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PubMed1995

Women and their shoes: unrealistic expectations?

Is it unrealistic for a woman to consistently expect fashion and comfort in the same shoe? Probably so, unless, of course, the current fashion is shoes with a low heel, round toe, and cushioned sole. But, if the fashion trends of the last 300 years are any indication, it is doubtful that this will be the case any time soon. However, a woman who is willing to compromise with a properly fitting, low-heeled, extra-depth or combination last pump augmented with a good quality cushioned insole has a better chance of finding comfort in a shoe. Although it is possible to have an orthopaedically sound shoe in a reasonably fashionable style, there is still room for the manufacturers and designers of shoes to improve the details of design. It is important to recognize that as long as society defines "fashionable" as a thin-soled, stiletto-heeled, narrow-pointed shoe, comfort and fashion are, to some extent, mutually exclusive. Any woman who wants the comfort of a tennis shoe will probably have to wear a tennis shoe.

Adult↗
PubMed2005

Changes in location of centre of pressure and hoof-unrollment pattern in relation to an 8-week shoeing interval in the horse.

REASONS FOR PERFORMING STUDY: In order to optimise shoeing and shoeing conditions, it is essential to know how the horse adapts to a common shoeing interval. OBJECTIVES: To measure changes in location of the centre of pressure (CoP) and hoof-unrollment pattern during a shoeing interval and to assess whether these changes in CoP result directly from changes in hoof conformation or are also influenced by compensatory mechanisms. METHODS: Eighteen horses were trotted over a pressure-force measurement system shortly after shoeing and 8 weeks later. The position of the CoP was measured and also predicted using calculations based on changes in hoof conformation. RESULTS: The measured shift in CoP was less than calculated. This difference was largest in the hind feet. The hoof-unrollment pattern stayed basically the same in the front feet, but in the hind feet there was a substantial lateral shift of the trajectory of the CoP. CONCLUSIONS: Horses can compensate, to a certain extent, for changes in hoof conformation that develop during 8 weeks on shoes. As the capacity to compensate is less in the forelimbs, the relative increase in loading of these limbs during a shoeing interval is larger than in the hindlimbs. POTENTIAL RELEVANCE: This study provides essential basic data for the development of science-based shoeing techniques.

Animals↗
PubMed2003

Elevated heels and adaptation to new shoes in frail elderly women.

Footwear is supposed to have influence on postural control and is a potential aspect to address in the prevention of falls in the elderly. This study aimed to show whether measurements of static balance and gait are different with habitual shoes compared to new special senior shoes with different heel height and whether these results change after adaptation. In a randomized controlled intervention study, 26 subjects (median age 87 years) were recruited from two nursing homes and one facility of assisted living. Measurements of static balance and gait were performed with habitual shoes and two types of new special senior shoes differing in heel height. Measurements were repeated after five weeks. There was no difference in static balance and gait with habitual shoes compared to either of the new footwear offered. Results of performance with higher heels were not different compared to lower heels. No further effect of adaptation after wearing a new shoe over five weeks could be demonstrated. With respect to static and dynamic balance, there seems to be a wide range of acceptable footwear as long as the heel height is below a critical value. A standardized shoe can be used in the assessment of balance because the effect of adaptation can be neglected.

Accidental Falls↗
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↗
PubMed2005

Biomechanical implications of the negative heel rocker sole shoe: gait kinematics and kinetics.

Rocker sole shoes are commonly prescribed to diabetic patients with insensate feet. Recent passage of the therapeutic shoe bill has drawn an increased focus to prescription rehabilitative footwear. The purpose of this work is to investigate the dynamics of lower extremity joints (hip, knee and ankle) with the application of a negative heel rocker sole shoe under controlled lab conditions. Forty normal adults volunteered for gait evaluations using controlled baseline and prescription negative heel rocker sole shoes. Three-dimensional motion analysis techniques were used to acquire kinematic and kinetic data using a six-camera Vicon 370 motion system and two AMTI force plates. No significant change in walking speed or stride length was seen with the negative heel rocker shoe, although cadence was increased. The most significant kinematic changes with the application of the negative heel shoe occurred at the ankle in the sagittal plane with increased plantarflexion at terminal stance. Significant hip and knee changes were also noted with increased mid-stance hip extension and knee flexion. The most significant kinetic effects were seen in the transverse plane followed by changes in the sagittal and coronal planes. Changes in power were mostly noted in the sagittal plane. Other statistically significant changes in gait kinematics and kinetics were observed, although the magnitudes and durations were limited and as a result were not considered clinically significant. The study results indicated the negative heel rocker shoe significantly altered proximal joint metrics (hip and knee). The most significant distal joint alterations were seen in sagittal plane ankle kinetics. These kinematic and kinetic changes, along with previously studied effects of pressure relief at the metatarsal heads, should aid medical professionals in prescribing prophylactic footwear.

