Recent Innovations in Footwear and the Role of Smart Footwear in Healthcare-A Survey.

Smart shoes have ushered in a new era of personalised health monitoring and assistive technologies. Smart shoes leverage technologies such as Bluetooth for data collection and wireless transmission, and incorporate features such as GPS tracking, obstacle detection, and fitness tracking. As the 2010s unfolded, the smart shoe landscape diversified and advanced rapidly, driven by sensor technology enhancements and smartphones' ubiquity. Shoes have begun incorporating accelerometers, gyroscopes, and pressure sensors, significantly improving the accuracy of data collection and enabling functionalities such as gait analysis. The healthcare sector has recognised the potential of smart shoes, leading to innovations such as shoes designed to monitor diabetic foot ulcers, track rehabilitation progress, and detect falls among older people, thus expanding their application beyond fitness into medical monitoring. This article provides an overview of the current state of smart shoe technology, highlighting the integration of advanced sensors for health monitoring, energy harvesting, assistive features for the visually impaired, and deep learning for data analysis. This study discusses the potential of smart footwear in medical applications, particularly for patients with diabetes, and the ongoing research in this field. Current footwear challenges are also discussed, including complex construction, poor fit, comfort, and high cost.

Textured insoles may improve some gross motor balance measures but not endurance measures in children with motor coordination issues. A randomised controlled feasibility trial.

BACKGROUND: Motor coordination concerns are estimated to affect 5%-6% of school-aged children. Motor coordination concerns have variable impact on children's lives, with gait and balance often affected. Textured insoles have demonstrated positive impact on balance and gait in adults with motor coordination disorders related to disease or the ageing process. The efficacy of textured insoles in children is unknown. Our primary aim was to identify the feasibility of conducting a randomised controlled trial involving children with motor control issues. The secondary aim was to identify the limited efficacy of textured insoles on gross motor assessment balance domains and endurance in children with movement difficulties. METHODS: An assessor-blinded, randomised feasibility study. We advertised for children between the ages of 5-12 years, with an existing diagnosis or developmental coordination disorder or gross motor skill levels assessed as 15th percentile or below on a norm-referenced, reliable and validated scale across two cities within Australia. We randomly allocated children to shoes only or shoes and textured insoles. We collected data across six feasibility domains; demand (recruitment), acceptability (via interview) implementation (adherence), practicality (via interview and adverse events), adaptation (via interview) and limited efficacy testing (6-min walk test and balance domain of Movement ABC-2 at baseline and 4 weeks). RESULTS: There were 15 children randomised into two groups (eight received shoes alone, seven received shoes and textured insoles). We experienced moderate demand, with 46 potential participants. The insoles were acceptable, however, some parents reported footwear fixture issues requiring modification. The 6-min walk test was described as problematic for children, despite all but one child completing. Social factors impacted adherence and footwear wear time in both groups. Families reported appointment locations and parking impacting practicality. Underpowered, non-significant small to moderate effect sizes were observed for different outcome measures. Improvement in balance measures favoured the shoe and insole group, while gait velocity increase favoured the shoe only group. CONCLUSION: Our research indicates that this trial design is feasible with modifications such as recruiting with a larger multi-disciplinary organisation, providing velcro shoe fixtures and using a shorter timed walk test. Furthermore, progressing to a larger well-powered randomised control trial is justified considering our preliminary, albeit underpowered, efficacy findings. TRIAL REGISTRATION: This trial was retrospectively registered with the Australian and New Zealand Clinical Trial Registration: ACTRN12624000160538.

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.

Selective orthotic constraint of lower limb movement during walking reveals new insights into neuromuscular adaptation.

