Search Results (582)

Prolonged standing and repetitive lifting are routine occupational stressors that elevate plantar pressures across workers. In those with diabetes, these demands represent additional risk factors for diabetic foot pathology, highlighting the need for ergonomic interventions beyond standard safety footwear. This study evaluated the perceived ergonomic performance of the MoonWalking^® insole, a novel adaptive pneumatic system designed for real-time pressure stabilization and offloading when integrated into safety footwear. A comparative experimental protocol tested two conditions: safety footwear with the manufacturer’s original insole and the same footwear with the MoonWalking prototype. Twenty participants assessed perceived comfort using a VAS and binary ergonomic questionnaires. The results showed statistically significant improvements in perceived cushioning, foot fit, and overall comfort when using the MoonWalking insole. Participants consistently identified pressure-stabilizing and offloading functions across all plantar regions, indicating that adaptive pressure control was clearly perceptible. No pain or movement restrictions were reported. Although perceived fatigue did not reach statistical significance, a decreasing trend was observed. A slight reduction in intention to reuse the footwear occurred with the prototype, possibly due to its increased weight. These findings provide evidence that integrating an adaptive pneumatic insole into safety footwear may improve plantar pressure redistribution and user comfort. Full article

Background: Chronic ankle instability (CAI) post-sprain leads to persistent functional deficits. This study evaluated CAI’s specific impact on ankle dorsiflexion, heel lift function, stability, broader functional impairments, and quality of life. Methods: A case–control study enrolled 100 CAI patients (post-ankle sprain) and 100 healthy controls. Ankle strength (isokinetic dynamometer), stability (pressure plate), maximum dorsiflexion/plantar flexion ROM (mobility meter), functional limitations (0–10 activity scale), pain (VAS), coordination (Agility T-test, figure-of-eight test), and quality of life (FAOS) were compared. ANOVA and Mann–Whitney U tests were used. Results: Compared to controls, the CAI group showed significantly reduced ankle dorsiflexion strength (114.53 ± 10.47 N vs. 156.34 ± 13.26 N), heel lift strength (78.69 ± 5.44 N vs. 105.45 ± 8.28 N), stability scores (4.73 ± 0.52 vs. 8.65 ± 0.71 points), and ROM (dorsiflexion: 16.49° ± 1.23° vs. 22.35° ± 1.65°; plantar flexion: 27.58° ± 6.51° vs. 43.27° ± 5.45°). CAI patients reported higher activity limitation (6.34 ± 1.25 vs. 2.16 ± 0.55) and pain (5.37 ± 1.02 vs. 0.23 ± 0.01) and prolonged Agility T-test (11.24 ± 1.37 s vs. 7.51 ± 1.16 s) and figure-of-eight (16.35 ± 1.67 s vs. 12.43 ± 1.39 s) times. FAOS subscale scores (symptoms, daily activities, sports, pain) were significantly lower in the CAI group. All p < 0.05. Conclusions: CAI significantly compromises ankle dorsiflexion, heel lift strength, stability, and functional mobility, correlating with increased pain, activity restriction, and diminished quality of life. Rehabilitation should prioritize neuromuscular re-education, strength restoration, and dynamic stability training to improve outcomes. Full article

Background: This study aimed to evaluate the effects of NP associated with LDD on balance, gait and foot pressure distribution. Methods: This prospective controlled study was conducted on 42 individuals aged between 40-70 years. There were 3 groups in the study: individuals diagnosed with NP associated with LDD (n=14), individuals with LDD without NP(n=14), and the control group (n=14). The Force Plate system and Core Balance System measured static and dynamic postural balance and stability limits. Gait and dynamic plantar pressure distribution analyses were performed with a computerized gait evaluation system. Results: The Leeds Assessment of Neuropathic Signs and Symptoms (LANSS), VAS during gait, and Oswestry Disability Index (ODI)scores were higher in LDD with NP group than in LDD without NP group (p<0. 05). It was found that LDD with NP group had backward dynamic balance control (p<0. 05). There was no significant difference in balance control, dynamic plantar pressure distribution, and spatiotemporal gait parameters between the groups (p>0. 05). Conclusion: Although participants with NP had higher levels of pain severity in gait and disability, there was no difference in postural balance, dynamic plantar pressure distribution, and spatiotemporal gait parameters compared to participants with LDD without NP and healthy individuals. All participants with LDD were unilaterally affected. Therefore, postural balance and gait tasks would be able to compensate for the unaffected limb. Full article

