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PubMed1995

Analysis of foot shape variation based on the medial axis of foot outline.

The variations in foot outline forms are analyzed by using flexion angles of the medial axis of foot outline. Foot outline and 12 conventional measurements taken on the right foot of 443 male and 297 female subjects with no visible pathological deformation of the foot were used for analyses. The results indicate that the foot is outflared in most of the subjects. Medial bulge and lateral concavity of foot outline are responsible for the foot outflare, and they are not correlated with each other. Medial bulge is due to the overhang of navicular bone that is caused by the pronation of the foot. Its intensity is negatively correlated with dorsal arch height. Lateral concavity is partly due to the abduction of talus and calcaneus relative to the tarsometatarsal bones anterior to them. These three-dimensional morphological characteristics of outflared feet intimately relate to the fit and comfort of the shoe. The flexion angles of medial axis of foot outline provide a useful tool in morphological analysis of the foot for the following reasons; (1) they carry the information on the three-dimensional foot shape that cannot be represented by conventional measurements; and (2) the data is easily obtained and calculations are easily made with minimum expense.

Adult↗
PubMed1998

The effect of foot structure on the three-dimensional kinematic coupling behavior of the leg and rear foot.

BACKGROUND AND PURPOSE: Differences in foot structures have been reported to account for the large variability in findings in previous studies that have examined the relationship between foot structure and the interdependent rotations of the lower extremity. The purpose of this study was to determine, in individuals with radiographically distinct foot structures, the effect of foot structure on three-dimensional kinematic behavior of the leg and rear foot during running. SUBJECTS AND METHODS: Based on radiographic measurements, 10 recreational runners were assigned to a low rear-foot group and another 10 recreational runners were assigned to a high rear-foot group. Three-dimensional kinematic data were collected during treadmill running. Individual axis rotations and the "coupled" relationship between the leg and rear-foot segments were defined using a Cardan angle system of three ordered rotations. RESULTS: The predominant rotations suggest a combined subtalar and talocalcaneal joint axis to favor calcaneal eversion and inversion for the low rear-foot group and tibial medial and lateral rotation for the high rear-foot group. Group differences were also found for the coupling ratio, which described the proportion of calcaneal eversion and inversion transferred or coupled to tibial axial rotation. CONCLUSION AND DISCUSSION: The rotational patterns and coupling response unique to each foot group may enhance our understanding of lower-extremity injuries related to certain foot structures. An assessment of the coupling relationship in combination with traditional frontal-plane measurements may better guide decisions regarding selection of footwear and orthoses.

Adolescent↗
PubMedDate not supplied

Foot bearing pressure in patients with unilateral diabetic foot ulcers.

Foot ulceration due to neuropathy is a serious cause of morbidity in diabetes. Ulceration usually occurs at the part of the foot subjected to excessive mechanical pressure. A more generalized increase in pressure under the feet has also been shown to be a feature of many patients with diabetic neuropathy. In this study the electrodynogram was used to measure the pressure at seven positions under each foot. The maximum vertical foot bearing pressure was found to be higher in 11 diabetic patients with previously healed unilateral foot ulcers (10.6 +/- 5.9 kg cm-2) than in 11 diabetic patients who did not have such a history (4.2 +/- 1.3 kg cm-2). However there was no difference in pressure between the foot with previous ulceration and the contralateral foot (9.7 +/- 6.8 kg cm-2, 11.6 +/- 7.9 kg cm-2). Vertical foot bearing pressure was decreased by an average of 18% by wearing shoes padded with a Professional Protective Technology insole and the decrease was greater in patients with higher foot pressure. These results showed that increased vertical foot pressure is an important, but not the only, factor in determining the occurrence of foot ulcer.

Body Weight↗
PubMed1993

Dynamics of below-knee child amputee gait: SACH foot versus Flex foot.