Introduction: A concern expressed by the clinical community is that the constraint of motion provided by an ankle foot orthosis (AFO) may lead the user to become dependent on its stiffness, leading to learned non-use. To examine this, we hypothesized that using an experimental AFO-footwear combination (exAFO-FC) that constrains ankle motion during walking would result in reduced soleus and tibialis anterior EMG compared to free (exAFO-FC) and control (no AFO, footwear only) conditions. Method: A total of 14 healthy subjects walked at their preferred speed (1.34 ± 0.09 m·s-1) for 15 min, in three conditions, namely, control, free, and stop. Results: During the stance phase of walking in the stop condition, ipsilateral soleus integrated EMG (iEMG) declined linearly, culminating in a 32.1% reduction compared to the control condition in the final 5 min interval of the protocol. In contrast, ipsilateral tibialis anterior iEMG declined in a variable fashion culminating in an 11.2% reduction compared to control in the final 5 min interval. During the swing phase, the tibialis anterior iEMG increased by 6.6% compared to the control condition during the final 5 min interval. The contralateral soleus and tibialis anterior exhibited increased iEMG in the stop condition. Discussion: An AFO-FC functions as a biomechanical motion control device that influences the neural control system and alters the output of muscles experiencing constraints of motion.

Does an acute transition to different footwear conditions affect walking patterns in people with different experiences of minimalist footwear?

BACKGROUND: Minimalistic footwear provides adequate toe space, tripod function, improving foot function, muscle activation and stability during walking similarly to barefoot walking. Due to the increasing popularity of this specific footwear, there is a lack of research focusing on general users of minimalistic footwear. RESEARCH QUESTION: Does annual walking in minimalistic footwear affect gait biomechanics? METHODS: Cross-sectional study involving twenty participants in a minimalistic footwear group with both experience (MFE) and no experience (NMFE). Participants walked in three different conditions (barefoot, minimalistic, and neutral footwear) in the laboratory at normal human walking speed. RESULTS: A significant main effect of groups regardless of footwear conditions show significantly greater values during walking in minimalistic footwear and barefoot in the stride length (p=0.035, p=0.003, respectively), and stride width (p=0.047, p=0.028, respectively) in the NMFE group compared to MFE group. The significant differences in the main effects of footwear regardless of experience were found in stance time (p<0.001), steps per minute (p<0.001), stride length (<0.001), foot adduction in TO (p<0.001), foot eversion angle in IC and TO (p<0.001, p<0.001, respectively), foot progression angle (p<0.001), ankle dorsiflexion angle in IC and TO (p<0.001, p<0.001, respectively), in ankle eversion angle in IC and TO (p<0.001, p<0.001, respectively), knee flexion angle in IC and TO (p<0.001; p<0.001, respectively), and in knee flexion range of motion (p<0.001). SIGNIFICANCE: Based on our findings, barefoot walking should be used primarily during daily activities if the environment is conducive. Only one year of experience with minimalistic footwear seems insufficient and an intervention should be incorporated to change the gait pattern when transitioning to full minimalistic footwear walking.

Efficacy of auxetic lattice structured shoe sole in advancing footwear comfort-From the perspective of plantar pressure and contact area.

Introduction: Designing footwear for comfort is vital for preventing foot injuries and promoting foot health. This study explores the impact of auxetic structured shoe soles on plantar biomechanics and comfort, motivated by the integration of 3D printing in footwear production and the superior mechanical properties of auxetic designs. The shoe sole designs proposed in this study are based on a three-dimensional re-entrant auxetic lattice structure, orthogonally composed of re-entrant hexagonal honeycombs with internal angles less than 90 degrees. Materials fabricated using this lattice structure exhibit the characteristic of a negative Poisson's ratio, displaying lateral expansion under tension and densification under compression. Methods: The study conducted a comparative experiment among three different lattice structured (auxetic 60°, auxetic 75° and non-auxetic 90°) thermoplastic polyurethane (TPU) shoe soles and conventional polyurethane (PU) shoe sole through pedobarographic measurements and comfort rating under walking and running conditions. The study obtained peak plantar pressures (PPPs) and contact area across seven plantar regions of each shoe sole and analyzed the correlation between these biomechanical parameters and subjective comfort. Results: Compared to non-auxetic shoe soles, auxetic structured shoe soles reduced PPPs across various foot regions and increased contact area. The Auxetic 60°, which had the highest comfort ratings, significantly lowered peak pressures and increased contact area compared to PU shoe sole. Correlation analysis showed that peak pressures in specific foot regions (hallux, second metatarsal head, and hindfoot when walking; second metatarsal head, third to fifth metatarsal head, midfoot, and hindfoot when running) were related to comfort. Furthermore, the contact area in all foot regions was significantly associated with comfort, regardless of the motion states. Conclusion: The pressure-relief performance and conformability of the auxetic lattice structure in the shoe sole contribute to enhancing footwear comfort. The insights provided guide designers in developing footwear focused on foot health and comfort using auxetic structures.