Adult↗
PubMed2001

Metabolic cost of walking with and without a shoe lift on the contralateral foot of an immobilised extended knee.

The purpose of the present study was to determine the metabolic cost of walking with and without a shoe-lift on the contralateral foot of an immobilised extended knee. Eight male subjects were randomly allocated and participated in both the treatment (walking with a 2.5 cm shoe-lift) and control (walking without a shoe-lift) conditions. Cardiac output (Q) and related cardiovascular measurements were analysed to determine the effect of a shoe-lift on central (heart rate (HR); stroke volume (SV)) and peripheral (arteriovenous oxygen difference (a-vO2 diff)) components of oxygen consumption (VO2). A metabolic analyser was used to determine VO2 (ml x kg(-1) x min(-1)), which was converted to oxygen cost (ml x kg(-1) x m(-1)). The shoe-lift had no significant (p > 0.05) effect on VO2 or oxygen cost. There were no significant differences in Q, HR, SV, a-vO2 diff, systemic vascular resistance, carbon dioxide production, respiratory exchange ratio, expired ventilation, tidal volume and respiratory rate between the two walking conditions with and without a shoe-lift. These findings demonstrate that a shoe-lift added to the contralateral foot of an immobilised extended knee does not produce clinically important effects on oxygen cost or efficiency during walking.

Adult↗
PubMed2005

[Lung cancer risk in shoe manufacturing].

OBJECTIVE: Workers in shoe manufacturing have been reported to be at a greater relative risk for bronchogenic carcinoma. Given the implications for our practice setting, we carried out a study to a) clarify whether working in shoe manufacturing is a risk factor for lung cancer and b) detect histological differences between lung cancers in shoe manufacturers and in other lung cancer patients. PATIENTS AND METHODS: This case-control study compared all lung cancer patients diagnosed in Hospital Elda, Alicante, Spain, between January 1994 and December 1999, with a control group composed of patients admitted to the same hospital for accidental fractures. Information on occupational history and tobacco dependency was collected from all patients by telephone questionnaire. RESULTS: One hundred and ninety-one case patients and 192 control patients were included in the study; 52 of the cases (27.2%) and 48 controls (25%) worked in shoe manufacturing. No statistically significant differences were found between the 2 groups, not even when we limited the cases and controls to only those who had worked more than 30 years in shoe manufacturing or when we analyzed only subjects who had had especially high risk occupations. No differences in tumor histology were found between cancer patients who worked in shoe manufacture and those who did not. CONCLUSIONS: Working in shoe manufacturing has not proven to be a risk factor for bronchogenic carcinoma.

Aged↗
PubMedDate not supplied

[Influence of postoperative shoes on plantar pressure patterns].

AIM: There are several different types of shoe devices in the postoperative treatment of forefoot surgery. They all have the aim to unload the operated region. Examples for forefoot surgery are hallux valgus operations or correction of claw toes. The aim of this study was to compare a special forefoot shoe (Darco's Ortho Wedge) with a lengthwise and crosswise prepared postoperative shoe (Darco's Medical Surgical). METHOD: Plantar pressure distribution measurements were used to evaluate the unloading effect of the shoe conditions. The pressure in a standard shoe (Nike's Air Triax) was measured for further comparison. RESULTS: The results demonstrate that all analyzed shoes relieve weight under the medial forefoot region. The lengthwise prepared Medical Surgical achieves the highest pressure reduction under the medial forefoot, but the midfoot and the lateral forefoot are subjected to significantly higher loads. The Ortho Wedge reduces the load under the toes and the forefoot and relieves the midfoot region. The pressure is redistributed under the hindfoot. The crosswise prepared Medical Surgical also relieves pressure under the forefoot but not to the same extent as the Ortho Wedge. CONCLUSION: In conclusion it can be stated that the Ortho Wedge shows the best results of the tested shoes for pressure relief and load transfer under the forefoot.

Adolescent↗
PubMed2004

Questionnaire for usability evaluation of orthopaedic shoes: construction and reliability in patients with degenerative disorders of the foot.

