A Design Study of Orthotic Shoe Based on Pain Pressure Measurement Using Algometer for Calcaneal Spur Patients (original) (raw)
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In-shoe pressure measurements with a viscoelastic heel orthosis
Archives of Physical Medicine and Rehabilitation, 1999
Objective: To detect the mechanical effect of a viscoelastic heel orthosis. Design: Two-factor analysis of variance with interactions between the orthosis and the subjects. The number of subjects was determined by presuming the effect of the orthosis to be twice as large as the error-free standard deviation (SD) of the interactions, the step-to-step SD four times as large as the error-free SD of the interactions, type 1 error probability equal to .05, and type 2 error probability equal to .20. Setting: A gait laboratory in a university hospital. Subjects: Twenty-two consecutive patients with treated heel pain. Main Outcome Measures: Peak pressure (PP), pressuretime integral (PTI), and foot-to-sensor contact time (COT) measured for five steps at 24 discrete sensors of predetermined positions in the foot with treated heel pain. Results: The orthosis reduced PPs, PTIs, and COT (p < .05) in the median midfoot and lateral midfoot; reduced PPs and PTIs (p < .05) in the posterior heel and medial midfoot; increased PP and PTI (p < .05) in the anterior part of the first metatarsal head; and increased PTI (p < .05) in the lateral part of the hallux. The ratios of the estimated step-to-step SDS to the estimated error-free SDS of the interactions of PPs, PTIs, and COT were less than four at all the sensors. Conclusion: Proper design and estimation of the variations ensured that there was sufficient power to detect the effect of an a priori specified size as statistically significant: the orthosis reduced the mechanical loads in the posterior heel and the midfoot and increased the mechanical loads in the anterior part of the first metatarsal head and the lateral part of the hallux during walking. 0 1999 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation S UBCALCANEAL HEEL PAIN is a very common foot problem in clinical practice. It can be caused by inflammation of the plantar fascia at its insertion on the calcaneus, heel spur, fracture, calcaneal periositis, subcalcaneal bursitis, nerve entrapment, and intrinsic heel pad patho1ogy.l Its treatment includes relative rest, nonsteroid anti-inflammatory medication, surgery, and heel 0rthoses.l" From the Department of Rehabilitation,
The Relationship of Heel Pad Elasticity and Plantar Heel Pain
Clinical Orthopaedics and Related Research, 1999
Loss of heel pad elasticity has been suggested as one of the possible explanations of plantar heel pain. This hypothesis is evaluated by this blinded observer prospective study, using an age and weight matched control population. Hindfoot lateral radiographs of 73 patients with plantar heel pain, 29 of whom had bilateral involvement (102 feet), and who ranged in age from 20 to 60 years, were studied and compared with 120 healthy subjects (240 feet). Heel pad thickness and heel pad compressibility index were not significantly different in patients with plantar heel pain than in healthy subjects matched for age and weight. In patients with unilateral heel pain, heel pad thickness and heel pad compressibility index on the painful side were not significantly different from the opposite painless side. The contribution of the heel pad elasticity measured as a visual compressibility index for plantar heel pain is a matter of debate.
The effect of loading conditions on stress in the barefooted heel pad
Medicine and science in sports and exercise, 2005
High internal stress is considered to be a possible cause of heel-pad problems. External biomechanical measurements are used to attempt to understand the causes of heel pain. However, internal stress cannot be measured experimentally. Therefore, the purpose of this study was to quantify the relationship between magnitude of force, time to peak force, and sole angle with internal stresses in the heel using a finite element model. Computer tomography (CT) was used to create a nonlinear time-dependent three-dimensional finite element model of the heel pad. The material model was based on previously reported force-displacement data derived from in vitro experiments. Although it was not possible to compare internal calculations of stress with experimental data, good agreement was found for external plantar pressures and strains when compared with in vivo values. Internal stresses and external plantar pressures were then investigated for different forces, loading rates (i.e., time to peak...
Archives of Physical Medicine and Rehabilitation, 1999
TT. Use of computerized insole sensor system to evaluate the efficacy of a modified ankle-foot orthosis for redistributing heel pressures. Arch Phys Med Rehabil 1999;SO: 801-4. Objective: Evaluation of orthosis purported to decrease pressure on the heel while walking. Design: The Multipodus System is an orthotic device, designed for this purpose, that can be worn with flat or rocker bottom boot. Ten subjects underwent four trials: first, an initial walk wearing their usual shoes, then using the orthosis on the left, with a flat bottom boot, then with a rocker bottom boot, and a final walk. Pressures exerted on the plantar surface of the hindfoot, midfoot, and forefoot were measured electronically and analyzed. Setting and Participants: Ten consecutive normal subjects were tested on a conventional tile floor in a gait laboratory. Results: Peak pressures in the initial walk averaged: heel, 9.6 1-2.3psi; midfoot, 2.6 I 1.7psi; and forefoot, 10.3 ? 2.6psi. Pressures on the foot were redistributed significantly when the orthosis was used. Heel pressure was reduced significantly compared to the ordinary shoes using both the flat bottom boot (5.0 t 1.2psi, a decrease of 48% [p = .OOOl]) and the rocker bottom boot (4.5 2 1.5psi, a decrease of 53% [p = .OOOl]). Pressure was increased at the midfoot with both the flat bottom boot (6.6 ? 3.2psi, an increase of 61% [p = .OOOl]) and the rocker bottom boot (6.8 ? 2.9psi, an increase of 62% [p = .OOOl]). Pressures at the forefoot decreased 19% (8.3psi) with the flat bottom boot and 32% (7.Opsi; p = .0003) with the rocker bottom boot. Conclusions: Redistribution of pressure on the foot with orthosis is characterized by reduction at the hindfoot and forefoot and increase at the midfoot with both the flat and rocker bottom boots, thereby promoting healing of calcaneal and forefoot ulcers. The integrity of the midfoot, however, must not be compromised.
