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PubMed2005

Effects of shoe inserts and heel height on foot pressure, impact force, and perceived comfort during walking.

Studying the impact of high-heeled shoes on kinetic changes and perceived discomfort provides a basis to advance the design and minimize the adverse effects on the human musculoskeletal system. Previous studies demonstrated the effects of inserts on kinetics and perceived comfort in flat or running shoes. No study attempted to investigate the effectiveness of inserts in high heel shoes. The purpose of this study was to determine whether increasing heel height and the use of shoe inserts change foot pressure distribution, impact force, and perceived comfort during walking. Ten healthy females volunteered for the study. The heel heights were 1.0cm (flat), 5.1cm (low), and 7.6cm (high). The heel height effects were examined across five shoe-insert conditions of shoe only; heel cup, arch support, metatarsal pad, and total contact insert (TCI). The results indicated that increasing heel height increases impact force (p<0.01), medial forefoot pressure (p<0.01), and perceived discomfort (p<0.01) during walking. A heel cup insert for high-heeled shoes effectively reduced the heel pressure and impact force (p<0.01), an arch support insert reduced the medial forefoot pressure, and both improved footwear comfort (p<0.01). In particular, a TCI reduced heel pressure by 25% and medial forefoot pressure by 24%, attenuate the impact force by 33.2%, and offered higher perceived comfort when compared to the non-insert condition.

Adult↗
PubMedDate not supplied

Skin-to-skin contact (Kangaroo Care) analgesia for preterm infant heel stick.

The purpose of the study was to compare a heel stick conducted during Kangaroo Care (skin-to-skin contact) with the mother to a heel stick in a warmer in reducing premature infant physiologic and behavioral pain responses. Twenty-four premature infants in a university-based neonatal intensive care unit were recruited and randomized to 2 sequences: sequence A group received 3 hours of Kangaroo Care (with a heel stick in Kangaroo Care) followed by 3 hours in a warmer (with a heel stick in the warmer). Sequence B group had warmer care and a heel stick (in the warmer) before Kangaroo Care and a heel stick (in Kangaroo Care). Heart rate, respiratory rate, oxygen saturation, crying time, and behavioral state were measured before, during, and after heel stick. Repeated measures ANOVA and Mann Whitney U statistics were performed. Heart rate and length of crying in response to pain were significantly reduced during Kangaroo Care and the Kangaroo Care heel stick as compared to when infants were in the warmer and had a heel stick in the warmer. Three infants did not cry at all during the Kangaroo Care heel stick; infants slept more during Kangaroo Care than in the warmer. Kangaroo Care positioning before and during heel stick is a simple and inexpensive analgesic intervention to ameliorate pain in stable premature infants.

Analgesia↗
PubMed2004

Venepuncture versus heel lance for blood sampling in term neonates.

BACKGROUND: Heel lance has been the conventional method of blood sampling in neonates for screening tests. Neonates undergoing this procedure experience pain. Despite various studies evaluating the role of pharmacological and non-pharmacological interventions to date, there are no effective and practical methods to alleviate pain from heel lance. OBJECTIVES: To determine whether venepuncture or heel lance is less painful and more effective for blood sampling in term neonates. SEARCH STRATEGY: Systematic search in accordance with the Cochrane Neonatal Collaborative Review Group. All randomized controlled trials which compared pain response to venepuncture vs. heel lance were identified using MEDLINE (1966-June 2004), EMBASE (1980-June 2004), CINAHL (1982-June 2004, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2004), reference lists of identified trials and personal files. No language restrictions were applied. SELECTION CRITERIA: Randomized controlled trials which compared pain response to venepuncture vs. heel lance were selected for this review. DATA COLLECTION AND ANALYSIS: Data regarding the primary outcome of pain response to venepuncture vs. heel lance as assessed by validated pain measures were abstracted. Secondary outcomes including the need of repeat blood sampling, bruising/hematoma at local site, and parental perception of their own anxiety and infant's pain were abstracted. All data were analysed using RevMan 4.2. When possible, meta-analysis was done using relative risk (RR) and risk difference (RD), along with their 95% confidence intervals (CI). If RD was significant, number needed to treat (NNT) was calculated. Weighted mean difference (WMD) was used for continuous data. When present, statistically significant between study heterogeneity was reported including the I(2) test. MAIN RESULTS: Four trials were eligible for inclusion in the review. Pain assessments were made using validated pain measures including Neonatal Infant Pain Scale (NIPS), Neonatal Facial Action Coding System (NFCS), Premature Infant Pain Profile (PIPP) score and cry characteristics. Two trials did not report on outcomes for all enrolled infants (not intention to treat analyses). Despite the heterogeneity in the pain measures used, all studies showed statistically significantly lower pain scores for venepuncture as compared to heel lance. A meta-analysis of the NIPS scores during the first minute of the procedure (reported in two studies) was statistically significantly decreased in the VP group compared to the HL group [WMD -1.84 (95% CI -2.61, -1.06)]. There was no statistically significant heterogeneity for this outcome (p = 0.22; I(2) 33.3%). The RR for requiring more than one skin puncture for venepuncture vs. heel lance (reported in 3 studies) was 0.30 (95% CI 0.18, 0.49. The risk difference was -39% (95% CI -50%, -28%). For this outcome there was statistically significant between study heterogeneity (for RR, p=0.02, I(2 )74.3%; for RD, p=0.0001, I(2) 88.9%). The number needed to treat (NNT) to avoid one repeat skin puncture was 3 (95% CI 2, 4). In one study, maternal anxiety was noted to be higher in the venepuncture group as compared to heel lance group prior to the procedure; however, after observing the procedure, mothers rated their infant's pain to be lower in the venepuncture group. REVIEWERS' CONCLUSIONS: Venepuncture, when performed by a skilled phlebotomist, appears to be the method of choice for blood sampling in term neonates. For each three venepunctures instead of heel lance, the need for one additional skin puncture can be avoided. Further well designed randomized controlled trials need to be conducted. The interventions should be compared in settings where several individuals perform the venepuncture and/or the heel lance.

