Effect of a Forefoot Off-loading Postoperative Shoe on Muscle Activity, Posture, and Static Balance

Paton, Joanne; Thomason, K.; Trimble, Karl; Metcalfe, J E; Marsden, Jonathan

doi:10.7547/1030036

Cited by 12 publications

(6 citation statements)

References 18 publications

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“…18 Concerns have also been raised with regard to unsteadiness and increased risk of falls in patients receiving the reverse camber shoe as part of their postoperative care. 12…”

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“…18 Concerns have also been raised with regard to unsteadiness and increased risk of falls in patients receiving the reverse camber shoe as part of their postoperative care. 12 Where difficulty with the reverse camber postoperative shoe has been encountered due to discomfort or unsteadiness, an alternative flat-sole postoperative shoe design has been used in our practice. This alternative design is known to have the least effect on patient gait when compared with normal footwear and is anecdotally better tolerated by the patient.…”

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Clinical and Radiological Outcomes of Forefoot Offloading Versus Rigid Flat Shoes in Patients Undergoing Surgery of the First Ray

et al. 2019

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Background: It is common clinical practice to use either flat or reverse camber shoes to protect the foot for up to 6 weeks after surgery for hallux valgus or hallux rigidus. To date there is a paucity of evidence as to whether there is any difference between these 2 postoperative shoes, in either patient satisfaction or clinical outcomes. Methods: One hundred consecutive patients undergoing scarf/Akin osteotomies or first metatarsophalangeal joint (MTPJ) arthrodesis were recruited. Patients were randomized 50:50 to either flat or reverse camber postoperative shoes. Patients undergoing ancillary lesser toe procedures were not excluded. Patient satisfaction was assessed by visual analog scale (VAS) pain score and Likert satisfaction survey. Radiographic outcomes were reviewed at 1 year observing differences in fusion rates or deformity recurrence. There were 47 patients in the reverse cam and 43 in the flat shoe group. No difference in primary forefoot operation, additional operation, age at surgery, or preop VAS pain score was seen. Results: At 6 weeks, there was no significant difference in postop VAS pain score. The flat shoe group was significantly more likely to be satisfied with their general mobility (86.0% vs 61.7%; P = .01) and with their stability in the shoe (90.7% vs 69.6%; P = .03). No significant difference was seen between groups for nonunion or hallux valgus recurrence rates. Conclusion: Both forms of postoperative footwear were effective in enabling patients to mobilize and in preventing adverse outcomes. Patients were more likely to be satisfied with a flat postoperative shoe due to improved stability and ease of mobilizing. The results of this study aid surgeon decision making for postoperative footwear in forefoot surgery. Level of Evidence: Level II, prospective randomized controlled trial.

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“…18 Concerns have also been raised with regard to unsteadiness and increased risk of falls in patients receiving the reverse camber shoe as part of their postoperative care. 12…”

mentioning

confidence: 99%

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confidence: 99%

Clinical and Radiological Outcomes of Forefoot Offloading Versus Rigid Flat Shoes in Patients Undergoing Surgery of the First Ray

et al. 2019

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“…As expected, orthopedic shoes sold in pairs may limit the problems of limb length discrepancies created by wearing a single orthopedic shoe. [ 16 - 18 , 20 , 21 ] There is also existing evidence for the use of heeled shoes, which provide significantly more forefoot offloading (between 2.5 and 4 times more depending on the design) compared to rocker bottom soles. [ 22 ] The findings of this study support the use of heel offloading shoes to acquire the highest degree of forefoot offloading, although rocker bottom shoes provided more speed in pairs.…”

Section: Discussionmentioning

confidence: 99%

Baropodometric comparison of orthopedic footwear to assess the effectiveness of pairs of orthopedic shoes for reducing the forefoot pressure

Sezer¹,

Hardy²,

Lopes³

2022

Jt Dis Relat Surg

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Objectives This study aimed to evaluate the distribution of foot pressure with the most frequently used orthopedic shoes and demonstrate the effect of offloading philosophy on the pressure distributions of rocker bottom or heel support shoes applied unilaterally or bilaterally. Materials and methods Three bilateral and four unilateral, a total of seven shoe designs with sensors included in the insole were tested by the same subject in a standard acquisition protocol. Two of the unilateral and one of the bilateral shoes had heel support, while others had a rocker bottom design. A descriptive analysis was performed for each shoe and compared to a reference value obtained from a standard shoe. Results Shoes with an offloading heel resulted in a greater reduction in pressure on the forefoot than other models. All other shoes increased pressure on the first metatarsophalangeal joint. Heel offloading models performed the best in forefoot offloading, and bilateral heel offloading shoes performed the best in first metatarsal offloading, with the highest scores of 83% and 82%, respectively. Conclusion This study showed that orthopedic shoes sold in pairs could reduce pressure on the forefoot at a comparable level to unilateral shoes. It supports their use to limit the disadvantages of single orthopedic shoes, such as limb length discrepancies.

