Article

Comparison of plantar pressure between elderly and young adults

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Abstract

Loading variables were compared for 35 elderly (71-90 years) and 35 young adult (aged 18-24 participants. Plantar pressures were measured at 70 Hz with a capacitiv8 platform with a resolution of two sensors per square centimetre. Subjects were required to walk barefoot at their 'preferred' gait speed down a 15-m walkway. Gait speed was determined via a photoelectric timing system. Five right foot pressure trials w8re gath8red and stored. During analysis seven plantar r8gions were identified: one heel, on8 midfoot, thfe8 for8foot (medial, central, and lat8ralL and two toe (m8dial toe or hallux and Ieaser toes). Averages were genefeted for each loading variable respective to each plantar region. Gait speed was signifiiantly slower for the elderly than the young adults. Thus, gait spe8d was used as a covariate in a multivariate analysis of covariance (MANCOVAI to det8ct differenc8s between the yowng ad&s and the elderly. Similar loading charact8ristics were found in the heel region of th8 foot. For the young adults, great8r plantar loading occurred across the midfoot region. There was a difference in the loading rate across the medial forefoot region for th8 elderly and no differences in force or peak pressures. The medial forefoot region exhibit8d gr8et8st peak pressure for the elderly. No diff8rences wer8 found betw8en groups in the central for&oot. The elderly exhibited a greater contact area and less contact time. For the 8ld8rly, less force was produced relative to the medial toe mgion. No differences betwe8n the loading characteristics of the lateral toe region betw8en the two groups were exhibited.

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... Finally, the important disparity between studies (protocols, measurement devices, footprint masks and units of measurements) prevent an effective comparison of the results [59] and is potentially the cause of divergent outcomes between studies, such as those concerning the impact of age [12,[60][61][62][63]. For instance, midfoot peak pressure was reported to have increased [61], decreased [60] or be unchanged [62] in elderly adults. ...
... Finally, the important disparity between studies (protocols, measurement devices, footprint masks and units of measurements) prevent an effective comparison of the results [59] and is potentially the cause of divergent outcomes between studies, such as those concerning the impact of age [12,[60][61][62][63]. For instance, midfoot peak pressure was reported to have increased [61], decreased [60] or be unchanged [62] in elderly adults. Plantar pressures changes during gait in the elderly are declared to be influenced by several factors, such as plantar callosity formation [60], loss of fat pad elasticity [61], toe deformation [62], a decrease in muscle strength [62], an increase in step width [60], centre of pressure medialisation [60], among others, indicating a less propulsive gait pattern [60,62]. ...
... For instance, midfoot peak pressure was reported to have increased [61], decreased [60] or be unchanged [62] in elderly adults. Plantar pressures changes during gait in the elderly are declared to be influenced by several factors, such as plantar callosity formation [60], loss of fat pad elasticity [61], toe deformation [62], a decrease in muscle strength [62], an increase in step width [60], centre of pressure medialisation [60], among others, indicating a less propulsive gait pattern [60,62]. These differences justify the choice of the integration of age as a covariate in this study. ...
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In-shoe systems and pressure plates are used to assess plantar pressure during gait, but additional tools are employed to evaluate other gait parameters. The GAITRite® system is a clinical gait evaluation tool. Extensive literature is available for spatiotemporal parameters, but it is scarce for relative plantar pressure data. Therefore, we investigated whether, when controlling for age, the GAITRite® system is able to distinguish the effects of walking velocity on plantar pressure parameters in six plantar regions in a large sample of adults. Participants (83 women and 87 men, aged 18–85 years) walked at three self-selected velocities (slow, preferred, fast) on a 6-m long GAITRite® walkway. Relative peak pressure, pressure-time integral, peak time and contact area were computed for six zones (lateral and medial heel, mid- and forefoot). The impact of age (covariate), sex, side, velocity, pressure zone and their interactions on pressure variables was evaluated. Velocity affected peak pressure, pressure-time integral, peak time and contact area (p < 0.001). With increasing self-selected gait velocity, medial forefoot peak pressure and pressure-time integral increased (p < 0.001), while heel and lateral forefoot regions displayed a nonlinear plantar pressure evolution. These results suggest lower (heel strike) or more equally distributed (push-off) loads at preferred gait velocity.
... With advancing age the foot might experience changes in appearance, joint mobility, perception, muscle and plantar fat pad atrophy (Jahss, Kummer, & Michelson, 1992;Kernozek & Lamott, 1995). Increase age is one of the main factors influencing spatiotemporal and pressure parameters ( McKay et al., 2017). ...
... Peak plantar pressure refers to the maximum pressure value recorded in a predetermined region of the foot during the gait cycle (Melai et al., 2011). For the YFA the highest peak pressure under the plantar foot has been found at BT area which was in line with to previous the previous study (Kernozek & Lamott, 1995;McKay et al., 2017) that the maximum pressures and maximum pressure changes occurred in the forefoot (Soames, 1985). But the result of this study also found some difference with the previous study. ...
