Article

Relationship between comfort of shoe inserts and anthropometric and sensory factors

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

The purposes of this study were (a) to determine lower extremity anthropometric and sensory factors that are related to differences in comfort perception of shoe inserts with varying shape and material and (b) to investigate whether shoe inserts that improve comfort decrease injury frequency in a military population. 206 military personnel volunteered for this study. The shoe inserts varied in arch and heel cup shape, hardness, and elasticity in the heel and forefoot regions. A no insert condition was included as the control condition. Measured subject characteristics included foot shape, foot and leg alignment, and tactile and vibration sensitivity of the plantar surface of the foot. Footwear comfort was assessed using a visual analog scale. Injury frequency was evaluated with a questionnaire. The statistical analyses included Student's t-tests for repeated measures, ANOVA (within subjects), MANOVA (within insert combinations), and chi-square tests. The average comfort ratings for all shoe inserts were significantly higher than the average comfort rating for the control condition. The incidence of stress fractures and pain at different locations was reduced by 1.5-13.4% for the insert compared with the control group. Foot arch height, foot and leg alignment, and foot sensitivity were significantly related to differences in comfort ratings for the hard/soft, the viscous/elastic, and the high arch/low arch insert combinations. Shoe inserts of different shape and material that are comfortable are able to decrease injury frequency. The results of this study showed that subject specific characteristics influence comfort perception of shoe inserts.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Four additional records were identified through cross-referencing citations. [21][22][23][24] Of these, 39 full-text records were assessed for eligibility and 22 were included in the systematic review. Three studies were excluded as these were not randomised intervention trials. ...
... Three studies were excluded as these were not randomised intervention trials. [25][26][27] Simkin et al 28 21 was included in the systematic review but excluded from the meta-analysis due to insufficient data. ...
... 33 The remaining studies either specified a clinical examination by a healthcare provider or study team member, review of diagnostic codes from a patient record, or did not specify diagnostic criteria. 21 ...
Article
Introduction Military members are exposed to high cumulative physical loads that frequently lead to injury. Prescribed footwear and orthoses have been used to prevent injury. The purpose of this systematic review with meta-analysis was to assess if prescribed prophylactic footwear or foot orthoses reduced the risk of lower extremity injury in military tactical athletes. Methods MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, SportDiscus, and Defense Technical Information Center databases were searched for randomised controlled trials published at any time that compared foot orthoses or prescribed footwear (to include shock-absorbing insoles and socks) with a placebo intervention or a no-treatment control. Methodological quality was assessed and the number of injuries, population at risk and duration of the study epoch were extracted and relative risk (RR) calculated. An omnibus meta-analysis was performed assessing all prescribed footwear and orthoses intervention studies, with subgroup analyses conducted on studies with similar interventions (ie, basketball athletic shoes, athletic shoes (prescribed by foot type), foot orthoses, shock-absorbing insoles, socks, tropical combat boots). Results Of 1673 studies identified, 22 were included. Three of eight studies that employed orthoses demonstrated significantly reduced overuse injuries compared with no-treatment controls (RR range: 0.34–0.68); one study showed neoprene insoles significantly decreased overuse injuries (RR: 0.75). There were no other significant effects in the individual studies and no protective effects observed in the omnibus meta-analysis or in the component subanalyses. Conclusions Prescribed footwear and orthoses do not appear to have a prophylactic effect on lower quarter musculoskeletal injuries in military members and cannot be recommended at this time.
... Brushøj et al 2008 23 Dijksma, 2020 119 Gross and Liu 2003 67 Knapik, 2006 128 McDevitt et al 2004 102 Milgrom et al 2005 62 Mundermann et al 2001 103 Pope, 1999 101 Thacker et al 2002 91 MSK-I, musculoskeletal injury; MSK-IMPP, musculoskeletal injury mitigation and prevention programme. proactively identify and mitigate potential barriers, and promote further leadership buy-in and support. ...
... 91 103 End-user acceptability of MSKI-MPPs can be measured, understood and where indicated, implementation of MSKI-MPPs can be adjusted; in these studies, methods for obtaining user feedback and measuring acceptability included questionnaires, 91 102 informal conversations, 101 visual analogue scales for assessing comfort. 103 Successful MSK-IMPP implementation and adherence rely heavily on end-user acceptance; acceptance often depends on the intervention's perceived impact on military task performance, comfort and/or safety. ...
Article
Full-text available
Introduction Musculoskeletal injury (MSK-I) mitigation and prevention programmes (MSK-IMPPs) have been developed and implemented across militaries worldwide. Although programme efficacy is often reported, development and implementation details are often overlooked, limiting their scalability, sustainability and effectiveness. This scoping review aimed to identify the following in military populations: (1) barriers and facilitators to implementing and scaling MSK-IMPPs; (2) gaps in MSK-IMPP research and (3) future research priorities. Methods A scoping review assessed literature from inception to April 2022 that included studies on MSK-IMPP implementation and/or effectiveness in military populations. Barriers and facilitators to implementing these programmes were identified. Results From 132 articles, most were primary research studies (90; 68.2%); the remainder were review papers (42; 31.8%). Among primary studies, 3 (3.3%) investigated only women, 62 (69%) only men and 25 (27.8%) both. Barriers included limited resources, lack of stakeholder engagement, competing military priorities and equipment-related factors. Facilitators included strong stakeholder engagement, targeted programme design, involvement/proximity of MSK-I experts, providing MSK-I mitigation education, low burden on resources and emphasising end-user acceptability. Research gaps included variability in reported MSK-I outcomes and no consensus on relevant surveillance metrics and definitions. Conclusion Despite a robust body of literature, there is a dearth of information about programme implementation; specifically, barriers or facilitators to success. Additionally, variability in outcomes and lack of consensus on MSK-I definitions may affect the development, implementation evaluation and comparison of MSK-IMPPs. There is a need for international consensus on definitions and optimal data reporting elements when conducting injury risk mitigation research in the military.
... In some cases, patient fit, and comfort were also evaluated [2,[13][14][15]. Patients treated with orthoses have demonstrated the ability to identify relationships between orthotic material hardness and orthotic comfort [16], and thus are also sensitive to variability in the selection of materials and crafting of the shape during orthotic manufacture. ...
... For clinical populations such as those with diabetes, foot neuropathies prevent patient feedback on measures of comfort with orthotic treatments [16]. One solution to this non-responsive cohort is to evaluate the comfort of such orthoses in a healthy cohort of participants before they are produced and tested in a potentially neuropathic population. ...
Article
Full-text available
Custom foot orthoses are used to treat a variety of foot pathologies. However, orthotic production requires significant hands-on fabrication time and expertise to produce orthoses that are both comfortable and effective. This paper introduces a novel 3D printed orthosis and fabrication method that utilizes custom architectures to produce variable-hardness regions. These novel orthoses are compared to traditionally fabricated orthoses during a 2-week user comfort study. Twenty (n = 20) male volunteers underwent orthotic fitting for both traditional and 3D-printed foot orthoses prior to engaging in treadmill walking trials and 2 weeks of wear. Each participant undertook a regional comfort, acceptance, and comparison analysis of the orthoses at three time points throughout the study (0, 1, and 2 weeks). Both the 3D-printed and the traditionally fabricated foot orthoses demonstrated statistically significant increases in comfort when compared to the factory fabricated shoe insert. Additionally, the two orthosis groups were not significantly different from each other in comfort rankings both regionally and overall at any time point. The similar comfort achieved by the 3D-printed orthosis to the traditionally fabricated orthosis after 7 days and 14 days emphasizes the potential of the future use of the more reproducible and adaptable 3D-printed orthosis manufacturing methodology.
... Footwear could play an important role in inducing localized pain, muscular activation and fatigue, and wearing discomfort, all of which can limit sports performance. Effects on muscular fatigue and wearing discomfort have been reported according to the different features and characteristics of the insole, such as material, thickness, and wedge for arch support [10][11][12]. Especially, insoles composed of soft material were more effective in ...
... For sprint running, the effect of footwear stiffness on sprint performance is still being examined among researchers, but the evidence is conflicting. While wearing stiffer shoes, a decrease in sprint time was reported in the previous study [12]. Conversely, stiffer shoes were also reported to have no significant effect on sprint performance [44,45]. ...
Article
Full-text available
Carbon fiber insole (CFI), which is lightweight and stiff to reduce energy loss and help wearers perform better in sports, has recently been introduced. However, reports are scarce on the effects of CFI on sports performance, muscle activation, and wearing comfort. This study investigated the acute effects of CFI on sports performance, lower extremity muscle activity, and subjective comfort. Thirty young healthy males with shoe sizes between 260 and 270 mm performed various sports tasks (power generation, agility, and speed) and treadmill runs with wearable sensors under two experimental insole conditions (benchmark insole as a baseline, CFI). The results showed that, compared to the benchmark insole, CFI significantly improved sports performance in terms of power generation (~1.5%) and agility (~1%). However, it activated more of the Tibialis Anterior (~0.7%) and Gastrocnemius Medialis (~0.8%) muscles, and was perceived to be stiffer and less comfortable. These findings suggested that CFI could improve sports performance, but could cause more lower extremity muscle activation and subjective discomfort.
... Footwear could play an important role in inducing localized pain, muscular activation and fatigue, and wearing discomfort, all of which can limit sports performance. Effects on muscular fatigue and wearing discomfort have been reported according to the different features and characteristics of the insole, such as material, thickness, and wedge for arch support [10][11][12]. Especially, insoles composed of soft material were more effective in ...
... For sprint running, the effect of footwear stiffness on sprint performance is still being examined among researchers, but the evidence is conflicting. While wearing stiffer shoes, a decrease in sprint time was reported in the previous study [12]. Conversely, stiffer shoes were also reported to have no significant effect on sprint performance [44,45]. ...
Preprint
Carbon fiber insole (CFI), which is lightweight and stiff to reduce energy loss and help wearers perform better in sports, has recently been introduced. However, there are scarce reports on the effects of CFI on sports performance, muscle fatigue and wearing comfort. This study investigat-ed the short-term effects of CFI on sports performance, lower extremity muscle activity, and sub-jective comfort. Thirty young healthy males performed various sports tasks and treadmill runs with wearable sensors under two experimental insole conditions (benchmark insole as a baseline, CFI). The results showed that compared to the benchmark insole, CFI significantly improved sports performance in terms of power generation and agility. However, it activated more of the Tibialis Anterior and Gastrocnemius Medialis muscles and was perceived stiffer, and less com-fortable. These findings suggested that CFI can improve sports performance, but it could cause more lower extremity muscle fatigue and subjective discomfort.
... Footwear could play an important role in inducing localized pain, muscular activation and fatigue, and wearing discomfort, all of which can limit sports performance. Effects on muscular fatigue and wearing discomfort have been reported according to the different features and characteristics of the insole, such as material, thickness, and wedge for arch support [10][11][12]. Especially, insoles composed of soft material were more effective in ...
... For sprint running, the effect of footwear stiffness on sprint performance is still being examined among researchers, but the evidence is conflicting. While wearing stiffer shoes, a decrease in sprint time was reported in the previous study [12]. Conversely, stiffer shoes were also reported to have no significant effect on sprint performance [44,45]. ...
Conference Paper
Background and Objective: Although the role of shoes on sports performance and injury has been extensively examined, only a few studies investigated the effects from insoles. Recent studies on carbon fiber insoles (CFI) on athletic performance reported that CFI could improve sports performance by reducing energy loss and increasing energy return. However, there are scarce reports on the effects of CFI on muscle fatigue and wearing comfort. While stiffer CFI insoles are superior in energy loss reduction and energy return, they could increase more muscle activation to absorb the shock or provide more propulsive force to push CFI, leading to increased muscle fatigue and discomfort. Therefore, this study aims to evaluate the effect of CFI on lower-extremity muscle activation and wearing comfort during treadmill running. Methods: Three types of insoles were compared, namely CFI, CFI with cushioning (CFIC), and a benchmark commercial insole (COM). Fifteen healthy young men participated in the experiment. Each participant wore the same sports shoe, three different insoles in a random order, and ran on a treadmill at a speed of 10 km/h for 5 minutes. Surface electromyography signals of four lower-extremity muscles (Rectus femoris, Tibialis anterior, Biceps femoris, and Gastrocnemius medialis) were recorded in real-time for measuring muscle activation. After completing a trial run with each experimental insole, the participants provided their subjective ratings on perceived insole stiffness, energy support, overall comfort, and fatigue. Analysis of variance (ANOVA) and post-hoc grouping analysis were conducted to statistically evaluate the effects from three different insoles. Paired t-test was performed to compare CFI and CFIC and explore any cushioning effect. Results: In terms of lower-extremity muscle activation, even though CFIC and COM showed no significant difference for all four lower-extremity muscles, CFI induced a marginally significant increase of 1.5% on Gastrocnemius medialis (p = 0.063) and a significant reduction of 0.7% on rectus femoris (p=0.011) than COM. For the subjective ratings, both CFI and CFIC were significantly stiffer than COM (p < 0.001), but there were no significant differences in overall comfort, energy support, and fatigue. Compared with CFI, CFIC significantly reduced Gastrocnemius medialis muscle usage by 2.1% (p = 0.012) and was marginally less stiff (p = 0.102).Conclusions: This preliminary study showed that the carbon fiber insole CFI induced higher calf muscle usage and was perceived to be stiffer during treadmill running, which could contribute to provide the propulsive force for better sports performance. Carbon fiber insole with cushioning (CFIC) can help to relieve muscular fatigue. Further research should be conducted to examine the carbon insole effects on sports performance and long-term muscle activation and perceived feelings.
