Assessment of plantar pressure in forefoot relief shoes of different designs.
BACKGROUND
After reconstructive forefoot surgery, patients require complete or partial forefoot relief, which can be obtained with a variety of shoe designs. The aim of this study was to evaluate the effectiveness of two different types of forefoot-relief shoes frequently used after surgery, especially their safety against unintentional forefoot load.


METHODS
Ten healthy volunteers were asked to perform five trials on a treadmill at self-selected speeds. In the first trial, mean peak pressure values in mass-produced shoes and insoles were evaluated and considered as 100%. Two different shoe designs (short heel-short sole, ii: short heel-complete sole) were compared in two trials each with appropriate and inappropriate use (attempting to put weight on the forefoot) gait pattern. Plantar pressure values were obtained using the Pedar cable system (Novel Inc., Munich, Germany). For analysis, pedobarographic pictures were subdivided into midfoot (31% to 60% of the total insole length) and forefoot (61% to 100% of the total insole length). ANOVA was used for statistical analysis, and p values less than 0.01 were considered significant.


RESULTS
With the short-soled shoe, forefoot and midfoot relief was 100% in both compliant and in noncompliant use. With wearing a complete sole, compliant use led to a significant reduction (p < 0.01) of mean peak pressure under the forefoot (34 +/- 13% remaining) and midfoot (47 +/- 13% remaining). Noncompliant use of the complete-sole shoe produced mean peak pressure values significantly higher (p < 0.01) than normal gait in mass produced shoes under the forefoot, but not under the midfoot.


CONCLUSIONS
Forefoot-relief shoes are effective in reducing both mean and peak plantar pressures. Shoes with a nonsupported midfoot and forefoot may be safer with inappropriate use than shoes with a complete sole. The kind of forefoot shoe should be carefully chosen to regulate weightbearing after reconstructive forefoot surgery.
Division of Orthopaedic Rheumatology, Department of Orthopaedic Surgery, University of Erlangen-Nuremberg, Rathsbergerstrasse 57, D-91054 Erlangen, Germany. Hans-Dieter.Carl@ortho-rheuma.med.uni-erlangen.de
Hans-Dieter
HD
Carl
David
D
Pfander
Bernd
B
Swoboda
D000328:Adult; D000704:Analysis of Variance; D004867:Equipment Design; D005260:Female; D005545:Forefoot, Human / Q000502:physiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D009989:Orthotic Devices / Q000592:standards; D011312:Pressure; D012775:Shoes