Gait kinematics and dynamics during stance of unilateral, below-knee child amputees were analyzed for self-selected, comfortable (0.9 m s-1) and fast (1.3 m s-1) speeds with the SACH foot and the energy-storing Flex-foot prostheses. The three-dimensional movements of the lower limbs were recorded and synchronized with ground reaction forces for 12 subjects (7 girls and 5 boys, ages 6-16 yr). Each lower limb was modeled as a set of interconnected rigid links (thigh, leg, and foot) with frictionless joints (hip, knee, and ankle) to calculate moment and joint power profiles. Marked asymmetries were noted in ground reaction force, joint moment, and power profiles for the prosthetic versus the natural limb, but with the Flex foot the asymmetries were less pronounced than with the SACH foot. For the amputee wearing the Flex foot, greater moments and power were generated by the natural limb at the comfortable pace as compared to the SACH foot, but during fast walking, the SACH foot required greater output from the natural limb. With both prostheses, for the prosthetic limb the amputees used similar force, moment, and power patterns, but with significantly different amplitudes. At both speeds of walking, the Flex foot returned significantly more energy (66% at comfortable and 70% at fast walking) than the SACH foot (21% at comfortable and 19% at fast walking). Thus, the Flex foot had a greater potential for reducing the energy cost of walking at comfortable and fast speeds for the below-knee child amputee.

Adolescent↗
PubMedDate not supplied

Foot education improves knowledge and satisfaction among patients at high risk for diabetic foot ulcer.

PURPOSE: The purpose of this study was to evaluate an intensive diabetes foot education program for veterans at high risk for foot ulcer. METHODS: We invited 100 consecutive patients with diabetes from a Department of Veterans Affairs Medical Center clinic who were insensate to the Semmes-Weinstein 5.07 monofilament to participate in a foot care education program. Two sessions were conducted by a nurse diabetes educator 3 months apart. Multiple educational approaches were used to teach patients foot self-examination, foot washing, proper footwear, and encouragement in enlisting proper physician foot care. Knowledge and satisfaction with care was measured before and after each visit. RESULTS: The 34 patients who attended both education sessions improved their foot care knowledge over the course of the program. After the second session, the mean improvement over baseline was 14%. These patients also reported improved satisfaction with foot care; mean improvement was 33%. CONCLUSIONS: An intensive education program improved the foot care knowledge and behavior of high-risk patients. Those who adhered to a foot care education program were more satisfied with their foot care than prior to the program. Ways to improve accessibility of education sessions must be explored.

Adult↗
PubMed2006

Preservation of residual foot length in partial foot amputation: a biomechanical analysis.

BACKGROUND: Partial foot amputation may be preferred to more proximal amputation because of the perceived improvement in function associated with preserving foot length and the ankle joint complex, thus enabling normal gait and push-off. Clinically, partial foot amputees display significant wasting of the triceps surae musculature, strongly indicative of disuse. This investigation aimed to examine the belief that preserving residual foot length should be the primary operative objective necessary to maintain normal foot and ankle function. METHOD: The gait patterns of eight partial foot amputees and a cohort of matched non-amputee control subjects were analyzed using a peak three-dimensional (3D) motion analysis system incorporating an AMTI force platform (Advanced Mechanical Technology Inc., Waterton, MA). Amputee subjects used their own prostheses for the evaluation. RESULTS: Amputations disarticulating the metatarsophalangeal (MTP) joint had little impact on the normal pattern of ankle power generation. However, amputation proximal to the MTP joint level resulted in virtually negligible power generation across the ankle, regardless of residual foot length. Subjects compensated for the lack of ankle power generation by adopting strategies in which the hip became the primary source of power to advance the body forward. CONCLUSIONS: The primary reason for a partial foot amputation is to preserve the normal function of the foot and ankle complex associated with push-off. As such, surgery should strive to preserve the metatarsal heads to allow amputees to use the ankle's contribution to walking. Given that amputation proximal to the metatarsal heads compromised the normal propulsive function of the foot and ankle, surgery should not strive to preserve residual foot length to maintain function but should instead aim to achieve good distal tissue coverage and healing, particularly given that the hip joint(s), not the ankle, become the primary source of power for walking.

Adult↗
PubMed2000

Biomechanical evaluation of foot pressure and loading force during gait in rheumatoid arthritic patients with and without foot orthosis.