OBJECTIVE: To develop a self-report questionnaire for patients with degenerative disorders of the foot to evaluate the usability of their orthopaedic shoes, and to assess the reproducibility and responsiveness of the instrument. DESIGN: Development of the Questionnaire for Usability Evaluation of orthopaedic shoes was based on a literature search, structured expert interviews and a ranking procedure. A cross-sectional study was carried out to determine the reproducibility and internal consistency of the questionnaire. SETTING AND SUBJECTS: The study population comprised 15 patients with degenerative disorders of the foot, who had worn their orthopaedic shoes for at least 3 years and 15 patients with degenerative disorders of the foot, who had never worn orthopaedic shoes, but would receive them within 1 month. RESULTS: Within the questionnaire 4 effectiveness items (pain, instability, callus, wounds), 1 efficiency item (putting on and taking off shoes) and 7 satisfaction items (pinch, slip, weight of shoes, cold feet, perspiration, maintenance, cosmetic appearance) were developed. All items in the questionnaire met the test-retest criteria. The smallest real difference ranged from 0.23 to 3.82 cm on a Visual Analogue Scale (10 cm). Cronbach's alpha's for the domains of pain and instability ranged from 0.70 to 0.92. CONCLUSION: The Questionnaire for Usability Evaluation should provide a good rationale to assess the usability of orthopaedic shoes and can be considered reliable.

Aged↗
PubMed2006

Increasing shoe instep improves gait dynamics in patients with a tibiotalar arthrodesis.

Degenerative osteoarthritis in subtalar and midtarsal joints occurring after tibiotalar arthrodesis may be related to biomechanical factors. For patients with tibiotalar arthrodesis walking with their everyday shoes, the ground reaction force is posterior at heel-off and the maximal foot-tibia dorsiflexion is at its upper limit. We hypothesized that increasing the instep of the shoes would improve these abnormalities. Three-dimensional gait analysis was done in nine patients with ankle arthrodesis fused in the neutral position and for 10 control subjects. Four conditions of walking were tested: barefoot, wearing everyday shoes, wearing everyday shoes with the instep increased by 1 cm, and wearing everyday shoes with the instep increased by 2 cm. In the arthrodesis group, the two modified delayed heel-off shoe conditions shifted the ground reaction force closer to the metatarsal heads at heel-off to a normal range, and reduced the maximal foot and tibia dorsiflexion angle. Based on these results, patients with a tibiotalar arthrodesis in the neutral sagittal position may be advised to choose shoes with an instep of approximately 25 mm.

Analysis of Variance↗
PubMed2005

Effect of environmental temperature on shock absorption properties of running shoes.

OBJECTIVE: To determine the effect of temperature changes on the shock attenuation of 4 running shoe shock absorption systems. DESIGN: Prospective. SETTING: Motion analysis laboratory. INTERVENTIONS: The shock attenuation of 4 different running shoes representing common shock absorption systems (Nike Air Triax, Asics Gel Nimbus IV, Adidas a3 cushioning, Adidas Supernova cushion) was measured at ambient temperatures of -20 degrees C, -10 degrees C, 0 degrees C, +10 degrees C, +20 degrees C, +30 degrees C, +40 degrees C, and +50 degrees C. Repeated-measures analysis of variance was used to determine differences between shoes. OUTCOME MEASURES: Shock attenuation as indicated by peak deceleration (g) measured by a mechanical impactor following ASTM Standard F1614-99. RESULTS: Shock attenuation decreased significantly with reduced temperature for each shoe tested. The Adidas a3 shoe exhibited significantly higher peak decelerations (lower shock attenuation) at cold temperatures compared with the other shoes. CONCLUSIONS: Cold ambient temperatures significantly reduce the shock attenuation of commonly used running shoes. These findings have important clinical implications for individuals training in extreme weather environments, particularly those with a history of lower limb overuse injuries.

Athletic Injuries↗
PubMed2005

Influence of heel height and shoe insert on comfort perception and biomechanical performance of young female adults during walking.