... The hypothesis that comfort is linked to reduced injury risk was partially developed from research on the effect of insoles on movement patterns and injury in soldiers. Mundermann et al. (2001) provided six different insoles to 206 military training personnel without lower extremity injuries and asked them to assess comfort of the insoles. The test group received the insole that they rated most comfortable and used it for the next 4 months. ...
... Lindorfer et al. (2020) examined coordination variability of lower extremity joint pairings in relation to most and least comfortable running shoes and did not find evidence to support this connection. Other than the seminal study by Mundermann et al. (2001) linking insole usage to injury reduction, no other studies have linked comfort and injury conclusively. ...
Article
Full-text available
Many runners seek health professional advice regarding footwear recommendations to reduce injury risk. Unfortunately, many clinicians, as well as runners, have ideas about how to select running footwear that are not scientifically supported. This is likely because much of the research on running footwear has not been highly accessible outside of the technical footwear research circle. Therefore, the purpose of this narrative review is to update clinical readers on the state of the science for assessing runners and recommending running footwear that facilitate the goals of the runner. We begin with a review of basic footwear construction and the features thought to influence biomechanics relevant to the running medicine practitioner. Subsequently, we review the four main paradigms that have driven footwear design and recommendation with respect to injury risk reduction: Pronation Control, Impact Force Modification, Habitual Joint (Motion) Path, and Comfort Filter. We find that evidence in support of any paradigm is generally limited. In the absence of a clearly supported paradigm, we propose that in general clinicians should recommend footwear that is lightweight, comfortable, and has minimal pronation control technology. We further encourage clinicians to arm themselves with the basic understanding of the known effects of specific footwear features on biomechanics in order to better recommend footwear on a patient-by-patient basis.
... Therefore, the objective of this study was to evaluate the impact of two different shoe insoles on stationary balance in healthy older adults compared to those who went barefoot. We chose to evaluate postural sway in barefoot individuals, as opposed to those wearing shoes, because footwear has been shown to affect sensory feedback, potentially acting as a sensory filter between feet and the surface upon which one is standing [20][21][22]. We hypothesized that both types of insoles would decrease postural sway when compared to going barefoot. ...
Article
Full-text available
Background: there is a high risk of falls in older adults. One of the factors contributing to fall episodes is advancing age due to deterioration of the proprioceptive system. Certain clinical procedures improve balance and posture, such as the use of insoles. Objective: the objective of this study was to evaluate the impact of hard and soft insoles on static foot balance in healthy older adults compared to barefoot people. Methods: a clinical trial was conducted with a sample size of 150 healthy adults (69 male and 81 women) with a mean age of 69.03 ± 3.82 years. Postural control was evaluated in different conditions of barefoot balance with hard and soft insoles. Results: All tests were statistically significant (p < 0.001). The test with soft insoles presented higher stabilometric values and presented worse postural control compared to the barefoot and hard insoles in all eyes-open and eyes-closed conditions. Conclusions: Hard and soft insoles show no improvement in postural control compared to barefoot standing. The findings suggest that soft insoles may result in impaired balance during standing. The density of the materials in the insoles emerges as a significant factor influencing postural control.
... These findings indicate that the shape of the foot changes from a normal to a low arch under static and dynamic conditions due to prolonged use of standard military boots, commonly worn during various activities, including military marching, long-term standing, and military exercises. This extended use of boots can lead to stretching of ligaments and aponeurosis, resulting in discomfort [42] and alteration of foot structure in a static state. Moreover, it appears that the muscles cannot support the foot structure in both static and dynamic states, as supported by the low arch of the military group which can likely confirm this deformation. ...
Article
Full-text available
Foot structure can be influenced by various factors, such as footwear, body weight and physical activity. A change in foot structure can alter shock absorption and force transition. The main objective of this study is to investigate the effect of the long-term use of military boots on foot shape parameters. Thirty military and thirty non-military subjects participated in this case-control study. All participants had been regularly wearing military boots for the past 12 years. After introducing the experiment, static and dynamic footprints were recorded via paper and ink while standing and walking. The footprints were analysed using ImageJ software to extract foot width indices, area indices, truncated arch index, footprint index and arch angle index. The findings indicated no significant difference in comparison static and dynamic variables in the military and non-military groups (p ≥ 0.05). However, there was a significant difference between the two groups in both static (midfoot area, arch index (AI), truncated arch index, footprint index and arch angle index) and dynamic (midfoot width, Staheli Index (SAI), truncated arch index and arch angle index) conditions, when static and dynamic variable were compared (p < 0.05). Findings revealed the military personnel have low arch, making them susceptible to musculoskeletal disorders. To mitigate this risk, it is recommended that military boots be reassessed or that insoles be used. Furthermore, it is suggested that military boots be limited to specific activities and fewer hours of usage to avoid potential health issues.
... This comfort can be improved through adequate footwear and orthotic design, both of which depend on a foot shape assessment. A better understanding of how an individual's characteristics, such as foot and leg alignment, influence foot shape may lead to improvements in the overall comfort and functionality of footwear and orthotic devices (Miller et al., 2000;Mundermann et al., 2001). Hence, a quantitative description of foot shape is crucial for a number of different applications OPEN ACCESS EDITED BY related to the ergonomic design of footwear, foot orthotics and insoles, as well as clinical assessment of foot deformities. ...
Article
Full-text available
Introduction Foot shape assessment is important to characterise the complex shape of a foot, which is in turn essential for accurate design of foot orthoses and footwear, as well as quantification of foot deformities (e.g., hallux valgus). Numerous approaches have been described over the past few decades to evaluate foot shape for orthotic and footwear purposes, as well as for investigating how one’s habits and personal characteristics influence the foot shape. This paper presents the developments reported in the literature for foot shape assessment. Method In particular, we focus on four main dimensions common to any foot assessment: (a) the choice of measurements to collect, (b) how objective these measurement procedures are, (c) how the foot measurements are analyzed, and (d) other common characteristics that can impact foot shape analysis. Results For each dimension, we summarize the most commonly used techniques and identify additional considerations that need to be made to achieve a reliable foot shape assessment. Discussion We present how different choices along these two dimensions impact the resulting foot assessment, and discuss possible improvements in the field of foot shape assessment.
... Therefore, when applying textile fabric in practical production and design, its Table 2 absorbent properties should be considered alongside other performance indicators, and a comprehensive evaluation should be conducted. In general, the opposite of stiffness was referred to as "flexibility" [31]. The flexibility of shoes was influenced by factors such as outsole hardness, materials, and structure. ...
Article
The shoes of the Terracotta Warriors hold significant historical and cultural value as an important legacy of ancient Chinese shoemaking craftsmanship. However, there is a dearth of research on terracotta shoes. Therefore, this study aimed to restore the Terracotta Warrior’s shoes from the perspectives of clothing engineering and archaeology, and then to assess the critical function of the restored shoes. Finally, we will explore why the soldiers of the Qin Dynasty (221–206 BC) were so successful in the military. In the restoration process, we utilized Augmented Reality ranging technology to conduct field investigations in museums, obtaining the basic form of the shoe of the kneeling archer figurine No.05438, and based on this, we studied its techniques and materials. Further, a quantitative analysis of the structural functionality of the Qin Dynasty shoes was carried out. Results show that: (1) the shoe soles of the Terracotta Warriors were adorned with neatly arranged circular patterns; the shoe sole was divided into three sections, with a ratio of 8:13:6 among the three sections; (2) the production technique of the shoe sole was consistent with the Thousand-layer sole, and the material used was red ramie; (3) we compared the replica shoes with two similar modern shoes and found that the replica shoes not only exhibited excellent flexibility but also demonstrated better slip resistance in wet conditions. Overall, we successfully reconstructed the shoe and evaluated its functionality using advanced archaeological techniques. Our finding unveiled notable advantages in flexibility and slip resistance in the Terracotta Warrior’s shoes, enhancing our understanding of ancient shoes. Additionally, this study also provides valuable practical experience and methodology for archaeology in restoring ancient shoes.
... Comfort of orthotics and footwear is subjective and highly specific to the individual (Anderson et al., 2020). There is no conclusive evidence for the effectiveness of orthotics overall for improving comfort (Menz & Bonanno, 2021), however there is prevalent evidence surrounding the effectiveness of contoured orthotics for increasing comfort (Mündermann et al., 2001(Mündermann et al., , 2003Springett et al., 2007) and reducing pain (De Almeida et al., 2016;Springett et al., 2007). Limited biomechanical data was collected alongside these comfort reports to fully understand factors contributing to changes in reported comfort in wearers. ...
... The authors found the insert group sustained less overall stress fractures and foot pain than the control group (8.8% vs 22.2%). 28 Finally, shoes that are more comfortable have been associated with decreased oxygen consumption while running, which may be another reason runners would select a shoe optimizing for comfort. 24 Luo et al 24 asked a group of proficient runners to try 5 different shoes and select for the most comfortable. ...
Article
Full-text available
Background The foot and ankle play a critical role in ultramarathon running. Because foot and ankle injuries are the most common location of injury in this group, proper care is essential for prevention. In this sport, small issues can become big problems over such long distances, and understanding the preventative measures taken by ultramarathon runners may provide insight for other athletes looking to avoid similar problems. The purpose of this study was to examine the routine and preventative care of the foot and ankle, as well as injury rates, in this group of high-risk athletes. Methods The Ultrarunners Longitudinal TRAcking (ULTRA) Study is the largest known prospective longitudinal study of ultramarathon runners. In this portion of the study, participants reported general health status, running behavior and performance, as well as foot and ankle care, injuries, stretching frequency, and shoewear. Results A total of 734 ultramarathon runners participated in the study. This group ran a median of 40.2 km per week. Overall, 71.2% of active ultramarathon runners reported a foot or ankle injury in the previous 12 months. The most common injuries reported were plantar fasciitis (36.3%), Achilles tendinitis (24.0%), nonspecific foot pain (14.0%), and stress fractures (13.4%). Sit and reach flexibility test showed that 63.7% of runners could not reach past their toes. There were no significant correlations for sit and reach flexibility or stretching frequency with injury rate. Conclusion The high prevalence of foot and ankle injuries in ultramarathon runners does not appear to be influenced by arch type, foot strike pattern, orthotic usage, stretching behavior, or actual flexibility. A high percentage of the study runners used comfort as a shoe selection method, independent of alignment or foot strike pattern. These findings guide the clinician in shared decision making with runners about routine care, including injury prevention and shoe selection. Level of Evidence Level II, prospective study.
... In general, the opposite of stiffness was referred to as " exibility" (Anne et al. 2001). The exibility of shoes were in uenced by factors such as outsole hardness, materials, and structure. ...
Preprint
Full-text available
The shoes of the Terracotta Warriors holds significant historical and cultural value as an important legacy of ancient Chinese shoemaking craftsmanship. But there is a dearth of research on terracotta shoes.Therefore, this study aimed to restore the Terracotta Warrior’s shoes from the perspectives of clothing engineering and archaeology, and then to assess the critical function of the restored shoes. Finally, we would explore why the soldiers of the Qin Dynasty (221-206BC) were so successful in military.In the restoration process, we utilized AR ranging technology to conduct field investigations in museums, obtaining the basic form of the shoeof the kneeling archer figurine No.05438, and based on this, we studied its techniques and materials. Further, a quantitative analysis of the structural functionality of the Qin Dynasty shoes were carried out.Results show that: (1) The shoe soles of the Terracotta Warriors were adorned with neatly arranged circular patterns; the shoe sole was divided into three sections, with a ratio of 8:13:6 among the three sections. (2) The production technique of the shoe sole was consistent with the Thousand-layer sole (TLS), and the material used was red ramie. (3) We compared the replica shoes with two similar modern shoes and found that the replica shoes not only exhibited excellent flexibility but also demonstrated better slip resistance in wet conditions.Overall, we successfully reconstructed the shoe and evaluated their functionality using advanced archaeological techniques. Our finding unveiled notable advantages in flexibility and slip resistance in the Terracotta Warrior’s shoes, enhancing our understanding of ancient shoes. Additionally, this study also provides valuable practical experience and methodology for archaeology in restoring the ancient shoes.