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“…The use of FOS is recommended after surgery to unload the anterior part of the foot, in case of injuries and ulcers, and for conservative treatments. While the effectiveness of the half-shoe in reducing forefoot pressure has been demonstrated extensively, concerns have been raised over the peculiar design of the outsole, which features a high heel and a low-profile elevated outsole in the forefoot region, thus potentially causing unstable and inefficient gait dynamics and affecting wearing comfort [ 16 ]. These factors have become increasingly important in the design of orthopaedic footwear, and are particularly critical when dealing with elderly patients with pre-existing balance problems, hence at higher risk of fall.…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown that wearing elevated orthopaedic shoes causes higher loads in the lower limb joints and significantly increases hip adduction and pelvic tilt on the ipsilateral side, unless it is compensated by an equivalent heel height on the contralateral foot [ 15 ]. More recently, stability and risk of falls in the half-shoe have been investigated by analysing the modifications in body dynamics and foot pressure [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Pedobarographic and kinematic analysis in the functional evaluation of two post‐operative forefoot offloading shoes

Caravaggi

Giangrande

Berti

et al. 2015

Journal of Foot and Ankle Research

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BackgroundForefoot offloading shoes are special orthopaedic footwear designed to protect and unload the injured part of the foot after surgery and for conservative treatments.The offloading action is often achieved by transferring plantar load to the rearfoot via rocker shoes with reduced contact area between shoe and ground. While these shoes are intended to be worn only for short periods, a compromise must be found between functionality and the risk of alterations in gait patterns at the lower limb joints. In this study, the pedobarographic, kinematic and kinetic effects of a traditional half-shoe and a double-rocker full-outsole shoe were compared to those of a comfortable shoe (control).MethodsTen healthy female participants (28.2 ± 10.0 years) were asked to walk in three different footwear conditions for the left/right foot: control/half-shoe, control/full-outsole, and control/control. Full gait analysis was obtained in three walking trials for each participant in each condition. Simultaneously a sensor insole system recorded plantar pressure in different foot regions. Normalized root-mean-square error, coefficient of determination, and frame-by-frame statistical analysis were used to assess differences in time-histories of kinematic and kinetic parameters between shoes.ResultsThe half -shoe group showed the slowest walking speed and the shortest stride length. Forefoot plantar load was significantly reduced in the half-shoe (maximum force as % of Body Weight: half-shoe = 62.1; full-outsole = 86.9; control = 93.5; p < 0.001). At the rearfoot, mean pressure was the highest in the full-outsole shoe. At the ankle, sagittal-plane kinematics in the full-outsole shoe had a pattern more similar to control.ConclusionsThe half-shoe appears significantly more effective in reducing plantar load at the forefoot than a double-rocker full-outsole shoe, which is designed to reduce forefoot loading by using an insole with a thicker profile anteriorly as to maintain the foot in slight dorsiflexion. However, the half-shoe is also associated with altered gait spatio-temporal parameters, more kinematic modifications at the proximal lower limb joints and reduced propulsion in late stance.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-015-0116-3) contains supplementary material, which is available to authorized users.

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Effect of a Forefoot Off-loading Postoperative Shoe on Muscle Activity, Posture, and Static Balance

Cited by 12 publications

References 18 publications

Clinical and Radiological Outcomes of Forefoot Offloading Versus Rigid Flat Shoes in Patients Undergoing Surgery of the First Ray

Clinical and Radiological Outcomes of Forefoot Offloading Versus Rigid Flat Shoes in Patients Undergoing Surgery of the First Ray

Baropodometric comparison of orthopedic footwear to assess the effectiveness of pairs of orthopedic shoes for reducing the forefoot pressure

Pedobarographic and kinematic analysis in the functional evaluation of two post‐operative forefoot offloading shoes

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