Journal of Research in Rehabilitation Sciences

Comparison of Foot Pressure Distribution Using Two Types of Medical Insoles Based on Location in Children with Flexible Flat Foot: A Quasi-Experimental Study

Document Type : Original Articles

Authors

1 MSc Student, Student Research Committee of Rehabilitation Students (TRITA) AND Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

2 Assistant Professor of Orthotics and Prosthetics, Musculoskeletal Research Center AND Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

3 Professor of Orthotics and Prosthetics, Musculoskeletal Research Center AND Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

10.48305/jrrs.2023.26554.0

Abstract

Introduction: Medical insoles play an important role in correcting the biomechanical characteristics of the foot in people with flat foot. The design and construction of the insole determines how it affects the foot. The aim of this study was to compare the effect of two types of semi-custom insole and custom molded insole made based on three-dimensional scanning technology on the distribution of surface and pressure in different areas of the sole of the foot.
Materials and Methods: This quasi-experimental study was performed on 16 children with flat foot  at the Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Participants were selected by simple non-probability method and randomly divided into two equal groups for intervention with semi-custom insoles and insoles made based on foot scans. The area of the parts involved in foot sole pressure and the size of the foot sole pressure and its location were measured before the intervention, immediately, and 6 weeks after continuous use of the insoles. Shapiro-Wilk test was used to examine the data distribution and two-way analysis of variance (ANOVA) was used for data analysis.
Results: Both types of insoles showed the maximum pressure in the whole sole of the foot after 6 weeks (P = 0.04) and the maximum pressure in the middle of the sole of the foot increased significantly for both types of insoles, while a significant decrease was observed in the front sole of the foot (P = 0.07). The results also showed that the use of custom insoles in comparison with semi-custom insoles did not lead to a significant difference in the average of the maximum pressure applied to the front of the foot sole (P = 0.63).
Conclusion: Although both custom insoles using Computer-aided design-Computer-aided manufacturing (CAD-CAM) and semi-custom insoles were effective in biomechanical effects such as pressure on the soles of the feet in children with flat feet, the custom insole was more effective. Since it is necessary to choose an advanced, uniform, and fixed method for designing and manufacturing medical insoles for children with flat feet, it is recommended that this study be performed with the help of scanners or other different and related design software.