Effects of technological running shoes versus barefoot running on the intrinsic foot muscles, ankle mobility, and dynamic control: a novel cross-sectional research.

BACKGROUND: Technological running shoes have become increasingly popular, leading to improvements in performance. However, their long-term effects on foot musculature and joint mobility have not been thoroughly studied. OBJECTIVE: To compare the activation of the intrinsic foot muscles between runners wearing technological footwear and barefoot runners. Secondary objectives included assessing ankle dorsiflexion (DF) range of motion (ROM) and dynamic postural control in both groups. METHODS: A cross-sectional study was conducted involving 22 technological footwear runners and 22 barefoot runners. Ultrasonography was used to measure the thickness of the plantar fascia (PF) and the quadratus plantae (QP), abductor digiti minimus (ADM), abductor hallucis (AH), and flexor hallucis longus (FHL) muscles. Ankle mobility and dynamic postural control were also recorded. RESULTS: Ultrasonography measurements showed statistically significant differences for PF thickness (mean difference [MD]: -0.10 cm; 95% CI: -0.13, -0.05 cm), QP cross-sectional area (CSA) (MD: -0.45 cm2; 95% CI: -0.77, -0.12 cm2), ADM CSA (MD: -0.49 cm2; 95% CI: -0.70, -0.17 cm2), and FHL thickness (MD: 0.82 cm; 95% CI: 0.53, 1.09 cm), with all measurements being lower in the group wearing technological footwear compared to the barefoot runners. Ankle DF ROM was also significantly greater for the barefoot runners (MD: -5.1°; 95% CI: -8.6, -1.7°). CONCLUSIONS: These findings suggest potential implications for the foot musculature and ankle mobility in runners using technological footwear.

Footwear, Orthoses, and Insoles and Their Effects on Balance in Older Adults: A Scoping Review.

BACKGROUND: Footwear, orthoses, and insoles have been shown to influence balance in older adults; however, it remains unclear which features, singular or in combination, are considered optimal. The aim of this scoping review was to identify and synthesise the current evidence regarding how footwear, orthoses, and insoles influence balance in older adults. Four electronic databases (MEDLINE, CINAHL, Embase, and AMED) were searched from inception to October 2023. Key terms such as "shoe*," "orthoses," "postural balance" and "older people" were employed in the search strategy. Studies meeting the following criteria were included: (i) participants had a minimum age ≥60 years, and were free of any neurological, musculoskeletal, and cardiovascular diseases; (ii) an active intervention consisting of footwear, foot orthoses, or insoles was evaluated; and (iii) at least one objective outcome measure of balance was reported. SUMMARY: A total of 56 studies from 17 different countries were included. Three study designs were utilised (cross-sectional study, n = 44; randomised parallel group, n = 6; cohort study n = 6). The duration of studies varied considerably, with 41 studies evaluating immediate effects, 14 evaluating effects from 3 days to 12 weeks, and 1 study having a duration of 6 months. Seventeen different interventions were evaluated, including/consisting of textured insoles (n = 12), heel elevation (n = 8), non-specific standardised footwear and changes in sole thickness or hardness (n = 7 each), sole geometry or rocker soles, contoured or custom insoles and high collar height (n = 6 each), insole thickness or hardness and vibrating insoles (n = 5 each), outsole tread (n = 4), minimalist footwear and slippers (n = 3 each), balance-enhancing shoes, footwear fit, socks, and ankle-foot orthoses (n = 2 each), and eversion insoles, heel cups, and unstable footwear (n = 1 each). Twenty-three different outcomes were assessed, and postural sway was the most common (n = 20), followed by temporo-spatial gait parameters (n = 17). There was uncertainty regarding intervention effectiveness. Overall, features such as secure fixation, a textured insole, a medium-to-hard density midsole and a higher ankle collar, in isolation, were able to positively impact balance. Conversely, footwear with an elevated heel height and the use of socks and slippers impaired balance. KEY MESSAGES: There is a substantial body of literature exploring the effects of footwear, orthoses, and insoles on balance in older adults. However, considerable uncertainty exists regarding the efficacy of these interventions due to variability in methodological approaches. Further high-quality research is necessary to determine whether a singular intervention or a combination of interventions is most effective for enhancing balance in older adults.