Flexible piezoresistive sensors are often vulnerable to modal ambiguity and bending-induced drift, both of which can obscure true pressure and strain signals under practical operation. Here, we address these limitations by suppressing bending sensitivity at the device level and disambiguating tactile modes at the algorithmic level. We propose and fabricate a Ti₃C₂T_x/graphene oxide (GO) sandwich sensor in which the conductive network is positioned near the neutral axis, thereby ensuring that bending induces negligible axial strain in the active layer. In contrast, out-of-plane pressing enlarges microcontacts, while in-plane stretching disrupts percolation pathways. We develop a composite-beam model to quantify neutral-axis alignment and the resultant bending immunity, realize the device via a straightforward casting process, and systematically characterize its electromechanical response under bending, pressing, nail pressing, and stretching. To further reduce modal ambiguity and improve tactile recognition, a lightweight one-dimensional convolutional neural network (1D-CNN) was introduced to classify temporal resistance signals from the sensor. Experimental results showed that the 1D-CNN achieved a high classification accuracy of 98.52% under flat-state training and testing conditions, and maintained 96.67% accuracy when evaluated on bending-state samples, demonstrating strong robustness against bending-induced interference. Together, the neutral-axis device architecture and the learning-based inference pipeline deliver high sensitivity to pressing and stretching while markedly suppressing the response to bending, thereby enabling wrist-worn pulse monitoring, soft-robotic joint sensing, and plantar pressure insoles. Full article

Flatfeet involve a collapse of the medial longitudinal arch, hindfoot valgus, and forefoot abduction. Flexible flatfoot is the most common type and can often be corrected with physiotherapy or orthotics. While some individuals remain asymptomatic, others develop symptoms for reasons that are not fully understood. This cross-sectional study compared plantar pressure distributions in 16 adults with asymptomatic and 16 with symptomatic flexible flatfeet (FPI-6 > 6; navicular drop > 5 mm), using a resistive-sensor-equipped pressure plate during walking and heel-strike running. During walking, symptomatic participants showed significantly higher total and peak forces at metatarsal 5 (p ≤ 0.003), and the midfoot (p ≤ 0.02146). The medial heel had significantly lower peak force (p = 0.00147), and metatarsal 4 showed higher peak force (p = 0.02539). Force ratios indicated a more lateralized pressure distribution in the symptomatic group. During heel-strike running, the symptomatic group exhibited higher total and peak forces at the fifth metatarsal, the midfoot, and the first metatarsal, with shorter time to peak force in the midfoot and the medial part of the heel. No significant ratio differences were found during running. Symptomatic individuals adopted a lateralized pressure distribution pattern, contrasting the traditional expectation of medial overload in flatfoot conditions. Full article