... Evidence in support of the preferred movement path paradigm was provided by a prospective trial in military recruits where a group of recruits who trained with their most comfortable footwear condition showed a lower incidence of running-related overuse injuries compared to a group who trained with a standard footwear condition (Mundermann et al., 2001). However, the footwear conditions selected by recruits as most comfortable were systematically softer than the control footwear condition and thus, the observed effect could also be explained by the impact force paradigm rather than the preferred movement path and comfort filter paradigms. ...
Article
Footwear science research has seen a roughly 10-fold increase in publications over the last 20 years. This commentary will focus on the three primary research themes of this time frame: methodological developments, running-related injuries, and performance. Within each theme, we summarise the knowledge generated through the substantial increase in publications over the last couple of decades. The methodological developments highlight both improvements in data analysis techniques as well as changes in how we measure variables of interest. Running-related injury prediction paradigms have evolved significantly during these years, which affect how we recommend moving forward in the field. Substantial excitement has filled the performance research field, as we discuss how the advent of Advanced Footwear Technologies altered the research questions and approaches. The undeniable growth in the field over in recent years can be attributed to a strong foundation of knowledge, nurtured by a curiosity to obtain understanding through holistic approaches. The community has embarked on the next stage of the journey, armed with new data collection tools and analytical methodologies, with the objective to better understand the effect of novel footwear design on performance enhancement and injury prevention.
... Such diversity challenges the users to define a proper fit, leading to non-suited footwear in terms of comfortable and fitting increase the chance of occurring injury during ambulation [6]. Comfort-based footwear fit has determined direct positive impact on enhancing biomechanical performance [7], decreasing the chance of movement-related injury [8], and practical-wise it is the most important factor for users to choose footwear [9]. Thus, Footwear should be fully/semi personalised fit to satisfy any customer in terms of comfort, safety and fitting [10]. ...
Conference Paper
Optical motion capturing explains the three-Dimensional (3D) position estimation of points through triangulation employing several depth cameras. Prosperous performance relies on level of visibility of points from different cameras and the overlap of captured meshes in-between. Generally, the accuracy of the estimation is practically based on the camera parameters e.g., location and orientations. Accordingly, the camera network configurations play a key role in the quality of the estimated mesh. This paper proposes an optimal approach for camera placement based on characteristics of a depth camera D435i - Intel RealSense. The optimal problem includes a cost function that contains several minimisation and maximisation terms. The minimisation terms are distance of the cameras to the center of the scanning object, resolution error, and sparsity. And the maximisation terms are distance between each two pair of cameras, percent of captured point from an object, and the level of overlap between cameras. The object is designed based on practical experiments of human walking and is a bounding box around one step of dynamic foot work-space from heel strike posture to toe-off posture. The accuracy and robustness of the algorithms are assessed via experiment measurement, and sensitivity to the number of cameras is investigated. Accordingly, the experiment results determined that the scanning accuracy can be as high as 2.5 % based on a reference scan with a high-end scanner (Artec Eva).
... Proper fit is an important feature related to comfort of footwear but also injury risk, fatigue, mobility, performance, and alignment of the lower limb [31][32][33][34][35]. Unlike running shoes, cushioning support in football boots is minimal, the outsole studs distribute pressures differently and the latter are narrower. ...
Article
The use of technology in football is increasing, although, products predominantly focus on men’s football in performance, safety, comfort, and fit considerations. A recent scoping review identified just 32 published scientific articles on technology in women’s football, despite demands of those playing/working in the women’s game increasing. We wish to highlight the progressions made so far and barriers remaining in the elite women’s football technology to shed a light on this topic and prod researchers and manufacturers to help support the evolution of women’s-football-focussed technological considerations. The ten questions presented in this paper address the generic question on whether women’s specific tailoring is needed (Question 1) as well as addressing specific questions on football technology and engineering, such as the progressions made and ongoing issues in the following areas: football kits, religious considerations (hijab designs), sports bras, football boots, balls, football pitches, performance tracking devices, menstrual cycle tracking devices (Question 2–10). It is evidence that certain areas have received more attention than others and with these ten questions we hope to steer readers towards research and engineering gaps for future work.
... There are many different types, including off-the-shelf and custom-made. Previous research into the use of orthotics has found that they can improve comfort, provide better arch support and decrease the incidence of certain lower limb injuries such as stress fractures [6][7][8][9]. However, some studies have found no statistically significant difference in the Incidence of certain RRIs, such as soft-tissue injuries, when comparing the use of orthotics to no orthotics [9,10]. ...
Article
Full-text available
Background: Evidence regarding the effectiveness of using orthotics in improving comfort, increasing running speed and helping to reduce injury rate during running is limited and mixed. Alongside the increasing popularity of running is the increasing rate of running-related injuries (RRIs). Further research into whether orthotics could be used to help reduce RRIs would be highly beneficial for those affected. Additionally, there is a need to clarify whether orthotics use increases comfort during running and helps improve running speed. Aim: To investigate whether running with Aetrex Orthotics improves comfort and performance and reduces injury whilst running. Methods: Runners were recruited on a voluntary basis if they were 18 or older with no serious health conditions, ongoing foot pain or deformity, previous foot surgery in their lifetime or any surgery in the past 6 mo. Participants were randomly assigned to either an intervention group or a control group. All participants were asked to complete runs and provide quantitative data regarding comfort during running, running time and distance, and any RRIs over an 8-wk study period. Participants in the intervention group ran with Aetrex L700 Speed Orthotics, whilst participants in the control group ran without orthotics. Other than the addition of orthotics for participants in the intervention group, all participants were asked to run as they usually would. This report presents preliminary data from the first 47 participants recruited for this study. Running speed was calculated from running distance and time and given in miles per hour. For each outcome variable, the mean for each group, effect size and 95% confidence interval were calculated, and a t-test was performed to determine if between-group differences were statistically significant. Results: Data for all three primary outcomes was provided from a total of 254 runs by the 23 participants in the intervention group and a total of 289 runs by the 24 participants in the control group. Participants in the intervention group reported higher comfort scores (8.00 ± 1.41 vs 6.96 ± 2.03, P ≤ 0.0001), faster running speeds (6.27 ± 1.03 vs 6.00 ± 1.54, P = 0.013), and lower RRI rates (0.70 ± 1.01 vs 1.21 ± 1.53, P = 0.18) than those in the control group. These findings were statistically significant for comfort and running speed but not for RRI rate, with statistical significance considered if P < 0.05. No adjustments were made for group differences in age, gender, tendency for RRIs or usual running speed. Conclusion: This preliminary report provides evidence for orthotics use in increasing comfort levels and running speed, but no significant difference in RRI rate.
... However, finite element studies focus on jumping movements in badminton are still scarce (Hong et al., 2013;Hu et al., 2015). Insoles can be used as a medium to improve the comfort of users (Mundermann et al., 2001). Other than that, the insoles with different materials and densities can also affect the shock absorption characteristics (Alirezaei Noghondar & Bressel, 2017;Chiu & Shiang, 2007). ...
Article
Previous research has reported that up to 92% of injuries amongst badminton players consist of lower limb, whereby 35% of foot fractures occurred at the metatarsal bone. In sports, insoles are widely used to increase athletes' performance and prevent many injuries. However, there is still a lack of badminton insole analysis and improvements. Therefore, this study aimed to biomechanically analyse three different insole designs. A validated and converged three-dimensional (3D) finite element model of ankle-foot complex was developed, which consisted of the skin, talus, calcaneus, navicular, three cuneiform, cuboid, five metatarsals and five phalanges. Three existing insoles from the market, (1) Yonex Active Pro Truactive, (2) Victor VT-XD 8 and (3) Li-Ning L6200LA, were scanned using a 3D scanner. For the analysis, single-leg landing was simulated. On the superior surface of the skin, 2.57 times of the bodyweight was axially applied, and the inferior surface of the outsole was fixed. The results showed that Insole 3 was the most optimum design to reduce peak stress on the metatarsals (3.807 MPa). In conclusion, the optimum design of Insole 3, based on the finite element analysis, could be a justification of athletes' choices to prevent injury and other complications.
... The static stability will be evaluated while barefoot rather than wearing shoes because footwear has been shown to affect sensory feedback, potentially acting as a sensory filter between the feet and the standing surface 18,20,21 . ...
Article
Full-text available
Abstract People with lower limb amputation present greater displacements of their centre of gravity in a static situation than able-bodied individuals, as they depend on visual information to a greater extent, which implies an altered stability pattern. The efficacy of different hardness of plantar support to help maintain stability has not yet been determined. The aim of the present study is to assess stability in people with unilateral transtibial amputation with prosthesis in a static situation with insoles of different degrees of hardness and visual conditions with respect to the able-bodied population. For this purpose, 25 patients with amputation and 25 able-bodied individuals were included in both groups, postural stability was assessed by stabilometry. This assessment was carried out under normal conditions (on the floor of the dynamometric platform with eyes open), and under altered conditions (with the interposition of different materials such as plantar support: rigid and soft insoles and, eyes shut). Three variables were considered to assess stability: length of movement of the barycenter (mm), lateral velocity (mm/sg) and anterior velocity (mm/sg). All of them were analysed with the patient in static on the dynamometric platform. The results showed statistically significant differences between the two groups, (amputees and controls) with less stability in the amputee group (p
... Badminton involves repeated rapid forward lunges, the dominant leg bears a greater load than the non-dominant leg. Therefore, the dominant and nondominant side characteristics of badminton shoes should also be examined [34]. The results from this study can provide insights for badminton footwear development. ...
Article
Full-text available
Background While the roles of injury prevention and performance enhancement have increasingly been investigated for badminton footwear, there is a lack of research on gender-specific badminton footwear. The purpose of this study was to examine the gender differences in footwear demands and foot injuries in badminton. Methods The study was a cross-sectional survey, in which 326 recreational badminton players were recruited. The questionnaire was divided into four sections enquiring about the characteristics of (1) participant profiles, (2) importance of shoe properties (3) shoe complaints (4) and pain or discomfort in different foot regions. The Mann-Whitney U test and Wilcoxon Signed Ranks test were performed to determine the differences between genders and the differences between leg dominance, respectively. The significance level was set at 0.05. Results Both males and females rated shoe fit as the most important features, followed by the overall comfort and injury protection. Females considered the shoe forefoot cushioning, comfort, breathability and colour as more important compared with the other properties, which showed distinct pattern differences from males. The shoe problem results indicated that plantar pain of the non-dominant foot was considered the most commonly reported footwear problem by both males and females. The problem of excessive arch-support on the dominant and non-dominant sides of male participants was significantly higher than females ( p < 0.05). Occasional pain or frequent pain were mainly distributed in the forefoot, followed by the rearfoot and midfoot regions. Conclusion There were small differences in footwear demand between the dominant and non-dominant sides, but several differences existed between females and males. The results from gender differences suggested that female shoes prefer a specific shoe last for better fit, rather than a modified version of male shoes. In the future, the design of badminton shoes should consider footwear demands and foot discomfort profiles in respective male and female badminton players.
... These views are supported by current literature, indicating that parallel use of running shoes is a protective factor from injury among recreational runners (Malisoux et al., 2015). Shoe comfort has been cited as a protective factor against injury (Mundermann et al., 2001), however, running performance is not associated to perceived comfort (Hébert-Losier et al., 2020). ...
Article
Full-text available
Until the mid-2000s, qualitative research has been virtually absent from running injury research. A handful of studies have been recently published regarding the attitudes and perceptions of runners and coaches toward injury development. Footwear is frequently perceived as a risk factor for running related injuries, but empeirical evidence fails to support such beliefs. The reasons why runners choose specific footwear warrants formal investigation to further understand the links between footwear and running related injuries. This study aimed to investigate the factors influencing runners choices of footwear. Interviews were conducted with 12 runners. Recordings from the interviews were transcribed verbatim and themes were developed using thematic analysis. Findings revealed 15 unique factors that influence runner's choices of footwear for running. These factors were grouped into three main themes: personal footwear characteristic preferences, other people and economic considerations. Runners largely gather information about their footwear choices from past experiences and people they trust and admire. They also emphasized the complexity of footwear choices due to availability and the constant changes preset within the footwear industry. This research adds to the growing body of knowledge to better understand the wider running injury system. Further studies are needed to establish how runners perceptions of their footwear impact injury rates and to develop effective injury prevention strategies.
... [18] Specific to the military context, Mundermann et al. found that shoe inserts that were perceived as comfortable were able to reduce stress fractures and pain at different locations by 1.5 to 13.4%. [19] Regarding the relationship between plantar pressure and comfort in military boots, Lange et al. reported comfort ratings improved with decreased peak pressure, particularly at the forefoot regions that were associated with high risk for metatarsal fractures. [20] These earlier findings suggested that biomechanical loading and comfort ratings are inter-connected and both factors can influence lower limb injuries. ...