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Background: Increase age is one of the main factors influencing spatiotemporal and pressure parameters. Adolescence and young adulthood are unique periods in the life span that present opportunities and challenges in improving health. Meantime, this age span involve significant growth and development. But the previous studies seldom examine the adolescents gait characteristics and pay attention to the plantar pressure changes between this age span. Purpose: Given the complex variation of these transitional ages and their implications to the foot care, the primary aim of this study was to investigate plantar pressure differences between teenager girls and young female adults during walking using an EMED pressure plate (Novel, Germany). Method: Nineteen young female adults (YFA) age at 24.7 (±2.21) and nineteen teenager girls (TG) age at 18.25 (±1.23) were participated this study. Data collections including peak pressure, contact area, pressure time integral were performed with an EMED pressure plate. The measurement protocol was barefoot walking across the platform along a 10m long straight trail. Pressures were evaluated for seven plantar areas on the foot according to the anatomical structure. Result and Conclusion: The result showed that walking speed was similar in both teenager girls and young female adults. The teenager girls shown higher peak pressure in the first metatarsal (FM), fourth and fifth metatarsals (FAFM), middle foot (MF) and rear-foot (RF) areas while the YFA shown larger pressure time integral at big toe (BT) and other toes (OT). Contact area was lower in the YFA for the several foot regions compared to the TG BT, OT, FAFM and MF. Greater pressure time integrals of the FM, FAFM and MF were found in the TG compared to the YFA, while the YFA shown larger pressure time integral at BT, OT and RF. The TG shown greatest peak pressure and pressure time integral in the FM while the YFA shown biggest peak pressure and pressure time integral in the BT. This normative data will provide a basis to assess pediatric pathologic foot deformities more accurately and to distinguish dynamic foot deformities from anatomic foot deformities.
... Dual-task training is widely used to reduce the risk of falls, and it trains not only the physical part of gait but also the cognitive part to increase stability and gait ability 6,7) . It is also known that proper weight distribution and foot function can be analyzed by measuring foot pressure 8) . The purpose of this study was to evaluate the effect of dual-task gait training on foot pressure in elderly women. ...
... Additionally, foot function is most important in gait because the feet perform an essential role in balance control by absorbing shock, providing momentum, and changing directions. Foot function can be examined through measurement of foot pressure 8,9) . Therefore, gait and foot function were evaluated by measuring foot pressure before dual-task gait training and at 4 and 8 weeks of dual-task gait training. ...
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[Purpose] The purpose of this study was to evaluate the effect of dual-task gait training on foot pressure in elderly women. [Subjects and Methods] Twenty elderly people in local communities performed dual-task gait training for 20 minutes three times per week for 8 weeks. Foot pressure was measured using an F-scan System (Tekscan, South Boston, MA, USA) before the intervention and in the 4th and 8th weeks of the intervention. [Results] Foot pressure increased significantly between the 4th and 8th weeks of the intervention in the CFF (central forefoot); between before the intervention and the 4th week, between the 4th and 8th weeks, and between before the intervention and the 8th week in the MF (midfoot); and between before the intervention and the 4th and 8th weeks in the HL (heel). [Conclusion] The results of this study indicate that dual-task gait training may improve the gait ability of elderly persons residing in the community.
... Additionally Hennig and colleagues reported three times higher relative midfoot load in infants in comparison to young adults but generally reduced peak pressures underneath the foot (Hennig and Rosenbaum, 1991;Hennig et al., 1994). Furthermore, studies about foot loading in elderly compared with young adults showed a decrease of peak pressure and force under the hindfoot and forefoot and longer contact times for the midfoot area (Hessert et al., 2005;Kernozek and LaMott, 1995;Scott et al., 2007). ...
... Alternatively, the higher pressure values in our elderly population may also be influenced by higher walking speed in comparison to other elderly which is known to lead to increased pressures in adults . However, this is unproven since neither this, nor previous investigations in elderly have used standardized velocity guidelines (Kernozek and LaMott, 1995;Hessert et al., 2005;Scott et al., 2007). The established contact times for the total foot in our investigation as a reference of walking speed showed no significant differences between adults and elderly. ...
Article
The human foot has to bear loads during all kinds of bipedal locomotion throughout the whole life. Rapid developmental changes of foot morphology and foot function occur during the first years of walking. Furthermore, disease dependent modifications can also have an influence on plantar loading. Therefore, it is reasonable to assume that foot function will undergo changes in life. However, the main differences between the pressure patterns in young and elderly have not been well described. The aim of the study was to evaluate age-dependent pressure patterns in different age-related stages. Hundred and four healthy humans of four different age groups were retrospectively analysed by means of plantar pressure measurements (toddlers: mean age 1.0 (SD 0.2) year; 7-year olds: 7.0 (SD 0.4) years; adults: 31.9 (SD 2.1) years; seniors: 68.7 (SD 3.2) years). The emed pressure platform was used to evaluate peak pressure, maximum force, contact time, contact area and arch index. Significant differences were found for each parameter between almost every age group. The highest peak pressure values were observed for the seniors' (P<0.001). Peak pressures are low in toddlers (145 kPa), high in 7-year olds and adults (400-600 kPa) and even higher in elderly (> or =800 kPa). Elderly adults can still be functionally mobile even if pressures are high. The results for the investigated age groups can be used as normative foot loading data to compare to pathological foot function.
... In this study, the older group had a more exterior distribution during in the stage of heel contact and propulsion, with lower values in the medial foot surface during the total support stage. 36 Moreover, Kernozek et al. 43 reported lower pressure on the hallux among older adults. These data indicate that there is less overload of internal foot structures in older adults than younger adults, mainly during gait, which could indicate a lower tendency toward prone support among older adults. ...
