHODS: Thirty volunteers of both genders participated in the study. Their mean age was 10.76 (± 1.35 years and none of them had postural abnormalities. Baropodometric data were collected using a computerized baropodometric system (Matscan Research, Tekscanâ, 5.72: without load (control and with loads of 5, 10 and 15% of body weight in a backpack, positioned on the back, on the chest and on the right and left shoulders. RESULTS: The PFD without load was greater on the left heel than on the right heel (p< 0.05. With a load of 10% on the left shoulder, the PFD was greater on the right and smaller on the left foot, in comparison with the control (p< 0.05. With a load of 5% on the back, the PFD was smaller on the right midfoot (RMF and left forefoot (lff; with 10%, it was smaller on the RMF and left midfoot (LMF and greater on the right toes (RT; with 15%, it was smaller on the RMF and greater on the RT (p< 0.05. The plantar force was greater on the RT with loads of 10% and 15% than it was with loads of 5% (p< 0.05. With loads of 15% on the back and on the chest, the pressure center displacement was greater than

Plantar calcaneal enthesophytes: new observations regarding sites of origin based on radiographic, MR imaging, anatomic, and paleopathologic analysis

International Nuclear Information System (INIS)

Abreu, M.R.; Chung, C.B.; Mendes, L.; Mohana-Borges, A.; Trudell, D.; Resnick, D.

2003-01-01

To determine the relationship between sites of calcaneal plantar enthesophytes and surrounding fascial and soft tissue structures using routine radiography, MR imaging, and data derived from cadaveric and paleopathologic specimens.Design and patients. Two observers analyzed the MR imaging studies of 40 ankles in 38 patients (35 males, 3 females; mean age 48.3 years) with plantar calcaneal enthesophytes that were selected from all the ankle MR examinations performed during the past year. Data derived from these MR examinations were the following: the size of the enthesophyte; its location in relation to the plantar fascia (PF) and flexor muscles; and the thickness and signal of the PF. The corresponding radiographs of the ankles were evaluated at a different time by the same observers for the presence or absence of plantar enthesophytes and, when present, their measurements. A third observer reviewed all the discordant observations of MR imaging and radiographic examinations. Two observers analyzed 22 calcaneal specimens with plantar enthesophytes at an anthropology museum to determine the orientation of each plantar enthesophyte. MR imaging of a cadaveric foot with a plantar enthesophyte with subsequent sagittal sectioning was performed to provide further anatomic understanding.Results. With regard to MR imaging, the mean size of the plantar enthesophytes was 4.41 mm (SD 2.4). Twenty (50%) enthesophytes were located above the PF, 16 (40%) between the fascia and abductor digiti minimi, flexor digitorum brevis and abductor hallucis muscles, and only one (3%) was located within the PF. In three (8%) cases the location was not determined. The size of enthesophytes seen with MR imaging and radiographs was highly correlated (P 0.8, kappa >0.9). Eleven of the 22 bone specimens had plantar enthesophytes oriented in the direction of the abductor digiti minimi and 11 oriented in the direction of the flexor digitorum brevis and PF. The cadaveric sections revealed different

Plantar calcaneal enthesophytes: new observations regarding sites of origin based on radiographic, MR imaging, anatomic, and paleopathologic analysis

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Abreu, M.R.; Chung, C.B.; Mendes, L.; Mohana-Borges, A.; Trudell, D.; Resnick, D. [Department of Radiology, Musculoskeletal Section, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161 (United States)

2003-01-01

To determine the relationship between sites of calcaneal plantar enthesophytes and surrounding fascial and soft tissue structures using routine radiography, MR imaging, and data derived from cadaveric and paleopathologic specimens.Design and patients. Two observers analyzed the MR imaging studies of 40 ankles in 38 patients (35 males, 3 females; mean age 48.3 years) with plantar calcaneal enthesophytes that were selected from all the ankle MR examinations performed during the past year. Data derived from these MR examinations were the following: the size of the enthesophyte; its location in relation to the plantar fascia (PF) and flexor muscles; and the thickness and signal of the PF. The corresponding radiographs of the ankles were evaluated at a different time by the same observers for the presence or absence of plantar enthesophytes and, when present, their measurements. A third observer reviewed all the discordant observations of MR imaging and radiographic examinations. Two observers analyzed 22 calcaneal specimens with plantar enthesophytes at an anthropology museum to determine the orientation of each plantar enthesophyte. MR imaging of a cadaveric foot with a plantar enthesophyte with subsequent sagittal sectioning was performed to provide further anatomic understanding.Results. With regard to MR imaging, the mean size of the plantar enthesophytes was 4.41 mm (SD 2.4). Twenty (50%) enthesophytes were located above the PF, 16 (40%) between the fascia and abductor digiti minimi, flexor digitorum brevis and abductor hallucis muscles, and only one (3%) was located within the PF. In three (8%) cases the location was not determined. The size of enthesophytes seen with MR imaging and radiographs was highly correlated (P<0.01). The interobserver agreement for all measurements was good (Pearson >0.8, kappa >0.9). Eleven of the 22 bone specimens had plantar enthesophytes oriented in the direction of the abductor digiti minimi and 11 oriented in the direction of the

The effects of orthotic intervention on multisegment foot kinematics and plantar fascia strain in recreational runners.

Science.gov (United States)

Sinclair, Jonathan; Isherwood, Josh; Taylor, Paul J

2015-02-01

Chronic injuries are a common complaint in recreational runners. Foot orthoses have been shown to be effective for the treatment of running injuries but their mechanical effects are still not well understood. This study aims to examine the influence of orthotic intervention on multisegment foot kinematics and plantar fascia strain during running. Fifteen male participants ran at 4.0 m · s(-1) with and without orthotics. Multisegment foot kinematics and plantar fascia strain were obtained during the stance phase and contrasted using paired t tests. Relative coronal plane range of motion of the midfoot relative to the rearfoot was significantly reduced with orthotics (1.0°) compared to without (2.2°). Similarly, relative transverse plane range of motion was significantly lower with orthotics (1.1°) compared to without (1.8°). Plantar fascia strain did not differ significantly between orthotic (7.1) and nonorthotic (7.1) conditions. This study shows that although orthotics did not serve to reduce plantar fascia strain, they are able to mediate reductions in coronal and transverse plane rotations of the midfoot.

