Associations between static foot posture, dynamic in-shoe plantar foot forces and knee pain in people with medial knee osteoarthritis: a cross-sectional exploratory study.

OBJECTIVE: To investigate relationships between static foot posture, dynamic plantar foot forces and knee pain in people with medial knee osteoarthritis (OA). DESIGN: Data from 164 participants with symptomatic, moderate to severe radiographic medial knee OA were analysed. Knee pain was self-reported using a numerical rating scale (NRS; scores 0-10; higher scores worse) and the Knee Injury and Osteoarthritis Outcome Score pain subscale (KOOS; scores 0-100; lower scores worse). Static foot posture was assessed using clinical tests (foot posture index, foot mobility magnitude, navicular drop). Dynamic plantar foot forces (lateral, medial, whole foot, medial-lateral ratio, arch index) were measured using an in-shoe plantar pressure system while walking. Relationships between foot posture and plantar forces (independent variables) and pain (dependent variables) were evaluated using linear regression models, unadjusted and adjusted for sex, walking speed, KL grade, shoe category, and body mass (for dynamic plantar foot forces). RESULTS: No measure of static foot posture was associated with any knee pain measure. Higher medial-lateral foot force ratio at midstance, and a higher arch index during overall stance, were weakly associated with higher knee pain on the NRS (regression coefficient=0.69, 95% confidence interval (CI) 0.09 to 1.28) and KOOS (coefficient=3.03, 95% CI 0.71 to 5.35) pain scales, respectively. CONCLUSION: Dynamic plantar foot forces, but not static foot posture, were associated with knee pain in people with medial knee OA. However, the amount of pain explained by increases in plantar foot force was small, thus these associations are unlikely to be clinically meaningful.

Alterations to plantar loading and ankle range of motion of the contralateral foot during assisted walking in patients with Type 2 Diabetes Mellitus.

AIMS: Patients with diabetic foot ulcers are instructed to be non-weight bearing on the affected limb to promote healing. Therefore, the aim of this study was to investigate the effect of different assistive devices on whole foot plantar loading, peak forefoot force, ankle range of motion, and locomotion speed during gait in patients with Type 2 Diabetes Mellitus. METHODS: Participants walked normally, with crutches, a walker, and a wheeled knee walker (WKW) in randomized order. Force sensitive insoles and 3D motion capture were used to record plantar normal force and ankle kinematics. Force sensitive pads were wrapped around handles of the crutches and walker to measure bodyweight offloaded onto the assistive device. An instrumented WKW was used to measure bodyweight offloaded onto the handlebars and knee cushion. RESULTS: Locomotion with the WKW produced the lowest whole foot plantar loading and peak forefoot force in the propulsive limb, while also producing the greatest ankle range of motion and locomotion speed amongst assistive devices. CONCLUSIONS: This pre-clinical study found that the WKW could be the preferred assistive device for total unilateral offloading of diabetic foot ulcers as it reduced propulsive limb whole foot and forefoot plantar loading while retaining ankle range of motion and locomotion speed.

Validity of estimating center of pressure during walking and running with plantar load from a three-sensor wireless insole.

The purpose of this study was to determine if estimated center of pressure (COP) from plantar force data collected using three-sensor loadsol insoles was comparable to the COP from plantar pressure data collected using pedar insoles during walking and running. Ten healthy adults walked and ran at self-selected speeds on a treadmill while wearing both a loadsol and pedar insole in their right shoe. Plantar force recorded from the loadsol was used to estimate COP along mediolateral (COPx) and anteroposterior (COPy) axes. The estimated COPx and COPy were compared with the COPx and COPy from pedar using limits of agreement and Spearman's rank correlation. There were significant relationships and agreement within 5 mm in COPx and 20 mm in COPy between loadsol and pedar at 20-40% of stance during walking and running. However, loadsol demonstrated biases of 7 mm in COPx and 10 mm in COPy compared to pedar near initial contact and toe-off.

