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Walking patterns of healthy subjects wearing rocker shoes.

We compared walking in rocker shoes with walking in athletic shoes at free and fast velocities in 15 healthy women who were between the ages of 21 and 30 years. Footswitches, electrogoniometers, surface electromyograms, and a force plate were used for data collection. No significant differences were found in velocity, cadence, gait-cycle duration, single-limb support, or swing-stance ratios in free and fast walking. Double-limb support was decreased by 9% in the rocker shoes in free walking. The ankle range of motion showed accommodation of the foot to the 8.5 degrees of plantar flexion built into the rocker shoes. Electromyographic responses appeared to be similar regardless of shoes or cadence.

Adult↗

Passive stability characteristics of ankle braces and tape in simulated barefoot and shoe conditions.

BACKGROUND: Ankle sprains are among the most common injuries in barefoot sport activities such as dance, gymnastics, or trampoline. At present, the use of external ankle devices for prevention of ligament injuries for barefoot activities remains unclear. HYPOTHESIS: External ankle devices have a significant loss of passive stability when used without a shoe in barefoot activities. STUDY DESIGN: Controlled laboratory study. METHODS: Twenty-five healthy subjects participated in the project (mean age, 26.2 +/- 3.3 years; mean body mass, 71.2 +/- 10.3 kg; mean height, 178 +/- 7 cm). Passive range of motion measurements were performed with 3 different ankle stabilizers (a stirrup brace, a lace-up brace, and tape), as well as 2 different shoe conditions (cutout shoe [simulated barefoot] and normal shoe). RESULTS: In the simulated barefoot condition, a significantly reduced stabilizing effect for inversion and eversion (19% and 29%, respectively) was found for the stirrup ankle brace. Small decreases were noted with the soft brace and tape, but these were not statistically significant. CONCLUSION: The passive stability characteristics of ankle braces depend to a great extent on being used in combination with a shoe. This is especially true for semirigid braces with stirrup design. Therefore, it is recommended that soft braces (like the one tested in the present investigation) be used in barefoot sports for restricting passive range of motion of the foot and ankle complex. CLINICAL RELEVANCE: This study provides useful information for clinicians to select or recommend an external ankle stabilizing device in barefoot sports to restrict passive range of motion of the foot-ankle complex most effectively.

Adult↗

Development of lower leg strength and flexibility with the strength shoe.

The Strength Shoe is a modified athletic shoe with a 4-cm thick rubber platform attached to the front half of the sole. It is promoted as an effective method of increasing "speed, quickness, and explosive power," as well as ankle flexibility and calf circumference, when used in a plyometrics-based training regimen. This study evaluates, in a prospective, randomized trial, the efficacy and safety of the Strength Shoe training regimen for increasing lower leg flexibility and strength in intercollegiate track and field participants. No enhancement of flexibility, strength, or performance was observed for participants wearing the Strength Shoe at the end of an 8-week training program, following the suggested regimen of the manufacturer. The use of the Strength Shoe cannot be recommended as a safe, effective training method for development of lower leg strength and flexibility. However, the use of plyometrics in a properly supervised setting may improve athletic performance and merits further investigation.

Evaluation Studies as Topic↗

Basketball shoe height and the maximal muscular resistance to applied ankle inversion and eversion moments.

To determine if the height of a basketball shoe alters the maximal inversion and eversion moment that can be actively resisted by the ankle in the frontal plane, we tested 20 healthy, young adult men with no recent ankle injuries. Subjects underwent unipedal functional ankle strength testing under weightbearing conditions at 0 degrees, 16 degrees, and 32 degrees of ankle plantar flexion using a specially designed testing apparatus. Testing was performed with the subject wearing either a low- or a three quarter-top basketball shoe. Shoe height did not significantly affect an individual's ability to actively resist an eversion moment at any angle of ankle plantar flexion. However, tests at 0 degrees of ankle plantar flexion demonstrated that the three quarter-top basketball shoe we tested significantly increased the maximal resistance to an inversion moment by 29.4%. At 16 degrees of ankle plantar flexion, inversion resistance was also significantly improved by 20.4%. These results show that athletic shoe height can significantly increase the active resistance to an inversion moment in moderate ankle plantar flexion. The findings apply to a neutral foot position in the frontal plane, an orientation equivalent to the early phase of a potential ankle sprain.

Adult↗

American Orthopaedic Foot and Ankle Society women's shoe survey.

Shoes have been implicated as being responsible for the majority of foot deformities and problems that physicians encounter in women. A total of 356 women were studied in this investigation to evaluate trends in women's shoe wear and their effect on the development of foot deformities and pain. The majority of women in this study wore shoes that were too small for their feet, had foot pain and deformity, and had increased shoe size since the age of 20. Few women had their feet measured in over 5 years. The women without foot pain or deformities also wore shoes that were smaller than their feet but to a lesser degree.

