Reduction of plantar heel pressures: Insole design using finite element analysis

Goske, Steven; Erdemir, Ali; Petre, Marc; Budhabhatti, Sachin P.; Cavanagh, Peter R.

doi:10.1016/j.jbiomech.2005.08.006

Cited by 142 publications

(108 citation statements)

References 14 publications

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“…We are not aware of an experimental study with systematically varied thickness and reports of pressure relief (although our group has previously published model results of this nature in the heel [17]). Furthermore, different manufacturers arbitrarily choose hardness values at or above the lower limit specified by Medicare, and the effects of such variation on plantar pressure have not been examined.…”

Section: Discussionmentioning

confidence: 99%

Custom Therapeutic Insoles Based on Both Foot Shape and Plantar Pressure Measurement Provide Enhanced Pressure Relief

et al. 2008

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OBJECTIVE -The purpose of this study was to determine whether custom insoles tailored to contours of the barefoot pressure distribution and shape of a patient's foot can reduce plantar pressures in the metatarsal head (MTH) region to a greater extent than conventional custom insoles.RESEARCH DESIGN AND METHODS -Seventy regions of elevated barefoot pressures (mean peak 834 kPa under MTHs) were identified in 20 subjects with diabetes. Foam box impressions of their feet were sent to three different orthotic supply companies for fabrication of custom insoles. One company was also given plantar pressure data, which were incorporated into the insole design. Measurements of in-shoe plantar pressures were recorded during gait for the three custom insoles in a flexible and a rocker-bottom shoe. Peak pressure and force-time integral were extracted for analysis.RESULTS -In 64 of 70 regions, the shape-plus-pressure-based insole in the flexible shoe achieved superior unloading compared with the two shape-based insoles. On average, peak pressure was reduced by 32 and 21% (both P Յ 0.0001) and force-time integral by 40 and 34% (both P Ͻ 0.0001) compared with the shape-based insoles. At the midfoot, force-time integral was increased by 51 and 33% (both P Ͻ 0.01). Similar trends were found using the rockerbottom shoe.CONCLUSIONS -Compared with insoles based only on shape, the use of foot shape with barefoot plantar pressure measurements in designing custom insoles results in enhanced offloading of high-pressure areas under the forefoot. This offloading was achieved by a greater transfer of load to the midfoot without additional loading of other forefoot structures.

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Section: Discussionmentioning

confidence: 99%

Custom Therapeutic Insoles Based on Both Foot Shape and Plantar Pressure Measurement Provide Enhanced Pressure Relief

et al. 2008

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“…Although a number of other investigators have used finite element models to design orthotic devices [9][10][11][12][13], the work of Erdemir et al is most pertinent to this project [13]. Erdemir et al investigated the shape and size of an individual plug placed within the midsole of the shoe.…”

Section: Discussionmentioning

confidence: 99%

“…Research by other investigators include a partial 2D-model of the 2 nd metatarsal region of the foot to study the effect on plantar pressure due to changes in insole and tissue thickness [9]; a 3D-model of the standing foot to study the effect of flat and conforming insole of different materials in the plantar pressure distribution [10,11]; a 2D-model of the heel region of the foot to study the effect that shape, material properties and thickness of the insole have on PPP [12]; a similar partial model of the 2 nd metatarsal described by Lemmon et al [9] to investigate the effect of softer single plugs of different shapes penetrating the complete thickness of the shoe midsole [13].…”

Section: Introductionmentioning

confidence: 99%

Multi-plug insole design to reduce peak plantar pressure on the diabetic foot during walking

Actis

Ventura

Lott

et al. 2008

Med Biol Eng Comput

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There is evidence that appropriate footwear is an important factor in the prevention of foot pain in otherwise healthy people or foot ulcers in people with diabetes and peripheral neuropathy. A standard care for reducing forefoot plantar pressure is the utilization of orthotic devices such as total contact inserts (TCI) with therapeutic footwear. Most neuropathic ulcers occur under the metatarsal heads, and foot deformity combined with high localized plantar pressure, appear to be the most significant factors contributing to these ulcers. In this study, patient-specific finite element models of the second ray of the foot were developed to study the influence of TCI design on peak plantar pressure (PPP) under the metatarsal heads. A typical full contact insert was modified based on the results of finite element analyses, by inserting 4 mm diameter cylindrical plugs of softer material in the regions of high pressure. Validation of the numerical model was addressed by comparing the numerical results obtained by the finite element method with measured pressure distribution in the region of the metatarsal heads for a shoe and TCI condition. Two subjects, one with a history of forefoot pain and one with diabetes and peripheral neuropathy, were tested in the laboratory while wearing therapeutic shoes and customized inserts. The study showed that customized inserts with softer plugs distributed throughout the regions of high plantar pressure reduced the PPP over that of the TCI alone. This supports the outcome as predicted by the numerical model, without causing edge effects as reported by other investigators using different plug designs, and provides a greater degree of flexibility for customizing orthotic devices than current practice allows.

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“…21,22 Total contact insoles can redistribute plantar pressure 23 and transfer pressure from the rearfoot to the midfoot region …”

Section: Discussionmentioning

confidence: 99%

Full-length silicone insoles versus ultrasound-guided corticosteroid injection in the management of plantar fasciitis

Yücel

Küçükşen

Cingöz

et al. 2013

Prosthetics &Amp; Orthotics International

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Background: Plantar fasciitis often leads to disability. Optimal treatment for this clinical condition is still unknown. Objective: To compare the effectiveness of wearing a full-length silicone insole with ultrasound-guided corticosteroid injection in the management of plantar fasciitis. Study design: Randomized clinical trial. Methods: Forty-two patients with chronic unilateral plantar fasciitis were allocated randomly to have an ultrasound-guided corticosteroid injection or wear a full-length silicone insole. Data were collected before the procedure and 1 month after. The primary outcome measures included first-step heel pain via Visual Analogue Scale and Heel Tenderness Index. Other outcome measures were the Foot and Ankle Outcome Score and ultrasonographic thickness of the plantar fascia. Results: After 1 month, a significant improvement was shown in Visual Analogue Scale, Heel Tenderness Index, Foot and Ankle Outcome Score, and ultrasonographic thickness of plantar fascia in both groups. Visual Analogue Scale scores, Foot and Ankle Outcome Score pain, Foot and Ankle Outcome Score for activities of daily living, Foot and Ankle Outcome Score for sport and recreation function, and plantar fascia thickness were better in injection group than in insole group (p < 0.05). Conclusions: Although both ultrasound-guided corticosteroid injection and wearing a full-length silicone insole were effective in the conservative treatment of plantar fasciitis, we recommend the use of silicone insoles as a first line of treatment for persons with plantar fasciitis. Clinical relevanceSilicone insole may be considered as a first-line treatment option in patients with plantar fasciitis.

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Reduction of plantar heel pressures: Insole design using finite element analysis

Cited by 142 publications

References 14 publications

Custom Therapeutic Insoles Based on Both Foot Shape and Plantar Pressure Measurement Provide Enhanced Pressure Relief

Custom Therapeutic Insoles Based on Both Foot Shape and Plantar Pressure Measurement Provide Enhanced Pressure Relief

Multi-plug insole design to reduce peak plantar pressure on the diabetic foot during walking

Full-length silicone insoles versus ultrasound-guided corticosteroid injection in the management of plantar fasciitis

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