Development of Plantar Force Assessment Model for Patients with Patellofemoral Pain / 医用生物力学

Objective To develop plantar force model of patellofemoral pain (PFP), so as to provide theoretical references for the assessment of PFP rehabilitation. Methods The case-control study was conducted, and a total of 126 patients with PFP and 126 healthy controls matched by gender and age were enrolled in the study. The participants were tested for plantar force and pressure during level walking, and twelve plantar regions were divided and recorded. Whether the participants suffered PFP was analyzed as dependent variable, meanwhile the peak force and peak pressure in 12 plantar regions of participants at selected speed during level walking were analyzed as independent variables. Conditional logistic regression (CLR) equations of peak force and peak pressure with PFP were established, respectively. The receiver-operating characteristic (ROC) curve of the corresponding equations was derived, and the area under ROC curve was calculated to analyzed the validity of different equations on PFP assessment. Results The CLC equation of peak force in 12 plantar regions of the participants with FFP was constructed, and only peak force of lateral heel was in the equation. The CLC equation of peak pressure in each plantar region included medial heel, midfoot, 1st and 2nd metatarsals. Meanwhile, the area under ROC curve of the pressure equation was larger than that of the force equation. Conclusions Peak force and pressure at different plantar regions can be used to assess PFP during level walking, and peak pressure is more effective for assessment.

Effect of speed and gradient on plantar force when running on an AlterG® treadmill.

BACKGROUND: Anti-gravity treadmills are used to decrease musculoskeletal loading during treadmill running often in return to play rehabilitation programs. The effect different gradients (uphill/downhill running) have on kinetics and spatiotemporal parameters when using an AlterG® treadmill is unclear with previous research focused on level running only. METHODS: Ten well-trained healthy male running athletes ran on the AlterG® treadmill at varying combinations of bodyweight support (60, 80, and 100% BW), speed (12 km/hr., 15 km/hr., 18 km/hr., 21 km/hr., and 24 km/hr), and gradients (- 15% decline, - 10, - 5, 0, + 5, + 10 + 15% incline), representing a total of 78 conditions performed in random order. Maximum plantar force and contact time were recorded using a wireless in-shoe force sensor insole system. RESULTS: Regression analysis showed a linear relationship for maximum plantar force with bodyweight support and running speeds for level running (p < 0.0001, adj. R2 = 0.604). The linear relationship, however, does not hold for negative gradients at speeds 12 & 15 km/h, with a relative 'dip' in maximum plantar force across all assisted bodyweight settings. CONCLUSIONS: Maximum plantar force peaks are larger with faster running and smaller with more AlterG® assisted bodyweight support (athlete unweighing). Gradient made little difference except for a downhill grade of - 5% decreasing force peaks as compared to level or uphill running.

Implications of Walking Aid Selection for Nonweightbearing Ambulation on Stance Limb Plantar Force, Walking Speed, Perceived Exertion, and Device Preference in Healthy Adults 50 Years of Age and Older.

BACKGROUND: Young adults often tolerate the increased energy expenditure, coordination, and stance limb discomfort associated with walking aids for nonweightbearing ambulation. Adults aged ≥50 years may not have the same tolerance. Therefore, the objective of this study was to determine how walking aid selection affects stance limb plantar force, walking speed, perceived exertion, and device preference in adults aged ≥50 years. METHODS: A prospective randomized crossover study was performed using healthy adults, aged ≥50 years, with no use of walking aids within 5 years. Participants walked 200 m in 4 randomized conditions: single nonweightbearing ambulation using crutches, a walker, a wheeled knee walker, and unaided walking. An in-shoe sensor measured stance limb plantar force, a stopwatch timed each walk, perceived exertion was reported using the BORG CR-10 scale, and device preference was identified. RESULTS: Twenty-one participants (7 male; age: 56 ± 5 years; BMI: 26.6 ±1.9) showed stance limb plantar force was lowest when using a wheeled knee walker (P < .001). Walking speed was similar in unaided and wheeled knee walker conditions (1.41 and 1.31 m/s), but slower with crutches or a walker (42%-68%, P < .001). Perceived exertion was similar in unaided and wheeled knee walker conditions (1.6 and 2.8), but higher with crutches or a walker (5.7 and 6.1, P < .001). Most (20/21) participants preferred the wheeled knee walker. CONCLUSIONS: Using a wheeled knee walker for nonweightbearing ambulation reduced stance limb plantar force, maintained unaided walking speed and perceived exertion, and was preferred to crutches or a walker. LEVEL OF EVIDENCE: Level II, comparative study.

Changes to stance limb peak, cumulative, and regional plantar foot forces among normal walking and three mobility aids in healthy older adults.

