Reliability of in shoe pressure systems

NewsBot · Feb 28, 2016

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Validity and repeatability of three in-shoe pressure measurement systems
Carina Price, Daniel Parker, Christopher Nester
Gait and Posture; Article in Press

Highlights
?We compared three commercially available in-shoe pressure measurement systems.
?Variables were repeatability and validity for whole insole and regional held loads.
?All systems compared displayed high between day repeatability for all variables.
?Pedar displayed the highest validity for pressure and Medilogic for contact area.
?When evaluating clinical risk from in-shoe pressure the Pedar system is recommended.
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In-shoe pressure measurement devices are used in research and clinic to quantify plantar foot pressures. Various devices are available, differing in size, sensor number and type; therefore accuracy and repeatability. Three devices (Medilogic, Tekscan and Pedar) were examined in a 2 day x 3 trial design, quantifying insole response to regional and whole insole loading. The whole insole protocol applied an even pressure (50-600 kPa) to the insole surface for 0-30 seconds in the Novel TruBlue? device. The regional protocol utilised cylinders with contact surfaces of 3.14 and 15.9 cm2 to apply pressures of 50 and 200 kPa. The validity (% difference and Root Mean Square Error: RMSE) and repeatability (Intra-Class Correlation Coefficient: ICC) of the applied pressures (whole insole) and contact area (regional) were outcome variables. Validity of the Pedar system was highest (RMSE 2.6 kPa; difference 3.9%), with the Medilogic (RMSE 27.0 kPa; difference 13.4%) and Tekscan (RMSE 27.0 kPa; difference 5.9%) systems displaying reduced validity. The average and peak pressures demonstrated high between-day repeatability for all three systems and each insole size (ICC≥0.859). The regional contact area % difference ranged from -97 to +249%, but the ICC demonstrated medium to high between-day repeatability (ICC≥0.797). Due to the varying responses of the systems, the choice of an appropriate pressure measurement device must be based on the loading characteristics and the outcome variables sought. Medilogic and Tekscan were most effective between 200-300 kPa; Pedar performed well across all pressures. Contact area was less precise, but relatively repeatable for all systems.
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NewsBot · Nov 15, 2016

Plantar force deviations in dynamic pedobarography – The role of insole and platform based systems as influencing factors
Elisa Westphal, Hans-Dieter Carl, Sebastian Krinner, Casper Grim, Bernd Swoboda, Thilo Hotfiel
Sports Orthopaedics and Traumatology;Article in Press

Background
Pedobarography systems have been used in numerous studies and have become an important tool for the evaluation of foot loads during sports activities. The aim of this study was to provide a valid comparison of plantar force patterns obtained with insole based and platform based systems.

Material and methods
14 healthy participants were recruited from the medical faculty. A total of two trials were performed. Firstly the participants walked on the platform under barefoot conditions (emed®-n50 platform, novel Inc., Munich, Germany). The second trial used a “neutral-shoe” with an in-shoe measurement system (Pedar® X system, novel Inc.). Peak force values were analysed from four foot regions.

Results
For all foot portions, forces on the platform were significantly lower than the corresponding in-shoe values, excepting the toes (p = 0.11) and metatarsal heads (p = 0.067) of the non-preferred foot. The biggest difference was observed for the midfoot (preferred foot: 24%, non-preferred foot: 33%). Forces under the metatarsal heads displayed the smallest difference between the systems (preferred foot: 10% (p < 0.05), non-preferred foot: 6% (p = 0.067)).

Conclusion
Absolute maximum force values from platforms cannot be equated to those from sensor-loaded insoles. Interpretation and comparison of pedobarographic data should be performed cautiously if different systems are chosen.
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NewsBot · Sep 21, 2017

Test-retest reliability of the Tekscan® F-Scan® 7 in-shoe plantar pressure system during treadmill walking in healthy recreationally active individuals.
Patrick K, Donovan L.
Sports Biomech. 2017 Sep 20:1-15. doi: 10.1080/14763141.2017.1355010