Blood Specimen Collection↗
PubMed1998

Reliability of weight-bearing heel pad thickness measurements by ultrasound.

OBJECTIVE: To evaluate the intra- and inter-operator reliability of measuring weightbearing heel pad thickness in healthy subjects. BACKGROUND: Heel pad thickness has been reported to be an important factor in determining stresses observed in healthy as well as pathological feet. To date no published data are available on inter- and intra-operator variation in sonographic heel pad thickness measurements in adults. METHOD: bilateral heel pad thickness was measured in 10 adult subjects, with no history of plantar heel pain, by two experienced operators, on two separate occasions. Limits of agreement for three replicate measurements by each ultrasonographer and for replicate measurements were determined. RESULTS: Replicate heel pad thickness measurements in 95% of cases differ by less than 0.39 mm, and the magnitude of variations is similar when measurements are made by either single or different ultrasonographers, and were similar for right and left heel pad thickness measurements. Between scan measurements demonstrated a coefficient of variation of 3.2%. CONCLUSION: Weightbearing heel pad thickness measurements by ultrasound using a standardised technique in normal adult feet are reasonably reliable. RELEVANCE: Heel pad thickness can be measured reliably. Heel pad thickness may be an important predictor in the cause of ulceration in diabetics, and a potential risk factor in plantar pain affecting athletes. Further work assessing the heel pad in pathological conditions and athletes merits further study.

Journal Article↗
PubMed1997

The measurement of knee-heel length in newborn infants using a simple vernier calipers.

OBJECTIVE: To assess the usefulness of a simple vernier calipers for measuring knee-heel length in neonates. SUBJECTS AND METHODS: Using a simple vernier calipers, knee-heel length was measured five times by 2 observers in 50 babies (29M, 21F; mean birthweight 1597 g; median gestational age at birth 29 weeks) at a median postnatal age of 11 days. A subgroup of 20 babies had knee-heel length measured similarly at weekly intervals for 3 weeks. Corrected gestational age and weight were simultaneously recorded. One observer was experienced in using the vernier calipers. The precision of the calipers was established using 4 steel gauge blocks of varying length (7.62-10.17 cm). RESULTS: The calipers were very precise when measuring steel gauge blocks. In babies, there was a downward trend across the first 2 measurements for both observers, the measurements stabilizing over the last three. Using the final three measurements per baby (n = 50), the experienced observer had a mean standard deviation of 0.023 cm and mean coefficient of variation 0.23% when measuring an average knee-heel length of 9.99 cm. The inexperienced observer had a mean standard deviation of 0.057 cm and a mean coefficient of variation of 0.56%, when measuring an average knee-heel length of 10.14 cm. The inter-observer reliability, measured by the intra-class correlation coefficient, was 0.99. The agreement between observers was such that one observer measured knee-heel length consistently less (0.15 cm, SD 0.18 cm) than the other. The reliability for knee-heel length velocity was lower (R = 0.85), but agreement between observers was high with an average difference of 0.016 cm/week. Knee-heel length was significantly correlated (p < 0.001) with corrected gestational age (r = 0.85) and with weight (r = 0.96). There was a weaker but significant correlation (r = 0.47, p < 0.001) between knee-heel length velocity and rate of weight gain (g/day), indicating that weight gain may not always be accompanied by an increase in linear growth. CONCLUSION: The measurement of knee-heel length by a simple vernier calipers is an accurate, reproducible and non-invasive method of assessing short-term linear growth in neonates. However, it is recommended that measurements of knee-heel length in a individual baby should be made by a single experienced observer.

