OBJECTIVE -The aim of this study was to investigate the effect of shoe design on the plantar pressure dynamics of patients with diabetic neuropathy during walking.RESEARCH DESIGN AND METHODS -Three shoe design categories were tested. Total contact area and biomechanical variables in multiple areas under the foot were measured.RESULTS -Shoes with a rocker bottom principle reduced pressure 35-65% underneath the heel and the central metatarsal heads. Increased contact area did not result in significant pressure reductions underneath the forefoot. Pressure dynamics underneath the heel and medial forefoot (first metatarsal head and hallux) on average showed no significant differences among the different shoes with a cushioning insole.CONCLUSIONS -The most effective way to offload the forefoot of patients with neuropathic feet is through the use of the rocker sole principle. In general, the effect of an insole depends on the design characteristics of a shoe. Predicting the effect of therapeutic footwear on an individual scale, however, remains difficult. Therefore, in-shoe pressure measurements seem to be necessary to evaluate a therapeutic shoe prescription in certain individual cases. Diabetes Care 26:441-445, 2003B auman et al. (1) were among the first researchers who published their study on the relationship between high-pressure areas and plantar ulceration in the insensitive foot. They appreciated the effect of both a total contact cast and certain orthopedic shoes on the healing process of neuropathic ulcers. They investigated the effect of shoe sole design on plantar pressure reduction using small pressure sensors taped to specific areas underneath the sole of the foot.Using similar equipment 25 years later, Nawoczenski et al. (2) showed that certain pivotal and curved rocker bottom shoes were able to effectively reduce forefoot pressure in normal subjects. Many studies have followed since then (rev. in 3). However, despite all the pioneering work, different disciplines dealing with the neuropathic foot often still disagree about which therapeutic shoe modalities to prescribe. In the Netherlands, also, this is a continuing topic of dispute. Although some strongly propagate the use of custom made (orthopedic) shoes with a stiff sole and rocker bar to prevent recurrence of a neuropathic ulcer, others recommend the use of an extra depth shoe. It has been argued that these less heavy, more cosmetically attractive shoes would be at least as effective in preventing recurrence of neuropathic ulcers.According to Spencer, "There is a need to measure the effectiveness of the range of pressure relieving interventions for the prevention and treatment of diabetic foot ulcers as there is a small amount of poor quality research in this area" (3). The present study was performed to investigate the relation between shoe design and pressure reduction in the context of the above discussion. Three shoe design categories were tested. Total contact area and biomechanical variables in multiple areas under the foot were measured usin...

Background: It is recognized that different types of hallux valgus exist. Classification occurs with radiographic and clinical parameters. Severity of different parameters is used in algorithms to choose between different surgical procedures. Because there is no consensus about each parameter nor their cut-off point we conducted this study to analyze the influence of these variables on the postoperative hallux valgus angle.

Category: Basic Sciences/Biologics Introduction/Purpose: A scientifically sound validated foot and ankle specific outcome measure for different European languages is still missing. Indeed, language-specific cross cultural validation in other languages than English is largely absent. Some outcome measures were validated for specific pathologies such as hallux valgus, ankle arthritis or flatfoot. The European Foot and Ankle Society (EFAS) established in 2013 a Score Committee to develop, validate, and publish a new score, the “EFAS Score”, which is not specific for single pathologies for different European languages. The principal aim of this project was to develop and validate the EFAS Score simultaneously for different European languages. Methods: The EFAS Score was developed and validated in three stages: 1) item (question) identification, 2) item reduction and scale exploration, 3) confirmatory analyses and responsiveness. The following score specifications were chosen: scale/subscale (Likert 0-4), questionnaire based, outcome measure, patient related outcome measurement. For stage 3, data were collected pre- operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using analyses from classical test theory and item response theory. Results: Stage 1 resulted in 31 general and 7 sports related questions. In Stage 2, a 6-item general EFAS Score was constructed using English, German, French and Swedish language data. In Stage 3, internal consistency of the scale was confirmed in seven languages: the original four languages, plus Dutch, Italian and Polish (Cronbach’s Alpha >0.86 in all language versions). Responsiveness was good, with moderate to large effect sizes in all languages, and significant positive association between the EFAS Score and patient-reported improvement. No sound EFAS Sports Score could be constructed. Conclusion: The multi-language EFAS Score has been successfully validated for orthopaedic foot and ankle surgery populations incorporating a wide variety of foot and ankle pathologies, including language-specific validation in seven languages so far (English, German, French, Swedish, Dutch, Italian, Polish). Validation for other languages (Danish, Finnish, Norwegian, Portuguese, Spanish, Turkish) is in progress. All validated score versions are freely available at www.efas.co .

The multi-language EFAS Score was successfully validated in the orthopaedic ankle and foot surgery patient population, including a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.co.