Foot orthoses are commonly used in patients with rheumatoid arthritis (RA) to support the foot and relieve pain, however little is known about the biomechanical effects of in-shoe foot orthoses in reducing or redistributing high pressures and loading forces. The purpose of this study was to compare the foot pressures and loading forces during gait in rheumatoid arthritic patients and healthy subjects, and evaluate the biomechanical effects of the foot orthoses in the RA patients. Twelve female RA patients with foot pain in walking, all Steinbrocker class II, and 8 healthy women without foot pain were matched for age. Foot pressures and loading forces with and without orthoses were measured using the F-Scan program. The pressure distributions and loading forces were standardized by the body weight and compared, and the effects of the foot orthoses were evaluated. The foot orthoses of RA patients provided higher pressure reduction than those of the control group (3.00 +/- 0.38 g/cm2/BW and 3.29 +/- 0.29 g/cm2/BW respectively, p < 0.001). Similar redistribution of plantar pressures and loading forces were found between two groups but the RA patients had a greater change at the stance phase of gait (p < 0.0001). The foot orthosis produces greater pressure and loading force relief and redistribution in RA patients than in normal subjects.

Adult↗
PubMed2006

Effect of foot shape on the three-dimensional position of foot bones.

To eliminate some of the ambiguity in describing foot shape, we developed three-dimensional (3D), objective measures of foot type based on computerized tomography (CT) scans. Feet were classified via clinical examination as pes cavus (high arch), neutrally aligned (normal arch), asymptomatic pes planus (flat arch with no pain), or symptomatic pes planus (flat arch with pain). We enrolled 10 subjects of each foot type; if both feet were of the same foot type, then each foot was scanned (n=65 total). Partial weightbearing (20% body weight) CT scans were performed. We generated embedded coordinate systems for each foot bone by assuming uniform density and calculating the inertial matrix. Cardan angles were used to describe five bone-to-bone relationships, resulting in 15 angular measurements. Significant differences were found among foot types for 12 of the angles. The angles were also used to develop a classification tree analysis, which determined the correct foot type for 64 of the 65 feet. Our measure provides insight into how foot bone architecture differs between foot types. The classification tree analysis demonstrated that objective measures can be used to discriminate between feet with high, normal, and low arches.

Biomechanical Phenomena↗
PubMed2002

The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort.

AIMS: To determine the incidence of, and clinically relevant risk factors for, new foot ulceration in a large cohort of diabetic patients in the community healthcare setting. METHODS: Diabetic patients (n = 9710) underwent foot screening in six districts of North-west England in various healthcare settings. All were assessed at baseline for demographic information, medical and social history, neuropathy symptom score, neuropathy disability score, cutaneous pressure perception (insensitivity to the 10 g monofilament), foot deformities, and peripheral pulses. Two years later, patients were followed up via postal questionnaire to determine the incidence of new foot ulcers. Cox's proportional hazards regression analysis was used to determine the independent, relative risk of baseline variables for new foot ulceration. RESULTS: New foot ulcers occurred in 291/6613 patients who completed and returned their 2-year follow-up questionnaire (2.2% average annual incidence). The following factors were independently related to new foot ulcer risk: ulcer present at baseline (relative risk (95% confidence interval)) 5.32 (3.71-7.64), past history of ulcer 3.05 (2.16-4.31), abnormal neuropathy disability score (> or = 6/10) 2.32 (1.61-3.35), any previous podiatry attendance 2.19 (1.50-3.20), insensitivity to the 10 g monofilament 1.80 (1.36-2.39), reduced pulses 1.80 (1.40-2.32), foot deformities 1.57 (1.22-2.02), abnormal ankle reflexes 1.55 (1.01-2.36) and age 0.99 (0.98-1.00). CONCLUSIONS: More than 2% of community-based diabetic patients develop new foot ulcers each year. The neuropathy disability score, 10 g monofilament and palpation of foot pulses are recommended as screening tools in general practice.

Adolescent↗
PubMed2004

Muscle weakness and foot deformities in diabetes: relationship to neuropathy and foot ulceration in caucasian diabetic men.