Age Factors↗
PubMed1999

Efficacy of dorsal pedal artery bypass in limb salvage for ischemic heel ulcers.

PURPOSE: Although pedal artery bypass has been established as an effective and durable limb salvage procedure, the utility of these bypass grafts in limb salvage, specifically for the difficult problem of heel ulceration, remains undefined. METHODS: We retrospectively reviewed 432 pedal bypass grafts placed for indications of ischemic gangrene or ulceration isolated to either the forefoot (n = 336) or heel (n = 96). Lesion-healing rates and life-table analysis of survival, patency, and limb salvage were compared for forefoot versus heel lesions. Preoperative angiograms were reviewed to evaluate the influence of an intact pedal arch on heel lesion healing. RESULTS: Complete healing rates for forefoot and heel lesions were similar (90.5% vs 86.5%, P =.26), with comparable rates of major lower extremity amputation (9.8% vs 9.3%, P =.87). Time to complete healing in the heel lesion group ranged from 13 to 716 days, with a mean of 139 days. Preoperative angiography demonstrated an intact pedal arch in 48.8% of the patients with heel lesions. Healing and graft patency rates in these patients with heel lesions were independent of the presence of an intact arch, with healing rates of 90.2% and 83.7% (P =.38) and 2-year patency rates of 73.4% and 67.0% in complete and incomplete pedal arches, respectively. Comparison of 5-year primary and secondary patency rates between the forefoot and heel lesion groups were essentially identical, with primary rates of 56.9% versus 62.1% (P =.57) and secondary rates of 67.2% versus 60.3% (P =.50), respectively. CONCLUSION: Bypass grafts to the dorsalis pedis artery provide substantial perfusion to the posterior foot such that the resulting limb salvage and healing rates for revascularized heel lesions is excellent and comparable with those observed for ischemic forefoot pathology.

Aged↗
PubMed1996

Heel spur: radiation therapy for refractory pain--results with three treatment concepts.

PURPOSE: To evaluate radiation therapy (RT) to treat refractory pain in plantar heel spur. MATERIALS AND METHODS: From 1984 to 1994, 141 patients with refractory painful plantar heel spur (170 heels, because of bilateral disease) underwent RT. Quantitative criteria were used to evaluate heel pain and ankle function prior to RT, 6-12 weeks after RT, and at last follow-up (median, 4 years). Patients were divided into three treatment groups: group A (n = 72 heels [two courses, 1.0-Gy fractions, 12-Gy total RT dose]), group B1 (n = 50 heels [one course, 0.3-Gy fractions, 3-Gy total dose]), and group B2 (n = 48 heels [one course, 0.5-Gy fractions, 5-Gy total dose]). RESULTS: At last follow-up, complete pain relief was achieved in 48 (67%) of 72 group A heels and in 71 (72%) of 98 group B heels. Statistically significant (P < .05) differences between groups were found for insufficient pain relief (< 80%) in patients in whom the response time after RT was longer than 4 weeks or in whom pain recurred during follow-up. The best results were achieved with the 5-Gy total RT dose (P < .05). Prognostic factors for complete pain relief were acute pain and short duration of pain prior to RT. The prognostic factor for insufficient pain relief was total RT dose. CONCLUSION: Refractory heel pain is effectively treated with RT, which should be considered a primary treatment approach rather than a last resort.

Adult↗
PubMed2001

The effect of heel elevation on strain within the plantar aponeurosis: in vitro study.