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Objectives: This study compared the influence of subtalar axis position on foot behavior in a closed kinetic chain in older and younger adults. Methods: The sample included 50 older adults and a control group of 50 younger adults. The variables were initially analyzed for both feet together, and were later analyzed separately, comparing each foot (right and left) between groups. Range of motion was assessed by validated goniometric procedures: the position of subtalar axis was evaluated by the palpation technique, while the Foot Posture Index was used to assess behavior in a closed kinetic chain. Student's t-test / Mann-Whitney test compared the main variables according to sample distribution, while Student's t-test / Wilcoxon test was used for paired samples. A standardized Haberman residuals test was also used to determine the connection between the position of subtalar joint axis and the Foot Posture Index. Results: Data from the right and left feet were similar for all variables. The older group had reduced mobility in the ankle and first metatarsophalangeal joint (5.42º [SD (Standard Deviation), 4.49] and 76.12º [SD, 19.24], respectively) with statistically significant values, (p
... In contrast, the adult-acquired flatfoot of the elderly could be compounded with morphological changes in physiological aging [54] and a higher prevalence of other foot deformities [57], in which 3D printed insoles or footwear may better address the poor fitting problem. The feet of elderly people tend to be flatter and broader [58,59] and have a medialized plantar pressure [60,61]. Han, et al. [62] fabricated arch support insoles for the elderly with flatfootedness and discovered that the insoles elevated the peak pressure of the medial midfoot region, which aligned with the trend of our study. ...
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Article
The advancement of 3D printing and scanning technology enables the digitalization and customization of foot orthosis with better accuracy. However, customized insoles require rectification to direct control and/or correct foot deformity, particularly flatfoot. In this exploratory study, we aimed at two design rectification features (arch stiffness and arch height) using three sets of customized 3D-printed arch support insoles (R+U+, R+U−, and R−U+). The arch support stiffness could be with or without reinforcement (R+/−) and the arch height may or may not have an additional elevation, undercutting (U+/−), which were compared to the control (no insole). Ten collegiate participants (four males and six females) with flexible flatfoot were recruited for gait analysis on foot kinematics, vertical ground reaction force, and plantar pressure parameters. A randomized crossover trial was conducted on the four conditions and analyzed using the Friedman test with pairwise Wilcoxon signed-rank test. Compared to the control, there were significant increases in peak ankle dorsiflexion and peak pressure at the medial midfoot region, accompanied by a significant reduction in peak pressure at the hindfoot region for the insole conditions. In addition, the insoles tended to control hindfoot eversion and forefoot abduction though the effects were not significant. An insole with stronger support features (R+U+) did not necessarily produce more favorable outcomes, probably due to over-cutting or impingement. The outcome of this study provides additional data to assist the design rectification process. Future studies should consider a larger sample size with stratified flatfoot features and covariating ankle flexibility while incorporating more design features, particularly medial insole postings.
... It has been reported that pressure on certain parts of the foot can be observed when performing various daily motions and functional activities 11) , and this is one of the subjects that should be investigated in the field of sports science. ...
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Article
[Purpose] The aim of this study was to examine the effect of a pelvis-concentrated exercise program and walking on the changes in body shape and foot base pressure. [Subjects and Methods] Thirty adults from K University in Busan, Republic of Korea, were randomly divided into the Swiss-ball exercise group and McKenzie exercise group, and they conducted exercise for 40 min 3 times a week for 6 weeks. [Results] Global postural system results and foot base pressure significantly decreased in both groups. A comparison of foot base pressure after the intervention between the two groups revealed that the Swiss-ball exercise group exhibited a greater reduction than the McKenzie exercise group. [Conclusion] The results of this study indicated that the Swiss-ball exercise may improve posture and foot base pressure in male adults.
... It is not clear whether these changes are due to physical limitations or an adaptive strategy for improved safety, however these spatiotemporal gait patterns are more common in fallers compared to non-fallers. Kinematic and kinetic alterations apparent in older people, compared to young, include reduced hip motion [92] [93], reduced angular velocity of the lower trunk [94], reduced ankle power generation [92] [95] [96] and range of motion [97], increased anterior pelvic tilt [92] [95] [96], increased hip extension moment during swing phase [98], increased mechanical energy demands of lower limb musculature [99], reduced toe pressure [100] and a larger toe-out angle [93] [96] [101]. Older adults seem to adopt a more cautious method of negotiating obstacles. ...
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Good balance is an imperative skill for daily life that requires the complex integration of sensory information regarding the position of the body relative to the surroundings and the ability to generate appropriate motor responses to control body movement. Balance calls upon contributions from vision, vestibular sense, proprioception, muscle strength and reaction time. With increased age, there is a progressive loss of functioning of these systems which can contribute to balance deficits. Balance disorders represent a growing public health concern due to the association with falls and fall-related injuries, particularly in regions of the world in which high proportions of the population are elderly. Falls present one of the most serious and costly problems associated with older adulthood. Falls can mark the beginning of a decline in function and independence and are the leading cause of injury-related hospitalisation in older people. One in three people over the age of 65 years who are living in the community experience at least one fall each year and 10-15% of these falls are associated with serious injury. In economic terms, the direct and indirect costs associated with falls are large and will grow as the proportion of older people increases. Consequently, understanding age-related changes in the physiological systems imperative to balance is of utmost importance to prevent falls in older people and reduce the injury-related burden on individuals and society.