Cryotherapy versus salicylic acid for the treatment of plantar warts (verrucae): a randomised controlled trial

Science.gov (United States)

Hewitt, Catherine; Hicks, Kate; Jayakody, Shalmini; Kang’ombe, Arthur Ricky; Stamuli, Eugena; Turner, Gwen; Thomas, Kim; Curran, Mike; Denby, Gary; Hashmi, Farina; McIntosh, Caroline; McLarnon, Nichola; Torgerson, David; Watt, Ian

2011-01-01

Objective To compare the clinical effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts. Design A multicentre, open, two arm randomised controlled trial. Setting University podiatry school clinics, NHS podiatry clinics, and primary care in England, Scotland, and Ireland. Participants 240 patients aged 12 years and over, with a plantar wart that in the opinion of the healthcare professional was suitable for treatment with both cryotherapy and salicylic acid. Interventions Cryotherapy with liquid nitrogen delivered by a healthcare professional, up to four treatments two to three weeks apart. Patient self treatment with 50% salicylic acid (Verrugon) daily up to a maximum of eight weeks. Main outcome measures Complete clearance of all plantar warts at 12 weeks. Secondary outcomes were (a) complete clearance of all plantar warts at 12 weeks controlling for age, whether the wart had been treated previously, and type of wart, (b) patient self reported clearance of plantar warts at six months, (c) time to clearance of plantar wart, (d) number of plantar warts at 12 weeks, and (e) patient satisfaction with the treatment. Results There was no evidence of a difference between the salicylic acid and cryotherapy groups in the proportions of participants with complete clearance of all plantar warts at 12 weeks (17/119 (14%) v 15/110 (14%), difference 0.65% (95% CI –8.33 to 9.63), P=0.89). The results did not change when the analysis was repeated but with adjustment for age, whether the wart had been treated previously, and type of plantar wart or for patients’ preferences at baseline. There was no evidence of a difference between the salicylic acid and cryotherapy groups in self reported clearance of plantar warts at six months (29/95 (31%) v 33/98 (34%), difference –3.15% (–16.31 to 10.02), P=0.64) or in time to clearance (hazard ratio 0.80 (95% CI 0.51 to 1.25), P=0.33). There was also no evidence of a difference in the number of plantar

Plantar pain is not always fasciitis

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N. Romano

2017-12-01

Full Text Available The case is described of a patient with chronic plantar pain, diagnosed as fasciitis, which was not improved by conventional treatment. Magnetic resonance imaging revealed flexor hallucis longus tenosynovitis, which improved after local glucocorticoid injection.

Vendaje Funcional para la Fascitis Plantar

OpenAIRE

Julián Rochina, Iván

2012-01-01

El profesor Vicente Tormo aplica un vendaje funcional que aproxima a su centro geométrico las estructuras que configuran la planta del pie, con el objetivo de mantener relajada la fascia plantar durante la bipedestación.

Treatment of chronic plantar fasciitis with extra corporeal shock wave therapy: ultrasonographic morphological aspect and functional evaluation

Directory of Open Access Journals (Sweden)

Roberto Androson

2013-12-01

Full Text Available Objective: This paper has the purpose to analyze prospectively the treatment results in patients with chronic plantar fasciitis resistant to conservative treatment who underwent extracorporeal shock wave therapy (ESWT. Methods: We evaluated 30 patients (36 feet; 16 (53.3% patients were male and 14 (47.7% female with mean age of 48.7 y.o., varying from 33 to 78 y.o.; 16 (53.3% present the problem on the left side, 14 (46.7% on the right ones and 6 (20% bilateral; the symptomatology varied from 6 to 60 months, with the average of 13.58 months. These patients were submitted to a weekly ESWT session for 4 consecutive weeks. We measured the plantar fascia thickness millimeters with ultrasound and we applied American Orthopaedic Foot and Ankle Society (AOFAS scale for ankle and hindfoot, and Roles & Maudsley scales in pre ESWT, after one, three and six months after and decrease in the plantar fascia thickness by the ultrasound (p = 0.011 along the different moments studied. Results: We observed improvement of the evaluated criteria (p < 0.001 and plantar fascia thickness by ultrasound (p = 0.011 at different time points studied. Conclusion: The ESWT can be considered an important tool in the primary or adjuvant treatment of the chronic plantar fasciitis when associated with conventional therapies. This methodology is safe, non-invasive and provides precocious rehabilitation and return to regular activities considering the results of the statistical analysis. This resource provides decrease in the thickness of the plantar fascia.

Effects of reduced plantar cutaneous sensation on static postural control in individuals with and without chronic ankle instability.

Science.gov (United States)

Song, Kyeongtak; Kang, Tae Kyu; Wikstrom, Erik A; Jun, Hyung-Pil; Lee, Sae Yong

2017-10-01

The purpose of this study was to determine how reduced plantar cutaneous sensation influences static postural control in individuals with and without CAI. A case-control study design. Twenty-six individuals with self-reported CAI and 26 matched healthy controls participated in this study. The plantar aspect of the participants' foot was then submersed in ice water (0°C) for 10min to reduce plantar sensation. Before and after the cooling procedure, plantar cutaneous sensation thresholds and single leg balance with eyes open and closed were assessed. Significantly, higher scores were observed in both groups after ice water submersion (ppostural control improvement in both groups post-cooling. In single limb balance with eyes closed, Group×Intervention interactions were observed for the TTB AP mean (p=0.003) and TTB AP SD (p=0.017); indicating postural control deficits in CAI group post-cooling, but no changes in the control group. The main finding of this study was that reduced plantar cutaneous sensation induced by an ice submersion procedure caused eyes closed postural control impairments in those with CAI but not healthy controls. The present investigation demonstrated that the ability to dynamically reweight among sensory inputs to maintain postural stability appears to be diminished in CAI patients compared to healthy controls. Copyright © 2016. Published by Elsevier Ltd.

A study of dynamic foot pressure measurement in diabetic patients

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Milka D Madhale

2017-01-01

Full Text Available Introduction: Diabetic foot ulcer is a major source of morbidity and a leading cause of hospitalization. It is estimated that approximately 20% of hospital admissions among patients with diabetes mellitus are due to diabetic foot ulcer. It can lead to infection, gangrene, amputation, and even death if appropriate care is not provided. Overall, the lower limb amputation in diabetic patients is 15 times higher than in non-diabetics. In the majority of cases, the cause for the foot ulcer is the altered architecture of the foot due to neuropathy resulting in abnormal pressure points on the soles. Purpose: The aim of this study is to develop low cost, lightweight foot pressure scanner and check its reliability and validity which can help to prevent foot ulceration. Design/Methodology/Approach: In the present study, a low cost, lightweight foot pressure scanner is developed, and dynamic plantar pressures in a group of 110 Indian patients with diabetes with or without neuropathy and foot ulcers are measured. Practical Implications: If these pressure points can be detected, ulcers can be prevented by providing offloading footwear. Originality/Value: Differences are found in dynamic foot pressures in different study groups, namely, diabetic patients, patients with diabetic peripheral neuropathy, patients with foot ulcers, and nondiabetics. The differences are significant (P < 0.01, which showed the validity of the tool. Reliability and consistency of the tool was checked by test–retest method. Paper Type: Original Research work. Conclusion: Based on the results of the present study, it is concluded that the scanner is successfully developed and it can measure foot pressures. It is a novel device to proactively monitor foot health in diabetics in an effort to prevent and reduce diabetic foot complications.