Mild, temporary reduction of symptoms from plantar fasciitis have been reported with the use of high heeled shoes (i.e. cowboy boots, ladies pumps). However, little is known on how heel elevation may contribute to a decrease in the pain and inflammation. The aim of this study was to quantify strain in the plantar aponeurosis in cadaveric feet with the use of various heel elevation configurations. An in vitro method that simulated "static" stance was used to determine the loading characteristics of the plantar aponeurosis (n = 12). Heel elevation was evaluated with blocks placed beneath the heel and with a contoured platform that simulated the arch profile of a shoe at three different heel heights (2.0, 4.0, 6.0 cm) with a level plane serving as the control. Strain in the plantar aponeurosis decreased with elevations of the heel that simulated the arch profile of a shoe at load levels (337, 450 N) (P < 0.05). Elevations of the heel with blocks did not significantly affect strain in the plantar aponeurosis (P < 0.05). Contrasting results of some specimen limbs compared with the overall means suggests that the influence of heel elevation on loading of the plantar aponeurosis may be dependent on individual variation and foot structure differences. Therefore, clinicians should be cautious in recommending heel elevation as a treatment for plantar fasciitis since some subjects may not achieve the desired decrease in plantar aponeurosis strain.

Adult↗
PubMed2005

Perception of large change in distribution of heel pressure during backward leaning.

We investigated the perception of the large change in distribution of heel pressure during backward leaning. Subjects were 12 healthy adults who reported perceiving a large change in distribution of heel pressure by a handheld switch while leaning voluntarily backward on a sole pressure analyzer and on a heel force plate. The large change was indicated at the center of heel pressure. Morphological features of the foot were measured on an X-ray film. The position of heel pressure center and the morphological locations were represented as relative distance (%) from the hindmost point of the heel, where foot length represented 100%. Center of heel pressure changed largely during backward leaning, and the position at which large change occurred was the same as that of the peak of the distribution. Large change in distribution of heel pressure was perceived at a position 1.3% posterior from that at which the large change actually occurred. The correlation between perceived and actual positions was significant (r = .91). Significant correlations were found between position of a large change of center and locations of heel pressure of both the lateral process of the calcaneal tuberosity and the top of the talar trochlea (r = .86; r = .71, respectively). The results indicate that subjects accurately perceive large changes in distribution of heel pressure and that the morphological features of the foot contribute to these changes.

Adult↗
PubMed1992

Heel movement within a court shoe.

Lateral movements of the leg and foot were filmed from behind to evaluate court shoes. Inversion/eversion may be an indicator of potential injuries, but estimates of actual inversion/eversion have typically been measured as the angular displacement of marker pairs on the lower leg and on the shoe. The purpose of this study was to measure the shoe movement versus the heel movement inside the shoe in order to determine the appropriateness of using shoe markers to represent the heel position. Two windows were cut into the heel counter of the shoe to show the heel position in addition to shoe position. The subjects were filmed from behind during a lateral side-stepping movement. The difference between the shoe and heel position was [corrected] statistically significant. The average maximum change in heel inversion inside the shoe was 13.3 +/- 3.8 degrees, compared with 30.7 +/- 6.2 degrees for the shoe. In addition, the maximum change in heel inversion in a barefoot movement was 10.1 +/- 3.1 degrees. The results suggest that for a lateral movement shoe markers do not accurately represent the position of the heel, and heel movement inside a shoe is similar to a barefoot movement. Skin markers on the heel as observed through windows in the shoe give a better indication of the actual position of the calcaneus than do markers placed directly on the shoe.

Adult↗
PubMed1992

Treatment of chronic heel pain by surgical release of the first branch of the lateral plantar nerve.

Sixty-nine heels (53 patients) with chronic heel pain had a surgical release of the first branch of the lateral plantar nerve. The average duration of heel-pain symptoms was 23 months (range, six months to eight years). No patient had less than six months of conservative treatment before surgery. The average duration of preoperative conservative treatment was 14 months. Forty-four patients (83%) had taken nonsteroidal antiinflammatory agents. Sixty-three heels (91%) had used heel cups and/or orthoses. Fifty-nine heels (86%) had received one or more injections of a steroid preparation. Thirty-four heels had developed pain initially during a sports activity. Postoperatively, 61 heels (89%) had excellent or good results; 57 heels (83%) had complete resolution of pain. The average follow-up period was 49 months. In general, heel pain resolves with conservative treatment. In recalcitrant cases, however, entrapment of the first branch lateral plantar nerve should be suspected. Surgical release of this nerve can be expected to provide excellent relief of pain and facilitate return to normal activity.

Adult↗
PubMed2004

Chronic plantar fasciitis: acute changes in the heel after extracorporeal high-energy shock wave therapy--observations at MR imaging.