Adult↗

A comparison of the effect of shoes on human tibial axial strains recorded during dynamic loading.

Percutaneous axial extensometers were mounted on the medial cortex of the midtibial diaphysis in seven male volunteers and the effect of three different shoes on in vivo peak-to-peak axial compression-tension strains measured during dynamic loading. Zohar shoes had lower axial strains and strain rates during treadmill walking than Nike Air Max running shoes or Israeli infantry boots. During running on a running track, there was no statistically significant difference between the axial strains or strain rates between the shoes tested. Shoe gear can modify tibial strains and strain rates that contribute to the development of tibial stress fractures.

Adult↗

Self-reported occupational health hazards and measured exposures to airborne impurities and noise in shoe repair work.

The authors identified occupational risk factors of shoe repairers and measured their exposures to organic solvents, dust, chromium, degradation products of synthetic shoe materials, and noise. Exposures were measured in 11 shops selected from the workplaces of 82 repairers who responded to a questionnaire about their work environments. The questions dealt with, e.g., chemicals used, work related diseases, perceived hazards in the environment, ventilation, and use of personal protective equipment. Solvent vapor concentration averaged 1.95 (range 0.01-13.2) times the occupational limit (OL) of the mixture during gluing, with higher levels in facilities with no mechanical ventilation. TWA concentrations of organic solvents averaged 0.34 (range 0.01-1.23) times OLs in the breathing-zone samples. Of all shoe repair shops in Finland, 30% had no mechanical ventilation. Concentrations of airborne particles were 0.07-1.01 mg/m3, and those of insoluble and hexavalent chromium 0.10-0.32 and 0.01-0.08 microg/m3, respectively, near roughing, scoring and finishing machines. Several polymer degradation products were present in the air during machining of shoes. Ventilation exchange rates in shops with natural ventilation were less than once/hour. The repairers' average exposure to noise was below 85 dB. They reported many work-related diseases such as rhinitis (prevalence 21%), musculoskeletal disorders (16%), and dermatitis (9%). Measured dust concentrations were low, but the shoe repairers considered dust to be the most common hazard.

Air Pollutants, Occupational↗

Technical evaluation of a CAD system for orthopaedic shoe-upper design.

Computer aided design is now employed routinely in the volume shoe trade. New styles are developed on a three-dimensional image of the last followed by automated pattern generation and engineering. It is suggested that such systems could be useful in the orthopaedic footwear industry although the different requirements for these bespoke products need careful consideration. A clinical trial has been conducted on the Shoemaster (Clarks Shoes) upper design system both to assess its technical capabilities and to consider its role in improvement of service and cosmetic appearance. This particular system works throughout on a three-dimensional representation of the shoe last, which offers particular advantages for integration with shape capture and reproduction. The report concentrates on the technical evaluation to assess (a) its ability to work with unusual last shapes dictated by medical requirements and (b) its potential for integration into a complete computer system for design of both shoe lasts and shoe uppers. The trial indicates that this particular system is promising in both respects.

Adult↗

Effects of shoe type on cardiorespiratory responses and rearfoot motion during treadmill running.

Running kinematics and physiological responses to high intensity submaximal treadmill running in training shoes and racing flats were evaluated. Eight women (mean age = 21.9 yr) completed a peak VO2 test on the treadmill (mean peak VO2 = 49.2 ml.kg-1.min-1). In two subsequent testing sessions, subjects completed 15-min runs at a speed corresponding to 90% of peak VO2 (range = 9.9-13.4 km.hr-1) while wearing training shoes and racing flats (balanced order assignment). No significant time effect or time by shoe condition interaction was observed for the rearfoot motion variables. Maximum rearfoot angle and total rearfoot motion averaged 42% and 13.9% higher, respectively, for the racing flat (P less than 0.05). There were significant increases over time for VO2, VE, HR, and RPE, indicating an increase in cardiorespiratory response and the perception of effort over the course of the 15-min run. Thus, metabolic and perceptual indications of fatigue at the end of the run emerged but were not accompanied by rearfoot motion changes in either running shoe. These results indicate that rearfoot motion is a function of shoe design and did not change during 15 min of high intensity running.

Adult↗

Unstable shoe construction and reduction of pain in osteoarthritis patients.