Article
Full-text available
Introduction Combat boots are essential protective gear for military personnel. The purposes of the present study were to examine (1) the influence of combat boot type on ground reaction force (GRF) variables and perceived comfort during unloaded and loaded walking and (2) the relationship between comfort and biomechanical measurements. Methods Four types of combat boots with different physical features (eg, mass, thickness) and mechanical properties (eg, cushioning, rigidity) were compared across 61 male participants with experience in military marching while carrying heavy loads. In each boot type, participants completed a 10-m walk under an unloaded and a 20-kg loaded conditions at their preferred speeds. Peak force and loading rate during walking were measured using the loadsol wireless in-shoe sensor system. Comfort level was assessed using a 7-point Likert scale. Difference between loaded and unloaded walking, and across boot types were statistically compared. Correlation analyses were performed between comfort and GRF variables. Results On average across all boot types, participants walked 2.1% slower when carrying 20-kg loads while experiencing 24.3% higher peak force and 20.8% higher loading rate. Boot D was perceived as most comfortable, followed by boots C, B and A (χ²(2)=115.4, p<0.001). Participants walked slightly faster (p=0.022, ηp² = 0.052) and displayed higher loading rates (p<0.001, ηp²=0.194) in the two more comfortable boots (C and D) than the less comfortable boots (A and B). No significant correlations were found between perceived comfort and any GRF variables. Conclusions Combat boot features can influence perceived comfort ratings substantially during walking, whereas biomechanical differences among boot types are more subtle regardless of load conditions. The lack of relationship between comfort and force variables suggests that both subjective and objective measurements should be considered for comprehensive evaluation of combat boots.
... In addition to facilitating a general sense of wellbeing, the use of comfortable footwear is also considered to have a range of practical advantages, as it may facilitate physical activity [6], enhance sporting performance [7], and reduce the incidence of injury [8]. Therefore, identifying the footwear design, physiological and psychological factors which influence comfort could assist in the development and manufacture of improved footwear for a wide range of population groups, and potentially have both individual and societal benefits. ...
Article
Full-text available
Objective To provide a narrative synthesis of the research literature pertaining to footwear comfort, including definitions, measurement scales, footwear design features, and physiological and psychological factors. Methods A systematic search was conducted which yielded 101 manuscripts. The most relevant manuscripts were selected based on the predetermined subheadings of the review (definitions, measurement scales, footwear design features, and physiological and psychological factors). A narrative synthesis of the findings of the included studies was undertaken. Results The available evidence is highly fragmented and incorporates a wide range of study designs, participants, and assessment approaches, making it challenging to draw strong conclusions or implications for clinical practice. However, it can be broadly concluded that (i) simple visual analog scales may provide a reliable overall assessment of comfort, (ii) well-fitted, lightweight shoes with soft midsoles and curved rocker-soles are generally perceived to be most comfortable, and (iii) the influence of sole flexibility, shoe microclimate and insoles is less clear and likely to be more specific to the population, setting and task being performed. Conclusion Footwear comfort is a complex and multifaceted concept that is influenced not only by structural and functional aspects of shoe design, but also task requirements and anatomical and physiological differences between individuals. Further research is required to delineate the contribution of specific shoe features more clearly, and to better understand the interaction between footwear features and individual physiological attributes.
... Luo et al. (1998) also incorporated a thin leather insole with an exaggerated arch support as one of five different footwear conditions used in their study. There is evidence that foot orthotics reduce foot and lower limb injuries of athletes (Kirby, 2017;Nigg et al., 1999) and improve overall footwear comfort (Mundermann, Stefanyshyn, & Nigg, 2001;Vicenzino, 2004). However, the link between comfort, measured for footwear including foot orthotics, and RE is still underreported and highlights a gap for potential future research. ...
Article
Full-text available
Footwear with or without custom foot orthotics have the potential to improve comfort, but the link with running performance needs further investigation. We systematically reviewed the association of footwear comfort on running economy in recreational runners. Nine electronic databases were searched from inception to March 2020. Eligible studies investigated both direct outcome measures of running performance (e.g. running speed) and/or physiological measures (e.g. running economy (RE)) alongside comfort for each footwear condition tested. Methodological quality was assessed using the “Effective Public Health Practice Project” (EPHPP). RE during submaximal running was the most common physiological outcome reported in 4 of the 6 eligible studies. The absolute difference in RE between the most and least comfortable footwear condition was computed, and meta-analysis was conducted using a random effect model. The most comfortable footwear is associated with a reduction in oxygen consumption (MD: −2.06 mL.kg⁻¹.min⁻¹, 95%CI: −3.71, −0.42, P = 0.01) while running at a set submaximal speed. There was no significant heterogeneity (I² = 0%, P = 0.82). EPHPP quality assessment demonstrated weak quality of the studies, due to reporting bias and failing to disclose the psychometric properties of the outcome measures. It can be concluded with moderate certainty that improved RE in recreational athletes is associated with wearing more comfortable footwear compared to less comfortable footwear. Highlights • This systematic review reports on the association of footwear comfort with running economy in recreational runners. • Running economy during constant submaximal running is likely improved in recreational runners wearing more comfortable compared to less comfortable footwear. • This finding is based on a meta-analysis, including four studies, showing a small but statistically significant decreased oxygen consumption at steady state speeds while wearing the most comfortable footwear.
... Die Optimierung von Sicherheitsschuhen erfolgt unter verschiedenen Aspekten -beispielsweise der Dämpfung [8] oder der Form sowie des Materials der Schuheinlagen [16]. In diesen beiden Studien konnte gezeigt werden, dass spezifische Anpassungen am Schuh Eine davon ist die Analyse der Herzfrequenzvariabilität (HRV), die objektiv mittels zeit-und frequenzbezogenen HRV-Parameter die allgemeine Beanspruchung erfasst sowie unabhängig von der subjektiven Wahrnehmung und Einschätzung der Person ist. ...
Article
Full-text available
Zusammenfassung Hintergrund Sicherheitsschuhe sind Teil einer persönlichen Schutzausrüstung zur Minderung des Unfallrisikos am Arbeitsplatz und bei vielen Tätigkeiten in verschiedenen Berufsgruppen vorgeschrieben. Das Tragen von normierten Arbeitsschuhen kann aufgrund der besonderen Eigenschaften (Passform und Gewicht) zu einer erhöhten Beanspruchung des Arbeiters führen. Eine zusätzliche Optimierung von Arbeitsschuhen, mit dem Ziel der Symmetrisierung des Ganges und der damit einhergehenden Verminderung der Beanspruchung, unter den besonderen Bedingungen des Arbeitsschutzes ist daher anzustreben. In dieser Studie soll überprüft werden, ob das Anbringen einer Gangjustierhilfe mit dem Ziel der Symmetrisierung des Ganges einen Einfluss auf die allgemeine Beanspruchung von Schichtarbeitern hat. Methodik Dafür wurde bei 29 männlichen Probanden (Interventionsgruppe: n = 15, Kontrollgruppe: n = 14) zu 2 Messzeitpunkten während der Spätschicht die Herzfrequenzvariabilität (HRV) kontinuierlich erfasst. Ergebnisse Nach 2‑wöchigem Tragen der Gangjustierhilfe zeigt sich eine signifikante Erhöhung der zeitbezogenen HRV-Parameter bei der Interventionsgruppe. Die frequenzbezogenen Parameter Gesamtleistung (Total Power) und Leistung im High Frequency Band (Power HF Band) zeigen bei der Kontrollgruppe eine Verringerung vom 1. zum 2. Messzeitpunkt. Die Ergebnisse sprechen dafür, dass die Gangjustierhilfe durchaus positive Effekte auf die HRV hat und damit die allgemeine Beanspruchungslage am Arbeitsplatz bei dieser Stichprobe positiv beeinflussen kann. Diskussion Weitere Studien zum Überprüfen eines Effektes mit größeren Fallzahlen und unter Berücksichtigung weitere Gruppierungsmöglichkeiten (bspw. Parameter der Ganganalyse, körperliche Leistungsfähigkeit und Vorerkrankungen) sind jedoch erforderlich.
... Four average values were also averaged and finally, an overall rating was found to be 1.67. This rating is an agreement of shoe comfort with a previous study [9] where the comfort rating was 1.84 for shoes without any special inserts. So according to the comfort rating scale and previous study, it can be said that the developed shoes exhibited good comfort property to the feet of the wearer. ...
Conference Paper
Full-text available
The traditional footwear uses stitch or adhesive bond to fix the upper with the bottom part. But permanently fixation makes several problems in shoe maintenance. The objectives of this study were to develop a shoe construction method where style and aesthetic look of shoe can be easily changed and to provide better cleaning facilities inside of the shoe. In this study, one pair of derby and another pair of oxford shoe with removable upper were designed and developed. In this construction, strips of Velcro and snap buttons were used along the feather edge of the shoe to attach the upper and bottom firmly. The replacement of the upper was possible through this construction. Several tests like strength analysis, wear trial and material consumption were carried out to ensure good functionality, comfort and efficient material consumption of the developed footwear. The average breaking load of the join along the lasting edge of the shoe was found to be 106 N by ASTM D 1683 method that was higher than the value of the control sample. Material consumption of derby shoe upper was compared by 0 0 of Russ and Small method (RSM) where the developed construction method consumed almost 125cm 2 more leather compared to the conventional cemented method. But the material consumption reduces comparatively by using more replaceable uppers on the same bottom. 14 days with each day 30 minutes wear trial was also carried out and the wearer rate 1.67 in pain rating scale (1 to 10) which indicates that the wearer felt comfort by wearing these shoes. So, this construction method may be a solution for particular people who want to change their shoe style frequently and it may also solve several difficulties related to shoe maintenance.
... The contrasting results between the present and previous studies also emphasize the large degree of interindividual variability common in running footwear research, 55-57 which may be influenced by age and sex. 4 These contrasting and comparable results between studies also highlight potential interindividual properties of the musculoskeletal system that determine runners' choice or response to stiffness metrics 22,58,59 among footwear types and the potential importance of individual choice in footwear selection that prioritizes comfort for preventing running injury. 60 As measured in this study, stiffness is a model that does not represent the true mechanical stiffness of the system. 39,61 Vertical, leg, and joint stiffness are influenced by computational methods and are sensitive to leg compression calculation. ...
Article
The running footwear literature reports a conceptual disconnect between shoe cushioning and external impact loading: footwear or surfaces with greater cushioning tend to result in greater impact force characteristics during running. Increased impact loading with maximalist footwear may reflect an altered lower-extremity gait strategy to adjust for running in compliant footwear. The authors hypothesized that ankle and knee joint stiffness would change to maintain the effective vertical stiffness, as cushioning changed with minimalist, traditional, and maximalist footwear. Eleven participants ran on an instrumental treadmill (3.5 m·s-1) for a 5-minute familiarization in each footwear, plus an additional 110 seconds before data collection. Vertical, leg, ankle, and knee joint stiffness and vertical impact force characteristics were calculated. Mixed model with repeated measures tested differences between footwear conditions. Compared with traditional and maximalist, the minimalist shoes were associated with greater average instantaneous and average vertical loading rates (P < .050), greater vertical stiffness (P ≤ .010), and less change in leg length between initial contact and peak resultant ground reaction force (P < .050). No other differences in stiffness or impact variables were observed. The shoe cushioning paradox did not hold in this study due to a similar musculoskeletal strategy for running in traditional and maximalist footwear and running with a more rigid limb in minimalist footwear.
... Such variability can make it hard for consumers to find a proper fit, resulting in users having to wear ill-fitting footwear with suboptimal comfort and being at risk of occupational injury during ambulation (Dobson et al., 2018). Footwear fit and comfort has shown benefits in increasing biomechanical performance (Pryhoda et al., 2021), reducing the risk of movement-related injury (Mündermann et al., 2001), and is often the number one factor for consumers to select footwear (Martínez-Martínez et al., 2017). Footwear should therefore be properly fit to a wide population range in order to be successful. ...
Article
A detailed understanding of foot morphology can enable the design of more comfortable and better fitting footwear. However, foot morphology varies widely within the population, and changes dynamically as the foot is loaded during stance. This study presents a parametric statistical shape model from 4D foot scans to capture both the inter- and intra-individual variability in foot morphology. Thirty subjects walked on a treadmill while 4D scans of their right foot were taken at 90 frames-per-second during stance phase. Each subject’s height, weight, foot length, foot width, arch length, and sex were also recorded. The 4D scans were all registered to a common high-quality foot scan, and a principal component analysis was done on all processed 4D scans. Elastic-net linear regression models were built to predict the principal component scores, which were then inverse transformed into 4D scans. The best performing model was selected with leave-one-out cross-validation. The chosen model predicts foot morphology across stance phase with a root-mean-square error of 5.2 ± 2.0 mm and a mean Hausdorff distance of 25.5 ± 13.4 mm. This study shows that statistical shape modeling can be used to predict dynamic changes in foot morphology across the population. The model can be used to investigate and improve foot-footwear interaction, allowing for better fitting and more comfortable footwear.