Ankle dorsiflexion range of motion (ADF-ROM) deficits has been linked to impaired function, altered gait, and injury risk. This study’s objective was to examine the acute effects of static self-stretching (SSS), foam rolling (FR), and instrument-assisted soft tissue mobilization (IASTM) of the posterior lower-leg on ADF-ROM and functional ankle outcomes in individuals with ADF-ROM deficits. Thirteen healthy, physically active college students with active ADF-ROM ≤ 13°, assessed in a non-weight-bearing position, completed all three interventions in a randomized, within-subject repeated-measures design. Pre- and post-intervention assessments included ADF-ROM, ankle plantar flexor isometric strength (APF-IS), single-leg countermovement vertical jump (SLCVJ), anterior reach distance in the Y-Balance Test (A-YBT), and gait parameters (contact time and plantar pressure). A two-way repeated-measures ANOVA with Bonferroni post hoc tests was used. Effect sizes reported as partial eta squared (${\eta }_p^2$) and Cohen $d_{\mathrm{z}}$. All interventions significantly improved ADF-ROM (p < 0.001; ${\eta }_p^2$ = 0.885), with IASTM showing the largest increase (50.7%, $d_{\mathrm{z}}$= 2.15), followed by FR (35.4%, $d_{\mathrm{z}}$ = 2.20) and SSS (21.5%, $d_{\mathrm{z}}$ = 1.82). Differences between IASTM and FR (p > 0.05, $d_{\mathrm{z}}$ = 0.40) and between FR and SSS (p > 0.05, $d_{\mathrm{z}}$ = 0.69) were nonsignificant, while IASTM was significantly greater than SSS (p < 0.05, $d_{\mathrm{z}}$ = 0.92). Significant gains were also seen in A-YBT (p < 0.05; ${\eta }_p^2$ = 0.302) and rearfoot plantar pressure (p < 0.01; ${\eta }_p^2$ = 0.482), although pairwise comparisons were nonsignificant and demonstrated small-to-moderate effect sizes ($d_{\mathrm{z}}$ = 0.35–0.52). No significant changes occurred in APF-IS, SLCVJ, or contact time and mid- and forefoot plantar pressures during roll-off. In conclusion, all interventions improved ADF-ROM, with IASTM and FR being comparably effective. However, only slight improvements in dynamic balance and certain gait parameters were noted, with no effect on strength or power. Full article

The use of diabetic insoles is crucial for preventing and rehabilitating foot ulcers associated with diabetic foot syndrome. However, conventional insole manufacturing is often expensive, labour-intensive, and requires specialised expertise. Therefore, an advanced, partly automated manufacturing process chain for individualised 3D-printed insoles was developed, combining techniques such as 3D-scanning and additive manufacturing for diabetic patients. After scanning both feet, a virtual insole was loaded from a data library in the software, which automatically suggested the appropriate size and adjusted the heel support based on the plantar pressure distribution of the foot. The template of the individual insole was manually adjusted and the final insole was manufactured using a 3D-printer. A feasibility study was conducted involving five patients with diabetic polyneuropathic foot syndrome to compare the conventionally manufactured and 3D-printed insoles regarding the plantar pressure distribution, spatiotemporal gait parameters, and subjective comfort. The 3D-printed insoles showed a partially improved plantar pressure distribution in the descriptive analysis and only a slightly higher peak plantar pressure (n = 4; standing 2.0%, d = 0.09; walking 14.5%, d = 1.08). Marginally reduced gait velocity (n = 5, 14.0%, d = 0.40) was observed with the 3D-printed insoles, whereas the step length (n = 5, 2.5%, d = 0.18) remained similar for both insoles. No differences in the overall wearing comfort (n = 5, d = 0.16) were observed. In conclusion, the proposed process chain was feasible and the 3D-printed insoles showed indications of functional comparability to conventionally manufactured insoles. Therefore, they may represent a promising alternative for diabetic patients. However, larger comparative studies are required to confirm our findings. Full article