OBJECTIVE: To examine the relationships among muscle weakness, foot deformities, and peroneal and tibial nerve conduction velocity in diabetic and nondiabetic men. RESEARCH DESIGN AND METHODS: A neuropathic and foot evaluation was undertaken in 10 nondiabetic control subjects (group C) and in 36 consecutive diabetic patients attending Diabetes Centre clinics, including 10 diabetic control subjects (group D), 15 diabetic neuropathic patients (group DN), and 11 diabetic patients with a history of ulceration (group DU). Neuropathy was defined as a peroneal motor nerve conduction <40 m/s. Muscle weakness was assessed in seven intrinsic and seven extrinsic muscles of the foot using a semiquantitative score (max score per muscle = 3). Foot deformities were assessed using a foot deformity score (max score = 3). A higher score indicated increased muscle weakness or more severe foot deformities. Muscle weakness and foot deformities were assessed without prior knowledge of patient and neuropathy status. RESULTS: Peroneal and tibial nerve conduction velocity were associated with weakness in muscles innervated by, respectively, the peroneal and tibial nerve (r = -0.70 and r = -0.51, P < 0.01) and foot deformities (r = -0.60 and r = -0.59, P < 0.001). The DN and DU groups had more weakness in intrinsic and extrinsic muscles compared with the C and D groups. Muscles innervated by the tibial nerve had a greater proportional muscle weakness than those innervated by the peroneal nerve in the DN and DU groups. The DN and DU patients had more foot deformities (median food deformity score [interquartile range]) (3 [2-3] and 2 [2-3]) compared with D and C patients (0 [0-0.75] and 0 [0-0]). CONCLUSIONS: Important relationships have been shown between motor nerve conduction deficit and muscle weakness; however, it is still not clear whether abnormal nerve function, leading to a decrease in muscle strength, could be responsible for the development of foot deformities.

Diabetic Foot↗
PubMed2000

The acute effects of intermittent pneumatic foot versus calf versus simultaneous foot and calf compression on popliteal artery hemodynamics: a comparative study.

INTRODUCTION: Intermittent pneumatic compression (IPC) is currently being investigated with respect to its effect on distal arterial volume flow in patients with peripheral vascular disease. Recently published data have shown a substantial acute enhancement in arterial calf inflow in response to IPC of the lower limb in both intermittent claudication and leg ischemia. PURPOSE: The aim of the study was to compare the immediate effects of intermittent pneumatic foot (IPC(foot)) versus calf (IPC(calf)) versus simultaneous foot and calf compression (IPC(foot+calf)) on popliteal artery hemodynamics in patients with intermittent claudication (Fontaine II) and in normal subjects, using duplex ultrasonography. For this purpose, 25 limbs of 20 healthy subjects (age range [mean], 51-74 [64] years) and 31 limbs of 25 claudicants (age range [mean], 56-81 [66.5] years; resting ankle-brachial indices, 0.38-0.75 [0.55]) were examined in the sitting position with and without IPC compression. RESULTS: Mean popliteal artery flow in healthy subjects increased by 98.8% on application of IPC(foot), 188% with IPC(calf), and 274% with IPC(foot+calf) (all P <.001). Mean flow in claudicants increased by 58% on application of IPC(foot), 132% with IPC(calf), and 174% with IPC(foot+calf) (all P <.001). The mean velocity, peak systolic velocity, and end diastolic velocity displayed a pattern of change similar to that for volume flow in both groups. Pulsatility index decreased in both groups on application of IPC; the lowest values were generated with IPC(foot+calf). CONCLUSION: Of the three compression modes investigated, IPC(foot+calf) was the most effective means of acutely augmenting arterial calf inflow in arteriopaths and normals. The significant increase in end diastolic velocity and decrease in pulsatility index indicate that peripheral vasodilatation is the central mechanism in this impulse-related flow augmentation. Prospective trials are indicated to determine the clinical potential of the long-term effects of IPC(foot+calf) in patients with symptomatic peripheral vascular disease.

Aged↗
PubMed2005

Foot musculoskeletal disorders, pain, and foot-related functional limitation in older persons.

