title: Medical-grade footwear: the impact of fit and comfort.
abstract: BACKGROUND
  Pressure-related skin lesions on the digits are a significant cause of discomfort. Most foot pain related to ill-fitting shoes occurs in the forefoot and digital areas. Pain has been associated with poor shoe fit, reduced toe box volume, as well as contour and shape of the shoe Off-the-shelf medical-grade footwear is designed as an intervention for chronic lesions on the digits. These shoes are designed with a flexible neoprene fabric upper that is thought to reduce pressure on the forefoot and reduce discomfort associated with ill-fitting shoes. The aim of this study was to investigate the effect of an off-the-shelf, medical-grade shoe on dorsal digital pressure and perceived comfort when compared to participant's own preferred shoe.
  
  
  METHODS
  Thirty participants (18 females, 12 males) scored their perceived comfort whilst wearing each footwear style using a visual analog comfort scale. Dorsal digital and interdigital pressures were measured in using the WalkinSense® in-shoe pressure system. Sensors were placed on predetermined anatomical landmarks on the digits. Participants were randomly assigned the test shoe and their own shoe. Once wearing the shoe, the participants walked across a 6 m walkway and pressure data from each sensor was collected and processed to obtain peak pressure, time to peak pressure and contact time.
  
  
  RESULTS
  Participants scored the test shoe with higher comfort points than their own footwear. Overall peak pressure, pressure time integral and contact time decreased, whilst the time taken to reach peak pressure increased across all anatomical landmarks whilst wearing the test shoe. Statistically significant changes were observed for all of the measured variables relating to pressure on the medial border of the first metatarsophalangeal joint.
  
  
  CONCLUSIONS
  The test shoe provided greater comfort and reduced the amount of pressure on the forefoot. The medical-grade footwear therefore, is a viable alternative to custom made prescription footwear and is more suitable than a regular everyday shoe when treating digital lesions associated with pressure.
authors.affiliation: Faculty of Health Sciences Staffordshire University, Leek Road, Stoke on Trent, ST4 2DF UK.
authors.forename: Bessie
authors.initials: B
authors.lastname: Hurst
authors.affiliation: Faculty of Health Sciences Staffordshire University, Leek Road, Stoke on Trent, ST4 2DF UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Branthwaite
authors.affiliation: Faculty of Health Sciences Staffordshire University, Leek Road, Stoke on Trent, ST4 2DF UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Greenhalgh
authors.affiliation: Faculty of Health Sciences Staffordshire University, Leek Road, Stoke on Trent, ST4 2DF UK.
authors.forename: Nachiappan
authors.initials: N
authors.lastname: Chockalingam
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D011312:Pressure; D011897:Random Allocation; D012775:Shoes; D014034:Toes / Q000502:physiology*; D016138:Walking / Q000502:physiology*
keywords: Comfort; Footwear; Footwear fit; Prescription footwear; Pressure measurement