Background/Objectives: Several methods have been proposed to assess lower limb-length discrepancies; however, none have demonstrated sufficient reliability and validity for diagnosing anatomical discrepancies (DA). Objectives: This study primarily aims to evaluate the accuracy of two traditional tests—the Modified Iliac Crests Palpation and Pelvimeter with Blocks test (ICPBL) and plantar pressure analysis—by comparing them with the gold standard telemetry (TE) method for diagnosing DA. The secondary objective is to assess the intra-rater reliability of these two tests and determine their potential applicability in clinical settings. Methods: Thirty subjects between the ages of 20 and 80 were enrolled in the present prospective, cross-sectional diagnostic accuracy pilot study; thirteen with a positive TE for DA of more than 3 mm were classified into the group with the condition DA, and 17 were classified into the group without the condition DA. Pelvic tilting and plantar pressures were evaluated. Results: The TE revealed a difference of 8.09 ± 3.24 mm between the short and long limbs, while subjects without DA had only a 0.41 mm difference (p < 0.001). Similarly, the Modified ICPBL test showed a 4.38 ± 2.10 mm difference in subjects with DA, compared to 0.51 ± 0.53 mm in those without DA (p < 0.001). Additionally, plantar pressure measurements supported these findings, with a difference of 5.17 ± 3.28 kg/cm² between the short and long limbs in subjects with DA, versus 2.28 ± 1.77 kg/cm² in subjects without DA (p < 0.05). The area under the receiver operating characteristic (ROC) curve was 0.783 (95% CI: 0.456–0.877) for plantar pressures and 1.000 (95% CI: 0.742–0.942) for the Modified ICPBL test. Conclusions: The Modified ICPBL and plantar pressure tests demonstrated high diagnostic accuracy within the sample studied, suggesting they are useful tools for supporting the diagnosis of DA. In this pilot study, the Modified ICPBL showed very high discriminative ability, while plantar pressure testing demonstrated moderate sensitivity. Both methods may serve as preliminary practical alternatives to telemetry TE, potentially reducing X-ray exposure; however, these results should be interpreted with caution due to the limited sample size and the specific clinical setting of this study. Full article

Background: Custom-made footwear that improves offloading using in-shoe pressure-guided techniques, when worn as recommended, reduces the risk of diabetic foot ulcer recurrence. We aimed to assess the cost-effectiveness of this approach, as it requires extra investments in equipment and personnel, and implementation is not yet widespread. Methods: We conducted an economic evaluation using data from the DIAFOS RCT that randomized 171 participants at high ulcer risk to either pressure-guided-offloading-improved (intervention) or non-pressure-guided (usual care) custom-made footwear. The clinical outcome was the 18-month ulcer recurrence incidence, available from the RCT. Costs were modeled from a partial healthcare perspective using bottom-up unit cost calculation, with ulcer treatment costs obtained from reference data. Univariable regression analyses were executed to obtain incremental cost-effectiveness ratios (ICERs). Bootstrapping techniques accounted for uncertainty. Results: For the intervention, costs for ulcer recurrence were non-significantly lower (€−436; 95% CI: €−1434; €563) than for usual care. The ICER was €−8124 (i.e., costs saved to prevent one extra participant from having an ulcer), and the maximum probability for cost-effectiveness was 0.81. In the subgroup of participants who were adherent to wearing their prescribed footwear, costs for the intervention were non-significantly lower at €−1170 (95% CI: €−2595; €254), with ICER of €−5317, and a maximum probability for cost-effectiveness of 0.94. Conclusions: The use of in-shoe pressure-guided-offloading-improved custom-made footwear to help prevent diabetic foot ulcer recurrence is cost-effective with high probability when ulcer treatment costs are considered. Probability further increases when users adhere to their footwear. Future economic analyses should consider a full healthcare and societal perspective and use prospectively collected data on ulcer treatment costs. Full article

Background: Flatfoot is a condition brought on by trauma, persistent foot stress, obesity, and poor biomechanics. These factors result in the development of a flat foot, collapse of the foot arch, and malfunction of the posterior tibial tendon. This study aimed to assess the immediate effects of Kinesio Tape on static plantar foot pressure and force in young females with flexible flatfoot. Methods: A pilot study (pre-experimental study design) with a convenience sample of 20 female subjects from a university with flexible flatfoot (age = 20.1 ± 1.3 years, weight = 91.8 ± 14.4 kg, height = 162.2 ± 6.3 cm, BMI = 34.9 ± 5, foot posture index (FPI) = 8.8 ± 2.1) was selected. The TekScan MatScan^® system was used to measure the static plantar forces and pressures, foot contact area, and the mediolateral displacement of COF over time while standing (Boston, MA, USA) before and immediately after the application of Kinesio Tape (KT). Results: While there were no statistically significant changes in the foot peak or total pressure, paired-sample t-tests showed a statistically significant reduction in foot contact area (p < 0.05) and a statistically significant increase in midfoot maximum force (p < 0.05) following the application of KT. Furthermore, after applying KT, there was a statistically significant decrease in the mediolateral COF velocity, indicating greater lateral displacement of COF (p < 0.05). Conclusions: The results of this study concluded that Kinesio Tape was a useful intervention method for immediately redistributing pressure and forces in young females with flexible flat feet. Full article