BACKGROUND: The possible negative effects of high-heeled shoes on subjective comfort perception and objective biomechanical assessment have been noted. Although shoe inserts have been widely applied in footwear to increase comfort and to reduce the frequency of movement-related injury, no study has attempted to identify insert effectiveness in high heels. The purpose of this study was to determine the effects of heel height and shoe inserts on comfort and biomechanics as represented by plantar pressure and ground reaction force (GRF). METHODS: Twenty young female adults performed the test conditions formed by the cross-matching of shoe inserts (shoe without insert and shoe with total contact insert [TCI]) and heel height (a flat, a low heel [3.8 cm] and a high heel [7.6 cm]). Two-way analyses of variance for repeated measures design were used to test condition effects on comfort rating, plantar pressure, and GRF during gait. To determine the biomechanical variables that can predict comfort, a multiple linear regression with stepwise method was done. RESULTS: The results showed that discomfort increased with heel height. In high heels, the plantar pressure in the heel and midfoot shifted to the medial forefoot, and the vertical and anteroposterior GRF increased. Use of the TCI reduced the peak pressure in the medial forefoot. Interestingly, the effectiveness of the TCI was greater in the higher heels than in the lower heels and in flat heels. The peak pressure in the medial forefoot, impact force, and the first peak vertical GRF could explain 75.6% of the variance of comfort in high-heeled gait. CONCLUSIONS: These findings suggest that higher heels result in decreased comfort, which can be reflected by both the subjective rating scale and biomechanical variables. Use of a TCI altered the biomechanics and therefore improved the comfort in high-heeled shoes.

Adult↗
PubMed1985

Shoes versus sneakers in toddler ambulation.

The purpose of this study was to determine the relative values and differences between shoes and sneakers for young children just learning to walk. In phase 1 of the study, 79 toddlers (47 females and 32 males), ranging in age from 11 months to 3 years, were carefully measured for footwear. Only 15 toddlers (19%) could be properly fitted in the medium-width sneakers that are currently available on the market. The majority of the measured toddlers required widths greater than D, and to accommodate these wider feet, it was necessary to fit them with longer sneakers than they actually needed otherwise, thus making ambulation a bit more difficult and clumsy. In phase 2, eight toddlers, randomly selected except for sex (four male and four female), ranging in age from 11 to 16 months who had been ambulating 2 weeks to 5 months, were tagged with an identifying letter and videotaped in four walking situations: sneakers on tile, shoes on tile, sneakers on rugging, and shoes on rugging. Four hours of video taping was edited down to one-half hour. Twenty-three observers (orthopaedic surgeons, pediatricians, and shoe fitters) carefully reviewed the tape on multiple occasions and came to the following conclusions: better fit, stance, gait, cadence, and stability were noted with shoes in all the toddlers and in all situations. Falls were three times more frequent in sneakers as compared to shoes on tile surfaces and five times more frequent on rugging. It was concluded that the slight economic advantage of sneakers over shoes was not that great to warrant jeopardizing the capabilities of the toddler in the earliest stages of ambulation.

Child, Preschool↗
PubMed1996

Preventing diabetic foot disease: lessons from the Medicare therapeutic shoe demonstration.

OBJECTIVES: Every year about 38,000 elderly people with diabetes have a lower extremity amputation. Therapeutic shoes are prescribed by clinicians specializing in foot care to prevent foot ulcerations and amputations among at-risk patients with diabetes. Medicare ran a 3-year demonstration of a therapeutic-shoe benefit for beneficiaries with diabetes. Medicare added the benefit nationwide in May 1993. METHODS: This paper describes the benefit and its implementation in the demonstration based on demonstration records, a patient survey, and discussions with clinicians and shoe suppliers before and during the demonstration. RESULTS: During the demonstration, far fewer beneficiaries applied for the therapeutic shoes than were eligible for them. The paper discusses reasons for the low beneficiary application rate and the associated low participation rate among physicians treating patients with diabetes. CONCLUSIONS: The benefit is unlikely to be used any more in the national program than in the demonstration unless physicians are educated in the role therapeutic shoes can play in diabetic foot disease, they prescribe the shoes for their patients, and they increase their patients' awareness of the shoes' value.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1995

The use of running shoes to reduce plantar pressures in patients who have diabetes.

We compared the plantar pressures generated by walking in leather-soled Oxford-style shoes and by walking in inexpensive running shoes with those generated by walking in thin socks on a hard surface for thirty-nine individuals (thirteen who had diabetes and neuropathy, and thirteen who had diabetes without neuropathy, and thirteen who had neither diabetes nor neuropathy [controls]). Except for two anatomical regions, the plantar pressure associated with the Oxford-style shoes were not different from those associated with walking without shoes. In comparison, the inexpensive running shoes relieved plantar pressure in the forefoot and heel by a mean (and standard deviation) of 31 +/- 9.1 per cent, with the most relief occurring in the feet that had the highest pressures when they were unshod. There were significant reductions in pressure in all regions of the foot except for the midfoot (p < 0.01), and there were no significant differences between the groups. Individuals who have insensate feet should be discouraged from wearing leather-soled Oxford-style shoes because of the risk of ulceration due to elevated plantar pressures. Inexpensive running shoes should be viewed as the very minimally acceptable choice for footwear for these individuals if the feet are free of deformity.

