The effect of shoe sole thickness on in-shoe plantar pressure and perceived comfort for patients with metatarsalgia

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The effect of shoe sole thickness on in-shoe plantar pressure and perceived comfort for patients with metatarsalgia


Author: Chan, Yau-keung
Title: The effect of shoe sole thickness on in-shoe plantar pressure and perceived comfort for patients with metatarsalgia
Degree: M.Sc.
Year: 2010
Subject: Hong Kong Polytechnic University -- Dissertations
Foot -- Abnormalities -- Treatment
Footwear -- Therapeutic use
Department: Dept. of Health Technology and Informatics
Pages: ix, 75 leaves : ill. ; 30 cm.
Abstract: Metatarsalgia may involve a component of mechanical overload causing forefoot pain. The biomechanical interventions for these conditions incorporate some form of off-loading through the use of shoe modifications, metatarsal pads and other orthoses. Previous studies concentrated in the effectiveness of orthoses in term of the off- loading capability. Advice on proper shoes to patients with metatarsalgia is important in the treatment regime and cannot be ignored. Except the heel height, other characteristics of off-the-shelf shoes are of minor concern in the management of metatarsalgia. The shoe sole thickness may affect those patients with metatarsalgia of biomechanical causes. The correlations between shoe sole thickness, in-shoe plantar pressure and perceived comfort of this group of patients are still unclear. The objective of the current study is to determine the effect of different shoe sole thickness on pressure parameters, perceived comfort and forefoot pain during walking for patients with metatarsalgia. Fifteen female subjects with metatarsalgia volunteered for the study. Three types of off-the-shelf shoes with different sole thickness (4 mm, 8 mm and 12 mm) were compared. The F-Scan System (Tekscan Inc., Boston, USA) was used to measure the in-shoe plantar pressure during three walking trials of each shoe with self-selected cadence along a 15 m long indoor level walkway. The peak pressures were measured at the forefoot, midfoot and hindfoot regions of subject's right feet when the subjects walked with the three types of shoes. The subjects also rated the perceived comfort and forefoot pain during the walking trials by Visual Analogue Scales (VAS). Analysis of variance tests were used to determine differences in pressure parameters, perceived comfort and forefoot pain between the three types of shoes. The result indicated that increasing shoe sole thickness decreased significantly the peak pressure at the forefoot and hindfoot (p <0.05). In particular, comparing the Leather Sneaker (12 mm sole thickness) with the Ballet Flat (4 mm sole thickness), thick-soled shoes reduced forefoot peak pressure by 26.9% and hindfoot peak pressure by 19.5%. Shoes with thicker soles also reduced the forefoot force-time integral by 15.7%. The comfort ratings were significantly increased in all foot regions with increasing shoe sole thickness (p < 0.05). In contrary, the forefoot pain score decreased significantly (p < 0.001) with the increase of sole thickness between Ballet Flat and Leather Sneaker. The findings suggested that thin-soled shoes resulted in increased plantar pressure and decreased plantar comfort, which was supported by both the pressure parameters and subjective rating scales. Increased forefoot pain was resulted when walking with thin-soled shoes. For the shoes compared in this study, peak plantar pressure and the force-time integral in the forefoot did not appear to be correlated to the perceived comfort. The result of this study serves as a simple guide for clinicians to advise patients with metatarsalgia for the selection of appropriate off-the-shelf shoes. Thick-soled shoes are preferred for this group of patients. The correct choice of shoes may help to relieve forefoot pain with or without fitting of other orthotic devices.

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