OBJECTIVES: To examine whether common musculoskeletal disorders of feet are associated with pain and foot-related functional limitation. DESIGN: A cross-sectional study using stratified random sampling. SETTING: A residential community. PARTICIPANTS: Ethnically diverse sample of elderly persons (n=784). MEASUREMENTS: Foot disorders (hallux valgus/bunion, pes planus (flat foot), pes cavus (high arch), hammertoe, mallet toe, claw toe, overlapping toes, bunionette, and plantar fasciitis), foot pain, the foot health functional status (FHFS, range 0-100, 100=no problems) scale, and walk time score (range 0-4, 4=fastest). RESULTS: Most commonly assessed musculoskeletal disorders, including hallux valgus and toe deformities, were not associated with pain or function limitation. Plantar fasciitis and, to a lesser extent, pes cavus were associated with worse FHFS scores; foot pain partially explained this association. Neither foot disorders nor foot pain were significantly associated with slower walk times. CONCLUSION: Many foot disorders had little relationship with foot pain or function and may not require clinical attention when asymptomatic. Risk factors and preventive and therapeutic interventions for plantar fasciitis require further longitudinal investigation.

Activities of Daily Living↗
PubMed2004

Analysis of the human and ape foot during bipedal standing with implications for the evolution of the foot.

The ratio of the power arm (the distance from the heel to the talocrural joint) to the load arm (that from the talocrural joint to the distal head of the metatarsals), or RPL, differs markedly between the human and ape foot. The arches are relatively higher in the human foot in comparison with those in apes. This study evaluates the effect of these two differences on biomechanical effectiveness during bipedal standing, estimating the forces acting across the talocrural and tarsometatarsal joints, and attempts to identify which type of foot is optimal for bipedal standing. A simple model of the foot musculoskeletal system was built to represent the geometric and force relationships in the foot during bipedal standing, and measurements for a variety of human and ape feet applied. The results show that: (1) an RPL of around 40% (as is the case in the human foot) minimizes required muscle force at the talocrural joint; (2) the presence of an high arch in the human foot reduces forces in the plantar musculature and aponeurosis; and (3) the human foot has a lower total of force in joints and muscles than do the ape feet. These results indicate that the proportions of the human foot, and the height of the medial arch are indeed better optimized for bipedal standing than those of apes, further suggesting that their current state is to some extent the product of positive selection for enhanced bipedal standing during the evolution of the foot.

Animals↗
PubMed2003

Cyclic h-reflex modulation in resting forearm related to contractions of foot movers, not to foot movement.

During rhythmic voluntary oscillations of the foot, the excitability of the H-reflex in the Flexor Carpi Radialis (FCR) muscle of the resting prone forearm increases during the foot plantar-flexion and decreases during dorsiflexion. It is known that, when the two extremities are moved together, isodirectional (in-phase) coupling is the preferred form of movement association. Thus the above pattern of the H-reflex excitability modulation may favor the preferred coupling between the two limbs. To gain some clues about its origin, FCR H-reflex excitability was tested before and after modifying the phase relations between the activation [electromyogram (EMG)] of foot movers and foot movement, either by loading of the foot or by changing the movement frequency. After foot loading, the movement cycle was consistently delayed with respect to the onset of the EMG in Soleus (Sol) or Tibialis Anterior (TA) muscles. Simultaneously, the FCR H-reflex modulation advanced by that same amount with respect to the foot movement, thus remaining phase-locked to the EMG onsets. Similarly, when movement frequency was varied step-wise between 1.0 and 2.0 Hz, the foot movement was progressively delayed with respect to both the EMG onset (Sol and TA) and the FCR H-reflex modulation, so that the phase relation between the motor command to the foot and the H-modulation in the forearm remained constant. These results suggest that modulation of H-reflex in the forearm is tied to leg muscle contraction, rather than to foot kinematics, and point to a central, rather than kinesthetic, origin for the modulation.

Biomechanical Phenomena↗
PubMed2001

Foot care practices, services and perceptions of risk among medicare beneficiaries with diabetes at high and low risk for future foot complications.

