Footprint Curvature in Spanish Women: Implications for Footwear Fit

Round 1

Reviewer 1 Report

 

 The authors have carried out an interesting study to identify the groups formed by the angulations between forefoot and rearfoot on a sample of the footprint of the right foot of Spanish women, by measuring  the angle between forefoot and rearfoot, in order to transfer their result to the footwear manufacture industry. 

I do have some comments about certain methodological issues covered below under major concerns with the manuscript that require attention prior to publication.

These will be discussed below relative to the sections of the manuscript.

TITLE

The title of this manuscript is too long. Perhaps a more concise version for clarity, interes and ease of read.

ABSTRACT

It is hard to get the detail in an abstract when the word count is limited and this is often the hardest part of a paper to write. However, I do feel that it would be beneficial to explain what specifically you are looking at in relation to pathology (this also applies to the main body of the paper). Is it the development of predictors of  foot disorders literature. This needs to be made clearer throughout the paper

KEYWORDS:

Please use recognised MeSH terms as this will assist others when they are searching for information on your research topic. The following website will provide these (simply start typing in a keyword and see if it exists or find an alternative if it does not):

https://www.ncbi.nlm.nih.gov/mesh

 

INTRODUCTION:

The introduction is weak. An introduction should announce your topic, provide context and a rationale for your work, while catching the reader ́s interest and attention. The above has not been given in the introduction that I have read.

Thus, I suggest in this section should be improved, with more details about prevalence, impact related with diabetes mellitus and his complications. Also, please describe functional limitations associated with fit shoes and related quality of life.

- Lines 77 to 87, maybe the authors should refer to studies that have found differences in the forefoot to rearfoot position (transverse plane) between men and women (see the paper titled “Metatarsus adductus angle in male and female feet: normal values using two techniques of measurement.”published in J Am Podiatr Med Assoc 2008; 98(5): 365-9.

MATERIAL AND METHODS:  Please describe in the text information related with exclusion criteria.

- Lastly, please provide the reference of aspects ethics and legal requirement about this research. Declaration of Helsinki

RESULTS:

The results in basis of the used method are correct.

DISCUSSION:

In general the discussion of the results of the study is correct, authors describe the results, the limitations and compare with other researches.

CONCLUSION: Novel and interesting study. 

REFERENCES: Please provide the references in the journal style

FIGURES AND TABLES: Correct.

 

 

 

Author Response

The authors have carried out an interesting study to identify the groups formed by the angulations between forefoot and rearfoot on a sample of the footprint of the right foot of Spanish women, by measuring  the angle between forefoot and rearfoot, in order to transfer their result to the footwear manufacture industry. 

I do have some comments about certain methodological issues covered below under major concerns with the manuscript that require attention prior to publication.

The title of this manuscript is too long. Perhaps a more concise version for clarity, interes and ease of read.

[Response #2]  Thanks for your suggestions. This information has been rewritten according to your suggestions

Authors  we  have  rewrite  another  title:  “Footprint Curvature in Spanish Women: Implications for Footwear Fit”

                                                                                              

[Response #3] Thank you so much for your suggestion. We delate some more information in the title to your suggestions.

We remove the following words to clarify the title in line 2, 3 and 4:“..Classification.. and.. Foot.. Health…Footprint ..”

It is hard to get the detail in an abstract when the word count is limited and this is often the hardest part of a paper to write. However, I do feel that it would be beneficial to explain what specifically you are looking at in relation to pathology (this also applies to the main body of the paper). Is it the development of predictors of  foot disorders literature. This needs to be made clearer throughout the paper

[Response #4] Thank you so much for your suggestion. We modified and added this information in the abstract section according to your suggestions: Adding “hallux valgus and metatarsus adductus” in line 23

Please use recognised MeSH terms as this will assist others when they are searching for information on your research topic. The following website will provide these (simply start typing in a keyword and see if it exists or find an alternative if it does not):

https://www.ncbi.nlm.nih.gov/mesh

[Response #5] Thank you so much for your suggestion. We modified and added this information in the methods section according to your suggestions Line 31 we delete letter “s” in keyword “foot disease” and also deleate the key word “foot health”

The introduction is weak. An introduction should announce your topic, provide context and a rationale for your work, while catching the reader ́s interest and attention. The above has not been given in the introduction that I have read.