EFFECTIVENESS OF INSTUMENTAL ASSISTED SOFT TISSUE MOBILIZATION TECHNIQUE WITH STATIC STRETCHING IN SUBJECTS WITH PLANTAR FASCIITIS

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Vinod Babu. K

2014-08-01

Full Text Available Background: Instrumental assisted soft tissue mobilization and static stretching found to be effective in plantar fasciitis, however the combined effectiveness of these techniques were unknown. The purpose of this study is to find the effect of Instrumental assisted soft tissue mobilization technique for plantar fascia combined with static stretching of triceps surae for subjects with chronic stage of Plantar Fasciitis on pain intensity, ankle dorsiflexion range of motion and functional disability. Methods: An experimental study design, selected subjects with chronic Plantar Fasciitis randomized subjects into each Study and Control group. Total of 40 subject’s data who completed study, 20 in each group, was used for analysis. Control group received conventional exercise while Study group received conventional exercises with Instrumental assisted soft tissue mobilization combined with static stretching of triceps surae muscle. Outcome measurements such as Intensity of pain using Numerical Pain Rating Scale-101 (NPRS-101, function disability using Foot Function Index Pain Subscale (FFI and ankle dorsiflexion active range of motion using Goniometer was measured before and after 2 weeks of intervention. Results: There is statistically significant improvement in means of NRS-101, ankle dorsiflexion active range of motion and Foot Function Index Pain Subscale after intervention in both groups. When the post-intervention means were compared between Study and Control group after 2 weeks of treatment there is statistically significant difference in means between the groups whereas study group showed greater percentage of improvement than control group. Conclusion: It is concluded that Instrumental assisted soft tissue mobilization technique combined with static stretching of triceps surae muscle is significantly effective than conventional exercises on reducing pain, improving ankle dorsiflexion range of motion and functional disability for subjects

Novel and Conservative Approaches Towards Effective Management of Plantar Fasciitis

Science.gov (United States)

Ahmad, Awaiz; Kiani, Immad; Ghani, Usman; Wadhera, Vikram; Tom, Todd N

2016-01-01

We assessed the effectiveness of the different treatments for plantar fasciitis (PF) based on the changes in functional outcomes. A systematic literature search was carried out and studies from 2010 to 2016 were included in this review. The databases from Google Scholar, PubMed and Cochrane were used for the various treatment modalities of plantar fasciitis. The objectives measured included visual analog scale (VAS), Roles and Maudsley scale, foot function index (FFI), plantar fascia thickness and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot scale as the tools to predict the improvement in symptoms of pain and discomfort. Eight randomized controlled trails that met the selection criteria were included in this review. Extracorporeal shock wave lithotripsy (ESWL) with botulinum toxin type A, corticosteroid injections, autologous whole blood and plasma treatment, novel treatments like cryopreserved human amniotic membrane, effect of placebo, platelet rich plasma injections and corticosteroid injections, physiotherapy and high strength training were analyzed. All the treatment modalities applied did lead to the reduction in pain scores, but for long term management autologous condition plasma and platelet rich plasma are the preferred treatment options. Impact of physiotherapy and high strength training is equivalent to corticosteroid injections and hence is suited for patients avoiding invasive forms of treatment.  PMID:28083457

Short-term step-to-step correlation in plantar pressure distributions during treadmill walking, and implications for footprint trail analysis.

Science.gov (United States)

Pataky, Todd C; Savage, Russell; Bates, Karl T; Sellers, William I; Crompton, Robin H

2013-09-01

The gait cycle is continuous, but for practical reasons one is often forced to analyze one or only a few adjacent cycles, for example in non-treadmill laboratory investigations and in fossilized footprint analysis. The nature of variability in long-term gait cycle dynamics has been well-investigated, but short-term variability, and specifically correlation, which are highly relevant to short gait bouts, have not. We presently tested for step-to-step autocorrelation in a total of 5243 plantar pressure (PP) distributions from ten subjects who walked at 1.1m/s on an instrumented treadmill. Following spatial foot alignment, data were analyzed both from three points of interest (POI): heel, central metatarsals, and hallux, and for the foot surface as a whole, in a mass-univariate manner. POI results revealed low average step-to-step autocorrelation coefficients (r=0.327±0.094; mean±st. dev.). Formal statistical testing of the whole-foot r distributions reached significance over an average of only 0.42±0.52% of the foot's surface, even for a highly conservative uncorrected threshold of p<0.05. The common assumption, that short gait bouts consist of independent cycles, is therefore not refuted by the present PP results. Copyright © 2013 Elsevier B.V. All rights reserved.

Resistance exercise prevents plantar flexor deconditioning during bed rest

Science.gov (United States)

Bamman, M. M.; Hunter, G. R.; Stevens, B. R.; Guilliams, M. E.; Greenisen, M. C.

1997-01-01

Because resistance exercise (REX) and unloading induce opposing neuromuscular adaptations, we tested the efficacy of REX against the effects of 14 d of bed rest unloading (BRU) on the plantar flexor muscle group. Sixteen men were randomly assigned to no exercise (NOE, N = 8) or REX (N = 8). REX performed 5 sets x 6-10 repetitions to failure of constant resistance concentric/eccentric plantar flexion every other day during BRU. One-repetition maximum (1RM) strength was tested on the training device. The angle-specific torque-velocity relationship across 5 velocities (0, 0.52, 1.05, 1.75, and 2.97 rad.s-1) and the full range-of-motion power-velocity relationship were assessed on a dynamometer. Torque-position analyses identified strength changes at shortened, neutral, and stretched muscle lengths. Concentric and eccentric contractile work were measured across ten repetitions at 1.05 rad.s-1. Maximal neural activation was measured by surface electromyography (EMG). 1RM decreased 9% in NOE and improved 11% in REX (P joint positions. Concentric (15%) and eccentric (11%) contractile work fell in NOE (P < 0.05) but not in REX. Maximal plantar flexor EMG did not change in either group. In summary, constant resistance concentric/eccentric REX completely prevented plantar flexor performance deconditioning induced by BRU. The reported benefits of REX should prove useful in prescribing exercise for astronauts in microgravity and for patients susceptible to functional decline during bed- or chair-bound hospital stays.

Uso da papaína na úlcera plantar

OpenAIRE

Otuka, Elizabet Shizue; Pedrazzani, Elisete Silva; Pioto, Mariangela Pedroso

1996-01-01

Este trabalho teve por objetivo contribuir para a diminuição da incapacidade em hanseníase e as contínuas recidivas de úceras plantares, através da utilização de um método de tratamento com o uso da papaína e ações de educação em saúde. Foi realizado em um Centro de Saúde com pacientes que apresentavam úcera plantar e que concordaram em participar do tratamento proposto. Analisando e comparando os dados obtidos antes e após o tratamento, concluímos que durante o tratamento foi observada uma m...