Flexible pressure sensors have been increasingly proposed for clinical monitoring applications. However, the available evidence on the technical characteristics and the biomedical applications of these technologies remains fragmented. To fill this gap, this scoping review aimed to map the available literature (i) to identify the existing flexible pressure sensor matrices proposed for biomedical applications, their technical characteristics, and usage contexts, and (ii) to determine the systems integrated into bed-based support surfaces for clinical monitoring functions. The scoping review was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. PubMed, Scopus, and Web of Science databases were systematically searched to identify studies published between 2015 and 2025 that describe flexible pressure sensor matrices for biomedical monitoring and care applications. A total of 5021 records were screened, and 45 studies were included. Existing flexible pressure sensor matrices were mainly based on resistive and capacitive principles. Systems integrated into clinical support surfaces were primarily used for pressure distribution and posture monitoring, and spanned from experimental prototypes to commercially available technologies. A lack of technical specifications and relevant heterogeneity was observed among the studies. Flexible pressure sensors demonstrated potential for clinical monitoring, but standardized technological reporting and clinical validation protocols are needed to develop technically robust and clinically oriented pressure sensing solutions. Full article

Background: Passive movement-based recovery strategies may support post-exercise recovery without additional metabolic demand. Objective: To examine the acute effects of passive foot flexions during recovery on isometric task performance after repeated exercise. Methods: Fourteen physically active men completed two randomized crossover sessions—passive rest and passive foot flexions—separated by a 7-day washout. Each session included a sustained static isometric plantar flexion task at 75% of maximal voluntary contraction (MVC), a 15 min recovery period, and a repeated isometric task. Work capacity was assessed as holding time. Cardiovascular, autonomic, and peripheral responses were recorded throughout the protocol. Results: Baseline holding time did not differ between the conditions. During the repeated isometric task, holding time was significantly longer following passive foot flexions compared to passive rest (67.7 ± 10.4 s vs. 52.9 ± 9.7 s; p < 0.05), with a large effect size (d ≈ 1.5). Passive foot flexions were associated with a greater increase in parasympathetic modulation, reflected by higher root mean square of successive differences (RMSSD) during recovery and altered muscle oxygenation dynamics, including faster post-exercise re-oxygenation. For both conditions, heart rate and systolic and diastolic blood pressure exhibited similar exercise–recovery patterns with no between-condition differences. Only minor changes in muscle stiffness were observed following the passive foot flexions. Conclusions: Passive foot flexions may support short-term recovery between repeated isometric efforts, particularly with respect to holding time and RMSSD. Full article

