Biomechanics of postoperative shoes

NewsBot · Jun 16, 2010

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Biomechanics of postoperative shoes: plantar pressure distribution, wearing characteristics and design criteria: a preliminary study.
Schuh R, Trnka HJ, Sabo A, Reichel M, Kristen KH.
Arch Orthop Trauma Surg. 2010 Jun 12. [Epub ahead of print]

BACKGROUND: Modern concepts in the postoperative treatment of first metatarsal osteotomies include special shoes that should decrease stress in the forefoot region. The purpose of this study was to determine plantar pressure distribution, wearing characteristics and stress-reducing effectiveness of five different types of commonly used postoperative shoes. Additionally, we wanted to modify the shoe that revealed the most favourable results in a way that improves forefoot relief as well as provides comfort to the patients.

METHODS: Eight persons consented to participate in the study. Plantar pressure distribution in five different types of postoperative shoes (Rathgeber((R)) normal, Rathgeber((R)) modified, 4. Darco((R)) flat, Darco((R)) VFE, Wocker((R))) was assessed using Mediologic((R)) insoles. Also, subjective criteria considering wearing comfort, stability and rolling characteristics were evaluated. Based on the postoperative shoe revealing the most favourable results, further prototypes were developed. Each new model was targeted to meet the given requirements, minimal forefoot pressure, in a different way.

RESULTS: The Rathgeber((R)) modified model revealed the most favourable results concerning plantar pressure distribution as well as subjective wearing characteristics. Therefore, it was chosen for further modifications. After adding an extra layer of high elastic and springy material for shock absorption at the hallux region, forefoot relief and wearing characteristics showed improved results.

CONCLUSION: The results of the present study indicate that damping material in the hallux region of postoperative shoes minimises stress in this region and improves patient's comfort.
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docbourke · Jun 17, 2010

I performed a pedobarographic study in patients who were 2 - 6 weeks following bunion surgery comparing a flat post op shoe with an orthowedge from Darco and a heelwalking shoe of our on design. Both the Darco and our heel walker shoe showed significant decrease in peak pressure, maximum force and force time and pressure time integrals compared to the flat shoe in the forefoot areas. Patients also preferred a high cut design that strapped around the anke to a low cut shoe. There is no doubt that post op shoes that prevent weight bearing through the forefoot such as a Darco or Stockholm shoe protect forefoot surgery. I can forward the powerpoint if anyone is interested as I have not published this study.
Gerard Bourke

Greg Quinn · Jun 17, 2010

Study sounds interesting and I'd appreciate a copy of your Ppt. Can you send it to gregquinn.podsurgeon@gmail.com .
Thanks.

docbourke · Jun 17, 2010

For anyone who wishes to download the study (it is too big to e mail) use the following links. Make sure the video file is in the same folder as the powerpoint otherwise it won' run. Please excuse the self indulgence of pictures of me with an ex Miss Universe in the presentation but opportunities like that don't come everyday.
Gerard
http://dl.dropbox.com/u/2004213/Pedobarographic Evaluation of 3 Post Operative Shoes utilised.ppt
http://dl.dropbox.com/u/2004213/output screen.avi

Any problems let me know

NewsBot · Mar 18, 2020

A comparison of two designs of postoperative shoe for hallux valgus surgery: A biomechanical study in a cadaveric model.
Navarro-Cano E et al
Foot Ankle Surg. 2020 Feb 24

BACKGROUND:
Hallux Valgus Surgery success depends not only on the operative technique, but also on the care of the foot during the postoperative period. Orthopedic shoes have been developed to decrease the weight load on the first ray, an excess of which might lead to a loss of fixation or pseudoarthrosis. The goal of this study was to determine how the load distribution changed as the forced applied to the foot increased, with and without an orthopedic shoe. Also, we compared to different shoe models.

METHODS:
Pressure sensors were placed under the first metatarsal head and the heel of twenty specimens of fresh cadaveric adult feet. Two orthopedic shoes were chosen, a double padded (MS) and a reverse camber shoe (RCS). 10 kg loads were progressively applied, up to 60 kg. We first compared three instances: no shoe, MS and RCS. A secondary analysis comparing barefoot versus shoes was performed. A mean comparison was performed (ANOVA/T-student).

RESULTS:
The mean pressure of the heed and the first metatarsal showed that there were significant differences between groups (P < .005). The secondary analysis (no shoe vs orthopedic shoes) showed that the pressure without shoe was significantly higher than with any orthopedic shoe (P < .005). There were no statistically significant differences between models of shoes (P = .402).