In-shoe plantar pressure systems are commonly used in clinical and research settings to assess foot function during functional tasks. Recently, Tekscan® has updated their F-Scan® in-shoe plantar pressure system; however, this system's test-retest reliability has not been established. Therefore, the purpose of this study was to determine the test-retest reliability of the F-Scan® 7 system in recreationally active individuals during treadmill walking. Seventeen healthy adults completed 2 sessions of treadmill walking. For each session, participants were fitted for shoes and pressure insoles and walked on a treadmill at a self-selected pace for 30 s. Following the sessions, the test-retest reliability peak pressure, pressure time integral, average pressure and pressure contact area over 4 regions of the foot (heel, mid-foot, forefoot and toes) was assessed by calculating intraclass coefficients (ICC 2,k) and coefficient of variation percentage (CoV%). Pressure contact area consistently had the highest ICCs and lowest CoV% (ICCs: 0.91-0.98; CoV%: 2.7-7.8%). Whereas, the forefoot and toe regions had the highest ICCs for all 4 measures (ICCs: 0.83-0.98; CoV%: 3.1-13.4%). During treadmill walking in healthy recreationally active individuals, the reliability of the new Tekscan F-Scan® ranged from poor to high and was dependent on the measure and region of the foot.
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NewsBot · Jun 12, 2018

Reliability of the Footscan® Platform System in Healthy Subjects: A Comparison of without Top-Layer and with Top-Layer Protocols.
Xu C et al
Biomed Res Int. 2017;2017:2708712.

The Footscan platform is a useful tool for plantar pressure measurement. However, there is still controversy over whether or not the platform should be covered by top-layer during the test. This study was designed to compare the reliability of the Footscan platform and identify the differences of the foot loading parameters between without top-layer (WOT) and with top-layer (WT) protocols. Measurements were taken from thirty-two healthy subjects. Participants were tested with a Footscan platform using the WOT and WT protocols. Three trials were performed during two separate testing sessions with a 7-day interval. Peak pressure, contact time, contact area, and pressure-time integral at ten foot zones were recorded and calculated for intra- and intersession reliability using intraclass correlation coefficients (ICCs) and coefficients of variation (CVs). The reliability and values of the analyzed parameters for the two protocols were compared. Both protocols produced a moderate to good level of intra- and intersession reliability. Compared with the WT protocol, the WOT protocol showed higher ICCs, lower CVs, and higher values in most of the parameters analyzed. The results suggest that the WOT protocol showed better reliability than the WT protocol. We recommend not using the top-layer when performing the plantar pressure test.
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NewsBot · Dec 25, 2018

A state-of-the-art review of foot pressure
Siti SyazniZulkifliLoh WeiPing
Foot and Ankle Surgery; 24 December 2018

Highlights
•Preliminary setups for foot pressure measurement during static or dynamic gait.
•Strength and limitations of recent devices with basic systems specifications.
•The crucial control variables in an experimental design.
•Challenges in experimental setup preliminaries in foot pressure analysis.
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The science of foot pressure studies the forces acting on the bottom and different regions of the foot along with the pressure exerted on the plantar surface with the interacting surface in contact. The information derived gave impact to human biomechanical assessment on body balance and ergonomics posture during gait. Various experiments designed at generating foot pressure data returns only with limited knowledge generated. Obviously, the procedure for experiment design needs to be properly understood from the foot morphology aspects; healthiness, footwear, surface in contact, load and forces impacts, and the foot sensitivity as well as the specification for the foot pressure. This paper reviews the proper preliminary experimental setups for foot pressure measurement analysis during static or dynamic gait. The strength and limitations of recent devices used and considerable variables are also discussed. The overall review explains that the comfortable natural gait in relation to the aspects of sensitivity, load, time duration, and stability are the standard considerations for plantar pressure experiments.
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NewsBot · Jan 20, 2020

A state-of-the-art review of foot pressure
Siti SyazniZulkifliWei PingLoh
Foot and Ankle Surgery; Volume 26, Issue 1, January 2020, Pages 25-32

Highlights
•Preliminary setups for foot pressure measurement during static or dynamic gait.
•Strength and limitations of recent devices with basic systems specifications.
•The crucial control variables in an experimental design.
•Challenges in experimental setup preliminaries in foot pressure analysis.
Click to expand...

