No abstract

The effect of walking with high-heel shoes on plantar foot pressure distribution was investigated. Ten normal women walking in shoes with low heels were compared to women walking in high-heel shoes. It was shown that high-heel shoes increased the load on the forefoot and relieved it on the hindfoot. The load passed toward the medial forefoot and the hallux. The lateral side of the forefoot showed a decrease in contact area, reduced forces, and peak pressures. The medial side of the forefoot had a higher force-time and pressure-time integral. It is suggested that these higher loads on the medial forefoot may aggravate symptoms in patients with hallux valgus deformity.

There is growing interest in the use of foot pressure measurement both clinically and in the study of normal subjects. A number of systems are now commercially available, but comparison of the results is complicated by the different techniques employed. This paper compares the results of two studies. The first examined a large group of normal subjects using the dynamic pedobarograph. The second was identical to the first except that the EMED F system was used. The second study was carried out in order to verify existing results and to assess the clinical significance of the expected differences. Comparison of the results from the two studies showed that the median peak pressures demonstrated similar patterns with the highest pressure in the forefoot under the second/third metatarsal heads and the toes taking gradually reduced pressure from the first to the fifth toe. The EMED F showed higher peak pressures than the dynamic pedobarograph under the heel, the medial four metatarsal heads, and the great toe and showed lower peak pressures and shorter contact times under the lateral four toes. The pattern of loading across the metatarsal heads was further analyzed using an objective method of splitting the subjects into groups. Four groups were isolated from both sets of results, and this has confirmed that only a proportion of normal subjects demonstrate highest loading under the first metatarsal head whereas the remainder show highest loading centrally within the forefoot.

The transcutaneous oxygen pressure (tcPo2) was measured by a polarographic technique in the legs of 161 volunteers and compared with the levels found in 62 patients with ischaemic skin due to peripheral vascular disease. The results show that the tcPO2 was related to the degree of ischaemia and, in many cases, was a more accurate guide to the viability of the skin than clinical assessment. Measurement of the transcutaneous oxygen pressure in the leg at the site of amputation in 24 patients with peripheral vascular disease showed that a preoperative level greater than 40 millimetres of mercury at an electrode temperature of 44 degrees Celsius was necessary for the skin of the stump to heal. The technique is simple, non-invasive and reliable. The tcPo2 accurately reflects the physiological and pathological changes in the circulation of the skin. It has potential in many fields of surgery where careful assessment of the viability of the skin is necessary. An accurate method of assessing the viability of skin would be invaluable in many ischaemic conditions including peripheral vascular disease and limb trauma associated with cutaneous damage and vascular injury.