PURPOSE: The purposes of this study were to assess a) the effectiveness of Masai Barefoot Technology (MBT) shoe in reducing knee pain in persons with knee osteoarthritis (OA) and (b) changes in balance, ankle and knee ROM, and ankle strength compared with a high-end walking shoe for 12 wk. METHODS: The research design was a randomized controlled trial (123 subjects, knee OA). Subjects were randomized to a MBT (N = 57) or a control shoe (N = 66). A Western Ontario and McMaster Universities (WOMAC) OA index, BMI, balance, active ROM, and ankle torque were quantified at week 0, 3, 6, 9, and 12. Two-sample t-tests were done for between-group comparisons. RESULTS: There was no significant difference between groups in total pain score. A significant reduction over the 12-wk period was found for both shoe conditions (-42/500 or 25.6% MBT, -46.2 or 27.1% control). There was no significant group difference in pain during walking (t = -1.09, P = 0.28). Pain during walking was significantly reduced by 5.2/100 mm in the MBT and 9.7/100 mm in the control group. Total pain showed a significant reduction for the MBT -27.4/500 (-16.6%) and the control group -28.9/500 (-17.0%) between baseline and week 3. Between week 3 and 6, there was a significant reduction for the MBT group only (-27.2/500 or -20.0%). There was a significant increase in the static balance between baseline and 12 wk in the MBT group only, although the difference between groups was not significant. DISCUSSION: The results indicate that special shoe interventions can reduce pain in subjects with moderate knee OA.

Adult↗

Effects of shoe heel height on biologic rollover characteristics during walking.

This study investigated the effects of shoe heel height on the rollover characteristics of the biologic ankle-foot system. Ten nondisabled adult female volunteers walked using three pairs of shoes with varying heel heights and at three walking speeds with each pair of shoes. Kinematic and kinetic data needed to calculate the rollover shapes of the ankle-foot systems of the participants were collected. Rollover shapes are the effective rocker geometries that ankle-foot systems conform to between heel contact and opposite heel contact. Parameters of the best-fit circular arcs to the rollover shapes were used in an examination of the effects of shoe heel height on the ankle-foot system. The results support the notion that nondisabled humans automatically adapt their ankle-foot systems to accommodate a range of shoe heel heights, resulting in rollover shapes that do not change appreciably. Given physiologic constraints, this adaptation may not be possible for very high heels.

Adult↗

Manufactured shoes in the prevention of diabetic foot ulcers.

OBJECTIVE: To evaluate the efficacy of manufactured shoes specially designed for diabetic patients (Podiabetes by Buratto Italy) to prevent relapses of foot ulcerations. RESEARCH DESIGN AND METHODS: A prospective multicenter randomized follow-up study of patients with previous foot ulcerations was conducted. Patients were alternatively assigned to wear either their own shoes (control group, C; n = 36) or therapeutic shoes (Podiabetes group, P; n = 33). The number of ulcer relapses was recorded during 1-year follow-up. RESULTS: Both C and P groups had similar risk factors for foot ulceration (i.e., previous foot ulceration, mean vibratory perception threshold > 25 mV). After 1 year, the foot ulcer relapses were significantly lower in P than in C (27.7 vs. 58.3%; P = 0.009; odds ratio 0.26 [0.2-1.54]). In a multiple regression analysis, the use of therapeutic shoes was negatively associated with foot ulcer relapses (coefficient of variation = -0.315; 95% confidence interval = -0.54 to -0.08; P = 0.009). CONCLUSIONS: The use of specially designed shoes is effective in preventing relapses in diabetic patients with previous ulceration.

Confidence Intervals↗

Compensation for changes in hoof conformation between shoeing sessions through the adaptation of angular kinematics of the distal segments of the limbs of horses.

OBJECTIVE: To determine the mechanism that enables horses to partially counteract the shift of the center of pressure under the hoof induced by changes in hoof morphology attributable to growth and wear during a shoeing interval. ANIMALS: 18 clinically sound Warmblood horses. PROCEDURES: Horses were evaluated 2 days and 8 weeks after shoeing during trotting on a track containing pressure-force measuring plates and by use of a synchronous infrared gait analysis system set at a frequency of 240 Hz. All feet were trimmed toward straight alignment of the proximal, middle, and distal phalanges and shod with standard flat shoes. Results-Temporal characteristics such as stance time and the time between heel lift and toe off (ie, breakover duration) did not change significantly as a result of shoeing interval. Protraction and retraction angles of the limbs did not change. Compensation was achieved through an increase in the dorsal angle of the metacarpohalangeal or metarsophalangeal (fetlock) joint and a concomitant decrease of the dorsal angle of the hoof wall and fetlock. There was an additional compensatory mechanism in the hind limbs during the landing phase. CONCLUSIONS AND CLINICAL RELEVANCE: Horses compensate for changes in hoof morphology that develop during an 8-week shoeing interval such that they are able to maintain their neuromuscular pattern of movement. The compensation consists of slight alterations in the angles between the distal segments of the limb. Insight into natural compensation mechanisms for hoof imbalance will aid in the understanding and treatment of pathologic conditions in horses.