Upcycling of industrial footwear waste into nonwoven fibrous structures with thermal and acoustic insulation properties.

The footwear industry significantly impacts the environment, from raw material extraction to waste disposal. Transforming waste into new products is a viable option to mitigate the environmental consequences, reducing the reliance on virgin raw materials. This work aims to develop thermal and acoustic insulation materials using polyester waste from footwear industry. Two nonwoven and two compressed nonwoven structures, comprising 80% polyester waste and 20% commercial recycled polyester (matrix), were produced. The materials were created through needle-punching and compression molding techniques. The study included the production of sandwich and monolayer nonwoven structures, which were evaluated considering area weight, thickness, air permeability, mechanical properties, morphology using field emission scanning electron microscopy, and thermal and acoustic properties. The nonwoven samples presented high tensile strength (893 kPa and 629 kPa) and the highest strain (79.7% and 73.3%) and compressed nonwoven structures showed higher tensile strength (2700 kPa and 1291 kPa) but reduced strain (25.8% and 40.8%). Nonwoven samples showed thermal conductivity of 0.041 W/K.m and 0.037 W/K.m. Compressed nonwoven samples had higher values at 0.060 W/K.m and 0.070 W/K.m. While the sample with the highest conductivity exceeds typical insulation levels, other samples are suitable for thermal insulation. Nonwoven structures exhibited good absorption coefficients (0.640-0.644), suitable for acoustic insulation. Compressed nonwoven structures had lower values (0.291-0.536), unsuitable for this purpose. In summary, this study underscores the potential of 100% recycled polyester structures derived from footwear and textile industry waste, showcasing remarkable acoustic and thermal insulation properties ideal for the construction sector.

Mathematical model for footwear upper material consumption estimation.

Appropriate material consumption estimation since the design phase for footwear fabrication is a vital issue as material costs account for a sizeable portion of the overall production cost of a pair of shoes. This paper presents a mathematical model to predict the calculation of footwear upper material consumption to improve the utilization ratio of materials through a suitable nesting map onto leather. The proposed model concentrates on the two-dimensional geometry of footwear components and the application of rich mathematical concepts. The model reflects the outlines of individual footwear components while determining the area using definite integral calculus. Five distinct rotational kinds are applied for component arrangements that correlate to the physiognomy of leather because nesting onto the leather is intractable. The simple concept of a minimal-area polygonal enclosure is applied to maximize material utilization with minimum waste. Finally, the model was verified for four consecutive Oxford footwear sizes by comparing actual upper material consumption with predicted upper material consumption. The noble contribution of this analysis is to use ImageJ software to compute upper material consumption in real case analysis through image processing techniques and separate estimation of wastes, especially the fourth waste. The results of the comparison study show that the proposed model can reduce average material requirements by 2.06 %. This minimization of waste could be beneficial in terms of economic and environmental sustainability. Therefore, this study can be applied to estimate more accurately the amount of upper material required for footwear fabrication and support better utilization of material in the footwear industry.

Role of midsole hollow structure in energy storage and return in running shoes.

Understanding the relationship between footwear features and their potential influence on running performance can inform the ongoing innovation of running footwear, aimed at pushing the limits of humans. A notable shoe feature is hollow structures, where an empty space is created in the midsole. Presently, the potential biomechanical effect of the hollow structures on running performance remains unknown. We investigated the role of hollow structures through quantifying the magnitude and timing of foot and footwear work. Sixteen male rearfoot runners participated in an overground running study in three shoe conditions: (a) a shoe with a hollow structure in the forefoot midsole (FFHS), (b) the same shoe without any hollow structure (Filled-FFHS) and (c) a shoe with a hollow structure in the midfoot midsole (MFHS). Distal rearfoot power was used to quantify the net power generated by foot and footwear together. The magnitude and timing of distal rearfoot work and ankle joint work were compared across shoe conditions. The results indicated that MFHS can significantly (p = 0.024) delay distal rearfoot energy return (3.4 % of stance) when compared to Filled-FFHS. Additionally, FFHS had the greatest positive (0.425 J/kg) and negative (-0.383 J/kg) distal rearfoot work, and the smallest positive (0.503 J/kg) and negative (-0.477 J/kg) ankle joint work among the three conditions. This showed that the size and location of the midsole hollow structure can affect timing and magnitude of energy storage and return. The forefoot hollow shoe feature can effectively increase distal rearfoot work and reduce ankle joint work during running.