The plantar fasciotomy: MR imaging findings in asymptomatic volunteers

International Nuclear Information System (INIS)

Yu, J.S.; Ashman, C.; Smith, G.; Kaeding, C.

1999-01-01

Objective. To determine the postoperative appearance of the plantar fascia on MR imaging after a fasciotomy has been performed, and to compare the postsurgical appearance of the fascia after an open and endoscopic procedure. Design and patients. Fifteen asymptomatic volunteers (12 women, 3 men; age range 22-49 years, mean age 33 years) with prior fasciotomies for treatment of longstanding plantar fasciitis were studied. Fourteen volunteers had a unilateral release and one volunteer had bilateral releases, allowing for assessment of 16 ankles. Eight fasciotomies were performed through an open incision and eight were performed endoscopically. The average time between surgery and imaging was 24 months (range 11-46 months). The site of surgery was established from the operative reports. Proton density (PD)-weighted and T2-weighted images in three orthogonal planes were obtained on a 1.5-T magnet. In eight studies, T1-weighted sagittal and STIR sagittal images were included. The fascia in each ankle was assessed for morphology and signal intensity. Perifascial soft tissues and bone marrow were assessed for edema. Preoperative MR studies were available in five volunteers. Results. There was no apparent difference in the postoperative appearance of the ankle after an open or endoscopic procedure except for scar formation in the subcutaneous fat which was common after an open procedure (P Conclusions. The average thickness of the plantar fascia in asymptomatic volunteers after surgery is nearly 2-3 times that of normal. While there is increased thickness at the site of surgery, the changes in morphology and signal intensity were most prominent at the enthesis. The key observation was absence of edema in the fascia and perifascial soft tissues. This baseline information may be of value when assessing MR studies of symptomatic patients. (orig.)

Children with ADHD Show No Deficits in Plantar Foot Sensitivity and Static Balance Compared to Healthy Controls

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Schlee, Gunther; Neubert, Tom; Worenz, Andreas; Milani, Thomas L.

2012-01-01

The goal of this study was to investigate plantar foot sensitivity and balance control of ADHD (n = 21) impaired children compared to age-matched healthy controls (n = 25). Thresholds were measured at 200 Hz at three anatomical locations of the plantar foot area of both feet (hallux, first metatarsal head (METI) and heel). Body balance was…

Rearfoot eversion has indirect effects on plantar fascia tension by changing the amount of arch collapse.

Science.gov (United States)

Lee, Sae Yong; Hertel, Jay; Lee, Sung Cheol

2010-01-01

Rearfoot eversion motion and arch height are believed to contribute to increased tension on the plantar fascia and arch collapse during gait but the specifics of these relationships are not clear. To examine the relationships among static arch height, rearfoot eversion, dynamic arch height, and plantar fascia tension. 28 healthy males participated. After static arch height was measured, the subjects were asked to run at 4.5m/s while frontal plane rearfoot motion, dynamic arch height, and ground reaction forces were collected. The relationships among variables were examined with bivariate correlations and path analysis. The results indicated a high correlation between dynamic arch height and static arch height (r=0.642), plantar fascia tension (r=-0.797), and maximum rearfoot eversion motion during gait (r=-0.518). The path analysis model without the direct rearfoot eversion effect explained 81.2% of the variance in plantar fascia tension, while the model with the direct rearfoot eversion effect explained 82.1% of the variance in plantar fascia tension. Including the indirect effect of maximum rearfoot eversion motion on plantar fascia tension through control of dynamic arch height is the model that best explains the interrelationships of these foot characteristics. The amount of maximum rearfoot eversion motion itself is not a good predictor of plantar fascia tension, however, together with the arch height, maximum rearfoot eversion motion is a good predictor because it has a pronounced indirect effect on plantar fascia tension. Copyright 2010. Published by Elsevier Ltd.

High probability of healing without amputation of plantar forefoot ulcers in patients with diabetes.

Science.gov (United States)

Örneholm, Hedvig; Apelqvist, Jan; Larsson, Jan; Eneroth, Magnus

2015-01-01

Diabetic foot ulcer is an important entity which in many cases is the first serious complication in diabetes. Although a plantar forefoot location is common, there are few studies on larger cohorts and in such studies there is often a combination of various types of ulcer and ulcer locations. The purpose of this study is to discern the outcome of plantar forefoot ulcers and their specific characteristics in a large cohort. All patients (n = 770), presenting with a plantar forefoot ulcer at a multidisciplinary diabetes foot clinic from January 1, 1983 to December 31, 2012 were considered for the study. Seven hundred one patients (median age 67 [22-95]) fulfilled the inclusion criteria and were followed according to a preset protocol until final outcome (healing or death). Severe peripheral vascular disease was present in 26% of the patients and 14% had evidence of deep infection upon arrival at the foot clinic. Fifty-five percent (385/701) of the patients healed without foot surgery, 25% (173/701) healed after major debridement, 9% (60/701) healed after minor or major amputation and 12% (83/701) died unhealed. Median healing time was 17 weeks. An ulcer classified as Wagner grade 1 or 2 at inclusion and independent living were factors associated with a higher healing rate. Seventy-nine percent of 701 patients with diabetes and a plantar forefoot ulcer treated at a multidisciplinary diabetes foot clinic healed without amputation. For one third some form of foot surgery was needed to achieve healing. © 2015 by the Wound Healing Society.

Immediate effects of plantar inputs on the upper half muscles and upright posture: a preliminary study.

Science.gov (United States)

Ciuffolo, Fabio; Ferritto, Anna L; Muratore, Filippo; Tecco, Simona; Testa, Mauro; D'Attilio, Michele; Festa, Felice

2006-01-01

This purpose of this study was to investigate the immediate effects of plantar inputs on both the upper half muscle activity (anterior temporal, masseter, digastric, sternocleidomastoid, upper and lower trapezius, cervical) and the body posture, by means of electromyography (EMG) and vertical force platform, respectively. Twenty four (24) healthy adults, between the ages of 24 and 31 years (25.3 +/- 1.9), with no history of craniomandibular disorder or systemic musculoskeletal dysfunction, were randomly divided into two groups: test group (fourteen subjects) and control group (ten subjects). A first recording session (TO) measured the baseline EMG and postural patterns of both groups. After this session, the test group wore test shoes with insoles that stimulated the plantar surfaces, while the control group wore placebo shoes. After one hour, a second set of measurements (T1) were performed. Significant differences between the groups at baseline were observed in the left anterior temporal, left cervical, and left upper trapezius, as well as at T1 in the left anterior temporal and right upper trapezius (p postural blindness in the test group compared to the control group was observed. Further studies are warranted to investigate the short and long-term effects of this type of insole, in patients with both craniomandibular-cervical and lower extremity disorders.