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Abstract Background: The foot and ankle complex undergoes significant structural and functional changes with advancing age. Research question: The objective of this systematic review and meta-analysis was to synthesize and critique the research literature pertaining to foot and ankle biomechanics while walking in young and older adults. Methods: Electronic databases (Web of Science, PubMed, Scopus and Embase) were searched from inception to April 2019 for cross-sectional studies which compared kinematics, kinetics and plantar pressure differences between young and older adults. Screening and data extraction were performed by two independent assessors, with disagreements resolved by consensus. Results: A total of 39 articles underwent full-text screening, and 19 articles met the inclusion criteria and were included. Meta-analysis showed that older adults had less ankle joint plantar flexion (5 studies; weighted mean difference [WMD]: −5.15; 95 %CI: −6.47 to −3.83; P < 0.001) and less ankle joint power generation (6 studies; standardized mean difference [SMD]: −0.62; 95 %CI: −0.82 to −0.41; P < 0.001) during propulsion compared to young adults. These differences persisted in subgroup analyses comparing different walking speeds. Plantar pressure findings were highly variable due to differences in data collection protocols and meta-analysis was not possible. Significance: Older adults have unique foot and ankle kinematics and kinetics during walking characterized by reduced ankle joint plantarflexion and power generation during propulsion.
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Abstract Hyperkeratoses are a common cause of foot pain due to the release of inflammatory mediators, which can have an impact on the mobility and independence of people suffering from them. However, the repercussions that hyperkeratoses have on gait parameters remain uncertain. Aim The aim of this study is to analyze the repercussions that plantar hyperkeratosis debridement has on several kinematic and kinetic variables of gait in a group of older participants. Methods 98 older participants (75.1 ± 6.7 years) were randomly assigned to two groups: Group A, Scalpel debridement of plantar hyperkeratoses; and Group B, Control group (Simulated debridement). Plantar hyperkeratotic pain was measured before and after treatment on a visual analog scale. Several kinematic and kinetic variables of gait were measured before and after treatment using a Win-Track pressure sensitive walkway. Results A significant difference was found in the level of pain between the treated group and the control group (p < 0.01 [8.55-18.15; 95% confidence interval]). Regarding the gait parameters, statistically significant reductions were found in peak pressures (p < 0.05; Cohen’s d = 2.688) and maximum force (p < 0.04; d = 0.262). Conclusions Data suggests that debridement of plantar hyperkeratosis may lead to a reduction in pain and appear to reduce peak maximum force and peak plantar pressure. No significant changes were observed in the kinematic variables analyzed. The duration of the benefits remain unknown.
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This study presented optimal estimation of total plantar force with a suitable sensor layout and a reliable equation for monitoring gait in daily life activities. The plantar pressure of 10 subjects during level walking was measured by Pedar® insoles at 100 Hz for establishing models and selecting the optimal one. Four types of virtual sensors with different sizes were designed. Stepwise linear regressions were performed to reconstruct total plantar force based on each particular type of virtual sensor. 14 models were established, which met the requirements of the explained variance of the regression model and the multicollinearity of the predictors. Estimated total plantar force from each model was compared with the real data from the Pedar® insoles. According to the correlation coefficient (R) and the root mean square error divided by the peak force (RMSE/PF), the optimal model had three sensors located under the heel and metatarsal. Another four subjects were used for validating the optimal model by performing level walking, running, vertical jump-landing, stair ascending and descending. For these five common activities, the correlation was high (R > 0.970) and the error was low (RMSE/PF < 10%). Therefore, this model can accurately estimate total plantar force in daily life activities.
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To investigate the effect of combination therapy of backward-walking training plus alpha-lipoic acid (ALA) treatment on the distribution of plantar pressure of the patients with Diabetic Peripheral Neuropathy (DPN). The test group was treated with combination therapy of backward walking exercise plus ALA, in which lipoic acid for 2 weeks and backward walking exercise for 12 weeks, and the control group only received lipoic acid treatment. Plantar pressure before and after the treatment was tested and analyzed with the flatbed plantar pressure measurement system Footscan. This study was carried out in a clinical and laboratory setting. Sixty patients with DPN were divided into test group (n=30), and control group (n=30). The test group was delivered with physical medicine plus pharmacotherapy interventions, i.e. backward walking exercise with ALA treatment the control group only received lipoic acid treatment. Plantar pressure before and after the treatment was tested and analyzed with the flatbed plantar pressure measurement system Footscan. After the treatment, the peak plantar pressure in the forefoot has dropped for both the test group and the control group, and the same dropped significantly for the test group, and the peak plantar pressure in the medial-foot has slightly increased for the test group, suggesting a more even distribution of plantar pressure in the test group after the treatment. The combination therapy of ALA plus backward walking has proved to be more effective than ALA monotherapy. Backward walking also has an ameliorating effect on the balance ability and muscle strength of DPN patients.
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OBJETIVO: Avaliar as características clínicas e baropodométricas da marcha de indivíduos com Hálux Valgo após a osteotomia em Chevron modificada, isolada ou em associação com a osteotomia de Weil. MÉTODOS: FORAM avaliados, antes e três meses após a cirurgia, 27 pés com deformidade leve e moderada. A avaliação clínica incluiu a pontuação da AOFAS e medidas radiográficas. A avaliação baropodométrica foi realizada através da Plataforma Emed-at. As variáveis Pico de Pressão, Integral Pressão-Tempo e Carga Relativa foram calculadas em 10 regiões: calcanhar, mediopé, 1-5º metatársicos, hálux, 2º, 3-5º dedos. RESULTADOS: Após a cirurgia houve aumento na pontuação da AOFAS e redução dos parâmetros radiográficos. A avaliação baropodométrica, após osteotomia em Chevron isolada, demonstrou redução da pressão e da força sob o 1º metatársico e hálux, assim como, aumento dessas variáveis nos metatársicos centrais e laterais. Após a osteotomia em Chevron/Weil ocorreram alterações significativas apenas na região do hálux e dos dedos. CONCLUSÃO: Em curto prazo, a técnica em Chevron modificada promoveu melhora das condições clínicas e dos parâmetros radiográficos. Em relação a avaliação baropodométrica constatou-se uma transferência de cargas da região medial para lateral do antepé, possivelmente pelo curto período de pós-operatório.