Thus, I suggest in this section should be improved, with more details about prevalence, impact related with diabetes mellitus and his complications. Also, please describe functional limitations associated with fit shoes and related quality of life.

- Lines 77 to 87, maybe the authors should refer to studies that have found differences in the forefoot to rearfoot position (transverse plane) between men and women (see the paper titled “Metatarsus adductus angle in male and female feet: normal values using two techniques of measurement.”published in J Am Podiatr Med Assoc 2008; 98(5): 365-9.

 

[Response #6] We appreciate these suggestions and have included more information about releated quality of life and diabetes mellitus,including the adequate reference. We Add:

 -Line 41 the following sentence: “ and in some cases on diabetic foot ,due to the use of inappropriate footwear”

-Line 254: We add the reference number 8:

Chicharro-Luna, E.; Pomares-Gómez, F.J.; Ortega-Ávila, A.B.; Marchena-Rodríguez, A.; Blanquer-Gregori, J.F.J.; Navarro-Flores, E. Predictive model to identify the risk of losing protective sensibility of the foot in patients with diabetes mellitus. Int. Wound J. 2020, 17, 220–227.

-Line 89 we add the following sentence: “Maldonado and Munuera also calculated, using radiographic images in dorsoplantar projection to obtain the mean values of the metatarsus adductus angle”

-Line 318 we add the reference number 36 ,according your suggestion:

Domínguez, G.; Munuera, P. V.; Pod, L. Metatarsus adductus angle in male and female feet normal values with two measurement techniques. J. Am. Podiatr. Med. Assoc. 2008, 98, 364–369.

Please describe in the text information related with exclusion criteria.

Lastly, please provide the reference of aspects ethics and legal requirement about this research. Declaration of Helsinki

[Response #7] Thanks for your suggestions. We have expanded all your suggestions:

-We include in line 103 the following sentence: “The study included those women who do not use orthosis in the lower limb or special shoes, who are asymptomatic, and who have not undergone surgery on the foot and/or ankle. All subjects provided informed consent for inclusion in the study before participating.”

-In Line 105: The following information was expanded in order to clarify your suggestions: “All subjects gave informed consent to the inclusion before participating in the study consent. The study was conducted in accordance with the Declaration of Helsinki .”

And we the reference number 38 in line 323:

-Holt, G.R. Declaration of Helsinki—The World’s Document of Conscience and Responsibility. South. Med. J. 2014, 107, 407–407.

 

Reviewer 2 Report

 

Dear Authors,

Glad to have an opportunity to review this manuscript, but first of all, this manuscript cann’t be accepted as its current form and format. There are severe problematic areas of the manuscript and the authors were not able to deal with the essential aspects of so-called “scientific research.” This study cann’t be progressed into any further steps of publication in this quality journal unless the following issues properly dealt with:

1. The abstract not successfully compiling and summarizing focal points of this study. I believe this is an outcome result of master’s level thesis study
2. Formatting issues – citation are not properly confirmed with the submission guideline and I found inconsistency in how to cite authors names
3. The authors were not successfully provide adequate rationales for their comments in many of sentences especially when they commented about the selection of subjects and methodology part. It is too brief and doesn’t provide quality justification of the purpose statement.
4. Validity issue – your study is not successful to provide validity evidence of your measurement issues – morphology of subjects’ foot can be categorized into more than 3 different shapes or angulation. What is your rationale to only have 3 different angulations? As you also mentioned, there is a great variability in the morphology of the foot. That is, your results and findings from this measurement progress would not be applicable to target population. There are already more and delicate and high-tech based insole and sports shoes services from global sports brands. I am not really convinced to your findings and not clear about what would be potential lessons from reading your study.   
5. Please check and re-confirm and have other experienced scholars to read your manuscript prior to “submission” in terms of “research process” and conclusion part. Your current conclusion is still too brief and not really meaningful.