BACKGROUND: Mobility aids are commonly prescribed to offload an injured lower extremity. Device selection may impact stance foot loading patterns and foot health in clinical populations at risk of foot ulceration. RESEARCH QUESTIONS: Two questions motivated this study: How does device selection influence peak plantar and regional (rearfoot, mid foot and forefoot) foot forces on the stance foot? Does device selection influence peak, cumulative, and regional plantar forces within a 200 m walking trial? METHODS: Twenty-one older adults walked 200 m at self-selected pace in four randomized conditions for this prospective crossover study. Participants used a walker, crutches, wheeled knee walker (WKW), and no assistive device (control condition). Plantar forces were measured using a wireless in-shoe system (Loadsol, Novel Inc., St. Paul, MN). Repeated measures analyses of variance were used to determine differences in peak and cumulative total and regional forces among walking conditions. Paired sample t-tests compared forces during first and last 30 s epochs of each condition to determine device influence over time. RESULTS: The WKW reduced peak net forces by 0.29 and 0.35 bodyweight (BW) when compared to the walker or control condition with similar trends in all foot regions. Crutch use had similar peak forces as control. There were no differences in the number of steps taken within devices comparing first and last epochs. Crutches had a 0.04 and 0.07 BW increase in peak net and forefoot forces during the last epoch. Walker use had 66.44 BW lower cumulative forefoot forces in the last epoch. SIGNIFICANCE: Crutches had similar stance foot loading as normal walking while a walker lowered forefoot forces at the expense of increased steps. A WKW may be the best choice to 'protect' tissues in the stance foot from exposure to peak and cumulative forces in the forefoot region.

Effect of Running Speed and Midsole Type on Foot Loading in Heel-Toe Running.

The purpose of this study was to explore the immediate effects of running speed and midsole type on foot loading during heel-toe running. Fifteen healthy male college students were required to complete 3 running trials on an indoor 45-m tartan runway at 4 different speeds (3, 4, 5, and 6 m/s) using 2 different running footwear types (engineering thermoplastic polyurethane elastomer, polyurethane elastomer; and ethylene vinyl acetate, vinyl acetate). The ground reaction force and plantar pressure data were quantified. Significant speed effects were detected both in ground reaction force and plantar pressure-related data (P < .05). Vertical average loading rate was significantly less, and time to first peak occurred later for the polyurethane elastomer compared with vinyl acetate footwear (P < .05). The peak pressure of the heel, medial forefoot, central forefoot, lateral forefoot, and big toe was significantly less when subjects wore a polyurethane elastomer than vinyl acetate footwear (P < .05). Overall, our results suggested that, compared with the vinyl acetate footwear, the special polyurethane elastomer footwear that is adhered with thousands of polyurethane elastomer granules was effective at reducing the mechanical impact on the foot.

Effects of Short-Foot Exercises on Foot Posture, Pain, Disability, and Plantar Pressure in Pes Planus.

CONTEXT: Pes planus is a prevalent chronic condition that causes foot pain, disability, and impaired plantar load distribution. Short-foot exercises are often recommended to strengthen intrinsic foot muscles and to prevent excessive decrease of medial longitudinal arch height. OBJECTIVE: To investigate the effects of short-foot exercises on navicular drop, foot posture, pain, disability, and plantar pressures in pes planus. DESIGN: Quasi-experimental study. SETTING: Biomechanics laboratory. PARTICIPANTS: A total of 41 participants with pes planus were assigned to the short-foot exercises group (n = 21) or the control group (n = 20). INTERVENTION: Both groups were informed about pes planus, usual foot care, and appropriate footwear. Short-foot exercises group performed the exercises daily for 6 weeks. MAIN OUTCOME MEASURES: Navicular drop, Foot Posture Index, foot pain, disability, and plantar pressures were assessed at the baseline and at the end of 6 weeks. RESULTS: Navicular drop, Foot Posture Index, pain, and disability scores were significantly decreased; maximum plantar force of midfoot was significantly increased in short-foot exercises group over 6 weeks (P < .05). No significant differences were determined between the baseline and the sixth week outcomes in control group (P > .05). CONCLUSIONS: Six-week short-foot exercises provided a reduction in navicular drop, foot pronation, foot pain, and disability and increment in plantar force of medial midfoot in pes planus.

Towards Wearable Comprehensive Capture and Analysis of Skeletal Muscle Activity during Human Locomotion.