Soft-Tissue Vibrations and Fatigue During Prolonged Running: Does an Individualized Midsole Hardness Play a Role?

Footwear has the potential to reduce soft-tissue vibrations (STV) but responses are highly subject-specific. Recent evidence shows that compressive garments minimizing STV have a beneficial effect on neuromuscular (NM) fatigue. The aim was to determine whether an individualized midsole hardness can minimize STV and NM fatigue during a half marathon. Twenty experienced runners were recruited for three visits: a familiarization session including the identification of midsole minimizing and maximizing STV amplitude (MIN and MAX, respectively), and two half marathon sessions at 95% of speed at the second ventilatory threshold. STV of the gastrocnemius medialis (GM) muscle, running kinetics, foot strike pattern, rating perceived exhaustion (RPE), and midsole liking were recorded every 3 km. NM fatigue was assessed on plantar flexors (PF) before (PRE) and after (POST) the half marathon. At POST, PF central and peripheral alterations and changes in contact time, step frequency, STV median frequency, and impact force frequency as well as foot strike pattern were found in both MIN and MAX. No significant differences in damping, STV main frequency, flight time, duty factor, and loading rate were observed between conditions whatever the time period. During the half marathon, STV amplitude of GM significantly increased over time for the MAX condition (+13.3%) only. Differences between MIN and MAX were identified for RPE and midsole liking. It could be hypothesized that, while significant, the effect of midsole hardness on STV is too low to substantially affect NM fatigue.

An Optical Sensor for Measuring Displacement between Parallel Surfaces.

An optoelectronic sensor was developed to measure the in-plane displacement between two parallel surfaces. This sensor used a photodetector, which was placed on one of the parallel surfaces, to measure the intensity of the red (R), green (G), blue (B), and white/clear (C) light spectra of a broad-spectrum light that was reflected off a color grid on the opposing surface. The in-plane displacement between these two surfaces caused a change in the reflected RGB and C light intensity, allowing the prediction of the displacement direction and magnitude by using a polynomial regression prediction algorithm to convert the RGB and C light intensity to in-plane displacement. Results from benchtop experiments showed that the sensor can achieve accurate displacement predictions with a coefficient of determination R2 > 0.97, a root mean squared error (RMSE) < 0.3 mm, and a mean absolute error (MAE) < 0.36 mm. By measuring the in-plane displacement between two surfaces, this sensor can be applied to measure the shear of a flexible layer, such as a shoe's insole or the lining of a limb prosthesis. This sensor would allow slippage detection in wearable devices such as orthotics, prostheses, and footwear to quantify the overfitting or underfitting of these devices.

Prototyping and Experimental Analysis of Active Offloading Footwear for Patients With Diabetes Using an Array of Magnetorheological Fluid-Based Modules.

BACKGROUND: Diabetic foot ulceration is a serious challenge worldwide which imposes an immense risk of lower extremity amputation and in many cases may lead to the death. The presented work focuses on the offloading requirements using an active approach and considers the use of magnetorheological fluid-based modules to redistribute high plantar pressures (PPs). METHODS & RESULTS: Experimentation validated a single module with a threshold peak pressure of 450 kPa, whereas an offloading test with a three-module array and complete footwear validated a maximum pressure reduction of 42.5% and 34.6%, respectively. CONCLUSION: To our knowledge, no such active and electrically controllable offloading footwear has been reported yet that has experimentally demonstrated PP reduction of more than 30% over the offloading site.

Influence of shoe upper structure on shoe microclimate and human physiological characteristics during running.