 

Author Response

The abstract not successfully compiling and summarizing focal points of this study. I believe this is an outcome result of master’s level thesis study

[Response #1] Thank you so much for your suggestion. Regarding your comment. We modified and added  information in the abstract section according to your suggestions: Adding “hallux valgus and metatarsus adductus” in line 23. On the other hand the results we exposed are developed during a period of time using the standards of research

Formatting issues – citation are not properly confirmed with the submission guideline and I found inconsistency in how to cite authors names

 [Response #2]  Thanks for your suggestions. We apologise for this inconvenient. We tried to respect the format citation standards using Mendeley, and we consider that is very important that formal aspect. We reviewed this topic in the new manuscript version

The authors were not successfully provide adequate rationales for their comments in many of sentences especially when they commented about the selection of subjects and methodology part. It is too brief and doesn’t provide quality justification of the purpose statement.

[Response# 3] We appreciate these suggestions and have included more information about selection criteria

Regarding this comment, we include in line 103 the following sentence: “Those subjects who do not use orthosis in the lower limb or special shoes, asymptomatic and who have not undergone surgery on the foot and / or ankle, were included in the study.”

The reason for including only asymptomatic patients is the main objetive  research ,the shoes manufacturing.

 

Validity issue – your study is not successful to provide validity evidence of your measurement issues – morphology of subjects’ foot can be categorized into more than 3 different shapes or angulation. What is your rationale to only have 3 different angulations? As you also mentioned, there is a great variability in the morphology of the foot. That is, your results and findings from this measurement progress would not be applicable to target population. There are already more and delicate and high-tech based insole and sports shoes services from global sports brands. I am not really convinced to your findings and not clear about what would be potential lessons from reading your study.  

[Response# 4] Thanks for your suggestions. This detail information appears in the manuscript according to main objective research, to classify feet in differents categories , in order to stably several shapes to manufacture footwear

 

Please check and re-confirm and have other experienced scholars to read your manuscript prior to “submission” in terms of “research process” and conclusion part. Your current conclusion is still too brief and not really meaningful.

 

[Response# 5] We appreciate these suggestions .This information has been rewritten according to your suggestions, in fact we include a certificate of grammatical and orthographic review of American Manuscript Editors, furthermore ,authors have rewriten the conclusion section including the following sentence:

“The forefoot-rearfoot relationship depends on the position of the foot. It would be interesting to evaluate studies of foot position to test its influence on foot curvature, and to collect the foot position during data collection”

Reviewer 3 Report

The introduction of the paper is succinct and objective. A well structured and complete state of the art on various physical problems of the feet is exposed, as well as some methods used in the analysis and study of the feet and gait. The identified problem is clear and the objectives outlined are well defined.

The study group is well identified and characterized and the sample size is reasonable. The procedure used in the study is easy to interpret and understand. However, I think it would be interesting, when presenting the results of the characteristics of the participants, to compare the average footprint length of 231.63 mm with the standard size of a number 38 shoe (240 mm in European size).

The discussion of the results presents a series of problems in the feet of the sample that can be caused by the use of wrong sizes and by badly sized lasts, this information can be very useful for the manufacturers of lasts and all the stakeholders, being worth noting the importance of these manufacturers to incorporate in the development processes podiatry professionals. In the discussion of the results, I think it would be very useful to understand one or two graphic figures that show the results obtained and the changes suggested in the geometry of lasts.

Author Response

The introduction of the paper is succinct and objective. A well structured and complete state of the art on various physical problems of the feet is exposed, as well as some methods used in the analysis and study of the feet and gait. The identified problem is clear and the objectives outlined are well defined.

