The Change of In-shoe Plantar Pressure according to Lever-point of Metatarsal-Bar

OBJECTIVE: To find the most effective lever-point to manufacture the rocker-outsole. METHOD: Ten healthy men were participated. Metatarsal-bar, 12x1x0.5 cm, was clung to the outsole of shoes. In the first experimental-group, we set the center of the metatarsal- bar to an imaginary line which across the center of the 1st metatarsal head with that of the 5th metatarsal head. In turns, we experimented the other groups as moved the center of the metatarsal-bar 0.5 cm backwards, each naming 2nd, 3rd, 4th group. Plantar peak pressures were measured at T0 (whole foot), M1 (heel), M2 (midfoot), M3 (1st, 2nd metatarsal area), M4 (3rd, 4th, 5th metatarsal area), M5 (great toe), M6 (2nd, 3rd toe) and M7 (4th, 5th toe). RESULTS: There was significant decrease in the peak pressure of M3 in the first experimental-group, which the center of metatarsal-bar was set to an imaginary line. CONCLUSION: In the first experimental-group, there was significant decrease in the peak pressure of M3. Therefore, the lever-point of rocker-outsole should be set to an imaginary line which connects the center of the 1st metatarsal head with that of the 5th metatarsal head.

The Effect of Metatarsal Pad for Foot Pressure

OBJECTIVE: To compare the foot pressure of the insole with medial longitudinal arch support and metatarsal pad and insole with medial longitudinal arch support only. METHOD: Thirty three normal subjects participated in this study. Insole were fabricated by Hana-meditec company after shaping the subjects' foot. The left insole had only medial longitudinal arch support and right insole had medial longitudinal arch support with metatarsal pad. Bare foot pressure were measured by EMED system(r) during comfortable gait. Shoes were manufactured by Osan University. Foot pressure in the shoes was measured by PEDAR system(R) during comfortable gait. Plantar pressure were analyzed by PEDAR C-expert program at T0 (whole foot), M1 (heel), M2 (midfoot), M3 (1st and 2nd metatarsal area), M4 (3rd, 4th and 5th metatarsal area), M5 (great toe), M6 (2nd and 3rd toes area), and M7 (4th and 5th toes area) zone. RESULTS: Right bare foot plantar peak pressure was identical with left side. Right plantar peak pressure with metatarsal pad in shoes was lower than left side with medial longitudinal arch support only at M1, M2 and M4 zone. CONCLUSION: For reducing the plantar peak pressure, the insole with medial longitudinal arch support and metatarsal pad were better than the insole with medial longitudinal arch support only.

The Comparison of the Plantar Peak Pressure in Diabetic Shoes of Normal Subjects to Diabetic Patients

OBJECTIVE: To compare the plantar peak pressure of diabetic patients without neuropathic and ischemic symptoms to normal subject wearing diabetic shoes and to compare the plantar peak pressures of P.W. minor (B) shoes to Apex (A) shoes. METHOD: Thirty three normal subjects and fourteen diabetic patients were participated. Plantar peak pressures in shoes were measured by pedar(r)during a comfortable gait wearing two types of diabetic shoes, respectively. A shoes and B shoes were used in this study. Plantar pressure was analyzed by pedar C-expert program at T0 (whole foot), M1 (heel), M2 (midfoot), M3 (1st, 2nd metatarsal area), M4 (3rd, 4th, 5th metatarsal area), M5 (great toe), M6 (2nd, 3rd toe area) and M7 (4th, 5th toe area) zones respectively. RESULTS: Plantar peak pressures of diabetic patients without neuropathic and ischemic symptom were not different from normal subjects. In normal subjects, plantar peak pressure of B shoes were lower than A shoes at both T0, M3 and M5 zones and left M6 and M7 zones. Plantar peak pressures of A shoes was lower than B shoes at both M2 zones. In diabetic patients plantar peak pressures of B shoes was lower than A shoes at right M4 and left M5 zones. CONCLUSION: There was no sgnificant difference between plantar peak pressures of normal subjects and diabetic patients without neuproathic and ischemic symptom. B shoes were better than A shoes to reduce plantar peak pressure.

Comparison of Dynamic Peak Plantar Pressure and Hindfoot Contact Time in Diabetic Patients and Healthy Adults

OBJECTIVE: To investigate and describe the peak plantar pressures and ground contact times of the foot during walking in diabetic patients and healthy adults. METHOD: 17 age-matched diabetic patients without any complications and 33 healthy adults participated in this study. The foot was divided into 10 different areas, and peak plantar pressures and ground contact times were measured during walking by EMED system . RESULTS: There were no significant differences in peak plantar pressures of both feet in both groups, but there were significant increases in peak plantar pressures of hindfoot and hindfoot contact times in the diabetic group. CONCLUSION: Despite having no definite diabetic neuropathy and vascular disease, diabetic patients have higher peak plantar pressures of hindfoot and prolonged hindfoot contact times because limb muscle dysfunction or impairment of proprioception may induce faster descent of the foot towards the ground or improper pattern of stance phases.

Comparison of Peak Plantar Pressure between Bare Foot and In-shoe in Diabetic Patients

OBJECTIVE: To investigate the efficiency of custom-made diabetic shoes through the measurement of peak plantar pressure, compared between bare foot and in-shoe in diabetic patients METHOD: Seventeen diabetic patients participated in this study. It used diabetic shoes manufactured by Apex and P.W. minor & son. The foot was divided into 6 different areas, and peak plantar pressures of bare foot and in-shoe were measured during walking by EMED system and PEDAR , respectively. RESULTS: There were significant decreases in peak plantar pressures of all plantar areas in all types of diabetic shoes. Especially, peak plantar pressures of diabetic shoes manufactured by P.W. minor & son in medial metatarsal and big toe areas were more decreased than by Apex. CONCLUSION: The custom-made diabetic shoes can effectively reduce plantar pressures in all palntar areas of the foot, and also can prevent the development or recurrence of foot ulcers at specific areas according to the variable physical constitution of diabetic shoes.

Comparing the Hard Outsole with the Soft Outsole in Diabetic Shoes

OBJECTIVE: To assess the proper type of outsole for the diabetic shoes according to the hardness of outsole in diabetic patients. METHOD: Seventeen diabetic patients and 33 normal control volunteers in the 5~6th decade were participated in this study. Walking exercise in the treadmill was performed in all subjects wearing the custom-made shoes with the two layers of hard outsole and one layer of soft outsole, respectively. Peak plantar pressures were measured after exercise by Pedar system with pressure sensitive insoles inserted in each shoes and compared with two types of outsoles. The degree of oxygen saturation was measured in the fourth toe by Oxysensor and the plantar thermography were measured by infrared thermometer before and after exercise, and compared with the two types of outsoles in diabetic and control groups, respectively. RESULTS: There were not significant differences of peak plantar pressures in all measuring points according to the type of outsole in diabetic group. The degree of oxygen saturation in the fourth toe was not significantly changed between the two types of outsoles before and after exercise in diabetic group. The plantar temperatures were significantly increased after exercise in all groups, but there was not significant difference according to the type of outsole. CONCLUSION: There was not significant difference between hard and soft outsole with the custom-made shoes for diabetic patient applied in this study. But more advanced studies about the outsole of diabetic shoe should be needed.