The effect of aging, obesity and diabetes on foot health and its association with current and future footwear technologies

Changes in foot health trends are beginning to demand significant changes to foot health provision globally, for which appropriate provision to retail and health services is key. With the right input to innovation and design, footwear can help keep us fit and active and contribute to our overall wellbeing, creating exciting opportunities for the footwear market. Likewise, the development of orthotic materials, designs and manufacturing processes is enabling more complex solutions to equally complex developing foot conditions. There are three key issues driving the demand for specific footcare; the global increase in the number of people with diabetes, those who are obese and the fact we are all living longer. The populations of diabetic, elderly and obese adults require specific footcare solutions to meet the specific characteristics of their foot health issues such as wider-fit footwear and pressure relieving orthotic materials. Characteristics of these populations' feet relating to their morphology, tissue characteristics, vascular supply and sensation impact on their requirements from footwear. Additional characteristics relating to their overall health such as excess mass and instability additionally impact on the wear on the loading of the footwear and design features which may be beneficial

Professional appraisal of online information about children’s footwear measurement and fit : readability, usability and quality

Parents increasingly use the internet to seek health information, share information and for purchasing textiles and footwear. This shift in footwear purchasing habits raises concern about how (and if) parents are getting their children's feet measured, and what support strategies are in place to support the fit of footwear. In response to this, some companies and healthcare organisations have developed resources to support home measurement of foot size, and link these measures to footwear selection, measurement and fitting. The aim of this research was to undertake an appraisal of web-based resources about measurement and fit of children's footwear, focussing specifically on readability, usability and quality. Search terms relating to children's foot measurement were compiled and online searching was undertaken. Search results were saved and screened for relevance. Existing resources were categorised based on their source e.g. a footwear company or a health website. The 15 most commonly identified resources were reviewed by a professional panel for readability, content, usability and validity. One researcher also assessed the accessibility and reading ease of the resources. Online resources were predominantly from commercial footwear companies (54%). Health information sources from professional bodies made up 4.2% of the resources identified. The top 15 resources had appropriate reading ease scores for parents (SMOG Index 4.3-8.2). Accessibility scores (the product of the number of times it appeared in search results and its ranking in the results) were highest for commercial footwear companies. The panel scores for readability ranged from 2.7 to 9 out of 10, with a similar range for content, usability and validity. Information for parents seeking to purchase footwear for their children is readily available online but this was largely dominated by commercial footwear companies. The quality and usability of this information is of a moderate standard; notable improvements could be made to the validity of the task the child is asked to undertake and the measures being taken. Improvements in these resources would improve the data input to the selection of footwear and therefore have a beneficial impact on footwear fit in children. [Abstract copyright: © The Author(s). 2020.

Symptomatic pes planus in children : a synthesis of allied health professional practices

This study sought to explore professional perspectives on the assessment and management of symptomatic pes planus in children. Data was collected from three professional groups (podiatrists, physiotherapists, and orthotists) with experience of managing foot problems in children. The survey was undertaken in the United Kingdom via a self-administered, online survey. Data was captured over a four-month period in 2018. Fifty-five health professionals completed the survey and the results highlighted that assessment techniques varied between professions, with standing tip-toe and joint range of motion being the most common. Treatment options for children were diverse and professionals were adopting different strategies as their first line intervention. All professions used orthoses. There were inconsistencies in how the health professionals assessed children presenting with foot symptoms, variation in how the condition was managed and differences in outcome measurement. These findings might be explained by the lack of robust evidence and suggests that more effort is needed to harmonise assessment and treatment approaches between professions. Addressing discrepancies in practice could help prioritise professional roles in this area, and better support the management of children with foot pain. [Abstract copyright: © The Author(s). 2020.

Automated design of robust discriminant analysis classifier for foot pressure lesions using kinematic data

In the recent years, the use of motion tracking systems for acquisition of functional biomechanical gait data, has received increasing interest due to the richness and accuracy of the measured kinematic information. However, costs frequently restrict the number of subjects employed, and this makes the dimensionality of the collected data far higher than the available samples. This paper applies discriminant analysis algorithms to the classification of patients with different types of foot lesions, in order to establish an association between foot motion and lesion formation. With primary attention to small sample size situations, we compare different types of Bayesian classifiers and evaluate their performance with various dimensionality reduction techniques for feature extraction, as well as search methods for selection of raw kinematic variables. Finally, we propose a novel integrated method which fine-tunes the classifier parameters and selects the most relevant kinematic variables simultaneously. Performance comparisons are using robust resampling techniques such as Bootstrap$632+$and k-fold cross-validation. Results from experimentations with lesion subjects suffering from pathological plantar hyperkeratosis, show that the proposed method can lead to$sim 96$correct classification rates with less than 10% of the original features