Biofeedback can reduce foot pressure to a safe level and without causing new at-risk zones in patients with diabetes and peripheral neuropathy.

Science.gov (United States)

De León Rodriguez, D; Allet, L; Golay, A; Philippe, J; Assal, J-Ph; Hauert, C-A; Pataky, Z

2013-02-01

Plantar pressure reduction is mandatory for diabetic foot ulcer healing. Our aim was to evaluate the impact of a new walking strategy learned by biofeedback on plantar pressure distribution under both feet in patients with diabetic peripheral neuropathy. Terminally augmented biofeedback has been used for foot off-loading training in 21 patients with diabetic peripheral sensory neuropathy. The biofeedback technique was based on a subjective estimation of performance and objective visual feedback following walking sequences. The patient was considered to have learned a new walking strategy as soon as the peak plantar pressure (PPP) under the previously defined at-risk zone was within a range of 40-80% of baseline PPP in 70% of the totality of steps and during three consecutive walking sequences. The PPP was measured by a portable in-shoe foot pressure measurement system (PEDAR(®)) at baseline (T0), directly after learning (T1) and at 10-day retention test (T2). The PPP under at-risk zones decreased significantly at T1 (165 ± 9 kPa, p biofeedback leads to a safe and regular plantar pressure distribution without inducing any new 'at-risk' area under both feet. Copyright © 2012 John Wiley & Sons, Ltd.

Effect of eccentric training on the plantar flexor muscle-tendon tissue properties.

Science.gov (United States)

Mahieu, Nele Nathalie; McNair, Peter; Cools, Ann; D'Haen, Caroline; Vandermeulen, Katrien; Witvrouw, Erik

2008-01-01

It has been shown that eccentric training can be effective in the rehabilitation of patients with Achilles tendonopathy. The mechanism behind these results is not clear. However, there is evidence that tendons are able to respond to repeated forces by altering their structure and composition, and, thus, their mechanical properties change. In this regard, the objective of the present study was to investigate whether eccentric training affects the mechanical properties of the plantar flexor's muscle-tendon tissue properties. Seventy-four healthy subjects were randomized into two groups: an eccentric training group and a control group. The eccentric training group performed a 6-wk eccentric training program for the calf muscles. Before and after this period, all subjects were evaluated for dorsiflexion range of motion using universal goniometry, passive resistive torque of the plantar flexors, and stiffness of the Achilles tendon. Passive resistive torque was measured during ankle dorsiflexion on an isokinetic dynamometer. Stiffness of the Achilles tendon was assessed using a dynamometer, in combination with ultrasonography. The results of the study reveal that the dorsiflexion range of motion was significantly increased only in the eccentric training group. The eccentric heel drop program also resulted in a significant decrease of the passive resistive torque of the plantar flexors (from 16.423 +/- 0.827 to 12.651 +/- 0.617 N.m). The stiffness of the Achilles tendon did not change significantly as a result of training. These findings provide evidence that an eccentric training program results in changes to some of the mechanical properties of the plantar flexor muscles. These changes were thought to be associated with modifications to structure rather than to stretch tolerance.

Anhidrotic Ectodermal Dysplasia with Palmo-plantar Keratoderma

Directory of Open Access Journals (Sweden)

Kamlesh Kumar

1982-01-01

Full Text Available A patient with anhidrotic ectodermal dysplasia and palmo-plantar keratoderma is presented. Palmo-planta keratoderma is an unusual association with this disease. Atopic dermatitis was another associated condition in this patient.

Effectiveness of custom-made orthopaedic shoes in the reduction of foot pain and pressure in patients with degenerative disorders of the foot

NARCIS (Netherlands)

Jannink, Michiel; van Dijk, Henk; IJzerman, Maarten; Groothuis-Oudshoorn, Karen; Groothoff, Johan; Lankhorst, Gustaaf

2006-01-01

Background: Degenerative disorders of the foot often are painful during standing and walking. It is assumed that, because of bone deformity, callus, and deformity of the plantar pads, the plantar pressure distribution changes. Prescription of orthopaedic shoes for patients with degenerative

Glabrous skin reconstruction of palmar/plantar defects: a case for the ...

African Journals Online (AJOL)

DR LEGBO

Methods: A prospective descriptive study of consecutive patients with benign soft tissue palmar/plantar defects .... cannot be closed by direct suturing. In the authors' view ... splintage ) did not lead to joint stiffness since majority were children ...

Palmar-plantar erythrodysesthesia associated with capecitabine ...

African Journals Online (AJOL)

We report a case of a 62 year-old patient who developed Palmar-plantar erythrodysesthesia upon receiving four cycles of capacitabine-based chemotherapy. She was on post surgical adjuvant treatment for invasive well differentiated adenocarcinoma of the colon. The clinical and therapeutic aspects of this ...

Finite element analysis of plantar fascia under stretch-the relative contribution of windlass mechanism and Achilles tendon force.

Science.gov (United States)

Cheng, Hsin-Yi Kathy; Lin, Chun-Li; Wang, Hsien-Wen; Chou, Shih-Wei

2008-01-01

Stretching plays an important role in the treatment of plantar fasciitis. Information on the internal stresses/strains of the plantar fascia under stretch is useful in enhancing knowledge on the stretch mechanisms. Although direct measurement can monitor plantar fascia changes, it is invasive and gathers only localized information. The purpose of this paper was to construct a three-dimensional finite element model of the foot to calculate the stretch effects on plantar fascia and monitor its stress/strain distributions and concentrations. A three-dimensional foot model was developed and contained 26 bones with joint cartilages, 67 ligaments and a fan-like solid plantar fascia modeling. All tissues were idealized as linear elastic, homogeneous and isotropic whilst the plantar fascia was assigned as hyperelastic to represent its nonlinearity. The plantar fascia was monitored for its biomechanical responses under various stretch combinations: three toe dorsiflexion angles (windlass effect: 15 degrees , 30 degrees and 45 degrees ) and five Achilles tendon forces (100, 200, 300, 400 and 500N). Our results indicated that the plantar fascia strain increased as the dorsiflexion angles increased, and this phenomenon was enhanced by increasing Achilles tendon force. A stress concentration was found near the medial calcaneal tubercle, and the fascia stress was higher underneath the first foot ray and gradually decreased as it moved toward the fifth ray. The current model recreated the position of the foot when stretch is placed on the plantar fascia. The results provided a general insight into the mechanical and biomechanical aspects of the influences of windlass mechanism and Achilles tendon force on plantar fascia stress and strain distribution. These findings might have practical implications onto plantar fascia stretch approaches, and provide guidelines to its surgical release.

MRI of the plantar structures of the foot after falanga torture

International Nuclear Information System (INIS)

Savnik, A.; Roegind, H.; Danneskiold-Samsoee, B.; Bliddal, H.; Boesen, J.

