Search Results (10)

Background: Defects of the foot and ankle area pose a significant challenge for both patients and surgeons. While the primary objective of microvascular free flap reconstructions of lower leg defects is limb preservation, there should be an effort to obtain the best functional and aesthetic results possible and to restore the patient’s quality of life. The aim of this study was to investigate the long-term post-operative functional outcome, health-related quality of life, scar quality, and aesthetic satisfaction in patients following microsurgical reconstructions of defects of the foot and ankle area. Methods: We conducted a monocentric, controlled cohort study of adult patients who underwent microsurgical reconstructions for defects of the foot and ankle area between 2006 and August 2022 at our department. As a control, we recruited healthy individuals. Patient-Reported Outcome Measures questionnaires were used to assess long-term results regarding functionality (LEFS: Lower Extremity Functional Scale), health-related quality of life (SF-36: Short-Form 36 Health Survey Questionnaire), scar quality (PSAS: Patient Scar Assessment Scale), aesthetic satisfaction (Aesthetic Likert Scale), pain at rest and activity (10-point Numeric Rating Scale) and usage of footwear. Results: Of the 55 potential patients who had received microvascular free flaps for reconstructions of ankle and foot defects and were eligible for study inclusion, 13 (23.6%) agreed to participate in this study. The study cohort consisted of 84.6% male subjects and the mean follow-up period was 8.6 years (±5.2). Significant moderate limitations were observed with regard to physical function of the lower extremity (LEFS: 42.5 ± 20.5, p = 0.002). Significant limitations were found in the SF-36 subscales of pain (55.8 ± 34.5, p = 0.019), physical functioning (55.0 ± 29.7, p = 0.013), and physical role functioning (38.5 ± 44.0, p = 0.006). The study yielded favorable outcomes with regard to aesthetic satisfaction (14.3 ± 4.4) and scar quality (23.5 ± 13.5). Out of all the patients, 61% were required to wear orthopedic shoes or insoles. Conclusions: Patients undergoing microsurgical reconstructions for ankle and foot defects experience moderate long-term physical limitations and persistent pain during activity. Furthermore, we observed a significant long-term impact on specific physical domains of health-related quality of life, whereas mental health seems less affected. Full article

Background/Objectives: Plantar fasciitis (PF) is a common condition that causes heel pain. While various conservative treatment modalities for PF exist, no previous studies have investigated the effectiveness of shoe rotation (ShR) in patients with PF pain. This study aimed to compare the therapeutic effectiveness of ShR with that of two conventional treatments for PF—namely, foot orthosis (FO) and physical therapy (PT). Methods: Charts of 42 patients with heel pain were retrospectively reviewed. Participants were allocated to one of three treatment groups: the ShR group, the customized FO group, and the PT group. Pain and functional outcomes were assessed using the Visual Analog Scale (VAS), Digital Pain Scale (DPS), Foot Function Index (FFI), Foot Pain and Function Scale (FPFS), and American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) at baseline and at 4 and 12 weeks after the intervention. Results: The ShR, FO, and PT groups all showed improvements, with statistically significant decreases in VAS, DPS, and FFI scores and significant increases in FPFS and AOFAS-AHS scores over time (p < 0.05). All three interventions resulted in significant improvements from baseline to 4 weeks and further to 12 weeks (p < 0.05). The ShR group exhibited a slightly larger effect on all measurements than the other groups. Conclusions: ShR, FO, and PT contributed to pain reduction and functional improvement, and alternating the shoes alleviated PF pain. These results suggest a new approach to managing PF and serve as a basis for providing convenient treatment for patients with PF. Full article

Background: Additive manufacturing (AM) for patient-specific medical care products offers great opportunities. However, evidence about the supply chain (SC) performance impact based on empirical data is limited. Methods: In this case study, we gathered real-life data about a traditional manufacturing orthopedic shoe SC and developed future scenarios in which AM is introduced at various points and with different degrees of penetration in the SC. Results: Presently, AM can only replace traditional manufacturing of tools and shoe components at a higher total cost. However, with maturing technology, the complete AM production of orthopedic shoes is expected to become feasible. Theoretically, that could disrupt existing SCs, eliminating 70% of the SC steps, improving SC lead time by 90%, and altering SC relations. However, certain thresholds currently prevent disruption. Specifically, the AM of complete orthopedic shoes has to become possible, manufacturing prices have to drop, and traditional craftsmanship has to be integrated into the digital product design. Conclusions: A framework for transition pathways, including directions for future research, is formed. Findings provide valuable insights for scholars and decision makers in the patient-specific products industry, health insurance providers, and healthcare policy makers to be better prepared by adjusting SC designs, relationships, and remuneration programs while AM technology develops towards maturity. Full article