PURPOSE: To prospectively evaluate with magnetic resonance (MR) imaging the acute changes in the heel associated with extracorporeal shock wave therapy (ESWT). MATERIALS AND METHODS: Institutional clinical study review board approved the study, and informed consent was obtained. MR imaging was performed within 24 hours before and after ESWT on 18 feet of 12 patients (eight women and four men; age range, 33-63 years; average, 49.9 years) with chronic plantar fasciitis. ESWT was applied to the most painful point on the plantar surface of the heel, with a total of 1500 shocks at 18 kV. The MR imaging protocol consisted of sagittal and coronal T1- and T2-weighted images with and without fat saturation. The images were reviewed to assess the post-ESWT changes in soft-tissue and bone marrow edema, the thickness of the proximal plantar fascia, and the presence of a heel spur. Paired t test was used for the statistical analysis. RESULTS: Soft-tissue edema, which was present in 16 (89%) of 18 heels before ESWT, had increased in severity in 12 (75%) heels after ESWT. Calcaneus bone marrow edema at the insertion site was observed in eight heels before ESWT. After ESWT, the extant of bone marrow edema had increased in one heel and had newly developed in another heel. The heel spur seen in nine (50%) feet was not affected by ESWT. In 17 (94%) heels, the proximal plantar fascia was abnormally thick, with thickness not significantly changed with use of ESWT (P > .05). CONCLUSION: Increase in soft-tissue edema is the most common acute response associated with ESWT.

Adult↗
PubMed1994

Lower extremity mechanics and energy cost of walking in high-heeled shoes.

In today's society, many women wear high-heeled shoes. However, the effect that shoes of different heel heights have on the biomechanics and energy cost of gait has not been fully investigated. In the present study, the energy cost and the lower extremity mechanics in shoes of different heel heights (1.25 cm, 3.81 cm, 5.08 cm, and 7.62 cm) were examined in 15 female subjects, seven of whom could be considered experienced high-heel wearers. Kinematic data from high-speed video and kinetic data from a force platform were collected to describe lower extremity mechanics while subjects walked overground at a speed of 4.2 km/hour. Heart rate and oxygen consumption were monitored while subjects walked on a treadmill, also at 4.2 km/hour. There were no significant differences in any of the parameters as a function of experience in wearing high heels; therefore, the data were pooled for further analysis. Analysis of the biomechanical data revealed that ankle plantar flexion, knee flexion, vertical ground reaction force, and the maximum anteroposterior braking force increased as a function of heel height. In addition, the timing of the subtalar and knee joint action was asynchronous with the increase in heel height. Metabolically, heart rate and oxygen consumption also increased with heel height. There were many significant differences between the 5.08-cm and the 7.62-cm heel conditions. Therefore, to maintain comfort and decrease the risk of injury, women may be advised not to wear shoes with a heel height greater than 5.08 cm.

Adolescent↗
PubMed1994

High heeled shoes: their effect on center of mass position, posture, three-dimensional kinematics, rearfoot motion, and ground reaction forces.

This study investigated changes in center of mass position, forefoot loading, lumbar curvature, and pelvic tilt during standing and ground reaction forces, rearfoot motion, sagittal lower extremity kinematics, and shoulder and pelvic rotations of women walking at 1.4 m.s-1 in different heights of high heeled shoes. Three different heel heights (1.91, 3.81, 7.62cm) were worn by each of 11 women. Vertical forces applied to the forefoot during standing increased with increased heel height. No significant differences in average lumbar curvature or pelvic tilt among shoe heights were found. Significant increases in vertical and anteroposterior forces during walking were found with increased heel height, and foot abduction angle during support showed significant less abduction with higher heels. With an increase in heel height the minimum vertical force (at midstance) and the maximum vertical force during the second half of support both occurred later in the support phase, whereas the maximum and minimum anteroposterior forces occurred earlier in support. Rearfoot angle measures obtained from high-speed video analysis showed a significantly greater angle of supination at footstrike and a smaller angle of maximum pronation in the high compared with the low heeled shoes. Ankle angles throughout the gait cycle showed a significant increase in plantarflexion with increased heel height. Maximum knee angle during swing and knee extension velocity decreased with increased heel height. Other sagittal plane kinematic measures and measures to hip and shoulder rotation derived from three-dimensional (3-D) cine data showed few consistent effects of heel height.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2001

The role of the heel pad and shank soft tissue during impacts: a further resolution of a paradox.