2000-01-01

Falanga is an ancient form of punishment or torture but is still commonly reported by our refugees. The late result of caning the heel and ball of the foot is a chronic painful condition with few clinical signs. The aim of the present study was to assess, by MRI, possible morphologic characteristics of the heel and ball of the foot, related to falanga and pain in correlation to clinical findings. Magnetic resonance imaging of the foot was obtained in 12 victims exposed to falanga torture and 9 healthy volunteers. Sagittal T1-weighted spin-echo images (TR 616-840 ms, TE 20 ms), T2-weighted spin-echo images (TR 1900 ms, TE 90 ms), and short tau inversion recovery (STIR) images (TR 1200 ms, TE 15 ms, TI 100 ms) were performed. The central portion of the plantar aponeurosis was generally significantly thicker in victims exposed to falanga torture as compared with that of controls (P < 0.05). In all except one of the victims, MRI demonstrated two layers of the thickened plantar aponeurosis: a deeper portion with normal homogeneous low signal intensity (SI) appearance, and a superficial layer with characteristic areas of mixed SI on both T1- and T2-weighted images. There were no signs of chronic muscular compartment syndromes, and the thickness of the plantar pad did not differ between the two groups. Magnetic resonance imaging may demonstrate morphologic characteristics of the plantar aponeurosis which may confirm falanga torture. Further imaging with more specific sequences is warranted to demonstrate the supposed injuries in the compartmental fat tissue chambers and the vascularity of the ball pad of the foot. (orig.)

MRI of the plantar structures of the foot after falanga torture

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Savnik, A. [Frederiksberg Hospital (Denmark). Dept. of Radiology; Frederiksberg Hospital (Denmark). Dept. of Rheumatology; Amris, K.; Prip, K. [Rehabilitation Center for Torture Victims RCT, Copenhagen (Denmark); Roegind, H.; Danneskiold-Samsoee, B.; Bliddal, H. [Frederiksberg Hospital (Denmark). Dept. of Rheumatology; Bojsen-Moeller, F. [Univ. of Copenhagen (Denmark). Panum Inst.; Bartels, E.M. [The Danish National Library of Science and Medicine, Copenhagen University Library 2, Noerre Alle 49, DK-2200 Copenhagen (Denmark); Boesen, J. [Frederiksberg Hospital (Denmark). Dept. of Radiology; Egund, N. [Department of Radiology R, Aarhus University Hospital, DK-8000 Aarhus C (Denmark)

2000-10-01

Falanga is an ancient form of punishment or torture but is still commonly reported by our refugees. The late result of caning the heel and ball of the foot is a chronic painful condition with few clinical signs. The aim of the present study was to assess, by MRI, possible morphologic characteristics of the heel and ball of the foot, related to falanga and pain in correlation to clinical findings. Magnetic resonance imaging of the foot was obtained in 12 victims exposed to falanga torture and 9 healthy volunteers. Sagittal T1-weighted spin-echo images (TR 616-840 ms, TE 20 ms), T2-weighted spin-echo images (TR 1900 ms, TE 90 ms), and short tau inversion recovery (STIR) images (TR 1200 ms, TE 15 ms, TI 100 ms) were performed. The central portion of the plantar aponeurosis was generally significantly thicker in victims exposed to falanga torture as compared with that of controls (P < 0.05). In all except one of the victims, MRI demonstrated two layers of the thickened plantar aponeurosis: a deeper portion with normal homogeneous low signal intensity (SI) appearance, and a superficial layer with characteristic areas of mixed SI on both T1- and T2-weighted images. There were no signs of chronic muscular compartment syndromes, and the thickness of the plantar pad did not differ between the two groups. Magnetic resonance imaging may demonstrate morphologic characteristics of the plantar aponeurosis which may confirm falanga torture. Further imaging with more specific sequences is warranted to demonstrate the supposed injuries in the compartmental fat tissue chambers and the vascularity of the ball pad of the foot. (orig.)

Ultrasound evaluation of foot muscles and plantar fascia in pes planus.

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Angin, Salih; Crofts, Gillian; Mickle, Karen J; Nester, Christopher J

2014-01-01

Multiple intrinsic and extrinsic soft tissue structures that apply forces and support the medial longitudinal arch have been implicated in pes planus. These structures have common functions but their interaction in pes planus is not fully understood. The aim of this study was to compare the cross-sectional area (CSA) and thickness of the intrinsic and extrinsic foot muscles and plantar fascia thickness between normal and pes planus feet. Forty-nine adults with a normal foot posture and 49 individuals with pes planus feet were recruited from a university population. Images of the flexor digitorum longus (FDL), flexor hallucis longus (FHL), peroneus longus and brevis (PER), flexor hallucis brevis (FHB), flexor digitorum brevis (FDB) and abductor hallucis (AbH) muscles and the plantar fascia were obtained using a Venue 40 ultrasound system with a 5-13 MHz transducer. The CSA and thickness of AbH, FHB and PER muscles were significantly smaller (AbH -12.8% and -6.8%, FHB -8.9% and -7.6%, PER -14.7% and -10%), whilst FDL (28.3% and 15.2%) and FHL (24% and 9.8%) were significantly larger in the pes planus group. The middle (-10.6%) and anterior (-21.7%) portions of the plantar fascia were thinner in pes planus group. Greater CSA and thickness of the extrinsic muscles might reflect compensatory activity to support the MLA if the intrinsic foot muscle function has been compromised by altered foot structure. A thinner plantar fascia suggests reduced load bearing, and regional variations in structure and function in feet with pes planus. Copyright © 2014 Elsevier B.V. All rights reserved.

Juvenile plantar dermatosis: A barrier disease beyond eczema: An open prospective uncontrolled study in a tertiary care hospital of South India

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Hari Kishan Kumar

2016-01-01

Full Text Available Background: Juvenile plantar dermatosis (JPD, also known as “wet and dry foot syndrome,” is a skin disorder of the feet that commonly affects children from ages 3–14. JPD is frequently seen in children with eczema, but it is not a requirement for diagnosis. Forefoot eczema (FE is synonymous with JPD is a condition characterized by dry fissured dermatitis of the plantar surface of the feet. Aims: To study the clinical patterns of FE and its associated risk factors. Methods: Twenty-five patients were recorded in the study during the period from April 2013 to March 2014. Fungal scrapings, patch testing, and biopsy for histopathological examination were done wherever required. Results: In our study, the most common site affected was the plantar surface of the toes in 8 (32% patients. Hand involvement, with fissuring and soreness of the fingertips and palm, was seen in two patients (8%. Four patients (16% had a personal history of atopy whereas a family history of atopy was present in 3 (12%. Nine patients (36% had associated risk factors with reported aggravation of itching with plastic, rubber, or leather footwear, and with prolonged contact with water and detergents. Negative fungal scrapings and culture in all patients ruled out a dermatophyte infection. Patch testing with Indian Standard Series was performed in all patients and was positive in three. Conclusions: This study concluded FE as a distinctive dermatosis of the first and second decade, predominantly in males, with a multifactorial etiology and confirming the concept of FE as a barrier disease beyond eczema.