... Joint moments were calculated by the inverse dynamics method and normalized by each subject's mass (i.e., unit: Nm/kg). For comfort testing, a visual analogue scale (VAS) questionnaire was completed after the subjects wore each shoe and performed light running for 1 km [34][35][36]. The questions regarded rear foot cushioning and overall comfort. ...
Article
Full-text available
(1) Background: The purpose of this study was to investigate the effects of a rounded heel shoe (RHS) and rounded lateral heel shoe (RLHS) on impact and lower extremity stability as well as their relationships with comfort during running. (2) Methods: Twenty healthy male adults participated in the study. The data were collected using eight infrared cameras while participants were running at a speed of 2.7 m/s in three shoe conditions on an instrumented treadmill. (3) Results: The peak vertical ground reaction force (PVGRF) was statistically smaller for the RHS and RLHS compared with the normal shoes (NS) (p < 0.05). The range of motion of inversion–eversion at the ankle joint was statistically smaller for the RLHS compared with the NS and RHS (p < 0.05). Increased dorsiflexion of the ankle joint at heel contact was negatively related to the comfort of a running shoe, and increased dorsi-plantarflexion ROM was positively related to comfort. (4) Conclusions: Based on these results, a curved heel shape of a running shoe may provide a positive influence on the biomechanical function and the comfort of running shoes. Future study, including measurements of lower extremity muscle activations and long-term comfort, would be beneficial to help validate current findings and develop further applications.
... Comfort was measured following the walking trials, rating the comfort of the footwear on a 100 mm visual analog scale (VAS) for 'overall comfort' based on the scale developed by Mundermann et al. [20]. Toe and heel comfort were assessed with separate VAS with the verbal anchors of 'too loose' and 'too tight', therefore a measure of 50 mm would indicate 'optimal comfort'. ...
Article
Background There is a common perception that poorly fitting footwear will negatively impact a child’s foot, however, there is limited evidence to support this. Aim To determine the effect of shoe size on foot motion, perceived footwear comfort and fit during walking, maximal vertical jump height and maximal standing broad jump distance in children aged 8–12 years. Methods Fourteen participants completed 3D walking gait analysis and jumping tasks in three different sizes of school shoes (one size bigger, fitted for size, one size smaller). In-shoe motion of the hindfoot, midfoot and 1st metatarsophalangeal joint (1st MTPJ) were calculated using a multi-segment kinematic foot model. Physical performance measures were calculated via maximal vertical jump and maximal standing broad jump. Perceived footwear comfort and fit (heel, toes and overall) was assessed using a 100 mm visual analog scale (VAS). Differences were compared between shoe sizes using repeated measures ANOVA, post-hoc tests and effect sizes (Cohen’s d). Results Compared to the fitted footwear, the smaller sizing restricted hindfoot eversion (−2.5°, p = 0.021, d = 0.82), 1st MTPJ dorsiflexion (−3.9°, p = 0.012, d = 0.54), and compared to the bigger footwear, smaller sizing restricted sagittal plane midfoot range-of-motion during walking (−2.5°, p = 0.047, d = 0.59). The fitted footwear was rated as more comfortable overall with the smaller size rated as too tight in both the heel (mean difference 11.5 mm, p = 0.042, d = 0.58) and toes (mean difference 12.1 mm, p = 0.022, d = 0.59), compared to the fitted size. Vertical and standing broad jump distance were not impacted by footwear size (p = 0.218−0.836). Significance Footwear that is too small restricts foot motion during walking in children aged 8–12 years. Jump performance was not affected. Children were able to recognise shoes that were not correctly matched to their foot length, reinforcing that comfort is an important part of the fitting process.
Article
This systematic review explores the biomechanical and subjective effects of shoe inserts, including foot orthotics (FOs) and insoles, in asymptomatic subjects. Aimed at understanding their implications, the review poses two key research questions: (i) the influence of shoe inserts on lower extremity biomechanics and subjective perception and (ii) the effects of different design characteristics on these aspects. Following Preferred Reporting of Systematic Reviews and Meta‐Analysis guidelines, a meticulous search of Scopus and PubMed from August 2022 to March 2023 yielded 34 articles, with 26 focusing on biomechanical effects and eight on comfort effects. The studies, conducted during static and dynamic activities, such as standing, walking, jogging, running, jumping, and cycling, reveal significant reductions in rearfoot eversion, knee joint forces, and lower extremity muscle forces through postings and wedging in FOs. Changes in stiffness impact rearfoot kinematics, plantar pressure distribution, and ankle–foot power distribution. Conversely, surface texture and arch variations demonstrate limited significance. FOs and shoe inserts, characterized by geometric, material, location, size, and fabrication features, effectively regulate forces and moments on the lower extremity. This control promotes uniform plantar pressure distribution and enhances comfort during various activities. These insights benefit manufacturers, clinicians, and stakeholders, providing a deeper understanding of the positive benefits of FOs and shoe inserts. However, further well‐designed studies on clinical populations are necessary to validate these findings and establish their clinical efficacy, as the current focus remains on healthy subjects.
Chapter
In this chapter, the effects of different structural properties of Futsal playing surfaces on the resulting change of direction performance, perceived traction properties, and dynamically measured friction forces are examined in relation to each other. Three types of playing surfaces (area-elastic: AE, point-elastic No. 1: PE1, and point-elastic No. 2: PE2) are investigated in conjunction with a defined Futsal shoe. In the agility test, participants performed significantly better on the point-elastic surfaces (PE1 and PE2) compared to the area-elastic surface (AE) (p < 0.05). Additionally, it was found that the PE2 surface exhibited the highest perceived traction. The results suggest that the significantly higher available friction coefficient explains the improvement in performance and traction perception on the PE2 surface. This successfully demonstrates that the structural difference (AE or PE) of the Futsal playing surface has a significant impact on the change of direction performance of experienced Futsal players and their perceived level of traction and friction properties.
Thesis
Full-text available
The developed device has effectively automated the shoe-covering process, thereby ensuring a convenient and efficient method of donning shoe covers to enhance hygiene and safety of all health care. In addition, the device incorporated a sterilization mechanism that effectively reduced the microbial load on the footwear protectors. This specific quality enhances sanitation and decreases the likelihood of cross-infection. In addition, the apparatus featured a disinfection and removal mechanism for shoe covers. The aforementioned feature allowed for the easy and secure disposal of used footwear protectors, while simultaneously sanitizing them to prevent the spread of pathogens. The implementation of an integrated disinfection process serves to maintain a clean and sterile environment. The audible and visual indicators are used to convey information to the user. Voice output and visual indicators were added to the device to improve its functionality. These characteristics served as practical indicators to inform users of the depletion of shoe covers. The use of vocal output and light indicators prompts users to replenish shoe covers, thereby upholding hygiene protocols and reducing the likelihood of inadequate protection. As to the assessed functionality of the system researchers conducted through the used of questionnaire to determine the perceived functional suitability of the system. The overall satisfaction with the device's functionality indicates its capacity to effectively meet the needs of healthcare professionals. The evaluation highlights the favorable response to the sterilization system that uses foot covers. Valued and essential to the system's usefulness and efficiency are the automated shoe covering and removal features, as well as the display of available shoe coverings. In addition, users appreciate the system's usability and effectiveness, which is likely due in part to the device's voice output and clear notifications. The system’s effectiveness of the device, was assessed using gram-stain and microscopic laboratory examination, the result was effective measures to enhance hygiene practices and reduce the nosocomial infection to contribute to overall public health safety.
Article
With the increasing professionalisation of men's netball and the high prevalence of foot-related problems and pain, manufacturers must develop shoes with the correct ergonomic design to meet the unique needs of male netball players. This study aimed to determine what factors men consider when selecting a netball-specific shoe and what design features they want in an ideal netball-specific shoe. 279 amateur, sub-elite and elite male netball players completed a 38-question online survey about their footwear habits and preferences. Support was the most influential factor when men selected a netball-specific shoe. A wider toe-box, more durable upper and outsole, and added cushioning and support in the midsole and insole were preferred fit, form and function features for an ideal netball-specific shoe. We recommend that manufacturers develop a range of netball-specific shoes based on the foot dimensions, playing demands and preferences of male netball players to meet men's fit and functionality requirements.
Article
There is debate and confusion over how to evaluate the biomechanical effects of running shoe design. Here we use an evolutionary perspective to analyze how key design features of running shoes alter the evolved biomechanics of the foot, creating a range of tradeoffs in force production and transmission that may affect performance and vulnerability to injury.
Article
Full-text available
Background: Running is a hugely popular sport. Unfortunately, running-related injury (RRI) rates are high, particularly amongst amateur and recreational runners. Finding ways to reduce RRI rates and maximise comfort and performance for runners is important. Evidence regarding whether orthotics can successfully improve these parameters is limited and contradicting. Further research is required to provide runners with clearer guidance on the usefulness of orthotics. Aim: To investigate the effect of Aetrex Orthotics on comfort, speed and RRI rates during recreational running. Methods: One hundred and six recreational runners were recruited on a voluntary basis via running clubs and social media pages and randomised into either the intervention or control group. Participants in the intervention group ran with Aetrex L700 Speed Orthotics inserted in their usual running shoes, whilst participants in the control group ran in their usual running shoes with no orthotics. The study ran for an 8-wk period. Participants provided data relating to running comfort, distance, and time during weeks 3-6. Participants provided data relating to any RRIs they sustained during all 8 wks. Running distance and time were used to calculate running speed in miles per hour (mph). For each outcome variable, 95% confidence intervals and P values were calculated to assess the statistical significance between the groups. For comfort and speed data, univariate multi-level analysis was performed, and for outcome variables with significant between group differences, multi-level multivariate analysis was performed to evaluate any confounding effects of gender and age. Results: Ninety-four participants were included in the final analysis (drop-out rate = 11%). Comfort and speed from 940 runs and 978 injury data reports were analysed. Participants who ran with orthotics reported, on average, speeds 0.30 mph faster (P = 0.20) and comfort scores 1.27 points higher (P ≤ 0.001) than participants who ran with no orthotics. They were also 2.22 times less likely to sustain an injury (P = 0.08) than participants who ran with no orthotics. However, findings were only significant for comfort and not for speed or injury rates. Age and gender were found to be significant predictors of comfort. However, the improvements in comfort reported by participants who ran with orthotics were still significant after adjusting for age and gender. Conclusion: This study found orthotics to improve comfort and speed and prevent RRIs whilst running. However, these findings were only statistically significant for comfort.
Article
Full-text available
Distance runners represent a unique patient population. The cyclic activity associated with distance running leads to a high incidence of injury. Gait patterns, the extrinsic and intrinsic muscles of the foot and ankle, foot strike pattern, shoe wear considerations, alignment, and orthotics are also all important considerations that must be considered by the treating provider. The purpose of this work is to review relevant functional anatomy, recent studies on gait patterns in running, orthotics, and theory on how the body moves through space during running in order to better equip the clinician to treat long distance runners.
Article
Research is often conducted to investigate footwear mechanical properties and their effects on running biomechanics, but little is known about their influence on runner satisfaction, or how well the shoe is perceived. A tool to predict runner satisfaction in a shoe from its mechanical properties would be advantageous for footwear companies. Data in this study were from a database (n = 615 subject-shoe pairings) of satisfaction ratings (gathered after participants ran on a treadmill), and mechanical testing data for 87 unique subjects across 61 unique shoes. Random forest and elastic net logistic regression models were built to test if footwear mechanical properties and subject characteristics could predict runner satisfaction in 3 ways: degree-of-satisfaction on a 7-point Likert scale, overall satisfaction on a 3-point Likert scale, and willingness-to-purchase the shoe (yes/no response). Data were divided into training and validation sets, using an 80–20 split, to build the models and test their accuracy, respectively. Model accuracies were compared against the no-information rate (i.e. proportion of data belonging to the largest class). The models were not able to predict degree-of-satisfaction or overall satisfaction from footwear mechanical properties but could predict runner’s willingness to purchase with 68–75% accuracy. Midsole Gmax at the heel and forefoot appeared in the top five of variable importance rankings across both willingness-to-purchase models, suggesting its role as a major factor in purchase decisions. The negative regression coefficient for both heel and forefoot Gmax indicated that softer midsoles increase the likelihood of a shoe purchase. Future models to predict satisfaction may improve accuracy with the addition of more subject-specific parameters, such as running goals or foot proportions.