[Response #1] Thanks for your comment we are very grateful for this recognize

 

The study group is well identified and characterized and the sample size is reasonable. The procedure used in the study is easy to interpret and understand. However, I think it would be interesting, when presenting the results of the characteristics of the participants, to compare the average footprint length of 231.63 mm with the standard size of a number 38 shoe (240 mm in European size).

[Response #2] We appreciate these suggestions, we will considerer it in the future, thanks. Because the research objective was stably a classify system of type of feet

 

The discussion of the results presents a series of problems in the feet of the sample that can be caused by the use of wrong sizes and by badly sized lasts, this information can be very useful for the manufacturers of lasts and all the stakeholders, being worth noting the importance of these manufacturers to incorporate in the development processes podiatry professionals. In the discussion of the results, I think it would be very useful to understand one or two graphic figures that show the results obtained and the changes suggested in the geometry of lasts.

[Response #3] We considerer these suggestions, but due to was not a research objective we will considerer it in the future, thanks.

 

Reviewer 4 Report

This manuscript investigated the angulations between forefoot and rearfoot and the footprint curvature classification in a specific population group. There are some revisions need to be made as follows:

 

1. Intro

The author just listed previous research findings in this section, while what are the connection between them and what are the gaps to drive the purpose of this study needs further justification. The author needs to rewrite the intro section to strengthen the rationale of this study and the unique points upon that.

Moreover, the author may need to add the purpose, hypothesis at the end of the intro.

 

2. Materials and Methods

Lines 109 – 137. The author needs to have a more detail description of forefoot and hindfoot angle measurement and mark it in Figure 1. Additionally, the author also needs to mark the other measurements in Figure 1.

 

4. Discussion

The author mentioned previous findings and the current findings, while the connection between them and the take-home message for this research needs further justification.

Author Response

The author just listed previous research findings in this section, while what are the connection between them and what are the gaps to drive the purpose of this study needs further justification. The author needs to rewrite the intro section to strengthen the rationale of this study and the unique points upon that.

 

Moreover, the author may need to add the purpose, hypothesis at the end of the intro.

 

[Response #1] We appreciate these suggestions This information has been rewritten this section according to your suggestions

Lines 78- 81: “determined that the curve in the foot is not related to the width or length of the foot. Later, Luximon and Goonetilleke [34] created a predictive model for shoe adjustment, from which it was deduced that the weight of the mould’s curvature is greater than the weight of its width.

Several authors have assessed the forefoot-rearfoot ratio in the transverse plane. Bunch [3], reported measures intended to improve the feet of athletic shoes for women. Kouchi [12]”

-Line 88-90 “identified four feet types based on the foot outline.Maldonado and Munuera [36] also calculated, using radiographic images in dorsoplantar projection to obtain the mean values of the metatarsus adductus angle”

Thank you so much for your suggestion. We modified and added this information in the introduction section according to your suggestions

-Line 98 The hypothesis in this research was: “it is possible to design a classify feet according to their angles within the same shoe size

Lines 109 – 137. The author needs to have a more detail description of forefoot and hindfoot angle measurement and mark it in Figure 1. Additionally, the author also needs to mark the other measurements in Figure 1.

[Response #2] Thank you for your comment, we add a new Figure 1 including  new detail marks in the picture about forefoot and hindfoot angle measurament

Discussion

The author mentioned previous findings and the current findings, while the connection between them and the take-home message for this research needs further justification.

[Response #3] Thanks for your suggestions. We have expanded all your suggestions:

We have added the following paragraph about current findings. Line 195-206 . “Rodrigo’s results were similar to those obtained by Kouchi and Tsutsumi [12] who propose the making of a last for a pronated foot, with angulation in the back of the last, while maintaining the usual last for those subjects who do not present angulation in the back of the foot.