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The visual assignment of pressure distribution patterns to anatomical structures utilising dynamic pedography of the forefoot is fraught with a high failure rate. In a comparative study visually determined pedographic results were related to marked reference pedographs. Pedographic recordings were derived from five steps each of 30 healthy individuals (20 women, 10 men) and were subsequently subdivided by five examiners into three areas: the medial forefoot, represented by the first metatarsal head; the central forefoot, represented by the second and third metatarsal head; and the lateral forefoot, represented by the fourth and fifth metatarsal head. The medial forefoot was correctly recognised in 57% of patients, the lateral forefoot in 48% and the central forefoot in as few as 36%. Because of this high rate of error, regularly occurring patterns were sought that allowed a more reliable visual assignment of pressure distribution patterns to anatomical structures. In addition 30 abnormal forefeet of female patients (hallux valgus n = 27, hallux rigidus n = 3, additional toe deformities n = 7) were radiologically and pedographically examined. The lateral forefoot aspect was wider than the medial and central aspect in healthy as well as abnormal forefeet. The medial forefoot region triggered four sensors in 75% of healthy forefeet at a sensor density level of two sensors/cm2. In healthy and abnormal forefeet a significant pressure increase within the central forefoot proved to be an additional orientation tool. A homogenous mediolateral expanse of the central forefoot region triggering four sensors was found in 98% of patients with normal and with a probability of P = 0.726 in patients with abnormal forefoot anatomy. The expected value of activated sensors was calculated as 3.92 for the central aspect of abnormal forefeet.
Article
The aim of this study was to investigate the effect of a 12-month moderate-to-vigorous exercise program on plantar pressure among postmenopausal women. A total of 121 white postmenopausal women participated in a randomized controlled trial (60 women in the exercise group and 61 women in the control group). Women in the exercise group attended training sessions of 60 minutes, 3 days per week, on nonconsecutive days. Weight and basal metabolic rate were evaluated by bioimpedance, and height was evaluated with a stadiometer. Plantar pressure data were collected using the Footscan platform and Software 7.1. After the 1-year intervention, women from the exercise group had (1) lower body mass index, (2) equal basal metabolic rate, (3) lower peak pressures, and (4) lower absolute impulses compared with the women from the control group. Interaction between the exercise group and practice time was found for most of the maximal peak pressure areas (except for metatarsal 4), for all absolute impulse values, and for relative impulses in the hallux, metatarsal 4, midfoot, and medial heel. This study seems to prove that women who exercise have decreased loading of maximal peak pressures and absolute impulses and, consequently, self-reported pain, soreness, and discomfort in the lower extremity. An interaction effect between group and practice time was found for most of the variables considered, meaning that this 12-month exercise program is effective in the improvement of the biomechanic parameters of plantar pressure.
Article
Plantar pressure measurement is an important tool in gait analysis. Manual placement of small masks (masking) is increasingly used to calculate plantar pressure characteristics. Little is known concerning the reliability of manual masking. The aim of this study was to determine the reliability of masking on 2D plantar pressure footprints, in a population with forefoot deformity (i.e. hallux valgus). Using a random repeated-measure design, four observers identified the third metatarsal head on a peak-pressure barefoot footprint, using a small mask. Subsequently, the location of all five metatarsal heads was identified, using the same size of masks and the same protocol. The 2D positional variation of the masks and the peak pressure (PP) and pressure time integral (PTI) values of each mask were calculated. For single-masking the lowest inter-observer reliability was found for the distal-proximal direction, causing a clear, adverse impact on the reliability of the pressure characteristics (PP and PTI). In the medial-lateral direction the inter-observer reliability could be scored as high. Intra-observer reliability was better and could be scored as high or good for both directions, with a correlated improved reliability of the pressure characteristics. Reliability of multi-masking showed a similar pattern, but overall values tended to be lower. Therefore, small sized masking in order to define pressure characteristics in the forefoot should be done with care.