Animals↗

Maternal shoe size and infant birth weight: correlation or fiction?

OBJECTIVE: To determine whether maternal prepregnancy shoe size can be used to reliably predict infant birth weight. METHOD: This is a cross-sectional study of 111 consecutive patients admitted to the maternity care unit of a small community hospital. Data collected included prepregnancy height, maternal weight, maternal shoe size, maternal age, gravidity, parity, ethnicity, and method of delivery. Infant birth weight was recorded within the first 2 hours of life. RESULTS: There was no correlation between maternal shoe size and birth weight (r = 0.01; P = NS). There was no correlation between shoe size and birth weight when corrected for parity and ethnicity. CONCLUSION: There is no correlation between maternal shoe and infant birth weight. This anthropometric measure should not be used to estimate infant birth weight.

Adult↗

Metatarsalgia and rheumatoid arthritis--a randomized, single blind, sequential trial comparing 2 types of foot orthoses and supportive shoes.

OBJECTIVE: To compare the effects of semi-rigid and soft orthoses worn in supportive shoes, and supportive shoes worn alone, on metatarsal phalangeal (MTP) joint pain. MTP joint synovitis, and lower extremity function in patients with rheumatoid arthritis. METHODS: Twenty-eight subjects referred to occupational therapy received in random order 3 interventions for 12 week trials, separated by 2 week washouts. A crossover design compared effectiveness of interventions. RESULTS: Twenty-four subjects completed the study. A reduction in mean pain scores from baseline to final visits showed that semi-rigid orthoses had a highly significant effect on pain. Soft orthoses did not show a significant effect on pain from baseline to final visit, nor did shoes worn alone. None of the interventions had a significant effect on synovitis or function. CONCLUSION: Semi-rigid orthoses worn in supportive shoes were an effective treatment for metatarsalgia. Supportive shoes worn alone or worn with soft orthoses did not provide pain relief for metatarsalgia.

Adult↗

Questionnaire study of the use of surgical shoes prescribed in a rheumatology outpatient clinic.

Our questionnaire study was undertaken to ascertain the proportion of patients who use an appliance and to what extent, up to a year after being prescribed. Twenty-four percent no longer used the appliance. Two-thirds wore their orthosis for more than 6 hours/day. Half the patients had surgical shoes--moulded and bespoke, most found their shoes of benefit. Moulded shoes were found to be worn more frequently and to be more comfortable, easier to put on and more attractive. Patients reported a significantly greater improvement in their condition with moulded shoes than with bespoke shoes.

Adult↗

Common shoe allergens undetected by commercial patch-testing kits: dithiodimorpholine and isocyanates.

The diagnosis of allergic contact dermatitis of the feet is challenging because the constituents of shoes are not labeled. In addition, the materials and technologies used in the manufacturing of shoes are continuously evolving. Since the 1950s, rubber allergens have been the most common cause of shoe dermatitis. However, the causal allergens in rubber have changed. Instead of 2-mercaptobenzothiazole, dithiodimorpholine, an allergen that is not contained on standard patch-testing trays, now may be one of the more common rubber sensitizers in shoes. Other allergens not found on standard series that can account for shoe dermatitis include isophorone diisocyanate, dimethylaminoethyl ether, and mixed dialkyl thioureas. Therefore, physicians evaluating patients with allergic-appearing foot dermatitis need to test with allergens beyond those present on standard screening series.

Allergens↗

[Compensation in leg length inequality with orthopedic shoe measures].

There are three different methods of compensating for differences in leg length. The first is the construction of special shoes, which is adequate for differences of up to about 3 cm. The heels can be either higher or lower, or a cork sole 5-10 mm thick can be incorporated, the shaft made higher, and supplementary features, such as aids to push-off, can also be implemented. The second method is the wearing of the classic orthopedic boot or shoe, in which the necessary compensation for the shorter leg is incorporated as a part of the orthopedic footwear. The third method is the construction of a shoe within a shoe, for which different designs have crystallized out for the five groups presented. All designs incorporate leather, the tried and tested material, next to the skin. Stabilizing components are made of fiberglass-reinforced synthetic resin or Thermoplast. New materials allow aesthetically acceptable orthopedic footwear. On average, such shoes are 25% lighter than conventional orthopedic boots. The stability and wear-resistance allow large perforations and open-toe designs, which has made it possible to solve the problem of ventilation.

Artificial Limbs↗