In a study published in 1995, Kouchi [11] considers that to adjust the curve of the last to the foot, it would be necessary to change the design of the back part of the last, since the foot is prone and outflare in most people, whereas the lasts are straight, designed for feet without pronation or outflare. This causes pressure in the forefoot, especially on the fifth toe, and the simple change of the toe does not relieve the pressure in this area

In podiatry, the recommendations regarding the angulation of the last are common according to the type of foot. Barton et al. [31]”

 

Round 2

Reviewer 1 Report

• Lines 23-24, please revise "aimed to identify", maybe should be replaced by "aimed at identifying".
• Line 88, "Maldonado and Munuera" should be replaced by "Domínguez and Munuera".
• Line 94, "aimed to determine" should be replaced by "aimed at determining".
• Maybe the authors could start the discussion section by briefly reminding the purpose of the study, and the main conclusion.
• Line 320, please release "Pod, L." that appears as an author, but the article number 36 has only two authors.

Author Response

Thank you for accepting the review of the current article and for the suggestions made, which could improve considerably the quality of the manuscript. Here, below your comments, you can see the comments and changes made after revision in highlight.

• Lines 23-24, please revise "aimed to identify", maybe should be replaced by "aimed at identifying

This has been changed in the text as suggested.

• Line 88, "Maldonado and Munuera" should be replaced by "Domínguez and Munuera".

Sorry it was a mistake we have changed in the correct way

• Line 94, "aimed to determine" should be replaced by "aimed at determining".

This has been changed in the text according to the recommendation.

 

• Maybe the authors could start the discussion section by briefly reminding the purpose of the study, and the main conclusion

We agree that this should be incorporated in the discussion. The following text has now been incorporated in the discussion section of the revised manuscript (p5, lines 170-172).

In text:

The porpuse of this study was to determine the values of the angle between forefoot and rearfoot in the transverse plane, in a sample of Spanish women, which allow the grouping of tracks.

 

• Line 320, please release "Pod, L." that appears as an author, but the article number 36 has only two authors.

Sorry there must be a mistake using mendeley citation manager we proceed to correct it

Reviewer 2 Report

Dear Editor, 

I have reviewed the resubmitted manuscript with the highlighted comments and some more paragraphs on the main areas of the study. However, I don't see any significant improvement in terms of most of important aspects of "scientific research." In other words, I still see many important areas are  missing and need to be greatly improved in terms of validation and reliability issues. Please work on these issues in a more careful manner. Returning in 2 days after the initial review...perhaps it might not be understandable for the authors' effort. 

Author Response

Thank you for accepting the review of the current article and for the suggestions made, which could improve considerably the quality of the manuscript. Here, below your comments, you can see the comments and changes made after revision in highlight.

We have discussed the relevancy of classify different kind of feet, probably some methodological aspect can be improved, in fact we include a limitation section in revised manuscript (p6, lines 218-219).

In text:

 

differences in the morphology of the foot have been documented by foot size, sex, ethnicity, and age, so it would be necessary to expand the research with other samples.

 

 We think have identified it as a limitation of the study according to the recommendations

We agree with this comment, however the aim of the study is determine the values of the angle between forefoot and rearfoot in the transverse plane, in a sample of Spanish women, which allow the grouping of tracks (p5, lines 170-172) in text, it is exposed a local consideration for the readers and can lose the initial intention of the study. We prefer maintain this analysis, in spite of risk of statistical error, and consider it as a limitation of the study.

This issue has been widely justified according to previous comments in R1, in fact, most of reviewers have decided to accept the manuscript because they considered is an interesting topic for the special issue and is adequate for the journal scope.

 

In other words, trhree of four reviewers think the manuscript can be published. Specially because authors have done a great effort at the research job.

Futhermore, a senior podiatric (ENF) performed all evaluations (demographic, forefoot and rearfoot  in the plane transverse angle).

The observer who performed the mesure exploration was described in the text. We have added the experience in the training with measurement footprint in the text as suggested “The observers were podiatrists who had more than 3 years of experience measurement foot print angles and were trained in this hability”

Reviewer 4 Report

The author had addressed my concerns and suggestions.

Author Response

We thank the reviewer for this constructive comment.