Preprint
Full-text available
Background: While the roles of injury prevention and performance enhancement have increasingly been investigated for badminton footwear, there is a lack of research on gender-specific badminton footwear. The purpose of this study was to examine the gender differences in footwear demands and foot injuries in badminton. Methods: A supervised questionnaire survey of 326 recreational badminton players was collected. The questionnaire was divided into four sections enquiring about the characteristics of (1) participant profiles, (2) importance of shoe properties (3) shoe complaints. (4) and pain or discomfort in different foot regions. The Mann-Whitney U test and Wilcoxon Signed Ranks test were performed to determine the differences between genders and the differences between leg dominance, respectively. The significance level was set at 0.05. Results: Both males and females rated shoe fit as the most important features, followed by overall comfort, and injury protection. Females considered forefoot cushioning, comfort, breathability and color as the more important compared with other properties, which showed distinct pattern differences from males. The shoe problem results indicated that plantar pain of the non-dominant foot was considered the most commonly reported footwear problem by both males and females. The problem of excessive arch-support on the dominant and non-dominant sides of male participants was significantly higher than females (p < 0.05). Occasional pain or frequent pain were mainly distributed in the forefoot, followed by the rearfoot and midfoot regions. Conclusion: There were small differences in footwear demand between the dominant and non-dominant sides, but several differences existed between females and males. The results from gender differences suggested that female specific shoes prefer a specific better fit, rather than a modified version of male shoes. In the future, the design of badminton shoes should consider footwear demands and foot discomfort profiles in respective male and female badminton players.
Article
Full-text available
Background A large volume of systematic reviews and meta-analyses has been published on the effectiveness of sports injury prevention programs. Purpose To provide a qualitative summary of published systematic reviews and meta-analyses that have examined the effectiveness of sports injury prevention programs on reducing musculoskeletal injuries. Study Design Systematic review; Level of evidence, 4. Methods We searched the PubMed, CINAHL, EMBASE, and the Cochrane databases for systematic reviews and meta-analyses that evaluated the effectiveness of sports injury prevention programs. We excluded published abstracts, narrative reviews, articles not published in English, commentaries, studies that described sports injury prevention strategies but did not assess their effectiveness, studies that did not assess musculoskeletal injuries, and studies that did not assess sports-related injuries. The most relevant results were extracted and summarized. Levels of evidence were determined per the Oxford Centre for Evidence-Based Medicine, and methodological quality was assessed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews, revised version). Results A total of 507 articles were retrieved, and 129 were included. Articles pertaining to all injuries were divided into 9 topics: sports and exercise in general (n = 20), soccer (n = 13), ice hockey (n = 1), dance (n = 1), volleyball (n = 1), basketball (n = 1), tackle collision sports (n = 1), climbing (n = 1), and youth athletes (n = 4). Articles on injuries by anatomic site were divided into 11 topics: general knee (n = 8), anterior cruciate ligament (n = 34), ankle (n = 14), hamstring (n = 11), lower extremity (n = 10), foot (n = 6), groin (n = 2), shoulder (n = 1), wrist (n = 2), and elbow (n = 1). Of the 129 studies, 45.7% were ranked as evidence level 1, and 55.0% were evidence level 2. Based on the AMSTAR-2, 58.9% of the reviews reported a priori review methods, 96.1% performed a comprehensive literature search, 47.3% thoroughly described excluded articles, 79.1% assessed risk of bias for individual studies, 48.8% reported a valid method for statistical combination of data (ie, meta-analysis), 45.0% examined the effect of risk of bias on pooled study results, and 19.4% examined the risk for publication bias. Conclusion This comprehensive review provides sports medicine providers with a single source of the most up-to-date publications in the literature on sports injury prevention.
Article
Most female soldiers report that in-service body armour systems are too large. We investigated whether a smaller prototype body armour system could improve thoracolumbar range of motion (ROM) and reduce interference when female soldiers performed dynamic postures. 97 female soldiers completed three ROM tasks and seven dynamic postures wearing no armour, an in-service body armour system, and a smaller prototype system. Feedback on comfort of the prototype system was also obtained. Thoracolumbar ROM and dynamic posture completion were both hindered by using body armour, although the participants’ performances were significantly less impeded when they wore the smaller prototype system compared to the in-service system. A smaller body armour system that is better matched to the anthropometric dimensions of female soldiers appears to improve overall fit and function. An increased range of body armour sizes and female-specific designs should be systematically explored to further enhance fit and function of body armour.
Article
Influence of footwear on posture in athletes is poorly documented despite its potential impact on biomechanics and injury risk. The aim of this study was to investigate effects of different footwear geometries on comfort and posture on a cohort of 48 elite rugby players. Spine posture was characterized by photogrammetry, while center of pressure was measured by means of a force platform. Three different footwear outsoles architectures (one rugby shoe with flat outsole, one rugby shoe with a 10 mm heel rise and foot arch support, and a running shoe with a 10mm heel rise and foot arch support) were compared to non-shod in randomized order. Then comfort felt at the level of foot and spine was also estimated by subjective questionnaires. Compared to the flat rugby model, both other models induced significantly (p<0.05) greater comfort at the level of foot and spine, a slight shift toward of center of pressure and a spinal posture closer to that observed when non-shod. The footwear geometry influences comfort and posture at the level of the foot as well as spine and should be considered in a dual purpose of injury prevention and performance.
Article
Perceived footwear comfort influences wearability and can impact on physical mobility, performance and foot-related complaints. To date, there has been no comprehensive review of the characteristics or methods for measuring perceived footwear comfort. The aims of this systematic review were to identify, appraise and synthesise the literature on methods used to assess perceived footwear comfort, and report their validity and reliability. Electronic databases were systematically searched and the articles screened and appraised for methodological risk of bias using a modified Quality Index checklist. Data on footwear comfort assessment tools (methods, populations, footwear types, reliability/validity) was extracted by two reviewers. A narrative synthesis was undertaken to describe the findings. Ninety-nine articles involving 6980 participants were assessed as eligible for review. Perceived footwear comfort has been assessed by a variety of methods including the visual analogue scale (VAS), Likert-type scales, ranking scales and questionnaires. The studies have covered a range of populations, both healthy and pathological, ranging between ages 8 and 75 years, most commonly adults. Investigations into reliability of perceived footwear comfort scales were limited, and whilst some tools had evidence of moderate to high reliability, findings were population dependent. Developmental or independent validity testing was typically not undertaken. Risk of bias was variable across studies. Perceived footwear comfort assessment has been performed across a wide range of populations and footwear types. Whilst select measures had evidence for their reliability, the results were variable and population dependent. There is scope for further research into the reliability and validity of perceived footwear comfort assessment tools in different populations.
Article
Runners and clinicians have long sought to enhance distance running performance and reduce the occurrence of running-related injuries. Footwear selection often comes to the forefront in such pursuits, yet remains a common source of controversy in the literature and practice. In particular, the utilization of minimalist footwear has fluctuated in popularity over the last several decades, with some proponents suggesting that it can promote improvements in running economy and reduce injury rates. However, a closer look at the literature shows anything but straightforward and consistent recommendations. The purpose of this article is to outline the effects of minimalist footwear on running performance and injury, with a focus on its associated impact on running mechanics. The authors also aim to identify who may be the ideal client to transition to minimalist running and how to minimize the risk of injury during the transition.
Preprint
Full-text available
Introduction: Military members are exposed to high cumulative physical loads that frequently lead to injury. Prescribed footwear and orthoses have been used to prevent injury. The purpose of this systematic review with meta-analysis was to assess if prescribed prophylactic footwear or foot orthoses reduced lower extremity injury risk in military tactical athletes. Methods: MEDLINE, Embase, Web of Science, CINAHL, SportDiscus, and DTIC databases were searched for randomized controlled trials published at any time that compared foot orthoses or prescribed footwear (to include shock-absorbing insoles and socks) to a placebo intervention or a no-treatment control. Methodological quality was assessed and numbers of injuries, population at risk, and the duration of the study epoch were extracted and relative risk (RR) calculated. An omnibus meta-analysis was performed assessing all prescribed footwear and orthoses intervention studies, with subgroup analyses conducted on studies with similar interventions [i.e., basketball athletic shoes; athletic shoes (prescribed by foot type); foot orthoses; shock-absorbing insoles; socks; tropical combat boots]. Results: Of 1,673 studies identified, 22 studies were included. Three of eight studies that employed orthoses demonstrated significantly reduced overuse injuries compared to no treatment controls (RR range: 0.34-0.68); one study showed neoprene insoles significantly decreased overuse injuries (RR: 0.75). There were no other significant effects in the individual studies, and no protective effects observed in the omnibus meta-analysis or in the component sub analyses. Conclusions: Prescribed footwear and orthoses do not appear to have a prophylactic effect on lower quarter MSKI in military members and cannot be recommended at this time.
Article
Background and Objective: Proprioceptors of the plantar surfaces of the foot have less efficiency and the stimulation and reinforcement of them may be lead to reduction of falling risk. One of the methods to reinforce proprioceptor receptors in these individuals is using textured foot orthoses. The aim of this study was to evaluate the effect of textured foot orthoses on frequency spectrum of lower extremity muscles, stance time and comfort in individuals over age of 55 years during walking. Methods: This quasi-experimental study was done on the 14 females and 14 males age ranged of 56-70 years with the ability to walk independently and with physical and mental health status. Subjects were compared during five conditions including without foot orthoses and using four foot orthoses (including small and large foot orthoses with two types of flexible and rigid), flexible and rigid large textured foot orthoses. The 8 electrodes were located on tibialis anterior, medial gastrocnemius, vastus medialis, vastus lateralis, biceps femoris, semitendinisus, gluteus, and erector spinae in 3 lumbar vertebrae region muscles. Results: Frequency content of tibialis anterior and vastus medialis was significantly increased in males than female (P<0.05). Vastus medialis frequency during walking with large foot orthoses was more than walking without foot orthoses (P<0.05). The comfort level was different during flexible large textured foot orthoses condition compared with flexible small textured foot orthoses condition (P<0.05). The stance time was not significant between all conditions. Conclusion: Increased frequency content of the vastus medialis muscle can increase the absorption and decrease the vertical loading rate imposed on the foot, which in turn reduces the risk of injury of the lower limb in older adults
Article
Full-text available
Using a 15-point rating scale, subjects rated perception of cushioning during running on a treadmill with three different footwear constructions of varying midsole hardness. During overground running, various biomechanical ground reaction force and pressure variables were collected and compared to the perception of cushioning scores. The perception scores identified the three shoes as very hard, medium soft, and soft. Peak pressures in the heel, the force rate, and the median power frequency of the impact force signal demonstrated increases in values with the perception of less cushioning. In the harder shoes, the subjects altered the loading patterns under their feet, resulting in lower impact forces and increased weight bearing of the forefoot structures.
Article
Full-text available
Sedentary individuals, particularly new military recruits, who start a physical training program have a substantial risk of developing an overuse injury of the lower limb. In this study we investigated the effect of neoprene insoles on the incidence of overuse injuries during 9 weeks of basic military training. The experimental group consisted of 237 randomly selected new recruits, while 1151 recruits were the control group. Insoles were given to the experimental group and compliance was monitored. A panel of doctors documented and classi fied all injuries occurring during the 9 week period. A total of 54 (22.8%) and 237 (31.9%) injuries were reported in the experimental and control groups, re spectively. In both groups, the majority of injuries were overuse (experimental group, 90.7%; control group, 86.4%). The mean weekly incidence of total overuse injuries and tibial stress syndrome was significantly lower (P < 0.05) in the experimental group. The mean incidence of stress fractures was lower in the experimental group but not significantly so (0.05 < P < 0.1). This study shows that the incidence of total overuse injuries and tibial stress syndrome during 9 weeks of basic military training can be reduced by wearing insoles.
Article
A technique using a three-dimensional digitizing device for the measurements of foot dimension, shape and structural characteristics was developed. A total of 23 variables were calculated from the coordinates of 26 digitized points on the foot and the leg when body weight was supported mainly by one foot as the other foot was resting on a platform. All variables were measured with reference to an anatomically defined reference frame on the foot. The intra- and intertester reliability were tested both for the device and for the foot measurements. High reliability (ICC> 0.999) was found for the device in measuring distances and angles on a plastic cube. Intra- and intertester reliability for the foot measurements were high (ICC> 0.8) in most of the variables, with the lowest intratester reliability of 0.57 and the lowest intertester reliability of 0.38.
Article
A triaxial electrogoniometer was used along with a Locam camera to measure knee rotation and gait characteristics of nineteen female college students while walking on a treadmill under three experimental conditions (barefoot, running shoes and high heels). Range of valgus-varus, flexion-extension and internal-external rotation during the swing and support phases, and maximum flexion during the swing walking step phase were studied. Significant differences (p < 0.01) were found among the three heel height treatments for range of knee flexion-extension during the swing walking phase and for internal-external rotation during the swing walking phase. Significant differences (p < 0.01) were also found between the high heeled swing phase mean value for internal-external rotation and the barefoot treatment mean values. ANOVA indicated a significant difference among the three experimental treatments for all distance and temporal variables studied.