Novel In-Shoe Exoskeleton for Offloading of Forefoot Pressure for Individuals With Diabetic Foot Pathology.

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Roser, Mark C; Canavan, Paul K; Najafi, Bijan; Cooper Watchman, Marcy; Vaishnav, Kairavi; Armstrong, David G

2017-09-01

Infected diabetic foot ulcers are the leading cause of lower limb amputation. This study evaluated the ability of in-shoe exoskeletons to redirect forces outside of body and through an exoskeleton as an effective means of offloading plantar pressure, the major contributing factor of ulceration. We compared pressure in the forefoot and hind-foot of participants (n = 5) shod with novel exoskeleton footwear. Plantar pressure readings were taken during a 6-m walk at participant's self-selected speed, and five strides were averaged. Results were taken with Achilles exotendon springs disengaged as a baseline, followed by measurements taken with the springs engaged. When springs were engaged, all participants demonstrated a decrease in forefoot pressure, averaging a 22% reduction ( P exoskeleton solution. Results suggest that when the novel exoskeletons were deployed in footwear and exotendon springs engaged, force was successfully transferred from the lower leg through the exoskeleton-enabled shoe to ground, reducing load on the forefoot. The results need to be confirmed in a larger sample. Another study is warranted to examine the effectiveness of this offloading to prevent diabetic foot ulcer, while minimizing gait alteration in daily physical activities.

Cryotherapy usage to treat plantar warts

International Nuclear Information System (INIS)

Miranda Diaz, BelkisTamara

2010-01-01

Treating dermatosis with liquid nitrogen as cryogen (substance generating cold) allows cellular destruction in more than 5 mm depth, making it indispensable to use it treating cutaneous cancers; besides that, it is cheap, easy to conserve and manage, and it is not considered flammable or toxic. Its applying retains the growth factor inside the injury, the collagen is not damaged as it is in burning by hot, there is not almost injury contraction, the perineurium is not altered, and when the tissue necrosis takes place, it retains tissue necrosis factor, helping to increase the necrosis of tissues. Taking into account the high incidence of dermatosis that can be treated with cryogen, in our consultation; we decided to generalize this treatment at the Provincial Interior Ministry Clinic. Plantar warts represent a big percent, limiting our patients in developing their working activities. This cutaneous viral disease is favored by the patients' systemic immunodepressions, hyperhidrosis and podalic disturbances. We selected the patients assisting to our extern al consultation with plantar wart clinical diagnosis in the period from September 2006 to September 2007. They signed an act of informed consent where the possible side effects are explained. Liquid nitrogen was applied with cotton applicators once a week after mechanical reduction. We made a clinical evolving evaluation fortnightly during the treatment, according to the elements and clinical characteristics referred by the patient, and proved by the physical examination carried out by the main investigator, because of the likelihood of short and long time side effects. This investigation demonstrated that cryotherapy is efficacious in treating plantar warts, since all the patients were healed in a short time period, most of them without side effects

Plantar fascia calcification a sequelae of corticosteroid injection in the treatment of recalcitrant plantar fasciitis.

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Fox, Thomas Peter; Oliver, Govind; Wek, Caesar; Hester, Thomas

2013-08-16

We report the case of a 72-year-old woman suffering with severe plantar fasciitis who received a therapeutic corticosteroid injection. Two-and-a-half years after the injection she developed a small calcified lump under the skin which subsequently caused ulceration and infection. She went on to develop a diabetic foot infection requiring an extended course of intravenous antibiotics.

Extracorporeal shock wave therapy in patients with plantar fasciitis. A randomized, placebo-controlled trial with ultrasonographic and subjective outcome assessments

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Babak Vahdatpour

2012-01-01

Full Text Available Background and Aim: Results of previous studies have been conflicting on the efficacy of extracorporeal shock wave therapy (ESWT in the treatment of plantar fasciitis. We evaluated the effects of ESWT on plantar fasciitis in terms of ultrasonographic and subjective evaluations. Materials and Methods: In this randomized placebo-controlled trial, patients with plantar fasciitis were assigned to receive ESWT (4000 shock waves/session of 0.2 mJ/mm 2 in 3 sessions at weekly intervals or sham therapy (n = 20 in each group. Outcomes were documented by the ultrasonographic appearance of the aponeurosis and by patients′ pain scores, performed at baseline and 12 weeks after completion of the therapy. Results : The two groups were similar in baseline characteristics. Over the study period, plantar fascia thickness significantly reduced in the ESWT group (4.1 ± 1.3 to 3.6 ± 1.2 mm, P < 0.001, but slightly increased in the sham group (4.1 ± 0.8 to 4.5 ± 0.9 mm, P = 0.03. Both groups showed significant pain improvement over the course of the study (P < 0.001, though pain scores were significantly more reduced in the ESWT than the sham group (-4.2 ± 2.9 vs. -2.7 ± 1.8, P = 0.049. Conclusions: Extracorporeal shock wave therapy contributes to healing and pain reduction in plantar fasciitis and ultrasound imaging is able to depict the morphologic changes related to plantar fasciitis as a result of this therapy.

Maximum toe flexor muscle strength and quantitative analysis of human plantar intrinsic and extrinsic muscles by a magnetic resonance imaging technique.

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Kurihara, Toshiyuki; Yamauchi, Junichiro; Otsuka, Mitsuo; Tottori, Nobuaki; Hashimoto, Takeshi; Isaka, Tadao

2014-01-01

The aims of this study were to investigate the relationships between the maximum isometric toe flexor muscle strength (TFS) and cross-sectional area (CSA) of the plantar intrinsic and extrinsic muscles and to identify the major determinant of maximum TFS among CSA of the plantar intrinsic and extrinsic muscles. Twenty six young healthy participants (14 men, 12 women; age, 20.4 ± 1.6 years) volunteered for the study. TFS was measured by a specific designed dynamometer, and CSA of plantar intrinsic and extrinsic muscles were measured using magnetic resonance imaging (MRI). To measure TFS, seated participants optimally gripped the bar with their toes and exerted maximum force on the dynamometer. For each participant, the highest force produced among three trials was used for further analysis. To measure CSA, serial T1-weighted images were acquired. TFS was significantly correlated with CSA of the plantar intrinsic and extrinsic muscles. Stepwise multiple linear regression analyses identified that the major determinant of TFS was CSA of medial parts of plantar intrinsic muscles (flexor hallucis brevis, flexor digitorum brevis, quadratus plantae, lumbricals and abductor hallucis). There was no significant difference between men and women in TFS/CSA. CSA of the plantar intrinsic and extrinsic muscles is one of important factors for determining the maximum TFS in humans.

The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations.