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Plantar hyperkeratotic lesions are common in older people and are associated with pain, mobility impairment and functional limitations. However, little has been documented in relation to the frequency or distribution of these lesions. The aim of this study was to document the occurrence of plantar hyperkeratotic lesions and the patterns in which they occur in a random sample of older people. A medical history questionnaire was administered to a random sample of 301 people living independently in the community (117 men, 184 women) aged between 70 and 95 years (mean 77.2, SD 4.9), who also underwent a clinical assessment of foot problems, including the documentation of plantar lesion locations, toe deformities and the presence and severity of hallux valgus. Of the 301 participants, 180 (60%) had at least one plantar hyperkeratotic lesion. Those with plantar lesions were more likely to be female (chi2 = 18.75, p < 0.01; OR = 2.86), have moderate to severe hallux valgus (chi2 = 6.15, p < 0.02; OR = 2.95), a larger dorsiflexion range of motion at the ankle (39.4 +/- 9.3 vs 36.3 +/- 8.4 degrees ; t = 2.68, df = 286, p < 0.01), and spent more time on their feet at home (5.1 +/- 1.0 vs 4.8 +/- 1.3 hours, t = -2.46, df = 299, p = 0.01). No associations were found between the presence of plantar lesions and body mass index, obesity, foot posture, dominant foot or forefoot pain. A total of 53 different lesions patterns were observed, with the most common lesion pattern being "roll-off" hyperkeratosis on the medial aspect of the 1st metatarsophalangeal joint (MPJ), accounting for 12% of all lesion patterns. "Roll-off" lesions under the 1st MPJ and interphalangeal joint were significantly associated with moderate to severe hallux valgus (p < 0.05), whereas lesions under the central MPJs were significantly associated with deformity of the corresponding lesser toe (p < 0.05). Factor analysis indicated that 62% of lesion patterns could be grouped under three broad categories, relating to medial, central and lateral locations. Plantar hyperkeratotic lesions affect 60% of older people and are associated with female gender, hallux valgus, toe deformity, increased ankle flexibility and time spent on feet, but are not associated with obesity, limb dominance, forefoot pain or foot posture. Although there are a wide range of lesion distribution patterns, most can be classified into medial, central or lateral groups. Further research is required to determine whether these patterns are related to the dynamic function of the foot or other factors such as foot pathology or morphology.
Article
Favorable to excellent clinical results have been reported for isolated subtalar joint arthrodesis. Pedobarography after subtalar bone-block distraction arthrodesis have demonstrated a more laterally shifted gait line. However pedobarographic measurements after primary in-situ isolated subtalar arthrodesis have not been reported. This is the first study considering this. Physical examination, AOFAS Hindfoot score, full weightbearing anterior/posterior and lateral radiographs were assessed in 15 feet. Peak pressures, ground reaction force and force distribution at foot-flat and push-off were measured. Average AOFAS-Score significantly improved. Subjective satisfaction was high. Non-union was found in 1 foot (7%), screws were removed in 4 of the 15 feet (27%). One new asymptomatic arthritic talonavicular joint was found. The pressure and force distributions under the operated and contralateral foot showed a different pattern compared to a normal foot. Ground reaction force under both the operated and contralateral feet were lower than a normal foot. This study found good clinical, subjective and radiographic results matching that of the reported literature. However, pedobarographic assessment suggests that great functional differences still remain when compared to a normal foot. Subtalar arthrodesis may induce an abnormal gait pattern by preventing compensation of axial rotation of the tibia. This is also reflected in the unaffected side, which may indicate an effort in the general locomotor control to keep a symmetrical gait pattern. This finally alters the pressure and force distribution under both feet. Nevertheless, subtalar arthrodesis is considered a valuable treatment for various isolated subtalar disorders.
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Article
The effects of a custom moulded insole and a rockerbar on peak pressure and force impulse as well as on pain scores in subjects with a history of metatarsalgia were studied. In addition the subjects' preference for the type of intervention was determined. Forty-two subjects with a history of primary metatarsalgia were selected. They were all provided with the same brand of extra depth shoes with a ready made insole. The effect of custom moulded insoles, a rockerbar and the interaction between the two interventions were studied by testing the four possible combinations: ready made insole without a rockerbar, ready made insole with a rockerbar, custom moulded insole without a rockerbar and custom moulded insole with rockerbar. At the most important region, the central distal forefoot, a rockerbar caused a decrease in force impulse of 15.1% and a decrease in peak pressure of 15.7%. The custom moulded insole produced a decrease of 10.1% in force impulse and of 18.2% in peak pressure. Pain scores were significantly lower for interventions with a custom moulded insole, while the rockerbar showed no influence on pain scores. Subjects with pain preferred a custom moulded insole more often than subjects without pain. Decrease of peak pressure or force impulse was not correlated to pain scores. The use of either a custom moulded insole or a rockerbar proudced an important decrease of peak pressure and force impulse at the central distal forefoot and, therefore, either is suitable in any situation which a decrease of pressure is vital.
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Article
The purpose of the study was to compare the range of motion, perceived pain and plantar loading characteristics of the Chevron (Austin) corrective procedures in treating hallux valgus (HV) 12 months postsurgically. Twenty-five female participants with the diagnosis of mild to moderate HV deformity were studied. All participants had a distal metatarsal osteotomy (Chevron (Austin)) to correct their deformity. First metatarsophalangeal and talocrural joint range of motion (ROM) and a 10-point analog pain scale were measured presurgically and 12 months post-surgically on each participant. Radiographic measures of hallux valgus and intermetatarsal (IM) angles were taken preoperatively and six weeks postoperatively for comparison. Five pressure distribution measurements were recorded of barefoot walking using the EMED-SF presurgically and 12 months postsurgically. Statistical analyses revealed that plantar loading is still altered 12 months postsurgically despite a decrease in perceived pain and adequate first metatarsophalangeal joint ROM. Greater loading occurred in the central forefoot (CFF) region with decreases in some of the loading parameters in the medial toe (MT) region postsurgically. Loading parameters in the lateral forefoot (LFF), heel (HL), midfoot (MF), and lateral toe (LT) were unchanged 12 months postsurgery compared to presurgery.
Article
Dye-based pressure-sensitive films are advantageous in plantar pressure studies due to their ease of use, cost-effectiveness, and ability to produce measurements within the shoe. To circumvent the use of proprietary equipment and software to relate the dye-stained film to load, an alternative approach of using a conventional flatbed scanner and generic image processing software is attempted here instead. The technique revealed high linear increasing and decreasing trends for the respective red and blue normalized intensities (R(2) > 0.95) and low standard deviation in all readings (<0.06) overall. By subtracting the blue from the red normalized intensity, it was discovered that the measurement sensitivity could be doubled. The results here confirm the viability of using a conventional flatbed scanner and generic image processing software to relate the dye-stained pressure films to load. The adoption of this approach promises substantial cost savings.