BACKGROUND: Motion capture and analyzing systems are essential for understanding locomotion. However, the existing devices are too cumbersome and can be used indoors only. A newly-developed wearable motion capture and measurement system with multiple sensors and ultrasound imaging was introduced in this study. METHODS: In ten healthy participants, the changes in muscle area and activity of gastrocnemius, plantarflexion and dorsiflexion of right leg during walking were evaluated by the developed system and the Vicon system. The existence of significant changes in a gait cycle, comparison of the ankle kinetic data captured by the developed system and the Vicon system, and test-retest reliability (evaluated by the intraclass correlation coefficient, ICC) in each channel's data captured by the developed system were examined. RESULTS: Moderate to good test-retest reliability of various channels of the developed system (0.512 ≤ ICC ≤ 0.988, p < 0.05), significantly high correlation between the developed system and Vicon system in ankle joint angles (0.638R ≤ 0.707, p < 0.05), and significant changes in muscle activity of gastrocnemius during a gait cycle (p < 0.05) were found. CONCLUSION: A newly developed wearable motion capture and measurement system with ultrasound imaging that can accurately capture the motion of one leg was evaluated in this study, which paves the way towards real-time comprehensive evaluation of muscles and joint motions during different activities in both indoor and outdoor environments.

Validation of a wireless shoe insole for ground reaction force measurement.

Ground reaction force measurements are a fundamental element of kinetic analyses of locomotion, yet they are traditionally constrained to laboratory settings or stationary frames. This study assessed the validity and reliability of a new wireless in-shoe system (Novel Loadsol/Pedoped) for field-based ground reaction force measurement in hopping, walking, and running. Twenty participants bilaterally hopped on a force plate and walked (5 km/hr) and ran (10 km/hr) on an instrumented treadmill on two separate days while wearing the insoles. GRFs were recorded simultaneously on each respective system. Peak GRF in hopping and peak GRF, contact time (CT), and impulse (IMP) in walking and running were compared on a per-hop and step-by-step basis. In hopping, the insoles demonstrated excellent agreement with the force plate (ICC: 0.96). In walking and running, the insoles demonstrated good-to-excellent agreement with the treadmill across all measures (ICCs: 0.88-0.96) and were reliable across sessions (ICCs within 0.00-0.03). A separate verification study with ten participants was conducted to assess a correction algorithm for further agreement improvement but demonstrated little meaningful change in systemic agreements. These results indicated that the Novel Loadsol system is a valid and reliable tool for wireless ground reaction force measurement in hopping, walking, and running.

Design of a Tri-Axial Force Measurement Transducer for Plantar Force Measurements.

Transducers for spatial plantar force measurements have numerous applications in biomechanics, rehabilitation medicine, and gait analysis. In this work, the design of a novel, tri-axial transducer for plantar force measurements was presented. The proposed design could resolve both the normal and the shear forces applied at the foot's sole. The novelty of the design consisted in using a rotating bump to translate the external loads into axial compressive forces which could be measured effectively by conventional pressure sensors. For the prototype presented, multilayer polydimethylsiloxane (PDMS) thin-film capacitive stacks were manufactured and used as sensing units, although in principle the design could be extended to various types of sensors. A quasi-static analytic solution to describe the behavior of the transducer was also derived and used to optimize the design. To characterize the performance of the transducer, a 3 cm diameter, 1 cm tall prototype was manufactured and tested under various combination of shear and normal loading scenarios. The tests confirmed the ability of the transducer to generate strong capacitive signals and measure both the magnitude and direction of the normal and shear loads in the dynamic range of interest.

Loading pattern of postoperative hallux valgus feet with and without transfer metatarsalgia: a case control study.