The prevalence of individuals with flat feet and high arches is very high (between 15% to 37%), which can often lead to other orthopedic complications. Three-dimensional-printed insoles are being studied and validated for their effects in correcting these highly prevalent foot disorders. Highly customizable parameters while printing the insole allows for precise correction of foot biomechanics. In this study, 200 patients suffering from various foot-related problems and joint pain were given 3d-printed insoles (designed using plantar pressure systems and clinical practitioner’s assessment) to use in their footwear. Tested activities included standing, walking, running, sports, and gym workout. Customization of insoles included custom density, heel cup, heel rise, medial arch height, and lateral wedge. Based on the patient history, additional podiatry elements were provided for patients with diabetes. Each insole was designed as per the insole profile of the shoe with a comfortable fit. These insoles were found to be effective in alleviating pain for more than 90% of the patients and provided a longer life cycle with effective orthotic correction (for >16 months of daily use). This paper presents the post-use effects (6–18 months) of custom 3D-printed insoles. Full article

In this study, the possibility of using modern AM technologies to produce designed heels for personalized orthopedic footwear with a medium heel was explored. Seven variants of heels were produced using three 3D printing methods and polymeric materials with different natures: PA12 heels made using the SLS method, photopolymer heels made using the SLA method, and PLA, TPC, ABS, PETG, and PA (NYLON) heels made using the FDM method. A theoretical simulation with forces of 1000 N, 2000 N, and 3000 N was performed in order to evaluate possible human weight loads and possible pressure during orthopedic shoe production. The compression test of the 3D-printed prototypes of the designed heels showed that it is possible to replace the traditional wooden heels of hand-made personalized orthopedic footwear with good-quality PA12 and photopolymer heels made using the SLS and SLA methods, but also with PLA, ABS, and PA (NYLON) heels printed using a cheaper FDM 3D printing method. All of the heels made using these variants withstood loads of more than 15,000 N without damage. It was determined that TPC is not suitable for a product of this design and purpose. Due to its greater brittleness, the possibility of using PETG for orthopedic shoe heels must be verified by additional experiments. Full article

Reconstructed 3D foot models can be used for 3D printing and further manufacturing of individual orthopedic shoes, as well as in medical research and for online shoe shopping. This study presents a technique based on the approach and algorithms of photogrammetry. The presented technique was used to reconstruct a 3D model of the foot shape, including the lower arch, using smartphone images. The technique is based on modern computer vision and artificial intelligence algorithms designed for image processing, obtaining sparse and dense point clouds, depth maps, and a final 3D model. For the segmentation of foot images, the Mask R-CNN neural network was used, which was trained on foot data from a set of 40 people. The obtained accuracy was 97.88%. The result of the study was a high-quality reconstructed 3D model. The standard deviation of linear indicators in length and width was 0.95 mm, with an average creation time of 1 min 35 s recorded. Integration of this technique into the business models of orthopedic enterprises, Internet stores, and medical organizations will allow basic manufacturing and shoe-fitting services to be carried out and will help medical research to be performed via the Internet. Full article

Gait analysis, as a common inspection method for human gait, can provide a series of kinematics, dynamics and other parameters through instrumental measurement. In recent years, gait analysis has been gradually applied to the diagnosis of diseases, the evaluation of orthopedic surgery and rehabilitation progress, especially, gait phase abnormality can be used as a clinical diagnostic indicator of Alzheimer Disease and Parkinson Disease, which usually show varying degrees of gait phase abnormality. This research proposed an inertial sensor based gait analysis method. Smoothed and filtered angular velocity signal was chosen as the input data of the 15-dimensional temporal characteristic feature. Hidden Markov Model and parameter adaptive model are used to segment gait phases. Experimental results show that the proposed model based on HMM and parameter adaptation achieves good recognition rate in gait phases segmentation compared to other classification models, and the recognition results of gait phase are consistent with ground truth. The proposed wearable device used for data collection can be embedded on the shoe, which can not only collect patients’ gait data stably and reliably, ensuring the integrity and objectivity of gait data, but also collect data in daily scene and ambulatory outdoor environment. Full article