The aim of this study was to test the hypothesis that the motion of the soft tissue of the lower leg contributes significantly to the attenuation of the forces during heel impacts. To examine this, a two-dimensional model of the shank and heel pad was developed using DADS. The model contained a heel pad element and a rigid skeleton to which was connected soft tissue which could move relative to the bone. Simulations permitted estimation of heel pad properties directly from heel pad deformations, and from the kinematics of an impacting pendulum. These two approaches paralleled those used in vitro and in vivo, respectively. Measurements from the pendulum indicated that heel pad properties changed from those found in vitro to those found in vivo as relative motion of the bone and soft tissue was allowed. This would indicate that pendulum measures of the in vivo heel pad properties are also measuring the properties of the whole lower leg. The ability of the wobbling mass of the shank to dissipate energy during an impact was found to be significant. These results demonstrate the important role of both the heel pad and soft tissue of the shank to the dissipation of mechanical energy during impacts. These results provide a further clarification of the paradox between the measurements of heel pad properties made in vivo and in vitro.

Biomechanical Phenomena↗
PubMed1999

Heel lancing in term new-born infants: an evaluation of pain by frequency domain analysis of heart rate variability.

The aim of the investigation was to assess pain by frequency domain analysis of heart rate variability (HRV) during a routine heel lancing procedure in term new-born infants. Beat-to-beat heart rate (HR) was recorded in 23 healthy new-born infants on the maternity ward during blood sampling for neonatal screening. A sham heel prick prior to the sharp lancing procedure was performed randomly in half of the infants. Spectral analysis of HRV was assessed for each of the following sequences: (1) baseline (2) sham heel prick (3) sharp heel prick and (4) squeezing the heel for blood sampling. The response to the sham prick did not differ significantly from the sharp prick. Compared with the baseline, sharp lancing gave rise to minor increases in HR and variability in the low frequency band of the spectral analysis. A clear stress response was provoked when the heel was squeezed for blood sampling, indicated by an increased HR and a decreased spectral power in the high frequency band (i.e. lower vagal tone). The different stress responses during the lancing and the squeezing of the heel were clearly illustrated when principal component analysis was applied and the vectors for the changes in HR and spectral pattern were indicated. In conclusion, the squeezing of the heel is the most stressful event during the heel prick procedure.

Blood Specimen Collection↗
PubMed2003

Physiology and prevention of heel ulcers: The state of science.

The prevalence of heel ulcers across settings is high and is increasing. Prevention of ulcers requires knowledge of their etiology and the scientific basis for preventive care. The interaction between external pressure and the heel vasculature is central to the prevention of heel ulcers. This article focuses on the prevention of heel pressure ulcers. The physiology of heel tissue perfusion, the effect of external pressure on heel perfusion, as well as what is known about strategies to reduce external pressure and approaches to improve heel skin blood flow will be discussed. It is only through understanding of the physiology of heel tissue perfusion and its relation to external pressure that effective preventive measures to reduce heel skin breakdown can be adapted in clinical practice.

Beds↗
PubMed2004

Compliance wearing a heel lift during 8 weeks of military training in cadets with limb length inequality.

STUDY DESIGN: Retrospective descriptive study. OBJECTIVES: To examine compliance in wearing heel lifts during 8 weeks of military training in cadets identified with limb length inequalities. BACKGROUND: Lack of compliance can be blamed for countless poor outcomes in the medical community. Reported compliance with intervention protocols has been reported to range from 11% to 95%. All 1100 new cadets in the class of 2005 were screened for a limb length inequality One hundred ninety-eight out of 1100 cadets were identified to have a limb length inequality on physical exam and volunteered to participate. Cadets were randomly assigned to a heel lift or control group. Cadets in the heel lift group were instructed to wear a heel lift at all times throughout cadet basic training to attempt to prevent overuse injuries. There was no difference (P > .05) between the heel lift group or the control group on injury rate or excusal days. METHODS AND MEASURES: In an attempt to discern whether the preventive intervention was ineffective by design or if noncompliance was to blame, investigators asked cadets via electronic mail survey to report compliance with heel lift wear as a percentage (0%-100%). RESULTS: Seventy-six out of 99 (76.8%) cadets in the heel lift group responded to the electronic mail survey. Mean reported compliance was 38%. Eighteen cadets reported between 70% and 100% compliance. The remaining 58 cadets reported less than 70% compliance. CONCLUSIONS: Cadet compliance was poor with the use of a heel lift. Physical therapists throughout the military often prescribe heel lifts, therapeutic exercises, or medication and assume good to excellent compliance. This study reminds providers that good compliance should not be assumed in any setting.

Adolescent↗