Article
In this paper, four pairs of insoles with different comfort characteristics were used to investigate the relationship between the pressure distribution under the foot and running shoe comfort. Fourteen male subjects were tested in four insole conditions by walking and running on a treadmill. The pressure at the plantar surface of the foot was measured by using an EMED pressure-measuring insole. For walking there were significantly higher pressures and forces in the midfoot area and significantly lower pressures in the medial forefoot and hallux area by wearing the most comfortable insole compared with wearing the least comfortable insole. The shift of the pressure from forefoot to midfoot for the most comfortable insole provided an even distribution of the pressure at the plantar surface of the foot. The results also demonstrated that the path of centre of force at the plantar surface of the foot moved to the lateral aspect of the foot for the most comfortable insole. For running, only the pressure in the medial forefoot area was found significantly lower for the most comfortable insole than for the least comfortable insole. The results of this study indicated that the pressure distribution between the plantar surface of the foot and the shoe could detect the change of shoe comfort. Thus it is a suggestion that pressure measurement may be related to understand factors important for shoe comfort. Comfort of sport shoes is important for the appropriate execution of sport activities. Additionally, comfort may influence fatigue and possibly the development of injuries. The quantification of comfort of sport shoes and the understanding of mechanical and/or biological functions related to it may be enhanced with the use of pressure measurements between the plantar surface of the foot and the shoe sole.
Article
The development of microsurgical techniques has generated a resurgence of interest in estimating local pressure sensibility as a measure of sensory improvement. Because our experience with Weinstein's modification of Von Frey's probes yielded variable and poorly understood results, we measured two sets of probes and examined them in the light of the engineering principles on which their behavior is based. The mechanical behavior of the nylon monofilaments can be described as buckling with one end built in and the other end pinned. The probes are relatively uniform and consistent. However, no loss in sensitivity would accompany division of the set into two or three equivalent sets. Variations in the buckling stress as high as a factor of eight are difficult to avoid. Gross errors arise from careless application, variations in the elastic modulus due to changes in temperature and humidity, and variations in the attachment of fibers to handles and differences in the ends of the filaments. Interpreting results for this instrument requires an understanding of the factors which can influence those results. The rpobes are simple to use but easy to misinterpret.
Article
In a randomized prospective study among 390 recruits, the hypothesis that improved shoe shock attenuation could lessen the incidence of overuse injuries was tested. During the 14 weeks of training, 90% of the recruits sustained overuse injuries. Recruits training in a modified basketball shoe had a statistically significant lower incidence of metatarsal stress fractures and foot overuse injuries, compared with standard infantry boots, but their overall incidence of overuse injuries was not reduced. The effect of improved shoe shock attenuation was limited to those overuse injuries resulting from vertical impact loads.
Article
In a prospective study of the effect of the appropriateness of foot-shoe fit and training shoe type on the incidence of overuse injuries among infantry recruits, it was found that three shoe widths for each shoe length size were necessary to adequately accommodate the recruit population's foot anatomy. Recruits compensated for the lack of available shoe widths by choosing larger shoe sizes. However, this compensation did not result in an increase in the incidence of overuse injuries. Recruits who trained in basketball shoes had a lower incidence of overuse injuries of the feet than recruits who trained in infantry boots (p = 0.0001), but the overall incidence of overuse injuries was the same in both groups.
Article
Five hundred questionnaires were distributed to long- distance runners who had used, or who were using orthotic shoe inserts for symptomatic relief of lower extremity complaints. Three hundred forty-seven (69.4%) responded (males, 71%; females, 29%). The mean age of the respondents was 36 years (range, 15 to 61). The average distance run per week was 39.6 miles (range, 5 to 98). The mean duration for use of the orthotic inserts was 23 months (range, 1 to 96). The predominant (63%) type of orthotic device used was flexible. The presumed diagnoses in the population studied were excessive pronation (31.1 %), leg length discrepancy (13.5%), patellofemoral disorders (12.6%), plantar fasciitis (20.7%), Achilles tendinitis (18.5%), shin splints (7.2%), and miscellaneous (4.9%). Of the runners responding, 262 (75.5%) reported complete resolution or great improvement of their symptoms. Results of treatment with orthotic shoe inserts were independent of the diagnosis or the run ner's level of participation. A high degree of overall satisfaction was demonstrated by the finding that 90% of the runners continued to use the orthotic devices even after resolution of their symptoms. Orthotic shoe inserts were most effective in the treatment of symp toms arising from biomechanical abnormalities, such as excessive pronation or leg length discrepancy. Along with other conservative measures, orthotic shoe inserts may allow the athlete to continue participation in run ning and avoid other treatment modalities that are more costly and time consuming, and therefore less accept able to them.
Article
One hundred five military recruits were evaluated in our outpatient clinic for pain in the lower limb following prolonged sustained physical effort and strain. Plain x-ray investigations augmented by technetium-99m polyphosphate demonstrated the presence of 80 stress fractures in 52.4% of the patients. None of the patients had any anatomical abnormalities of the lower limbs. Of the stress fractures seen, 82.5% were located in the tibial and femoral diaphyses and 16.2% were in the small bones of the foot. Plain radiography gave false negative results in 87.3% of documented fractures. The remaining 47.6% of these recruits had no evidence of stress fractures. However, 74% of them had various anatomical deformities of the lower limb, mainly of the feet. Correction of these deformities enabled these patients to return to previous strenuous activities of their basic military training. The pathogenesis of stress fractures is still not understood. However, the development of persistent pain in the lower limb following prolonged sustained intensive physical activity needs further investigation. Anatomical deformities may be associated with development of stress fractures.
Article
In a series of prospective studies among infantry recruits the biomechanics of stress fractures have been studied. In this recruit model bone geometry and the natural shock absorbers of the body have been found to be related to stress fracture morbidity. Using the technique of accelerometry in this model, it has been shown that in the fatigue state shock absorption decreases, resulting in an increase in the amplitude of vertical accelerations that propagate up the skeleton at heel strike. Experiments to study the possibility of lowering stress fracture morbidity in this model by means of viscoelastic orthotics have been successful only in the case of femoral and metatarsal stress fractures among certain subpopulations. Stress fracture management in this model has been improved by early detection and by treatment regimens according to a protocol that emphasizes limited rest periods to allow healing to take place rather than judging recovery by pain levels.
Article
In a prospective study, quantitative measures of the structure of the longitudinal arch of the foot were established and related to the incidence of stress fractures in the bones of the lower limbs of military recruits. In addition, the role of a semirigid orthotic device (Langer military stress orthotic) in preventing stress fractures was evaluated as a function of the structure of the longitudinal arch. Femoral and tibial stress fractures were found to be more prevalent in the presence of feet with high arches, whereas the incidence of metatarsal fractures was higher in feet with low arches. The use of an orthotic device reduced the incidence of femoral stress fractures only in the presence of feet with high arches and the incidence of metatarsal fractures only among feet with low arches. The findings suggest that the normal foot with a low arch acts as a better shock absorber than the normal foot with a high arch, and that an orthotic device may improve the shock absorbing capacity of the arch.
Article
Ninety-six women participated in a crossover study to evaluate the effectiveness of viscoelastic polyurethane insoles in reducing back, leg, and foot pain among adults who spend the majority of each work day standing. Twenty-five of the subjects reported that the insoles made their shoes too tight to be comfortable. The remainder, however, found the insoles very comfortable (P less than .002, Wilcoxon, signed-rank test) and reported significant reductions in back pain (P less than .02), foot pain (P less than .03), and leg pain (P less than .007). When these subjects were asked whether they would prefer to wear their shoes alone or with insoles, the preference for insoles was overwhelming (P less than .007, back; P less than .03, leg; and P less than .009, foot pain). It is concluded that viscoelastic insoles can effectively improve comfort and reduce back, leg, and foot pain in individuals who must stand throughout the day.
Article
A prospective controlled trial was carried out to determine the usefulness of a viscoelastic polymer insole in prevention of stress fractures and stress reactions of the lower extremities. The subjects were 3,025 US Marine recruits who were followed for 12 weeks of training at Parris Island, South Carolina. Polymer and standard mesh insoles were systematically distributed in boots that were issued to members of odd and even numbered platoons. The most important finding was that an elastic polymer insole with good shock absorbency properties did not prevent stress reactions of bone during a 12-week period of vigorous physical training. To control for the confounding effects of running in running shoes, which occurred for about one and one-half hours per week for the first five weeks, we also examined the association of age of shoes and cost of shoes with injury incidence. A slight trend of increasing stress injuries by increasing age of shoes was observed. However, this trend did not account for the similarity of rates in the two insole groups. In addition, we observed a strong trend of decreasing stress injury rate by history of increasing physical activity, as well as a higher stress injury rate in White compared to Black recruits. The results of the trial were not altered after controlling for these factors. This prospective study confirms previous clinical reports of the association of stress fractures with physical activity history. The clinical application of a shock absorbing insole as a preventive for lower extremity stress reactions is not supported in these uniformly trained recruits. The findings are relevant to civilian populations.
Article
This review article describes shoe inserts and provides information to assist physical therapists to identify patients who may benefit from foot orthoses. The article discusses goals for and types of shoe inserts, in addition to the materials and methods that can be used in fabricating appliances. Clinical considerations for the use of shoe inserts and application to specific patient populations are presented.
Article
As the number of runners has increased dramatically, so has the incidence of running-related injuries. In order to determine what training factors are associated with running-related injuries, as well as what percentage of injured runners seeks professional medical attention, a random sample of entrants to a 10 kilometer race was asked to complete a questionnaire. There were 451 respondents, 355 men and 96 women, with a nonresponse rate of 12.7%. Nonrespondents did not differ from respondents with regard to age or sex. Forty-seven percent of respondents indicated that they had sustained a running-related injury in the last 2 years. Injured runners differed significantly from noninjured runners in that they were more likely to have run more miles per week, run more days per week, run a faster pace, run more races in the last year, stretched before running, and not participated regularly in other sports. Associated with injury, but not statistically significant, were those who had run marathons and had done muscle-strengthening exercises. No association was found with regard to the length of time running, running surfaces, part of the foot first contacting the ground, or running intervals, sprints, or hills. Seventy percent of those injured sought professional medical care, with 76% of these having a good or excellent recovery from their injuries. Compliance with medical advice correlated well with treatment success.
Article
Visual analogue scales (VAS) of sensory intensity and affective magnitude were validated as ratio scale measures for both chronic and experimental pain. Chronic pain patients and healthy volunteers made VAS sensory and affective responses to 6 noxious thermal stimuli (43, 45, 47, 48, 49 and 51 degrees C) applied for 5 sec to the forearm by a contact thermode. Sensory VAS and affective VAS responses to these temperatures yielded power functions with exponents 2.1 and 3.8, respectively; these functions were similar for pain patients and for volunteers. The power functions were predictive of estimated ratios of sensation or affect produced by pairs of standard temperatures (e.g. 47 and 49 degrees C), thereby providing direct evidence for ratio scaling properties of VAS. Vas sensory intensity responses to experimental pain, VAS sensory intensity responses to different levels of chronic pain, and direct temperature (experimental pain) matches to 3 levels of chronic pain were all internally consistent, thereby demonstrating the valid use of VAS for the measurement of and comparison between chronic pain and experimental heat pain.
Article
It is widely accepted that persons with flat or high-arched feet are at increased risk of exercise-associated injury, even though this purported association has not been scientifically evaluated. We evaluate the risk of exercise-associated injury among young men with flat, normal, and high-arched feet. A prospective study of 246 US Army Infantry trainees followed up over a rigorous 12-week training program. All subjects were evaluated prior to onset of training. Evaluation included photographs of the right, weight-bearing foot that were digitized and utilized to make several measures of arch height. An army initial entry training center. All trainees beginning army training on 2 successive weeks were potential volunteers. There were no criteria for exclusion other than declining to participate (n = 3). The subjects were healthy, active young men with a mean age of 20.3 years. The occurrence of a lower-extremity musculoskeletal injury resulting in a visit to and a diagnosis by an army physician or physician assistant. Treating physicians and physician assistants were blind to participation status and were not study staff members. On univariate analysis, there was an association between arch height and risk of injury using several alternative operational definitions of foot type. The 20% with the flattest feet were at the lowest risk (reference group; odds ratio, 1.0), with adjusted odds ratios for any musculoskeletal injury of 3.0 (P < .05) for the middle 60% group and 6.1 (P < .05) for the highest 20% group. These findings do not support the hypothesis that low-arched individuals are at increased risk of injury, and they have implications for runners, exercise enthusiasts, and clinicians. It may be possible to prevent substantial morbidity among active populations by identifying individuals at high risk and advising alternate activities.