BACKGROUND: Postoperative transfer metatarsalgia is a common complication after hallux valgus surgeries. Shortening of the first metatarsal is traditionally thought to be the primary cause of it. However, we speculate the abnormal loading pattern during gait is the real reason. This study is to determine specific differences in the loading patterns between reconstructive hallux valgus (HV) feet with and without postoperative transfer metatarsalgia, so as to find risky loading characteristics of this complication. METHODS: Thirty feet with postoperative transfer metatarsalgia were recruited as pain group, while another 30 postoperative feet without pain as controls. All participants were asked to walk barefoot at self-selected speed through a plantar force measuring plate (Rs-Scan Inc.) for three times. Certain plantar load variables were recorded or calculated, and their differences between two groups were compared. RESULTS: For pain group, the maximum plantar force and force time integral of the first metatarsal decrease significantly; the force time integral of the central rays (second plus third metatarsal) does not significantly differ with that in the controls, but their cumulative load percentage to the whole foot is higher. In pain group, the time point when central rays reached their peak force during the push-off is significantly later than that in controls. And the regional instant load percentage at this moment presented significantly higher for central rays, while significantly lower for the first metatarsal and the hallux compared to the controls. CONCLUSIONS: For hallux valgus feet with postoperative metatarsalgia, the load function of the first metatarsal is obviously impaired. But for central rays, indicative difference is not reflected in either peak or cumulative load during the gait cycle, but in the instant load distribution when central rays reach their peak load. So we can conclude that whether the remaining regions can adequately share certain load during walking, especially around the time metatarsalgia often occurs, plays an unnegligible role. So surgeons should pay more attention to reconstruct a foot where load can be evenly distributed.

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

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

Analysis on plantar force parameters of gait under different simulated gravities / 医用生物力学

Objective To investigate the plantar force characteristics during human walking and running under different gravity environment. Methods Seven healthy male volunteers walked and ran in vertical position on a weight-loss suspension treadmill under simulated Mars gravity (1/3 G) and lunar gravity (1/6 G), and traditional earth gravity (1 G) respectively at three different velocities (3, 7 and 10 km/h). During the exercise, parameters such as stance phase, plantar force, and gait balance in gait cycle were analyzed by using the F-scan insole pressure distribution measurement system. Results At the same velocity during a gait cycle, the contact phase was significantly shorter with the decrease of gravity, but the swing phase was significantly longer (P0.05). The peak and average plantar force, force integrity were significantly reduced with the decrease of gravity. Under normal gravity, the increase of velocity could lead to an obvious increase in peak and average plantar force and an obvious decrease in force integrity. While under simulated lunar and Mars gravity, no significant changes were found in plantar force (P>0.05). Under the three gravities, the ratio of vertical impact was quite different in between (P<0.05), but no significant difference was found in the phase symmetry index. Conclusions As compared to normal gravity environment, parameters benefiting for skeleton and muscle function such as plantar force and contact phase were found to be much smaller under low gravity environment, indicating the necessity of considering these factors when designing countermeasures or exercise prescriptions for space flight so as to sustain the astronaut’s normal function of skeleton and muscle.

Simulation on dynamic characteristics of the ankle gait simulator and experimental verification / 医用生物力学

Objective To study dynamic characteristics of the ankle gait simulator, simulate plantar forces in the vertical, anterior-posterior, right-left direction during the stance phase, and validate such forces in the experimental setup. Methods The Adams virtual prototype and ankle model (including tendons, ligaments and soft tissues of foot) were established for dynamic simulation based on the self-developed 5 DOF gait simulator. The dynamic results from both the prototype and gait simulator were compared with the real plantar forces. Results The simulated plantar force could accurately fit the normal in vivo ankle position curves during a stance phase in three directions, and the tendons, ligaments and soft tissues had important influences on the correct gait. The simulated plantar force by the gait simulator could be repeatedly fit for the real stance plantar force. Conclusions The gait simulator was proved to simulate the human gait stance well and can provide a clinical research platform for those experiments which are incapable of in vivo measurement.

Is it possible to individualize intensity of eccentric cycling exercise from perceived exertion on concentric test?