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Kirkpatrick, Joshua; Yassaie, Omid; Mirjalili, Seyed Ali

2017-06-01

The plantar calcaneal spur (PCS) is a bony outgrowth from the calcaneal tuberosity and has been studied using various methods including cadavers, radiography, histology and surgery. However, there are currently a number of discrepancies in the literature regarding the anatomical relations, histological descriptions and clinical associations of PCS. Historically, authors have described the intrinsic muscles of the foot and/or the plantar fascia as attaching to the PCS. In this article we review the relationship between the PCS and surrounding soft tissues as well as examining the histology of the PCS. We identify a number of key associations with PCS, including age, weight, gender, arthritides, plantar fasciitis and foot position; these factors may function as risk factors in PCS formation. The etiology of these spurs is a contentious issue and it has been explained through a number of theories including the degenerative, inflammatory, traction, repetitive trauma, bone-formers and vertical compression theories. We review these and finish by looking clinically at the evidence that PCS causes heel pain. © 2017 Anatomical Society.

Pressure relief and load redistribution by custom-made insoles in diabetic patients with neuropathy and foot deformity

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Bus, Sicco A.; Ulbrecht, Jan S.; Cavanagh, Peter R.

2004-01-01

Objective. To study the effects of custom-made insoles on plantar pressures and load redistribution in neuropathic diabetic patients with foot deformity. Design. Cross-sectional. Background. Although custom-made insoles are commonly prescribed to diabetic patients, little quantitative data on their

Plantar fascia rupture in a professional soccer player.

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Suzue, Naoto; Iwame, Toshiyuki; Kato, Kenji; Takao, Shoichiro; Tateishi, Tomohiko; Takeda, Yoshitsugu; Hamada, Daisuke; Goto, Tomohiro; Takata, Yoichiro; Matsuura, Tetsuya; Sairyo, Koichi

2014-01-01

We report the case of a 29-year-old male professional soccer player who presented with symptoms of plantar fasciitis. His symptoms occurred with no remarkable triggers and gradually worsened despite conservative treatments including taping, use of insoles, and physical therapy. Local corticosteroid injection was given twice as a further intervention, but his plantar fascia partially ruptured 49 days after the second injection. He was treated conservatively with platelet-rich plasma, and magnetic resonance imaging showed regenerative change of the ruptured fascia. Five months after the rupture, he returned to his original level of training. If professional athletes find it difficult to refrain from athletic activity, as in the present case, the risk of rupture due to corticosteroid injection should not be overlooked.

Ultrasound evaluation of intrinsic plantar muscles and fascia in hallux valgus

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Lobo, César Calvo; Marín, Alejandro Garrido; Sanz, David Rodríguez; López, Daniel López; López, Patricia Palomo; Morales, Carlos Romero; Corbalán, Irene Sanz

2016-01-01

Abstract A cross-sectional area (CSA) and thickness reduction of the abductor hallucis (AbH) is shown in subjects with hallux valgus (HV). To date, other soft-tissue structures have not been researched in relation with HV. The aim of this study was to compare the CSA and thickness of the intrinsic plantar muscles and fascia (PF) between feet with and without HV. Therefore, a cross-sectional and case-control study was performed using B-mode with an iU22 Philips ultrasound system and a 5 to 17-MHz transducer. The CSA and thickness were measured for the AbH, flexor digitorum brevis (FDB) and flexor hallucis brevis (FHB), and also the thickness for the anterior, middle, and posterior PF portions. A convenience sample of 40 feet, 20 with HV and 20 without HV, was recruited from a clinical and research center. A multivariate regression analysis using linear regression was performed to evaluate the ultrasound imaging measurements (α = 0.05). Consequently, statistically significant differences were observed between the groups (P plantar fascia thickness increase in favor of the HV group. On the contrary, the FDB thickness and CSA did not show statistically significant differences (P ≥ 0.05). In conclusion, the CSA and thickness of the AbH and FHB intrinsic plantar muscles are reduced, whereas the thickness of the anterior, middle, and posterior PF portions are increased, in subjects with HV compared with those without HV. PMID:27828846

Treatment of Athlete's Plantar Warts Using a Botanical Blend: A Case Report.

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Nelson, Erik O; Kozin, Adam F; Ruiz, Guillermo; Lasku, Arben; Langland, Jeffrey O

2017-05-01

Context • Viral plantar warts, or verruca plantaris, are a benign epithelial tumor caused by various strains of the human papilloma virus (HPV). Current treatments have had mixed degrees of success, are moderately invasive, and are often incompatible with participation in sports. Objective • The study intended to examine the benefits of treating plantar warts with a topical, botanical blend that has had clinical success treating herpes simplex virus cold sores. Methods • A synergistic botanical blend was applied topically. Setting • The case report was completed at the Southwest College of Naturopathic Medicine (Tempe, Arizona, USA). Participant • The participant was a 24-y-old male soccer player, 177.8 cm tall, and weighing 69 kg with previously diagnosed, viral mosaic warts. Intervention • The patient used a pumice stone during bathing for the first week to remove dead tissue and ensure sufficient contact and entry of the botanical gel into infected tissue. After drying the area, the patient applied the botanical gel blend 1 to 2 times daily postshower, spreading it evenly across the surface of the entire lesion. The patient discontinued the exfoliation technique after the first week. Results • Within the first week of treatment, the patient noted changes to the infected area of the hallux epidermal tissue. The combination of exfoliation and application of the gel caused marked, visible differences in presentation by the fifth day of treatment. At 1-mo postintervention, or day 90, the epidermal tissue was asymptomatic and devoid of petechiae, malformations, or visible infection. Conclusions • The results of the current case study directly contrast with the drawbacks of commonly accepted, first-line interventions in the treatment of viral plantar warts and, in many respects, demonstrate better efficacy and fewer side effects than the standard of care. The positive results also highlight the necessity for additional study in the fields of sports

Development of gait segmentation methods for wearable foot pressure sensors.

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Crea, S; De Rossi, S M M; Donati, M; Reberšek, P; Novak, D; Vitiello, N; Lenzi, T; Podobnik, J; Munih, M; Carrozza, M C

2012-01-01

We present an automated segmentation method based on the analysis of plantar pressure signals recorded from two synchronized wireless foot insoles. Given the strict limits on computational power and power consumption typical of wearable electronic components, our aim is to investigate the capability of a Hidden Markov Model machine-learning method, to detect gait phases with different levels of complexity in the processing of the wearable pressure sensors signals. Therefore three different datasets are developed: raw voltage values, calibrated sensor signals and a calibrated estimation of total ground reaction force and position of the plantar center of pressure. The method is tested on a pool of 5 healthy subjects, through a leave-one-out cross validation. The results show high classification performances achieved using estimated biomechanical variables, being on average the 96%. Calibrated signals and raw voltage values show higher delays and dispersions in phase transition detection, suggesting a lower reliability for online applications.