A cohort of Medicare beneficiaries with diabetes was identified from inpatient and outpatient claims data and their risk for foot complications was estimated based on claims reflecting services for recent foot problems. A telephone survey of a random sample from this cohort was conducted to assess their foot care practices, barriers, and perceptions of risk. Eight percent of respondents reported a history of foot ulcers and 7% a history of lower extremity amputation. Based on claims data, 30% of respondents were at high risk for future foot complications. Compared to those at low risk, those at high risk were more likely to report having an annual foot exam, using protective footwear, and perceiving themselves to be high risk for future foot complications. However, 50% of those with claims indicating a high risk perceived themselves to be at low risk for future foot complications. Overall, 20% of respondents seldom checked their feet daily for sores or irritations. Among this group, 60% felt that it was unimportant and 9% reported they were limited by poor vision or physical problems. Our findings suggest that strategies are needed to improve the delivery of preventive foot care services to older persons with diabetes. Additionally, emphasis is needed to help individuals understand their risk and seek and perform appropriate preventive foot care.

Aged↗
PubMed2004

Orthotic design and foot impression procedures to control foot alignment.

The traditional theory on subtalar joint neutral position and intrinsic foot deformities for the evaluation and treatment of foot and ankle disorders has been the basis for foot orthotics for many years. Although clinical evaluations have suggested a relationship between subtalar pronation and a variety of lower limb problems, such as shin splints and anterior knee pain, recent research has raised serious concerns about the reliability and validity of the assessment and intervention methods. Results of recent studies in foot biomechanics suggest that the orthosis design to control foot alignment should stabilise the medial apical bony structure of the arch to control the first ray mobility and transmit load through the lateral support structures of the foot, locking the calcaneocuboid joint and decreasing strain in the plantar aponeurosis. The concept of "posting" according to a measured foot deformity is de-emphasised. Reliable foot impression procedures are required to provide appropriate orthotic design and thus management. A prone lying position manipulated foot impression method using polycaprolactone based low temperature thermoplastic material was introduced. Ten (10) subjects were recruited to participate in the reliability tests, which were conducted by 2 orthotists specialized in foot orthotics. Results showed high intrarater and interrater reliability of the measured forefoot width and the navicular height. The reliability of the forefoot-rearfoot relationship was demonstrated by the small variance of the root mean square calculation. Subsequently orthotic intervention can be done in a more consistent manner.

Calcium Sulfate↗
PubMed1996

Foot type biomechanics. comparison of planus and rectus foot types.

The basic premise central to the diagnosis and treatment of most mechanogenic foot and ankle pathologies is that a given foot will display a characteristic function depending on the biomechanical alignment of the hindfoot and forefoot. However, the effects of foot type on an individual's ability to perform comfortable cadence locomotion have not been scientifically proven. Therefore, this study was conducted on 21 healthy, young subjects (10 subjects with planus foot type and 11 subjects with rectus foot type) to test whether different foot types yield distinguishable foot functions. New methods were developed to quantify biomechanical foot function during posture and comfortable cadence locomotion. The results of the study indicate that individuals with planus and rectus foot types show statistically significant differences in the biomechanical function of the foot.

Adult↗
PubMedDate not supplied

A method of dynamic foot-pressure measurement for the evaluation of pediatric orthopaedic foot deformities.

Dynamic foot-pressure measurements are time-sensitive measurements of the pressures under the foot while walking. Historically, many methods are used to measure these pressures; however, current medical literature does not contain a method suitable for the evaluation of pediatric orthopaedic foot deformities. A method for the measurement of dynamic foot pressure for the treatment of pediatric orthopaedic foot deformities was defined in this study. We established the dynamic foot-pressure pattern of a normal population using this method. Dynamic foot-pressure measurements were collected from 54 normal subjects (108 feet). These measurements were divided into the following five segments: the heel, the lateral midfoot, the medial midfoot, the lateral forefoot, and the medial forefoot. Standard tables and graphs were created describing the normal progression of pressure across each segment of the foot while walking. These standard tables and graphs can be used as a reference with which clinical measurements can be compared. This method may be useful as a diagnostic measure of foot deformities and may increase the clinician's ability to measure changes in foot deformity resulting from treatment intervention.

Adolescent↗