Background: Diabetic foot ulcers (DFUs) are considered a prevalent complication of diabetes mellitus, frequently accompanied with compromised peripheral circulation, slower healing, as well as high risk of infection in addition to risk of amputation. Additional treatments that enhance microvascular perfusion and lessen plantar pressure may accelerate the healing process. This study was carried out to examine the impact of pulsed electromagnetic field (EMF) therapy as well as customized silicone gel insoles in terms of peripheral circulation in addition to vascular indices in patients with DFUs. Methods: A randomized, controlled clinical trial, including sixty-six adults diagnosed with type II diabetes as well as plantar DFUs (Wagner grade I–II) were divided into three groups (n = 22 each): Group A was given low-frequency electromagnetic field therapy (15–50 Hz, 2–5 mT, 30 min, three times per week for 8 weeks), Group B was given a customized silicone gel insoles produced for ulcer offloading, and Group C (control) was given conventional physiotherapy along with wound care. Peripheral microcirculation as well as tissue perfusion were the primary outcomes, and they were measured using Laser Doppler Flowmetry (LDF), Photoplethysmography (PPG), in addition to the Toe–Brachial Index (TBI). The secondary outcome included the Ankle–Brachial Pressure Index (ABPI). A blinded assessor measured the outcomes at the beginning of the study, after the intervention (week 8), and again after the follow-up (week 16). Results: EMF therapy significantly improved LDF (baseline: 45.2 ± 6.5 PU; week 8: 62.5 ± 7.2 PU), PPG (0.42 ± 0.08 mV to 0.68 ± 0.10 mV), TBI (0.64 ± 0.07 to 0.82 ± 0.08), and ABPI (0.88 ± 0.06 to 0.97 ± 0.05) compared with insoles and controls (p < 0.001, partial η² 0.25–0.37). The insole group exhibited moderate enhancements, whereas the control group demonstrated minor changes. Between-group analyses showed substantial differences in favor of EMF therapy across all measured variables (F = 13.5–19.9, p < 0.001). Improvements continued at the 8-week follow-up. Conclusions: Patients with DFUs who receive EMF therapy experience a significant improvement in their peripheral microcirculation, tissue perfusion, as well as vascular indices. This is more effective than just mechanical offloading, and custom insoles offer extra benefits by redistributing pressure. Combining EMF therapy with regular DFU care may speed up healing and lower the risk of problems. Additional research should investigate the efficacy of combined EMF as well as off-loading interventions and their long-term outcomes. Full article

Background: Diabetic foot ulcers (DFUs) represent a major chronic complication of diabetes mellitus, often leading to severe infection, amputation, and reduced quality of life. Among various factors affecting DFUs, plantar pressure plays a pivotal role in ulcer formation and recurrence. Despite growing interest in this domain, few studies have comprehensively evaluated the research landscape concerning plantar pressure in the context of DFUs from a bibliometric perspective. Aim: To conduct a comprehensive bibliometric analysis and visualization of global research trends, hotspots, and collaborative networks in the field of plantar pressure-related diabetic foot studies from 2000 to 2024. Methods: A systematic search was conducted in the Web of Science Core Collection (WoSCC) on 16 February 2025, for articles published between 2000 and 2024 using terms related to “diabetic foot” and “plantar pressure”. A total of 2518 records were retrieved, from which 2110 English-language articles and reviews were included. Bibliometric and visual analyses were performed using Microsoft Excel 2021, VOSviewer (v1.6.20), CiteSpace (v6.4.R1), Charticulator, and Scimago Graphica. Analyses included publication trends, country/institution/author collaborations, journal distributions, keyword co-occurrence and clustering, citation bursts, and reference co-citation networks. Results: A total of 2110 publications were identified, showing an overall increase in annual publication output from 2000 to 2024, with some year-to-year fluctuations. The United States led in publication volume (678 articles), citation frequency, and H-index, followed by the United Kingdom and China. Armstrong, David was the most prolific and also had the highest H-index among the listed authors, while the University of Amsterdam was the leading institution. “Journal of Wound Care” had the highest publication count, whereas “Diabetes Care” ranked first in citation frequency. Keyword analysis revealed major research clusters including “diabetic foot”, “plantar pressure”, “wound healing”, “offloading”, and “negative pressure wound therapy”. Recent trends show an increased focus on microcirculation, regenerative medicine, customized footwear, and wound care technologies. Conclusions: The bibliometric analysis reveals research trends and current hotspots in plantar pressure management for diabetic foot ulcers, with a particular focus on managing plantar pressure through personalized offloading strategies and custom footwear. These findings highlight the practical value of tailoring interventions to individual patient needs, emphasizing the importance of biomechanical factors in ulcer prevention and healing. Full article