Assessment of Plantar Pressure in Forefoot Relief Shoes of Different Designs

Abstract

Background: After reconstructive forefoot surgery, patients require complete or partial forefoot relief, which can be obtained with a variety of shoe designs. The aim of this study was to evaluate the effectiveness of two different types of forefoot-relief shoes frequently used after surgery, especially their safety against unintentional forefoot load. Methods: Ten healthy volunteers were asked to perform five trials on a treadmill at self-selected speeds. In the first trial, mean peak pressure values in mass-produced shoes and insoles were evaluated and considered as 100%. Two different shoe designs (short heel – short sole, ii: short heel – complete sole) were compared in two trials each with appropriate and inappropriate use (attempting to put weight on the forefoot) gait pattern. Plantar pressure values were obtained using the Pedar® cable system (Novel Inc., Munich, Germany). For analysis, pedobarographic pictures were subdivided into midfoot (31% to 60% of the total insole length) and forefoot (61% to 100% of the total insole length). ANOVA was used for statistical analysis, and p values less than 0.01 were considered significant. Results: With the short-soled shoe, forefoot and midfoot relief was 100% in both compliant and in noncompliant use. With wearing a complete sole, compliant use led to a significant reduction (p < 0.01) of mean peak pressure under the forefoot (34 ± 13% remaining) and midfoot (47 ± 13% remaining). Noncompliant use of the complete-sole shoe produced mean peak pressure values significantly higher (p < 0.01) than normal gait in mass produced shoes under the forefoot, but not under the midfoot. Conclusions: Forefoot-relief shoes are effective in reducing both mean and peak plantar pressures. Shoes with a nonsupported midfoot and forefoot may be safer with inappropriate use than shoes with a complete sole. The kind of forefoot shoe should be carefully chosen to regulate weightbearing after reconstructive forefoot surgery.