Article
The aim of this study was to compare foot characteristics and plantar force and pressure patterns in young and older people. Fifty young (mean age 20.9+/-2.6 years) and 50 older (mean age 80.2+/-5.7 years) people without foot problems underwent tests of foot posture, range of motion, strength, sensation and deformity. Plantar force and pressure distribution during gait were evaluated using a floor-mounted resistive sensor mat system. Older participants exhibited flatter/more pronated feet, reduced range of motion of the ankle and 1st metatarsophalangeal joints, a higher prevalence of hallux valgus, toe deformities and toe plantarflexor weakness, and reduced plantar tactile sensitivity. Plantar pressure analysis revealed decreased magnitude of forces and pressures under the heel (-13% to 16%), metatarsophalangeal joints (-11% to 16%) and hallux (-19% to 25%), but greater relative contact time under the heel (+21%), midfoot (+14%) and metatarsophalangeal joints (+5% to 8%) in older participants. Multiple regression analysis revealed that these age-related differences could be largely explained by differences in step length and various foot characteristics, particularly foot posture and the severity of hallux valgus. These findings indicate that ageing is associated with significant changes in foot characteristics which contribute to altered plantar loading patterns during gait.
Article
The unaffected contralateral side of patients with unilateral clubfeet has sometimes been taken as control in foot pressure measurement studies. However, it has never been shown that the pressure pattern under the contralateral foot is similar to a normal foot. Sixteen patients with unilateral clubfoot and 110 normal subjects took part in this study. All participants were aged from 4 to 8 years. Studies comprised clinical examination and foot pressure measurements in barefoot walking. Evaluations of the measurements were completed by the calculation of forces acting under 10 anatomical foot areas normalized to ground reaction force at foot-flat and push-off. Significant differences in peak pressure were observed between the control group and the contralateral foot of patients under the heel and the metatarsals 1 to 4. Significant differences in the forces at foot-flat and push-off are seen especially in the midfoot. Both sides of the patients with unilateral clubfeet exert significantly less ground reaction force than normal subjects. Different pressure and force distributions of clubfoot children on their contralateral side compared with the normal feet of the control group may indicate differences in the general control pattern generated by the central nervous system. Differences can still be observed after normalization of the forces. We therefore conclude that when foot pressure measurements are made with clubfeet, it might be advisable to use a collective of normal feet, instead of the contralateral foot, for comparison.
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The purpose of this study was to describe and compare the free-speed gait characteristics of healthy young men with those of healthy elderly men. Data collection consisted of high-speed cinematography resulting in synchronized front and side views of 24 healthy male volunteers, 12 between 20 and 32 years of age and 12 between 60 and 74 years of age. Young men were recruited to match the elderly men on the basis of right-leg length. Each subject participated in three filmed trials of free-speed ambulation down a 14-m walkway. The processed film was analyzed for eight gait characteristics. Differences in characteristics between the two groups were examined using a correlated t test (p less than .01). No significant differences were observed between the groups for step and stride length, velocity, ankle range of motion, vertical and horizontal excursions of the center of gravity, and pelvic obliquity; however, the younger men demonstrated a significantly larger stride width than the elderly men (p less than .01). The results suggest that the two populations of healthy adult men have similar gait characteristics.
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Article
The purpose of our study was to describe and compare free-speed gait patterns of healthy young women with healthy elderly women. The evaluation was completed with high-speed cinematography using synchronized front and side views of 26 healthy volunteers. One group was composed of 13 subjects 20 to 35 years of age, and the other group was composed of 13 subjects 60 to 84 years of age. Each subject participated in one test session consisting of three filmed trials of free-speed ambulation down a 14-m walkway. The processed film was analyzed for 10 gait characteristics. Differences in gait characteristics between the two groups were examined using a correlated t test (p less than .01). The elderly women demonstrated significantly smaller values of step length, stride length, ankle range of motion, pelvic obliquity, and velocity when compared with the younger women. The results of our study suggest that the physical therapist should not establish similar expectations for young women and elderly women during gait rehabilitation.
Article
The reliability of foot pressure measurement using the EMED F system has been tested by recording 25 walks with 10 volunteer subjects at three different speeds. Coefficients of reliability calculated for 1-25 walks showed that a good level of reliability was achieved using one measurement for most force/pressure variables but when the mean result of three or more walks was used reliability was excellent. Measurements related to time were more variable than the total force, the peak pressure and the area. The total force and peak pressure were also shown to increase with increasing speed but this was not true for all sites on the foot.
Article
The problems of mobility impairment in the elderly constitute new and major challenges for biomechanics research. This paper outlines what some of the important problems are, discusses the relevance of biomechanics research to these problems, and reviews some of the current state of knowledge about factors related to the biomechanics of mobility impairments in the elderly. The population of old adults is growing rapidly and the incidence of mobility impairments in old adults is high. Mobility impairment biomechanics research is needed to make the assessments of impairments more precise, to design therapeutic programs that are more effective and to learn more about how mobility impairments can be prevented.