Generally, there are two types of working style, i.e., some people work in sitting conditions, and the remaining work mostly in a standing position. For people working in a standing position, they can spend hours in a day doing their work standing. These people do not realize that it can cause medical issues, especially for the feet, namely biometric problems. In addition, several doctors in Indonesia are already aware of this issue and state that the biometric problems faced by those kinds of people can be predicted from the load distribution on the foot. However, the tool used by the doctors in Indonesia to measure biometric problems is not a digital tool. Therefore it is very difficult to measure and predict the biometric problems quantitatively. This study aims to develop a low-cost static load measuring device using force-sensing resistor (FSR) sensors. The measuring instrument is designed in the form of a pressure plate platform which consist of 30 FSR 402 sensors. The sensors are placed right underneath the display area of the foot, 15 sensors on the soles of the left and right feet. Ten students from the Department of Mechanical Engineering, Diponegoro University (five men and five women) were asked to stand on the platform. Each subject also measured foot length (FL) to estimate shoe size, foot area contact (FAC) for validation between genders, and foot type using the digital footprint tools. From the results of measurements obtained for the left foot in the medial mid foot area, i.e., in sensors 5 and 7, not exposed to the load, on almost all subjects except subject number 3 with a load of 0.196 kg on sensor 7. The highest average load occurs in the heel area i.e., sensor 1 measured 0.713 kg and the smallest average load occurs in the five sensors, with 0 kg. A static load gauge that is designed to be used to measure each leg area for subjects with a shoe size of 40–42 with low price to be held in hospital-orthopedic hospitals and biomechanical research centers. Full article

Background: The mobility of the first metatarsophalangeal joint (I MPTJ) has been related to the proper windlass mechanism and the triceps surae during the heel-off phase of running gait; the orthopedic treatment of the I MPTJ restriction has been made with typical Morton extension orthoses (TMEO). Nowadays it is unclear what effects TMEO or the novel inverted rocker orthoses (NIRO) have on the EMG activity of triceps surae during running. Objective: To compare the TMEO effects versus NIRO on EMG triceps surae on medialis and lateralis gastrocnemius activity during running. Study design: A cross-sectional pilot study. Methods: 21 healthy, recreational runners were enrolled in the present research (mean age 31.41 ± 4.33) to run on a treadmill at 9 km/h using aleatory NIRO of 6 mm, NIRO of 8 mm, TMEO of 6 mm, TMEO of 8 mm, and sports shoes only (SO), while the muscular EMG of medial and lateral gastrocnemius activity during 30 s was recorded. Statistical intraclass correlation coefficient (ICC) to test reliability was calculated and the Wilcoxon test of all five different situations were tested. Results: The reliability of values was almost perfect. Data showed that the gastrocnemius lateralis increased its EMG activity between SO vs. NIRO-8 mm (22.27 ± 2.51 vs. 25.96 ± 4.68 mV, p < 0.05) and SO vs. TMEO-6mm (22.27 ± 2.51 vs. 24.72 ± 5.08 mV, p < 0.05). Regarding gastrocnemius medialis, values showed an EMG notable increase in activity between SO vs. NIRO-6mm (22.93 ± 2.1 vs. 26.44 ± 3.63, p < 0.001), vs. NIRO-8mm (28.89 ± 3.6, p < 0.001), and vs. TMEO-6mm (25.12 ± 3.51, p < 0.05). Conclusions: Both TMEO and NIRO have shown an increased EMG of the lateralis and medialis gastrocnemius muscles activity during a full running cycle gait. Clinicians should take into account the present evidence when they want to treat I MTPJ restriction with orthoses, and consider the inherent triceps surae muscular cost relative to running economy. Full article

Background and Objectives: Patients with Down syndrome have many orthopedic problems including flat foot. Insertion of an insole for a flat foot provides support to the medial longitudinal arch; thus, insole therapy is often used to treat a flat foot. However, the influence of an insole insertion on the knee joint kinematics for a patient with Down syndrome is unknown. This study aimed to elucidate the influence of an insole for a flat foot on the knee kinematics during gait for a patient with Down syndrome. Materials and Methods: The subject was a 22-year-old male with Down syndrome who had a flat foot. The knee joint angle during the gait was measured using a 3D motion capture system that consisted of eight infrared cameras. Results: The gait analysis demonstrated a reduction in the knee flexion angle during double knee action. The knee valgus and tibial internal rotation angles also decreased during the loading response phase while wearing shoes that contained the insole. Conclusions: As the angle of the knee joint decreased during the gait, it was considered that the stability of the knee joint improved by inserting the insole. In particular, there was a large difference in the tibial internal rotation angle when the insole was inserted. It is thus hypothesized that the insole contributes to the rotational stability of the knee joint. This study suggests that knee stability may improve and that gait becomes more stable when a Down syndrome patient with a flat foot wears an insole. Full article