BACKGROUND: Shoes upper has been shown to affect the shoe microclimate (temperature and humidity). However, the existing data on the correlation between the microclimate inside footwear and the body's physical factors is still quite limited. OBJECTIVE: This study examined whether shoes air permeability would influence foot microclimate and spatial characteristics of lower limb and body. METHODS: Twelve recreational male habitual runners were instructed to finish an 80 min experimental protocol, wearing two running shoes with different air permeability. RESULTS: Participants wearing CLOSED upper structure shoe exhibited higher in-shoe temperature and relative humidity. Although there was no significant difference, shank temperature and metabolism in OPEN upper structure shoes were lower. CONCLUSIONS: This indicates that the air permeability of shoes can modify the microclimate of the feet, potentially affecting the lower limb temperature. This study provides relevant information for the design and evaluation of footwear.

Can the recent sex-specific evolutions in elite running performances be attributed to advanced footwear technology?

Recent improvements in elite running performances across all distances have been largely attributed to the introduction of advanced footwear technology (AFT), which features a curved and stiff plate working synergistically with a new generation of midsole foams demonstrating enhanced resilience and compliance. These recent improvements appear to be considerably more pronounced in women's events, highlighted by improvements in road racing world records by an average of 3.7% (range: 2.6%-5.2%) compared to mean progressions of 1.5% (range: 1.3%-1.9%) in the same men's events. Although there is a growing body of research investigating the mechanisms underpinning running performance enhancements derived from AFT, there remains no explanation for potential sex-based differences in their benefits. We overview the currently available evidence and highlight why the recent direction of AFT research provides a barrier to progress by focusing primarily on male athletes. We subsequently provide our perspective on why women may be benefiting from the new generation of shoes more than men, suggest potential mechanisms leading to hypotheses that need to be further investigated in upcoming studies, and finally propose that factors outside of footwear innovation may have concurrently driven the recently observed performance evolutions.

Shoe sole impedes leg muscle activation and impairs dynamic balance responding to a standing-slip.

The shoe sole is identified as a fall risk factor since it may impede the afferent information about the outside world collected by the plantar sensory units. However, no study has directly quantified how the shoe sole compromises body balance and increases fall risk. This study aimed to inspect how the sole affects human balance after an unexpected standing-slip. It was hypothesized that individuals wearing the sole, relative to their barefoot counterparts, would exhibit 1) more impaired stability and 2) disrupted lower limb muscle activation following a standing-slip. Twenty young adults were evenly randomized into two groups: soled and barefoot. The soled group wore a pair of customized 10-mm thick soles, while the other group was bare-footed. Full-body kinematics and leg muscle electromyography (EMG) were collected during a standardized and unexpected standing-slip. The EMG electrodes were placed on the tibialis anterior, gastrocnemius, rectus femoris, and biceps femoris bilaterally. Dynamic stability, spatiotemporal gait parameters, and the EMG latency of the leg muscles were compared between groups. The sole impeded the initiation of the recovery step possibly because it interfered with the accurate detection of the external perturbation and subsequently activated the leg muscles later in the soled group than in the barefoot group. As a result, individuals in the soled group experienced a longer slip distance and were more unstable than the barefoot group at the recovery foot liftoff. The findings of this study could augment our understanding of how the shoe sole impairs body balance and increases the fall risk.

Toe Box Shape of Running Shoes Affects In-Shoe Foot Displacement and Deformation: A Randomized Crossover Study.

BACKGROUND: Long-distance running is popular but associated with a high risk of injuries, particularly toe-related injuries. Limited research has focused on preventive measures, prompting exploration into the efficacy of raised toe box running shoes. PURPOSE: This study aimed to investigate the effect of running shoes with raised toe boxes on preventing toe injuries caused by distance running. METHODS: A randomized crossover design involved 25 male marathon runners (height: 1.70 ± 0.02 m, weight: 62.6 + 4.5 kg) wearing both raised toe box (extended by 8 mm along the vertical axis and 3 mm along the sagittal axis) and regular toe box running shoes. Ground reaction force (GRF), in-shoe displacement, and degree of toe deformation (based on the distance change between the toe and the metatarsal head) were collected. RESULTS: Wearing raised toe box shoes resulted in a significant reduction in vertical (p = 0.001) and antero-posterior (p = 0.015) ground reaction forces during the loading phase, with a notable increase in vertical ground reaction force during the toe-off phase (p < 0.001). In-shoe displacement showed significant decreased movement in the forefoot medial (p < 0.001) and rearfoot (medial: p < 0.001, lateral: p < 0.001) and significant increased displacement in the midfoot (medial: p = 0.002, lateral: p < 0.001). Impact severity on the hallux significantly decreased (p < 0.001), while impact on the small toes showed no significant reduction (p = 0.067). CONCLUSIONS: Raised toe box running shoes offer an effective means of reducing toe injuries caused by long-distance running.