Adult↗
PubMed2000

Effectiveness and safety of a nonremovable fiberglass off-bearing cast versus a therapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study.

OBJECTIVE: To evaluate and compare the rate of reduction of the surface area of neuropathic plantar ulcers in diabetic patients treated with nonremovable rigidity-differentiated fiberglass off-bearing casts or a cloth shoe with a rigid sole with unloading alkaform insoles. The secondary aim was to evaluate the side effects and degree of patient acceptance of treatment. RESEARCH DESIGN AND METHODS: Fifty diabetic patients with neuropathic plantar ulcers were consecutively enrolled and randomized to one of two treatment groups. Of the 50 patients, 24 were treated with a specialized cloth shoe with a rigid sole and an unloading alkaform insole (shoe group), and 26 patients were treated with a nonremovable off-bearing fiberglass cast (cast group). All patients in both study groups returned to the clinic for weekly control visits. Their ulcers were treated with a standard dressing. Tracings of the ulcer area using a transparent dressing were performed on the day of entry to the study and after 30 days of treatment. The presence of new ulcerations caused by the use of the pressure-relief apparatus was recorded. Patient acceptance of the treatment was measured using a visual analog scale. RESULTS: At the end of the treatment period, an 8.3% increase of the ulcer area was observed in two patients in the shoe group, whereas in the cast group, no patient presented an increase. The reduction of the ulcer area was statistically more rapid in the cast group (Mann-Whitney test, P = 0.0004). Furthermore, the number of ulcers completely healed at the 30-day time point was 13 (50%) in the cast group and 5 (20.8%) in the shoe group (P = 0.03). In both groups, no side effects were recorded. The average score +/- SD of patient acceptance was 91.15 +/- 9.9 in the shoe group and 88.33 +/- 17.3 (NS) in the cast group. CONCLUSIONS: Our study has shown a significant difference in the speed of the reduction of neuropathic plantar ulcers treated with a fiberglass cast compared with a specialized cloth shoe. The use of fiberglass material with variable rigidity has also shown two important results: the elimination of side effects including ulcers caused by the cast, and high patient acceptance. These data show that the use of off-bearing casts made with fiberglass bandages of variable rigidity is the elective treatment of neuropathic plantar ulcers.

Aged↗
PubMed2003

The influence of shoe design on plantar pressures in neuropathic feet.

OBJECTIVE: The aim of this study was to investigate the effect of shoe design on the plantar pressure dynamics of patients with diabetic neuropathy during walking. RESEARCH DESIGN AND METHODS: Three shoe design categories were tested. Total contact area and biomechanical variables in multiple areas under the foot were measured. RESULTS: Shoes with a rocker bottom principle reduced pressure 35-65% underneath the heel and the central metatarsal heads. Increased contact area did not result in significant pressure reductions underneath the forefoot. Pressure dynamics underneath the heel and medial forefoot (first metatarsal head and hallux) on average showed no significant differences among the different shoes with a cushioning insole. CONCLUSIONS: The most effective way to offload the forefoot of patients with neuropathic feet is through the use of the rocker sole principle. In general, the effect of an insole depends on the design characteristics of a shoe. Predicting the effect of therapeutic footwear on an individual scale, however, remains difficult. Therefore, in-shoe pressure measurements seem to be necessary to evaluate a therapeutic shoe prescription in certain individual cases.

Aged↗
PubMed2002

Short-term effect of therapeutic shoeing on severity of lameness in horses with chronic laminitis.

OBJECTIVE: To evaluate the short-term effects of 4 therapeutic shoeing systems on lameness and voluntary limb-load distribution in horses with chronic laminitis. ANIMALS: 10 horses with chronic laminitis. PROCEDURES: A clinical trial was conducted that used a concurrent control, crossover design to evaluate the relative effectiveness of a standard flat shoe, fullered egg-bar shoe, heart-bar shoe, and modified equine digital support system to alleviate chronic lameness in horses. Therapeutic success was assessed during a 7-day period by use of subjective (Obel grade and clinical score) and objective (force-plate data) evaluations. RESULTS: Comparison of pretreatment and intertreatment control data indicated that disease status of the horses did not change during the course of the study. None of the therapeutic shoeing treatments used resulted in a significant change in severity of lameness. CONCLUSIONS AND CLINICAL RELEVANCE: Results were interpreted to imply that substantial clinical improvement should not be expected during the first 7 days after therapeutic shoeing for the specific shoes tested in this study. On the basis of our results, we hypothesize that when used as the lone indicator of therapeutic success, severity of lameness may not be a valid indicator.

Animals↗