CONCLUSION:
After a surgical procedure for hallux valgus fixation, postoperative shoes should be indicated to decrease the pressure on the first metatarsal head and heel in order to avoid an overload of the postoperative area.
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NewsBot · Jul 19, 2022

The Influence of Partial Weight Bearing on Plantar Peak Forces Using Three Different Types of Postoperative Shoes
AnnetteEidmannWiebkeVinkeAxelJakuscheitMaximilianRudertIoannisStratos
Foot and Ankle Surgery 19 July 2022

Background
Therapeutic shoes and partial weight bearing regimes are used after foot surgery to prevent the operated region from excessive load. It remains unclear to which extent partial weight bearing reduces the plantar peak forces. Therefore, we investigated the correlation of weight bearing and plantar peak forces in commonly used therapeutic shoes.

Methods
Three different weight bearing regimes (20 kg, 40 kg, full weight) were investigated in 20 healthy volunteers. Sensor insoles were used to measure peak forces of the forefoot, midfoot, heel and the complete foot using four kind of shoes (bandage shoe, forefoot relief shoe, short walker and standard sneaker). Peak forces were compared between shoes using one-way ANOVA. The influence of partial weight bearing relative to the peak forces was examined by linear regression analysis.

Results
All therapeutic shoes reduced significantly peak forces of the fore- and midfoot when compared to the reference shoe; the largest reduction was achieved by the forefoot relief shoe (-70% at forefoot). Weight load and the resulting peak force showed a positive linear correlation for all regions and shoe types. Partial weight bearing significantly reduced the forefoot’s force ratio compared to full weight bearing for all shoes except the forefoot relief shoe.

Conclusions
Partial weight bearing is a strong instrument to reduce plantar peak forces of the forefoot, additionally to the proven offloading effect of therapeutic shoes
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NewsBot · Jan 19, 2023

Pedobarographic evaluation of five commonly used orthoses for the lower extremity
C Ehrnthaller et al
Arch Orthop Trauma Surg. 2022 Dec 26

Introduction: Orthoses are designed to achieve immobilization or off-loading of certain regions of the foot. Yet, their off-loading capacity for the specific regions has not yet been studied. Therefore, the aim of this study was to analyze the plantar pressure distribution of five commonly applied orthoses for foot and ankle in a healthy population.

Materials and methods: Five orthoses (postoperative shoe, forefoot relief shoe, short walker boot, high walker boot, and calcaneus fracture orthosis) were compared pedobarographically using insoles on a treadmill to a ready-made running shoe in eleven healthy subjects (median age 29 years). Peak pressure, maximum force, force-time integral, contact time, and contact area were evaluated separately for the forefoot, midfoot, and hindfoot.

Results: The forefoot relief shoe, the short- and high walker boot significantly reduced the peak pressure at the forefoot with no significant differences between these orthoses. None of the five orthoses off-loaded the midfoot, but the calcaneus fracture orthosis and the short walker boot instead increased midfoot load. For the hindfoot, the calcaneus fracture orthosis was the only device to significantly reduce the peak pressure.

Conclusions: This is the first study to investigate the specific off-loading capacities of different orthoses for specific foot regions in a healthy collective. The knowledge of absolute and relative load shifts for the different orthoses is of fundamental interest for targeted clinical decision-making of physicians.
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NewsBot · Mar 30, 2023

Halving the usage of rigid-soled postoperative shoes does not affect outcomes in forefoot reconstruction surgery
Daniel N Bianco-Adames et al
Foot Ankle Surg. 2023 Mar 10

Background: Postoperative shoes are commonly used after forefoot surgery. This study's aim was to demonstrate that reducing rigid-soled shoe time to 3 weeks neither compromises functional outcomes nor does it produce complications.

Methods: Prospective cohort study: 6 weeks versus 3 weeks of rigid postoperative shoe (100 and 96 patients respectively), after forefoot surgery with stable osteotomies. Manchester-Oxford Foot Questionnaire (MOXFQ) and pain Visual Analog Scale (VAS) were studied preoperative and one year postoperative. Radiological angles were also assessed after removing the rigid shoe and at 6 months.

Results: The MOXFQ index and pain VAS depicted similar results in each group (group A: 29.8 and 25.7; group B: 32.7 and 23.7) with no differences between them (p = .43 Vs. p = .58). Moreover, no differences were reported in their differential angles (HV differential-angle p = .44, IM differential-angle p = .18) or in their complication rate.

Conclusion: In forefoot surgery with stable osteotomies, shortening the postoperative shoe time to 3 weeks, neither impairs clinical results nor the initial correction angle.
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