Article
Peak pressures and regional impulses were determined under the feet of 15 children and 111 adults by means of a capacitive pressure distribution platform. The measurements were taken during walking and running and revealed insights into foot function during the process of locomotion skill acquisition. Considerably reduced peak pressures in the infant group could be attributed to a softer foot structure and a lower body-weight to foot-contact area ratio. An almost three times higher relative load under the midfoot of the infant foot shows that the longitudinal foot arch is still a weak structure. Within a few months of gait development remarkable changes toward an adult loading pressure pattern were observed.
Article
Age-related changes in the feet include alterations in the skin, which becomes dry, inelastic, and cool and often exhibits hyperkeratoses. Thickened and brittle toenails complicate pedicure. The contour of the foot widens with age and may have increased forefoot height in the presence of toe deformities. Sensory acuity diminishes, as does joint mobility, muscle-force production, and ability to withstand stress. The elderly person's gait is slower and less forceful, with shorter strides. Visual loss affects footwear donning and toenail trimming. Older individuals on a limited income are less likely to have appropriate shoes and hose. Preventive care begins with good hygiene and continues with selection of suitable hosiery and shoes. Conservative management of the podiatric conditions most often seen in geriatric patients (eg, metatarsalgia and hallux valgus) should be based on relating the pathomechanics of the disorder to the options available in shoe selection, modification, and insert design.
Article
Self-paced walking was used as a measure of the neuromuscular slowing observed with aging. The effects of age on the choice of speed of walking, stride length, and step frequency were described for 289 males and 149 females aged 19 to 102 yr. These subjects were asked to walk at three self-selected paces (slow, normal, and fast) over an 80-m indoor course. Sixty-two years coincided with an accelerated decline in speed of walking. Before 62 yr, there was a 1 to 2% per decade decline in normal walking speed. After 63 yr, females showed a 12.4% per decade decrease and males showed a 16.1% per decade decrease. The eldest group (63 yr and older) had a significantly slower speed of walking and smaller step length than the younger groups (19 to 39 and 40 to 62 yr) for all paces. Heart rate at the three paces was not changed across age. In a multiple regression analysis, the only significant independent variable for walking speed at all three paces was (age), which accounted for 19 to 38% of the variance. When the population was divided into two age ranges (19 to 62 and 63 to 102 yr), walking speed was associated with height before 62 yr and with height and age after 62 yr.
Article
Gains in longevity in the United States since the mid-nineteenth century occurred as a result of an epidemiologic transition: deaths from infectious diseases were replaced by deaths from degenerative diseases. Recent trends in cause-specific mortality suggest a distinct new stage, one of postponement of degenerative diseases. Projections based on these data must be applied cautiously; their implication for health and social policies are likely to be profound.
Article
The purposes of this study were to expand the data base of active range of motion (ROM) in the upper and lower extremities of older persons measured by goniometry and to determine if differences exist related to age, sex, and physical activity. Active ROM was measured with a clinical goniometer in 28 joint motions of the upper and lower extremities of the right side in 60 older subjects. Thirty men and 30 women were equally divided in two age groups of 60 to 69 and 75 to 84 years of age. Multivariate analysis of variance showed no significant differences in ROM that were attributable to sex and age. In univariate tests, however, 12 motions were significantly different (p less than .05) between the sexes, but only in 4 motions was the difference greater than intertester error. Physical activity, as assessed by a questionnaire and a rating scale, was not related to specific changes of joint range. Within the older subjects, however, a significant relationship between ROM and age or ROM and physical activity cannot be assumed. These results suggest that a data base of normative values is needed for older individuals.
The results of 277 self-paced walking tests have been analysed for the effects of body composition, sex and age using step-up multiple regression analysis. Equations are given for the influence of the significant factors on chosen walking speeds and on heart rate (fc) (standardised at 4.8 km . h-1 by interpolation from points recorded at three walking speeds). The basic equations are: Normal speed (km . h-1) = 1.72 + 2.13 stature (m) - 0.008 age (years) Fast speed (km . h-1) = 0.54 + 3.69 stature (m) - 0.016 age (years) For men: fc4.8 (beat . min-1) = 161 - 50.7 stature (m) + 0.223 body weight (kg) For women: fc4.8 (beat . min-1) = 161 - 50.7 stature (m) + 0.223 body weight (kg) + 4.43 The significant factors affecting freely chosen walking speeds are stature and age. When estimates of body composition are available, percentage fat is found to be the most influential single factor affecting fc, while sex no longer has a significant effect, and age now has a negative influence. When allowance is made for these factors the effects of customary physical activity can be seen more clearly.
Article
Peak pressures and relative loads were determined under the feet of 125 children between 6 and 10 years of age. These results were compared with previously published data from 111 adults. A capacitive pressure distribution platform with a resolution of 2 sensors/cm2 was used for data collection during walking. As compared with the group of adults, the school children showed considerably lower peak pressures under all anatomical structures. Larger foot dimensions with respect to body weight result in reduced foot pressures for the children by distributing the ground reaction forces across larger contact areas. With increasing age, a medial load shift in the forefoot could be observed for the older children. Data analysis of the pressures under the midfoot revealed that the longitudinal foot arch development is almost complete before the age of 6. Contrary to the findings in adults, body weight was identified to be of major influence on the magnitude of the pressures under the feet of school children. No differences were found for the foot pressures between boys and girls.
The pressure distribution under the foot during burejoot wulking. [Doctoral dissertation]. The Pennsylvania State University
  • Te Clarke
Clarke TE. The pressure distribution under the foot during burejoot wulking. [Doctoral dissertation]. The Pennsylvania State University, 1980