OBJECTIVE: To assess the safety and acute effects of a procedure using perceived exertion during a prior submaximal concentric (CON) test to individualize eccentric (ECC) cycling exercise intensity. DESIGN: Prospective, monocentric open study. SETTING: Technological investigation platform at a physical medicine and rehabilitation department in a university hospital. PARTICIPANTS: Healthy subjects (N=18; 15 men, 3 women) aged between 22 and 37 years. INTERVENTIONS: The subjects performed 3 cycling exercises: (1) incremental CON test to determine the comfortable pedaling power (CPP) corresponding to a Borg scale rating of 12 (rate of perceived exertion); (2) steady-state CON exercise at the CPP workload to determine the corresponding plantar pressure; and (3) steady-state ECC exercise with an imposed resistance corresponding to the CPP plantar pressure. MAIN OUTCOME MEASURES: Rate of perceived exertion on Borg scale, oxygen uptake (V˙o2), heart rate, cardiac output, and stroke volume using inert gas rebreathing techniques were measured during steady-state CON and ECC exercises. Muscle soreness was rated on a visual analog scale immediately, 24, and 48 hours after the tests. RESULTS: No adverse effects were reported. V˙o2 was about 5 times the resting value during CON exercise, while it was twice that during ECC exercise. Cardiac output was lower during ECC exercise (P<.05). This moderate increase of cardiac output was exclusively linked to a greater increase in stroke volume during ECC exercise than during CON exercise (P<.05). CONCLUSIONS: Moderate-intensity ECC cycling exercise tailored according to perceived exertion during a prior CON test is well tolerated. It corresponds to a limited muscular use of oxygen and to an isolated increase in stroke volume. It appears to be a feasible procedure for preconditioning before ECC training.

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

OBJETIVO: Investigou-se a influência da carga e posicionamento do material escolar sobre a distribuição da força plantar (DFP) e trajetória do centro de pressão (COP) em estudantes. MÉTODOS: Participaram 30 voluntários (10,7 ± 1,35 anos), ambos os gêneros, sem alteração postural. Dados baropodométricos foram coletados em sistema de baropodometria computadorizada (Matscan Research, Teckscanâ, 5.72): sem carga (controle); com carga (mochila) de 5, 10 e 15 por cento da massa corporal, posicionada nas regiões anterior e posterior do tronco, ombro direito e esquerdo. RESULTADOS: Sem carga, a DFP foi maior no calcâneo esquerdo comparado ao direito (p< 0,05). Com carga de 10 por cento no ombro esquerdo, a DFP foi maior à direita e menor à esquerda, comparado ao controle (p< 0,05). Com 5 por cento na região posterior do tronco, a DFP foi menor no médio-pé direito (mpD) e antepé esquerdo (apE); com 10 por cento, foi menor no mpD e mpE e maior no artelho direito (atD); com 15 por cento, foi menor no mpD e maior no atD (p< 0,05). A força plantar foi maior no atD com carga de 10 e 15 por cento em relação a 5 por cento (p< 0,05). Com carga de 15 por cento nas regiões anterior e posterior do tronco, a trajetória do COP foi maior (p< 0,05) comparada à carga de 5 por cento. A DFP não foi influenciada pelas diferentes cargas e posições da mochila. CONCLUSÕES: Considerando o aumento da trajetória do COP com carga de 15 por cento, recomenda-se que a carga das mochilas escolares não ultrapasse 10 por cento da massa corporal. Sugere-se investigação das adaptações da postura às diferentes cargas e posições da mochila, visando detectar possíveis alterações e propor ações preventivas.

OBJECTIVE: The influence of the weight and positioning of school supplies and books in backpacks, on plantar force distribution (PFD) and pressure center location, was investigated among students. METHODS: Thirty volunteers of both genders participated in the study. Their mean age was 10.76 (± 1.35) years and none of them had postural abnormalities. Baropodometric data were collected using a computerized baropodometric system (Matscan Research, Tekscanâ, 5.72): without load (control) and with loads of 5, 10 and 15 percent of body weight in a backpack, positioned on the back, on the chest and on the right and left shoulders. RESULTS: The PFD without load was greater on the left heel than on the right heel (p< 0.05). With a load of 10 percent on the left shoulder, the PFD was greater on the right and smaller on the left foot, in comparison with the control (p< 0.05). With a load of 5 percent on the back, the PFD was smaller on the right midfoot (RMF) and left forefoot (lff); with 10 percent, it was smaller on the RMF and left midfoot (LMF) and greater on the right toes (RT); with 15 percent, it was smaller on the RMF and greater on the RT (p< 0.05). The plantar force was greater on the RT with loads of 10 percent and 15 percent than it was with loads of 5 percent (p< 0.05). With loads of 15 percent on the back and on the chest, the pressure center displacement was greater than with a load of 5 percent (p< 0.05). The PFD was not influenced by the different loads and backpack positions. CONCLUSIONS: Taking into consideration the increased pressure center displacement with a load of 15 percent, it is recommended that school backpack loads should not exceed 10 percent of body mass. Investigations on posture adaptations to different loads and backpack positions are suggested, in order to detect possible abnormalities and propose preventive actions.