Forensic measurement comparison of foot insole impressions.

In forensic podiatry, footprints have been shown to provide a valuable source of discriminatory information. Footprints may be found in various forms, such as bare footprints, sock-clad footprints, or as impressions on insoles within footwear. This study utilized quantitative measures of foot impressions on pairs of insoles from shoes worn by the same person from a population of 31 adults. The measurements were determined by using the Reel method and comprised measurements from the heel to the tips of the toes and width of the ball. The purpose of the study was to assess the margin of error for these measurements to determine whether they were sufficiently accurate for forensic use. A secondary purpose of this study was to determine whether the analyst's experience or lack thereof in forensic podiatry had an impact on the precision of measurement data. The insole foot impressions were assessed by two podiatrists with forensic podiatry experience in footprint analysis, footprint research, and in using the Reel method of footprint measurement, as well as by three students of podiatric medicine without any such experience. A statistical analysis of the data from the study was performed using SPSS v28 (IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp). The most reliable measurements were of forefoot width, heel to first toe, heel to second toe, and heel to fourth toe. The greatest variation occurred in the measurements of the heel to the third and fifth toes. The measurements of the forensic podiatrist analysts showed less variability than those of the podiatry students, suggesting that measurement precision is related to the experience of the analyst.

Effectiveness of footwear and foot orthoses in reducing medial metatarsophalangeal joint pressure in women with hallux valgus.

BACKGROUND: Hallux valgus is a common condition where the subluxation of the first metatarsophalangeal joint and lateral deviation of the hallux at the interphalangeal joint creates difficulty with footwear fit. Footwear and foot orthoses are commonly prescribed nonsurgical treatments for hallux valgus. RESEARCH QUESTION: Do extra-width footwear and foot orthoses influence peak pressure at the medial aspect of the metatarsophalangeal and interphalangeal joints in women with hallux valgus? METHODS: Community-dwelling women with symptomatic hallux valgus underwent gait testing when wearing their own shoes and when wearing extra-width footwear fitted with three-quarter length, arch-contouring prefabricated foot orthoses. Peak pressure (kPa) on the medial aspect of the metatarsophalangeal and medial interphalangeal joints and on the plantar surface of the foot (hallux, lesser toes, metatarsophalangeal joint 1, metatarsophalangeal joints 2-5, midfoot and heel) were measured using the novel pedar®-X system with the pedar® pad and pedar® insole, respectively (Novel, GmbH, Munich, Germany). Paired samples t-tests were used to calculate the differences between the two conditions, and the magnitude of observed differences was calculated using Cohen's d. RESULTS: We tested 28 participants (aged 44-80 years, mean 60.7, standard deviation 10.7). Compared to their own footwear, wearing the intervention footwear and orthoses was associated with a statistically significant decrease in pressure on the medial aspect of the metatarsophalangeal joint (58.3 ± 32.8 versus 42.6 ± 32.8, p=0.026, d=0.49), increased pressure under the midfoot (70.7 ± 25.7 versus 78.7 ± 23.6, p=0.029, d=0.33) and decreased pressure underneath the heel (137.3 ± 39.0 versus 121.3 ± 34.8, p=0.019, d=0.45). SIGNIFICANCE: The intervention footwear and orthoses significantly decreased peak pressure on the medial aspect of the first metatarsophalangeal joint but had no significant effect on the interphalangeal joint. Further studies are required to determine whether these changes are associated with improvements in symptoms associated with hallux valgus.