The science of foot pressure studies the forces acting on the bottom and different regions of the foot along with the pressure exerted on the plantar surface with the interacting surface in contact. The information derived gave impact to human biomechanical assessment on body balance and ergonomics posture during gait. Various experiments designed at generating foot pressure data returns only with limited knowledge generated. Obviously, the procedure for experiment design needs to be properly understood from the foot morphology aspects; healthiness, footwear, surface in contact, load and forces impacts, and the foot sensitivity as well as the specification for the foot pressure. This paper reviews the proper preliminary experimental setups for foot pressure measurement analysis during static or dynamic gait. The strength and limitations of recent devices used and considerable variables are also discussed. The overall review explains that the comfortable natural gait in relation to the aspects of sensitivity, load, time duration, and stability are the standard considerations for plantar pressure experiments.
Click to expand...

NewsBot · Jan 28, 2022

Reliability and Repeatability of the Footwork Plantar Pressure Plate System
José-Víctor Alfaro-Santafé, Antonio Gómez-Bernal, Alejandro-Jesús Almenar-Arasanz, Javier Alfaro-Santafé
J Am Podiatr Med Assoc. 2021 Dec 15;111(6).

Background: Plantar pressure plate instruments are commonly used in clinical practice and biomechanical analysis and are useful to establish a relationship between gait disorders and foot pressure. The aim of this study was to verify the reliability and repeatability of the Footwork pressure plate system for static and dynamic conditions.

Methods: Forty healthy adults, without apparent gait pathology, were recruited. For the static condition, participants were asked to stand static on the Footwork pressure plate for 5 sec in natural position (arms on either side of the body, feet shoulder-width apart in a comfortable angle, and looking ahead). For the dynamic condition, subjects were told to step five times with each foot on the plate following the three-step protocol. Both conditions were performed in two testing sessions spaced by 1 week.

Results: Intrasession and intersession reliability for both conditions showed substantial to almost perfect intraclass correlation coefficient (ICC) values, and low coefficient of variation, low standard error measure, and low percentage error. Intrasession ICCs were 0.724 to 0.993 for static condition evaluation and 0.639 to 0.986 for dynamic condition evaluation. Intersession reliability ICCs ranged from 0.850 to 0.987 for the static condition and from 0.781 to 0.996 for the dynamic condition. Coefficient of variation values were below 8% in both cases and percentage error calculated from standard error measure were less than 10%.

Conclusions: The present work demonstrates that the Footwork plantar pressure plate system is a reliable instrument for collecting plantar pressures in static and dynamic conditions. Reliability data were higher for the static trials, probably because of the individual physiologic fluctuations, which are larger during dynamic gait. Reliability for intersession and average intrasession trials were higher than single-test reliability. The results from the present work can be used as a starting point for future research and to establish a basis for sample sizes for investigations that would use the Footwork platform.
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NewsBot · Mar 11, 2022

Assessment of in-shoe pressure: Development of a clinical user guide based on a DELPHI-derived consensus
Joshua Palaya et l
Foot (Edinb). 2021 Dec 24

Background: The F-Scan (F-Scan System by Tekscan, Boston, USA) is an in-shoe pressure measurement device used to provide dynamic pressure, force and timing information to guide appropriate offloading of plantar foot ulcers. Despite the clinical utility of an in-shoe pressure measuring device there are some limitations in the validity and reliability of the output of the F-Scan. The aim of this study was to develop a consensus-based guideline following information provided by experienced clinicians, synthesis of research evidence and manufacturer's guidelines on the most appropriate use and interpretation of the data generated by the F-Scan to manage plantar foot ulceration.

Methods: Using the Delphi method a series of sixteen consensus statements were developed following a two-step questionnaire utilising clinicians feedback, a review of evidence and the manufacturer's guidelines.

Findings: Seventeen clinicians responded to the first questionnaire and 11 to the second, that included 8 podiatrists and 9 pedorthists working in the public and private sectors. Of the sixteen statements there was strong consensus for ten and moderate consensus for a further four. Only two statements failed to reach consensus and the feedback from the respondents was of great value providing sound clinical rationale for their rejection.

Interpretation: The objective of this study has been achieved in developing a clear and concise set of guiding statements (Table 1) to standardise use of the F-Scan. The application of the guiding statements will encourage standardisation of practice with the aim of highlighting the limitations of the system and reducing potential systematic error in measurement from output produced.
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NewsBot · Jul 25, 2022

The Podoprint® plantar pressure platform: Evaluation of reliability and repeatability, and determination of the normality parameters
Paula Cobos-Moreno et al
J Tissue Viability. 2022 Jul 16;S0965-206X(22)00079-1

Introduction: The Podoprint® pressure platform system is widely used in routine podiatric clinical practice to measure plantar pressures. It allows non-invasive examination of the patient, and provides fast results with high levels of precision, reliability, and repeatability. Once these conditions have been demonstrated, the clinical and/or research use of baropodometry allows results to be obtained in the field of podology that are far from inconsiderable. The study was designed to evaluate the repeatability and reliability of the platform, and to identify the normal foot pressure parameters.