Keywords

  1. Webster J, Murphy D. Atlas of orthoses and assistive devices. Amsterdam, the Netherlands: Elsevier Health Sciences; 2019.
  2. Ki SW, Leung AK, Li AN. Comparison of plantar pressure distribution patterns between foot orthoses provided by the CAD-CAM and foam impression methods. Prosthet Orthot Int 2008; 32(3): 356-62.
  3. Menz HB. Foot orthoses: How much customisation is necessary? J Foot Ankle Res 2009; 2: 23.
  4. Pauk J, Ezerskiy V, Raso JV, Rogalski M. Epidemiologic factors affecting plantar arch development in children with flat feet. J Am Podiatr Med Assoc 2012; 102(2): 114-21.
  5. Harris EJ, Vanore JV, Thomas JL, Kravitz SR, Mendelson SA, Mendicino RW, et al. Diagnosis and treatment of pediatric flatfoot. J Foot Ankle Surg 2004; 43(6): 341-73.
  6. Whitford D, Esterman A. A randomized controlled trial of two types of in-shoe orthoses in children with flexible excess pronation of the feet. Foot Ankle Int 2007; 28(6): 715-23.
  7. Roth S, Roth A, Jotanovic Z, Madarevic T. Navicular index for differentiation of flatfoot from normal foot. Int Orthop 2013; 37(6): 1107-12.
  8. Kothari A, Dixon PC, Stebbins J, Zavatsky AB, Theologis T. The relationship between quality of life and foot function in children with flexible flatfeet. Gait Posture 2015; 41(3): 786-90.
  9. Evans AM. The flat-footed child -- to treat or not to treat: what is the clinician to do? J Am Podiatr Med Assoc 2008; 98(5): 386-93.
  10. Evans AM, Rome K. A Cochrane review of the evidence for non-surgical interventions for flexible pediatric flat feet. Eur J Phys Rehabil Med 2011; 47(1): 69-89.
  11. Halabchi F, Mazaheri R, Mirshahi M, Abbasian L. Pediatric flexible flatfoot; clinical aspects and algorithmic approach. Iran J Pediatr 2013; 23(3): 247-60.
  12. Chen KC, Tung LC, Tung CH, Yeh CJ, Yang JF, Wang CH. An investigation of the factors affecting flatfoot in children with delayed motor development. Res Dev Disabil 2014; 35(3): 639-45.
  13. Rome K, Ashford RL, Evans A. Non-surgical interventions for paediatric pes planus. Cochrane Database Syst Rev 2010; (7): CD006311.
  14. Dunn JE, Link CL, Felson DT, Crincoli MG, Keysor JJ, McKinlay JB. Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. Am J Epidemiol 2004; 159(5): 491-8.
  15. Powell M, Seid M, Szer IS. Efficacy of custom foot orthotics in improving pain and functional status in children with juvenile idiopathic arthritis: A randomized trial. J Rheumatol 2005; 32(5): 943-50.
  16. Gould N, Moreland M, Alvarez R, Trevino S, Fenwick J. Development of the child's arch. Foot Ankle 1989; 9(5): 241-5.
  17. Khodaei B, Saeedi H, Jalali M, Farzadi M, Norouzi E. Comparison of plantar pressure distribution in CAD-CAM and prefabricated foot orthoses in patients with flexible flatfeet. Foot (Edinb) 2017; 33: 76-80.
  18. Jahani MR, Jalalvand A. Effect of flat foot on excursions of lower limb joints during running. Shahid Sadoughi Univ Med Sci 2020; 28(2): 2373-83. [In Persian].
  19. Ledoux WR, Hillstrom HJ. The distributed plantar vertical force of neutrally aligned and pes planus feet. Gait Posture 2002; 15(1): 1-9.
  20. Rai DV, Aggarwal LM, Bahadur R. Plantar pressure changes in normal and pathological foot during bipedal standing. Indian J orthop 2006; 40(2): 119.
  21. Razak AH, Zayegh A, Begg RK, Wahab Y. Foot plantar pressure measurement system: A review. Sensors (Basel) 2012; 12(7): 9884-912.
  22. Redmond AC, Landorf KB, Keenan AM. Contoured, prefabricated foot orthoses demonstrate comparable mechanical properties to contoured, customised foot orthoses: a plantar pressure study. J Foot Ankle Res 2009; 2: 20.
  23. Bus SA, Ulbrecht JS, Cavanagh PR. Pressure relief and load redistribution by custom-made insoles in diabetic patients with neuropathy and foot deformity. Clin Biomech (Bristol, Avon) 2004; 19(6): 629-38.
  24. Xu R, Wang Z, Ren Z, Ma T, Jia Z, Fang S, et al. Comparative study of the effects of customized 3d printed insole and prefabricated insole on plantar pressure and comfort in patients with symptomatic flatfoot. Med Sci Monit 2019; 25: 3510-9.
  25. Collins NJ, Hinman RS, Menz HB, Crossley KM. Immediate effects of foot orthoses on pain during functional tasks in people with patellofemoral osteoarthritis: A cross-over, proof-of-concept study. Knee 2017; 24(1): 76-81.
  26. Chen Y, Li JX, Hong Y, Wang L. Plantar stress-related injuries in male basketball players: variations on plantar loads during different maximum-effort maneuvers. Biomed Res Int 2018; 2018: 4523849.
  27. van der Wilk D, Dijkstra PU, Postema K, Verkerke GJ, Hijmans JM. Effects of ankle foot orthoses on body functions and activities in people with floppy paretic ankle muscles: a systematic review. Clin Biomech (Bristol, Avon) 2015; 30(10): 1009-25.
  28. Umehara J, Ikezoe T, Nishishita S, Nakamura M, Umegaki H, Kobayashi T, et al. Effect of hip and knee position on tensor fasciae latae elongation during stretching: An ultrasonic shear wave elastography study. Clin Biomech (Bristol, Avon) 2015; 30(10): 1056-9.
Journal of Research in Rehabilitation Sciences
Volume 17, Issue 1 - Serial Number 1
April 2021
Pages 153-159