Validity and repeatability of three in-shoe pressure measurement systems

In-shoe pressure measurement devices are used in research and clinic to quantify plantar foot pressures. Various devices are available, differing in size, sensor number and type; therefore accuracy and repeatability. Three devices (Medilogic, Tekscan and Pedar) were examined in a 2 day×3 trial design, quantifying insole response to regional and whole insole loading. The whole insole protocol applied an even pressure (50-600kPa) to the insole surface for 0-30s in the Novel TruBlue™ device. The regional protocol utilised cylinders with contact surfaces of 3.14 and 15.9cm(2) to apply pressures of 50 and 200kPa. The validity (% difference and Root Mean Square Error: RMSE) and repeatability (Intra-Class Correlation Coefficient: ICC) of the applied pressures (whole insole) and contact area (regional) were outcome variables. Validity of the Pedar system was highest (RMSE 2.6kPa; difference 3.9%), with the Medilogic (RMSE 27.0kPa; difference 13.4%) and Tekscan (RMSE 27.0kPa; difference 5.9%) systems displaying reduced validity. The average and peak pressures demonstrated high between-day repeatability for all three systems and each insole size (ICC≥0.859). The regional contact area % difference ranged from -97 to +249%, but the ICC demonstrated medium to high between-day repeatability (ICC≥0.797). Due to the varying responses of the systems, the choice of an appropriate pressure measurement device must be based on the loading characteristics and the outcome variables sought. Medilogic and Tekscan were most effective between 200 and 300kPa; Pedar performed well across all pressures. Contact area was less precise, but relatively repeatable for all systems

The effect of dual tasking on foot biomechanics in people with functional ankle instability

Background: Some cases of repeated inversion ankle sprains are thought to have a neurological basis and are termed functional ankle instability (FAI). In addition to factors local to the ankle, such as loss of proprioception, cognitive demands have the ability to influence motor control and may increase the risk of repetitive lateral sprains. Objective: The purpose of this study was to investigate the effect of cognitive demand on foot kinematics in physically active people with functional ankle instability. Methods: 21 physically active participants with FAI and 19 matched healthy controls completed trials of normal walking (single task) and normal walking while performing a cognitive task (dual task). Foot motion relative to the shank was recorded. Cognitive performance, ankle kinematics and movement variability in single and dual task conditions was characterized. Results: During normal walking, the ankle joint was significantly more inverted in FAI compared to the control group pre and post initial contact. Under dual task conditions, there was a statistically significant increase in frontal plane foot movement variability during the period 200ms pre and post initial contact in people with FAI compared to the control group (p<0.05). Dual task also significantly increased plantar flexion and inversion during the period 200ms pre and post initial contact in the FAI group (p<0.05). Conclusion: participants with FAI demonstrated different ankle movement patterns and increased movement variability during a dual task condition. Cognitive load may increase risk of ankle instability in these people

Variability in foot contact patterns in independent walking in infants

The purpose of this work was to quantify plantar pressures and contact areas (and variability thereof) in natural independent walking in infants

Contributions of foot muscles and plantar fascia morphology to foot posture

Background: The plantar foot muscles and plantar fascia differ between different foot postures. However, how each individual plantar structure contribute to foot posture has not been explored. The purpose of this study was to investigate the associations between static foot posture and morphology of plantar foot muscles and plantar fascia and thus the contributions of these structures to static foot posture. Methods: A total of 111 participants were recruited, 43 were classified as having pes planus and 68 as having normal foot posture using Foot Posture Index assessment tool. Images from the flexor digitorum longus (FDL), flexor hallucis longus (FHL), peroneus longus and brevis (PER), flexor hallucis brevis (FHB), flexor digitorum brevis (FDB) and abductor hallucis (AbH) muscles, and the calcaneal (PF1), middle (PF2) and metatarsal (PF3) regions of the plantar fascia were obtained using a Venue 40 ultrasound system with a 5–13 MHz transducer. Results: In order of decreasing contribution, PF3&gt;FHB&gt;FHL&gt;PER&gt;FDB were all associated with FPI and able to explain 69% of the change in FPI scores. PF3 was the highest contributor explaining 52% of increases in FPI score. Decreased thickness was associated with increased FPI score. Smaller cross sectional area (CSA) in FHB and PER muscles explained 20% and 8% of increase in FPI score. Larger CSA of FDB and FHL muscles explained 4% and 14% increase in FPI score respectively. Conclusion: The medial plantar structures and the plantar fascia appear to be the major contributors to static foot posture. Elucidating the individual contribution of multiple muscles of the foot could provide insight about their role in the foot posture