Methods: Records were collected from 52 random healthy individuals, 10 men and 42 women, in two sessions separated by one week. The study variables were: maximum pressure, mean pressure, support surface areas (heel, midfoot, and forefoot), and contact time. Repeatability and reliability were evaluated by calculating the interclass correlation coefficient (ICC) and the coefficient of variation (CV) in the three tests.

Results: The ICCs showed moderate to good repeatability for the variables of interest, and the CVs were all less than 18%. The maximum pressure was under the forefoot (mean 2675.4 ± 513.8 g/cm2). The mean contact time of the steps was 0.72 ± 0.07 s.

Conclusions: The Podoprint® system is a reliable tool for evaluating the distribution of plantar pressures in the dynamic study of the barefoot gait of healthy individuals.
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NewsBot · Nov 17, 2022

Effect of pressure insole sampling frequency on insole measured peak force accuracy during running
L.J.Elstub et al
Journal of Biomechanics 13 November 2022, 111387

Pressure sensing insoles enable us to estimate forces under the feet during activities such as running, which can provide valuable insight into human movement. Pressure insoles also afford the opportunity to collect more data in more representative environments than can be achieved in laboratory studies. One key challenge with real-world use of pressure insoles is limited battery life which restricts the amount of data that can be collected on a single charge. Reducing sampling frequency is one way to prolong battery life, at the cost of decreased measurement accuracy, but this trade-off has not been quantified, which hinders decision-making by researchers and developers. Therefore, we characterized the effect of decreasing sampling frequency on peak force estimates from pressure insoles (Novel Pedar, 100 Hz) across a range of running speeds and slopes. Data were downsampled to 50, 33, 25, 20, 16 and 10 Hz. Force peaks were extracted due to their importance in biomechanical algorithms trained to estimate musculoskeletal forces and were compared with the reference sampling frequency of 100 Hz to compute relative errors. Peak force errors increased exponentially from 0.7% (50 Hz) to 9% (10 Hz). However, peak force errors were <3% for all sampling frequencies down to 20 Hz. For some pressure insoles, sampling rate is inversely proportional to battery life. Therefore, these findings suggest that battery life could be increased up to 5x at the expense of 3% errors. These results are encouraging for researchers aiming to deploy pressure insoles for remote monitoring or in longitudinal studies.
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NewsBot · Jan 23, 2023

Validity and reliability of the XSENSOR in-shoe pressure measurement system
Daniel Parker et al
PLoS One. 2023 Jan 17;18(1)

Background: In-shoe pressure measurement systems are used in research and clinical practice to quantify areas and levels of pressure underfoot whilst shod. Their validity and reliability across different pressures, durations of load and contact areas determine their appropriateness to address different research questions or clinical assessments. XSENSOR is a relatively new pressure measurement device and warrants assessment.

Research question: Does the XSENSOR in-shoe pressure measurement device have sufficient validity and reliability for clinical assessments in diabetes?

Methods: Two XSENSOR insoles were examined across two days with two lab-based protocols to assess regional and whole insole loading. The whole insole protocol applied 50-600 kPa of pressure across the insole surface for 30 seconds and measured at 0, 2, 10 and 30 seconds. The regional protocol used two (3.14 and 15.9 cm2 surface area) cylinders to apply pressures of 50, 110 and 200 kPa to each insole. Three trials of all conditions were averaged. The validity (% difference and Root Mean Square Error: RMSE) and repeatability (Bland Altman, Intra-Class Correlation Coefficient: ICC) of the target pressures (whole insole) and contact area (regional) were outcome variables.

Results: Regional results demonstrated mean contact area errors of less than 1 cm2 for both insoles and high repeatability (≥0.939). Whole insole measurement error was higher at higher pressures but resulted in average peak and mean pressures error < 10%. Reliability error was 3-10% for peak pressure, within the 15% defined as an analytical goal.