Article
Although foot orthotics are often prescribed to alter the lower-extremity mechanics during the stance period of gait, there is little documentation of the actual effect of foot orthotics on the movement of the lower-extremity joints during walking and running. This study examined the effect of foot orthotics on the range of motion of the talocrural/subtalar joint and the knee joint in three dimensions during walking and running. Ten female adolescent subjects, aged 13 to 17 years (X = 14.4, SD = 1.1) who were diagnosed with patellofemoral pain syndrome and exhibited forefoot varus greater than 6 degrees and/or calcaneal valgus greater than 6 degrees participated in the study. Thirty strides of walking and running on a treadmill were recorded for each of the orthotic and nonorthotic conditions for each subject using an optoelectronic recording technique. Analyses of variance for repeated measures were performed on the range of motion of the talocrural/subtalar joint and knee joint for each plane of motion (ie, six separate analyses). The main factors of each analysis were the effect of the orthotic (orthotic condition versus nonorthotic condition), mode of ambulation (walking and running), and phase of the stance period (contact, mid-stance, and propulsion). No differences were found in sagittal-plane movements. Reductions of 1 to 3 degrees occurred with orthotic use for the talocrural/subtalar joint during walking and running in the frontal and transverse planes. The orthotics reduced knee motion in the frontal plane during the contact and mid-stance phases of walking, but increased the motion during the contact and mid-stance phases of running. This study shows that corrections to the static position of forefoot varus and calcaneal valgus can result in changes in transverse- and frontal-plane motion of the foot and knee during walking and running.
Article
In conclusion, a functional orthosis may be used to effectively treat most, but not all, abnormalities of the lower extremity that cause abnormal function of the foot. Abnormalities that are resistant to treatment with functional orthoses are compensated talipes equinus, excessive verticality of the oblique axis of the midtarsal joint, forefoot adductus that exceeds 15 degrees of adductus, Charcot's disease, congenital shortage of the iliopsoas muscle, and certain neurologic diseases that exhibit transient muscle spasm or paralysis, resulting in abnormal forces acting upon the foot that vary with time. Unfortunately, laboratories that claim to fabricate functional orthoses may turn out products that vary from nondescript arch supports to orthoses that only partially control function of the foot. The author hopes the practitioner who reads this article will be better able to evaluate whether his or her laboratory is providing his or her patient with a functional orthosis when one is ordered.
Article
In quantitative sensory testing, certain methods may lead to incorrect estimates of vibratory (VDT), cool (CDT), or warm (WDT) detection thresholds. We have shown that the specific forced-choice algorithm of testing employed in our Computer-Assisted Sensory Examination (CASE IV) system, when compared with other tests of nerve dysfunction, provides accurate and reproducible estimates of these thresholds. Because this forced-choice algorithm is time consuming and performance might be made worse by drowsiness or boredom, we explored other algorithms that might provide estimates of threshold similar to those obtained with the forced-choice algorithm, but more quickly. In a trial of 25 healthy subjects and 25 patients with neuropathy, the 4, 2, and 1 stepping algorithm with null stimuli, based in part on comparative data from computer simulation and insights from patient decision making, provides an accurate estimate of threshold. On average, the time needed for forced-choice testing was 12.8 +/- 2.9 minutes (mean +/- SD). For 4, 2, and 1 stepping testing, it was 2.7 +/- 2.5 minutes--a large saving of time. Since null stimuli were employed in the 4, 2, and 1 stepping algorithm, it was possible to monitor for spurious responses and repeat the test if they occurred at an excessive rate. The algorithm appears to be sufficiently robust to be recommended for clinical use and for some controlled clinical and epidemiologic trials.
Article
Lower limb injuries present the greatest source of medical problems during basic military training. These main overuse lower limb injuries, anterior compartment syndrome, stress fractures, Achilles tendinitis, plantar fasciitis, shin splints, and chondromalacia patellae, are reviewed with respect to current knowledge of rates, diagnosis, and treatment. Part 2 shall review possible etiological factors involved in the causation of these injuries.
Article
Soccer referees participating in large soccer tournaments may develop overuse injuries. In this study the effect of shock absorbing heel inserts in the incidence of soreness was investigated. Forty-eight referees were randomly selected to wear shock absorbing heel inserts (SAH) in the 5 day-tournament, while 43 referees were the control group. A daily questionnaire inquiring about complaints from the locomotive system was completed for each referee and in case of any soreness they were examined by doctors to document and classify the anatomical site. Calf, thigh, back, achilles tendon and knee were the most common localizations of overuse symptoms. The incidence of soreness in achilles tendon, calf and back were significantly reduced by the use of (SAH) inserts.
Article
A group of 304 runners enrolling in a marathon training program had alignment measurements performed and completed a questionnaire on training practices and injuries over the previous 12 months. The alignment measures consisted of arch index (AI), heel valgus (HV), knee tubercle-sulcus angle (TSA), knee varus (KV), and leg-length difference (LLD). Results indicated few consistent statistical associations between these alignment measures and risk of injuries, either bivariately or multivariately: left AI with hamstring injuries; right AI with shin injuries; right HV with back injuries; left TSA with ankle injuries; KV with hip injuries; and LLD with back, ankle, and foot injuries. A few statistically significant relationships were also found between other training and anthropometric factors and injuries: mileage with hamstring injuries; interval training with shin injuries; hard surfaces with back and thigh injuries; shoe use patterns with foot and overall injuries; and body mass index with heel injuries. We conclude that lower-extremity alignment is not a major risk factor for running injuries in our relatively low mileage cohort; however, prospective studies are necessary to confirm or refute these findings.
Article
The purposes of this paper were to discuss the perceived benefits of inserts and orthotics for sport activities and to propose a new concept for inserts and orthotics. There is evidence that inserts or orthotics reduce or prevent movement-related injuries. However, there is limited knowledge about the specific functioning an orthotic or insert provides. The same orthotic or insert is often proposed for different problems. Changes in skeletal movement due to inserts or orthotics seem to be small and not systematic. Based on the results of a study using bone pins, one may question the idea that a major function of orthotics or inserts consists in aligning the skeleton. Impact cushioning with shoe inserts or orthotics is typically below 10%. Such small reductions might not be important for injury reduction. It has been suggested that changes in material properties might produce adjustments in the muscular response of the locomotor system. The foot has various sensors to detect input signals with subject specific thresholds. Subjects with similar sensitivity threshold levels seem to respond in their movement pattern in a similar way. Comfort is an important variable. From a biomechanical point of view, comfort may be related to fit, additional stabilizing muscle work, fatigue, and damping of soft tissue vibrations. Based on the presented evidence, the concept of minimizing muscle work is proposed when using orthotics or inserts. A force signal acts as an input variable on the shoe. The shoe sole acts as a first filter, the insert or orthotic as a second filter, the plantar surface of the foot as a third filter for the force input signal. The filtered information is transferred to the central nervous system that provides a subject specific dynamic response. The subject performs the movement for the task at hand. For a given movement task, the skeleton has a preferred path. If an intervention supports/counteracts the preferred movement path, muscle activity can/must be reduced/increased. Based on this concept, an optimal insert or orthotic would reduce muscle activity, feel comfortable, and should increase performance.
Article
Objective: To quantify the relationship between the tactile and vibration sensitivity thresholds of the sole of the human foot with plantar pressure distribution while walking and running. Design: Cross-sectional study performed in a laboratory setting. Background: Results of previous studies of human locomotion have identified potentially dangerous variations in locomotion patterns. A common approach to manage these variations is with the use of orthotics. Individual responses to differences in the construction and shape of orthotics cannot be fully explained with a mechanical model. It has been suggested that sensory feedback from the receptors in the feet may play an important role in regulating gait patterns. Methods: Fifteen subjects were recruited for this study. Pressure (tactile) and vibration thresholds were determined from each subject. Plantar pressure distributions were obtained while walking at 1.5 m s(-1) and running at 3.5 m s(-1). Sensitivity measurements were correlated to pressure measurements under the foot. Results: Significant negative correlation exists between the vibration threshold of the hallux at 125 Hz and peak pressures under the hallux while walking (P=0.02) and running (P=0.01). A significant negative relationship was shown between the foot mean vibration threshold at 125 Hz with peak force during running (P=0.038). A similar trend was seen at the heel, lateral arch and first metatarsal head. Conclusions: The results from this study support recent hypotheses that suggest that the body can detect and respond to external stimuli. The relationship between plantar sensitivity and peak pressures at the hallux, and the relationship between sensitivity to higher frequency vibrations and peak force during running suggests that neurological feedback should be incorporated in to any model that attempts to explain gait patterns. Relevance: It is suggested that the body is able to detect small biomechanical changes in the external environment and alter gait patterns as a defensive mechanism. Understanding the relationship between neural feedback and gait patterns will help in the development of criteria for the proper application of inserts, and the prevention of lower extremity injuries.
Article
To quantify the effects of medial foot orthoses on skeletal movements of the calcaneus and tibia during the stance phase in running. Kinematic effects of medial foot orthoses (anterior, posterior, no support) were tested using skeletal (and shoe) markers at the calcaneus and tibia. Previous studies using shoe and skin markers concluded that medially placed orthoses control/reduce foot eversion and tibial rotation. However, it is currently unknown if such orthoses also affect skeletal motion at the lower extremities. Intracortical Hofman pins with reflective marker triads were inserted under standard local anesthetic into the calcaneus and tibia of five healthy male subjects. The three-dimensional tibiocalcaneal rotations were determined using a joint coordinate system approach. Eversion (skeletal and shoe) and tibial rotation were calculated to study the foot orthoses effects. Orthotic effects on eversion and tibial rotations were found to be small and unsystematic over all subjects. Differences between the subjects were significantly larger (p<0.01; up to 10 degrees ) than between the orthotic conditions (1-4 degrees ). Significant orthotic effects across subjects were found only for total internal tibial rotation; p<0.05). This in vivo study showed that medially placed foot orthoses did not change tibiocalcaneal movement patterns substantially during the stance phase of running. Orthoses may have only small kinematic effects on the calcaneus and tibia (measured with bone pins) as well as on the shoes (measured with shoe markers) during running of normal subjects. Present results showed that orthotic effects were subject specific and unsystematic across conditions. It is speculated that orthotic effects during the stance phase of running may be mechanical as well as proprioceptive.
Article
The purpose of this study was to determine the relationships between foot and leg characteristics, shoe characteristics, and the short-term subjective comfort of three different pairs of athletic shoes. Static measurements of foot dimension and leg angles were taken from eighteen subjects. Subjects rated the comfort of three different athletic shoes for standing, walking and running. The shoes were quantified by internal dimensions, hardness, flexibility and torsional stiffness. Average comfort ratings decreased from standing to walking to running. One shoe seemed suited for only a small group of subjects. In contrast, another shoe was generally comfortable for a large group. Skeletal alignment, specifically eversion angle, was related to comfort for one shoe. Therefore, fit of the shoe is not sufficient for comfort. Skeletal alignment, shoe torsional stiffness and cushioning seem to be mechanical variables which may be important for comfort.
Article
OBJECTIVE: Perceptual ratings of mechanical variables were compared with biomechanical variables that are related to running injuries. DESIGN: Eight identical running shoes with a relatively close range of midsole hardness were used. Ground reaction force (GRF), in-shoe pressure distribution and rearfoot motion were measured during running. Perceptual ratings were obtained after the running trials. BACKGROUND: Previous studies reported high correlations between cushioning perception and biomechanical variables for shoes that featured large differences in midsole hardness. METHODS: A 15-point categorical rating scale was used to judge impact severity, pressure magnitude and rearfoot motion in running. Rating scores were compared with biomechanical variables (GRF, pressure distribution and pronation values) using regression analyses. RESULTS: Regression analyses revealed high relations between different biomechanical variables and the perception scores. The best relation to perception was analysed for the median power frequency of the vertical GRF (r(2) = 0.97). A negative correlation (r(2) = 0.54) between the first impact of GRF and the perception of impact severity could be revealed. CONCLUSION: The present study suggests that the body's sensory system seems to differentiate well between impacts of different frequency content. Based on perceptual abilities, subjects adapt their running style to avoid high heel impacts.
A review of lower limb overuse injuries during basic military training Part 1: types of overuse injuries Prevention of common overuse injuries by the use of shock absorbing insoles
  • G Jordaan
  • T D Noakes
ROSS, J. A review of lower limb overuse injuries during basic military training. Part 1: types of overuse injuries. Mil. Med. 158:410-415, 1993. 26. SCHWELLNUS, M. P., G. JORDAAN, and T. D. NOAKES. Prevention of common overuse injuries by the use of shock absorbing insoles. Am. J. Sports Med. 18:636-640.
The validation of visual analogue scales as ratio scale measures for chronic and experimental pain
  • D D Price
  • P A Mcgrath
  • A Rafic
  • B Buckingham
PRICE, D. D., P. A. MCGRATH, A. RAFIC, and B. BUCKINGHAM. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 17:45-56, 1980.