title: The effects of heel-elevated total contact insole on rearfoot pressure reduction in heel injury patients who had neurosensory impairment after receiving reconstructive flap operations.
abstract: OBJECTIVE
  To evaluate the effects of a custom-molded heel-elevated total contact insole (TCI) on rearfoot pressure reduction and heel cushion for patients with heel-reconstruction.
  
  
  METHODS
  Eleven patients with unilateral heel-reconstruction were recruited in this study. Maximal force and plantar pressures (peak pressure and pressure-time integral) at three different areas (heel Midfoot and forefoot) were measured under 3 randomized conditions (shoe-only flat insole and heel- elevated TCI) after wearing a heel-elevated TCI for 3 months. Ulceration inspection and pain intensity were evaluated before and 3 months after wearing a heel-elevated TCI Results: Pain intensity was decreased and walking velocity was improved in all patients (p<0.01), and ulcerations were completely healed in all of the five patients who had heel ulcers 3 months after wearing heel-elevated TCIs. Compared to shoe-only condition, the heel-elevated TCI was effectively reduced maximal force and plantar pressures in heel area (p<0.01) while part of the body weight was shifted from heel to midfoot and forefoot. Plantar pressures in heel area were more effectively reduced in the heel-elevated TCI than in the flat insole (p<0.05).
  
  
  CONCLUSIONS
  These findings suggested that heel-elevated TCI provided more effective heel pressure reduction and shock absorption, and resulted in improvement of clinical symptoms.
authors: Department of Medicine, Veterans General Hospital Taipei Taiwan.
authors: John Tzu-Ning
authors: JT
authors: Chen
authors: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial HospitalLinkou Taiwan.
authors: Alice Chu-Wen
authors: AC
authors: Tang
authors: Department of Sports Medicine, China Medical University Taichung Taiwan.
authors: Wei-Hsien
authors: WH
authors: Hong
authors: Department of Medicine, Veterans General Hospital Taipei Taiwan; School of Medicine, Chang Gung University Taiwan. Electronic address: fttang@adm.cgmh.org.tw.
authors: Simon Fuk-Tan
authors: SF
authors: Tang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004867:Equipment Design; D005260:Female; D005528:Foot; D018409:Foot Injuries / Q000150:complications / Q000534:rehabilitation* / Q000601:surgery; D061826:Foot Orthoses; D016523:Foot Ulcer / Q000209:etiology / Q000517:prevention & control / Q000534:rehabilitation*; D006365:Heel / Q000293:injuries* / Q000601:surgery; D006801:Humans; D006987:Hypesthesia / Q000209:etiology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D011312:Pressure; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult
keywords: Plantar pressure; Reconstructed heel; Total contact insole