Seated Virtual Reality-Guided Exercise Improved Gait in a Postoperative Hallux Valgus Case

Virtual reality (VR)-guided exercise therapy using mediVR KAGURA has been reported to improve gait function by extending the arm to spatial targets while sitting. We aimed to investigate toe and trunk–pelvic function and plantar sensation during gait in a postoperative patient with hallux valgus. A 60-year-old woman, whose foot deformities had improved 6 months earlier, participated in the study. The exercise therapy interventions were performed twice weekly for 15 min. This study used an A-B-A design: 1-week pre-phase, 3-week intervention phase, and 2-week post-phase. The plantar pressure distribution and thoracic and pelvic displacements during gait were recorded at the end of each phase. The tactile pressure thresholds of the foot were determined before and after each exercise. The maximum force and impulse under the hallux increased after the intervention. The sensory threshold of the hallux was reduced. The amplitude of the thoracic and pelvic displacement was shortened in lateral and extended in the vertical and progressional directions after the intervention. We found that a 3-week VR-guided exercise improved toe function, plantar sensation, and postural adjustment of the trunk and pelvis during gait in a patient who had undergone surgery for hallux valgus, and the effects continued for 2 weeks.

A Review of the Plantar Pressure Distribution Effects from Insole Materials and at Different Walking Speeds

Among people with diabetes mellitus (DM), the two common strategies for decreasing peak plantar pressure (PPP) to reduce diabetic foot ulcers (DFUs) risks are to modify walking speeds and to change insole materials. This study reviewed the PPP reduction based on various walking speeds and insole materials. The articles were retrieved from four major scientific databases and manual search. We identified 1585 articles, of which 27 articles were selected for full-text analysis. We found that in faster walking speeds, the forefoot PPP was higher (308 kPa) than midfoot (150 kPa) and rearfoot (251 kPa) PPP. The appropriate walking speed for reducing the forefoot PPP was about 6 km/h for non-DM and 4 km/h for DM people. The forefoot PPP in DM people was 185% higher than that of non-DM people. Ethylene–vinyl acetate (EVA) insole material was the most popular material used by experts (26%) in the forefoot and reduced 37% of PPP. In conclusion, the suitable walking speed for DM was slower than for non-DM people, and EVA was the most common insole material used to decrease the PPP under the forefoot. The clinicians might recommend DM people to walk at 4 km/h and wear EVA insole material to minimize the DFUs.

Foot Loading Analysis of Intraarticular Tibia Pilon Fracture

BACKGROUND: Although pilon fractures are rare, they are important for orthopedic surgeons because of the difficulty of treatment and adverse effects on gait function. The aim of the study to evaluate the relationship between the reduction quality of the fracture, functional results, ankle arthrosis and plantar pressure distribution in patients with tibia pilon fractures. METHODS: In this study, a total of 62 patients treated for an intraarticular pilon fracture in our clinic between January 2015 and January 2019 were evaluated retrospectively. Postoperative reduction qualities of the patients were evaluated with the Ovadia-Beals criteria, ankle functional scores with the Teeny-Wiss score, and ankle arthrosis with the Takakura classification. In the last follow-up of the patients, foot loading analysis was performed and the results of the patients were evaluated for their relation with postoperative reduction quality, ankle functions and ankle arthrosis. RESULTS: There were 62 patients (50 men and 12 women). The average age was 43.3 years (range 19-78). The mean follow-up was 34.3 months (range 24 - 58). The mean Ovadia-Beals score was 12.35 {plus minus} 4.6 in the postoperative plain radiographs of the patients; the mean Teeny-Wiss score in the last follow-up was 76.82 {plus minus} 17.69, and the Takakura score was 1.47 {plus minus} 1.35. Based on the pedobarographic measurements, 47.58% of the patients put weight on the anterior and 52.42% on the posterior of the foot in the anteroposterior plane. In the mediolateral plane, 42.15% loaded on the medial of the ankle and 57.85% loaded on the lateral of the foot. CONCLUSION: Intra-articular tibia pilon fractures can be demonstrated by lateralization of the walking axis and changes in gait patterns and can be associated with clinical outcome.

Pedobarography: A Review on Methods and Practical Use in Foot Disorders

Pedobarographic examination is a non-invasive method that enables the quantitative and qualitative evaluation of plantar pressure distribution, notably the plantar pressure distribution, referring to the function of the entire musculoskeletal system. This is a scoping review that aims to update knowledge on the practical use of pedobarography in foot disorders. We also attempted to systematize the methodological principles of conducting the pedobarographic examination. We searched Medline/PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews for the articles on the methodology of pedobarography. The search encompassed clinical trials, randomized controlled trials, meta-analyses, and reviews published in English between January 1982 and February 2021. The literature distinguishes three different types of examinations: static, postural, and dynamic. The rationale for each is presented. The review pointedly shows the unique use of pedobarography for the quantitative and qualitative evaluations of the plantar pressure distribution. It also points to the need for enhancing the awareness among medical professionals of the method and advantages it provides for patient management. Shortcomings of the method are discussed of which the difficulty in establishing the cause-and-effect relationship of foot disorders is the most disturbing as it limits the comparative verification of results of different studies. There also appears a need for developing standardized algorithmic protocols and recommendations to seamlessly perform pedobarography in clinical settings, which would help make wider use of this valuable tool.

Insole Gait Acquisition System Based on Wearable Sensors

Human gait analysis is a growing field of research interest in medical treatment, sports training and structural health monitoring. In our study, we propose a low-cost insole design with wearable sensors based on piezoelectric discs (PZT) and an inertial measurement unit (IMU) to acquire the human gait. The sensors are placed at three points of a shoe sole: toe, metatarsal and heel. The human gait obtained from such an insole layout is significantly affected by plantar pressure distribution and alignment of the feet. The PZT sensors give an insight into the pressure map under the feet, and the IMUs record projection and orientation of the feet.