Significance: Errors associated with the quantification of pressure are low enough that they are unlikely to influence the assessments of interventions or screening of the at-risk-foot considering clinically relevant thresholds. Contact area is accurate due to a high spatial resolution and the repeatability of the XSENSOR system likely makes it appropriate for clinical applications that require multiple assessments.
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NewsBot · Apr 3, 2023

Reliability of F-Scan® in-shoe plantar pressure measurements in people with diabetes at risk of developing foot ulcers
Sigrid Simonsson et al
Foot (Edinb). 2023 Mar 25

Background: The provision of therapeutic footwear, to prevent the development of diabetic foot ulcers by re-distributing high peak plantar pressure is frequently prescribed for patients with diabetes. Areas of interest (ROI) are identified by placing boxes on the visualised pressure movie. The aims were to evaluate the inter-reliability of the placements of seven ROI boxes and to explore how the box placement affected peak pressure in the seven ROIs.

Methods: Plantar pressure movies from 20 of a total of 40 movies were selected for the analysis. Boxes were placed at ROIs, the heel, the lateral midfoot, the metatarsal phalangeal heads (5, 3-4, 2 and 1) and the hallux. The box placements were registered for the left vertical position (L) and the top horizontal position (T) for each of the ROIs, based on registrations by two certified prosthetists and orthotists.

Findings: The inter correlation coefficient of the placement of the boxes ranged from 1.00 to 0.12 (heel_L and metatarsal phalangeal head 2_L respectively). Of the 14 positions of the boxes; four were excellent, four were good, two were moderate and four were poor. No significant differences in the mean peak pressure corresponding to the box placements were found between the CPOs.

Interpretation: The inter-reliability of eight of the 14 registered placements, made by prosthetists and orthotists, of the boxes in Scan® was good to excellent. A variation of 1.00-0.12 was present. Despite the variation, no significant differences in the corresponding mean peak pressure between prosthetists and orthotists was found.
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NewsBot · May 19, 2023

Can the F-Scan in-shoe pressure system be combined with the GAITRite® temporal and spatial parameter-recording walkway as a cost-effective alternative in clinical gait analysis? A validation study
Stephanie Speight, Sarah Reel & John Stephenson
Journal of Foot and Ankle Research volume 16, Article number: 30 (2023)

Background
Clinical gait analysis is widely used to aid the assessment and diagnosis of symptomatic pathologies. Foot function pressure systems such as F-scan and analysis of the spatial–temporal parameters of gait using GAITRite® can provide clinicians with a more comprehensive assessment. There are systems however, such as Strideway™ that can measure these parameters simultaneously but can be expensive. F-Scan in-shoe pressure data is normally collected whilst the person is walking on a hard floor surface. The effects of the softer Gaitrite® mat upon the F-Scan in-shoe sensor pressure data is unknown. This study therefore aimed to assess the agreement between F-Scan pressure measurements taken from a standard walkway (normal hard floor), and those from a GAITRite® walkway to establish whether these two pieces of equipment (in-shoe F-Scan and GAITRite®) can be used simultaneously, as a cost-effective alternative.

Method
Twenty-three participants first walked on a standard floor and then on a GAITRite® walkway wearing F-Scan pressure sensor insoles with same footwear. They repeated these walks three times on each surface. Mid gait protocols were utilised by analysing the contact pressure of the first and second metatarsophalangeal joint of the third, fifth and seventh step from each walk. For both joints, 95% Bland–Altman Limits of Agreement was used to determine a level of agreement between the two surfaces, using mean values from pressure data collected from participants who successfully completed all required walks. The intraclass correlation coefficient (ICC) and Lin’s concordance correlation coefficient were calculated as indices of reliability.

Findings
ICC results for the hard surface and the GAITRrite® walkway at the first and second metatarsophalangeal joints were 0.806 and 0.991 respectively. Lin’s concordance correlation coefficient for the first and second metatarsophalangeal joints were calculated to be 0.899 and 0.956 respectively. Both sets of statistics indicate very good reproducibility. Bland–Altman plots revealed good repeatability of data at both joints.

Conclusion
The level of agreement in F-Scan plantar pressures observed between walking on a normal hard floor and on a GAITRite® walkway was very high, suggesting that it is feasible to use F-Scan with GAITRite® together in a clinical setting, as an alternative to other less cost-effective standalone systems. Although it is assumed combining F-Scan with GAITRite® does not affect spatiotemporal analysis, this was not validated in this study.
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