Are in-shoe pressure characteristics in symptomatic idiopathic pes cavus related to the location of foot pain?

People who have extremely high arched feet may be subject to substantial levels of foot pain, despite the lack of obvious pathology. This study sought to investigate the effect of pes cavus on pain intensity and location and on the magnitude and distribution of foot pressure. Measurements were derived from the more symptomatic foot of 130 participants with painful, idiopathic pes cavus. Data were collected using Pedar® in-shoe pressure sensors and averaged over nine randomly selected steps. Participant information, including location and intensity of pain, Foot Posture Index values and anthropometric and "quality of life" variables, were also recorded. Painful idiopathic pes cavus seems to provoke a more cautious gait pattern than normal, with reduced peak and mean pressure values, particularly in the fore- and rear-foot regions. In particular, participants with pain confined to the rear-foot exhibit an antalgic gait pattern, with lower pressure values and a longer period of foot-ground contact in the heel region than those with pain only in the fore-foot. We determined no clear predictors of pain in terms of foot posture or demographics, although people with high body mass index values are more likely to have pain in several regions. The relationship between the posture of the foot and the presentation of pain remains unclear, however we believe that the presence of heel pain in pes cavus may be more restricting than fore-foot pain

Predicting outcomes in the orthotic management of painful, idiopathic pes cavus

OBJECTIVE: People who have extremely high arched feet are subject to substantial foot pain, despite a lack of obvious pathology. Customized foot orthoses improve pain and function and reduce foot pressure, but their specificity is unclear. This study sought to identify predictive variables for improvement and to determine whether changes in foot pressure were correlated to changes in pain and function. DESIGN: Retrospective analysis of data from a randomized controlled clinical trial. SETTING: Clinical movement analysis laboratory, School of Physiotherapy, University of Sydney. PARTICIPANTS: Subjects with painful, idiopathic pes cavus. INTERVENTIONS: Sixty-six subjects received customized foot orthoses; sixty-seven subjects were allocated a sham intervention. MAIN OUTCOME MEASURES: Foot pressure data, location and intensity of pain, Foot Posture Index values, and anthropometric and quality of life variables. RESULTS: No relationship between change in foot pressure and change in symptoms was found in either group. No individual characteristics were linked to improvement. Subjects who improved most had substantial pain, lowest function scores, and lowest scores for quality of life variables at entry. There was a possible link, in the orthosis group, between improvement and pain confined to the rear-foot region. CONCLUSIONS: The mechanisms by which orthotic intervention is effective in improving pain and function in painful, idiopathic pes cavus remain unclear and equivocal. A strong placebo effect may be in place, or perhaps relatively small changes in foot pressure, even those brought about by a flexible insole with limited shock-absorbing properties, is enough to achieve a clinically meaningful change in symptoms

Effect of neutral-cushioned running shoes on plantar pressure loading and comfort in athletes with cavus feet : a crossover randomized controlled trial

Background: High injury rates observed in athletes with cavus feet are thought to be associated with elevated plantar pressure loading. Neutral-cushioned running shoes are often recommended to manage and prevent such injuries. Purpose: To investigate in-shoe plantar pressure loading and comfort during running in 2 popular neutral-cushioned running shoes recommended for athletes with cavus feet. Study Design: Controlled laboratory study. Methods: Plantar pressures were collected using the in-shoe Novel Pedar-X system during overground running in 22 athletes with cavus feet in 2 neutral-cushioned running shoes (Asics Nimbus 6 and Brooks Glycerin 3) and a control condition (Dunlop Volley). Comfort was measured using a validated visual analog scale. Results: Compared with the control, both neutral-cushioned running shoes significantly reduced peak pressure and pressure-time integrals by 17% to 33% (P <.001). The Brooks Glycerin most effectively reduced pressure beneath the whole foot and forefoot (P <.01), and the Asics Nimbus most effectively reduced rearfoot pressure (P <.01). Both neutral-cushioned running shoes reduced force at the forefoot by 6% and increased it at the midfoot by 12% to 17% (P <.05). Contact time and area increased in both neutral-cushioned running shoes (P <.01). The Asics Nimbus was the most comfortable, although both neutral-cushioned running shoes were significantly more comfortable than the control (P <.001). Conclusion: Two popular types of neutral-cushioned running shoes were effective at reducing plantar pressures in athletes with cavus feet. Clinical Relevance: Regional differences in pressure reduction suggest neutral-cushioned running shoe recommendation should shift from being categorical in nature to being based on location of injury or elevated plantar pressure

Pressure characteristics in painful pes cavus feet resulting from Charcot-Marie-Tooth disease

Charcot–Marie–Tooth (CMT) disease often presents with peripheral muscle imbalance associated with a painful cavus (medial higharched) foot deformity which becomes increasingly severe and rigid as the disease progresses. The purpose of this study was to investigate the effect of pes cavus on foot pain and dynamic plantar pressure in CMT, and to explore the relationships between plantar pressure and pain. Sixteen participants diagnosed with CMTand painful pes cavus were assessed for foot posture, ankle dorsiflexion range of motion, levels of foot pain, functional impairment, health-related quality of life and plantar pressure distribution while walking. Plantar pressure parameters (mean pressure, peak pressure, pressure–time integral) and contact duration were measured using the Novel Pedar1 in-shoe capacitance transducer system and the foot was divided into rearfoot, midfoot and forefoot regions for analysis. Increasing cavus foot deformity was associated with more widespread foot pain and increased pressure under the forefoot and midfoot regions. In contrast, peak pressure decreased under the rearfoot. Neither relationship was found between foot pain intensity and any of the pressure variables, nor was ankle dorsiflexion range of motion correlated with pain location, intensity or degree of pes cavus. Although pes cavus in CMT is associated with substantial pain and dysfunction, there is no clear link between foot pain and plantar pressure. The more severe the degree of pes cavus, however, the more pressure develops under the lateral margin of the foot; probably as a result of the changed foot-ground contact seen during gait