Effect of antipronation foot orthosis geometry on compression of heel and arch soft tissues
Journal of Rehabilitation Research and Development, 2015
This study aimed to understand how systematic changes in arch height and two designs of heel wedging affect soft tissues under the foot. Soft tissue thickness under the heel and navicular was measured using ultrasound. Heel pad thickness was measured while subjects were standing on a flat surface and also while they were standing on an orthosis with 4 and 8 degree extrinsic wedges and 4 and 8 mm intrinsic wedges (n = 27). Arch soft tissue thickness was measured when subjects were standing and when standing on an orthosis with 6 mm, standard, and +6 mm increments in arch height (n = 25). Extrinsic and intrinsic heel wedges significantly increased soft tissue thickness under the heel compared with no orthosis. The 4 and 8 degree extrinsic wedges increased tissue thickness by 28.3% and 27.6%, respectively, while the 4 and 8 mm intrinsic wedges increased thickness by 23.0% and 14.6%, respectively. Orthotic arch height significantly affected arch soft tissue thickness. Compared with the no orthosis condition, the 6 mm, standard, and +6 mm arch heights decreased arch tissue thickness by 9.1%, 10.2%, and 11.8%, respectively. This study demonstrates that change in orthotic geometry creates different plantar soft tissue responses that we expect to affect transmission of force to underlying foot bones.
Foot & Ankle Specialist, 2017
Introduction. Chronic plantar heel pain (CPHP) is a significant, painful condition referring to a range of undifferentiated foot conditions that affect the heel of the foot. Method. Participants presenting with CPHP of more than 6 months’ duration were recruited on a first through the door basis. Computer-Aided Design and Computer-Aided Manufactured (CAD-CAM) orthoses were designed and constructed for each participant, then dispensed as per normal practice. Pre- and postintervention assessment of pain was performed at baseline and after 6 weeks of use, utilizing the pain subset of the Foot Function Index (FFI). Results. There was a significant reduction in the mean pain scores for all participants in all constructs of the FFI. Total FFI score was also significant ( P = .003). Conclusion. CAD-CAM orthoses have the potential to become a treatment modality of choice in CPHP since they have resulted in a significant improvement in heel pain after only 6 weeks’ use. Levels of Evidence: T...
BMC Musculoskeletal Disorders
Backround Calcaneal spurs are described as bony outgrowths arising on medial calcaneal, where inappropriate footwear can promote disease progression. Objective Investigate the effectiveness of mechanical treatment with customized insole and minimalist flexible footwear during gait training program in women with calcaneal spur. Methods Design: A single-blinded, randomized and controlled trial. Setting: Biomechanics laboratory. Participants: Forty-three women, 29 with calcaneal spur and 14 control. Intervention Gait training program with use of the minimalist flexible footwear (MFG n = 15, age: 48.9 ± 9.4, height: 1.61 ± 0.1, BMI: 32.1 ± 7.0) and customized insole on footwear (COIG n = 14, age: 50.3 ± 5.8, height: 1.62 ± 0.1, BMI: 32.2 ± 4.3) and control (CG n = 14, age: 47.8 ± 8.6, height: 1.63 ± 0.1, BMI: 27.5 ± 4.5), followed of the evaluations: baseline (T0) and after three (T3) and six (T6) months. Duration of the intervention was of the six months consecutive for at least 42 h p...
Medical Engineering & Physics, 2012
The aims of the present work were to build a 3D subject-specific heel pad model based on the anatomy revealed by MR imaging of a subject's heel pad, and to compare the load-displacement responses obtained from this model with those obtained from a compression device used on the subject's heel pad. A 30 year-old European healthy female (mass = 54 kg, height = 165 cm) was enrolled in this study. Her left foot underwent both MRI and compression tests. A numerical model of the heel region was developed based on a 3D CAD solid model obtained by MR images. The calcaneal fat pad tissue was described with a visco-hyperelastic model, while a fiber-reinforced hyperelastic model was formulated for the skin. Numerical analyses were performed to interpret the mechanical response of heel tissues. Different loading conditions were assumed according to experimental tests. The heel tissues showed a non-linear visco-elastic behavior and the load-displacement curves followed a characteristic hysteresis form. The energy dissipation ratios measured by experimental tests (0.25 ± 0.02 at low strain rate and 0.26 ± 0.03 at high strain rate) were comparable with those evaluated by finite element analyses (0.23 ± 0.01 at low strain rate and 0.25 ± 0.01 at high strain rate). The validity and efficacy of the investigation performed was confirmed by the interpretation of the mechanical response of the heel tissues under different strain rates. The mean absolute percentage error between experimental data and model results was 0.39% at low strain rate and 0.28% at high strain rate.