OAR@UM Collection:

Foot orthoses for forefoot pressure reduction and the hypothesized role in calf muscle stretching : a systematic review highlighting an evidence gap

Thu, 01 Jan 2026 00:00:00 GMT

Title: Foot orthoses for forefoot pressure reduction and the hypothesized role in calf muscle stretching : a systematic review highlighting an evidence gap Authors: Thiaspras, Loukas; Formosa, Cynthia; Papanas, Nikolaos; Gatt, Alfred Abstract: Background: Excessive forefoot plantar pressures are associated with pain, ulceration risk, and functional limitations in both healthy individuals and those with pathologies such as rheumatoid arthritis (RA). Limited ankle dorsiflexion, often related to gastrocnemius–soleus tightness, may contribute to forefoot overload. Although foot orthoses (FOs) are widely used to redistribute plantar loads, it remains unclear whether the existing evidence includes orthotic interventions designed to promote posterior chain flexibility.; Objective: To systematically evaluate the effectiveness of foot orthoses in reducing forefoot plantar pressure and pressure-time integral (PTI), and to identify whether current evidence addresses orthoses specifically intended to facilitate calf muscle stretching.; Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Five databases were searched up to December 2024. Inclusion criteria encompassed adult populations, studies reporting plantar pressure outcomes, and interventions involving foot orthoses. Methodological quality was assessed using RoB 2 and ROBINS-I tools. Due to substantial clinical and methodological heterogeneity, a meta-analysis was not undertaken and findings were synthesized narratively.; Results: Twelve studies involving 456 participants met the inclusion criteria. No eligible studies directly evaluated orthoses designed to stretch the triceps surae. All included studies reported reductions in peak plantar pressure (PPP) and/or pressure-time integral (PTI). Descriptively, PPP reductions were greater in healthy cohorts (unweighted mean 20.2%) compared to RA populations (14.5%), whereas PTI reductions were descriptively higher in RA participants (22.2% vs. 14.7%). Interventions incorporating metatarsal pads and soft contoured orthoses showed consistent reductions in forefoot loading across studies.; Conclusions: Foot orthoses appear to be consistently associated with reductions in forefoot plantar loading across populations, particularly in individuals with inflammatory or structural pathology. The absence of studies specifically evaluating posterior chain flexibility represents a clear evidence gap. Future research should explore whether orthotic designs combining forefoot offloading with mechanisms that may influence ankle dorsiflexion or posterior chain mechanics could have biomechanical relevance.

An innovative treatment using sterile hyaluronic acid injections to reduce foot ulcer recurrence in patients with diabetes : a pilot study

Thu, 01 Jan 2026 00:00:00 GMT

Title: An innovative treatment using sterile hyaluronic acid injections to reduce foot ulcer recurrence in patients with diabetes : a pilot study Authors: Hughes, Catherine; Papanas, Nikolaos; Formosa, Cynthia Abstract: To evaluate whether plantar injection of hyaluronic acid using the Curacorn® technique can reduce ulcer recurrence in high-risk patients with diabetes. This pilot study included 14 patients with type 2 diabetes and a history of recurrent healed neuropathic or Charcot-related plantar foot ulcers. All ulcers were healed for at least 4 weeks prior to inclusion. Patients underwent 3-4 treatment sessions using a sterile, cross-linked hyaluronic acid gel implanted beneath previous ulcer sites. They were followed for 6–12 months to assess ulcer recurrence. Seven patients (50%) experienced no ulcer recurrence during the follow-up period of the study. Patients without recurrence received a higher total volume of hyaluronic acid when compared with those who experienced recurrence (mean 7.4 ml vs 3.9 ml). Ulcer recurrence in the remaining patients occurred after an initial ulcer-free period of approximately six months. In this pilot cohort, hyaluronic acid injection using the Curacorn® technique was associated with a reduction in ulcer recurrence, particularly when adequate gel volumes were administered. These findings support further investigation of this minimally invasive approach as a preventive strategy in high-risk diabetic foot patients.

Evaluation of plantar pressure and stability parameters in a forefoot offloading footwear : a comparative study

Thu, 01 Jan 2026 00:00:00 GMT

Title: Evaluation of plantar pressure and stability parameters in a forefoot offloading footwear : a comparative study Authors: Chockalingam, Nachiappan; Gomez-Galdon Perez, Jose; Horrocks, Adam; Franklin, Esmé; Greenhalgh, Andrew; Sinclair, Jonathan Kenneth; Dickinson, Simon; Healy, Aoife Abstract: Forefoot offloading footwear is widely used in postoperative care, trauma management, and the prevention of diabetic foot ulceration, where redistribution of plantar load must be achieved without compromising gait stability. This study evaluated plantar pressure and centre of pressure characteristics of a new side-specific forefoot offloading footwear design in comparison with commonly used clinical and retail footwear. Twelve healthy adults completed treadmill walking trials at 4.0 km/h under five footwear conditions. Plantar pressure data were collected using an in-shoe pressure measurement system and analysed for peak pressure, average pressure, force–time impulse, centre of pressure velocity, and centre of pressure excursion index across seven anatomically defined plantar regions. Across all conditions, consistent left–right asymmetry in plantar loading was observed, although overall variability between footwear designs was modest. The experimental footwear demonstrated pressure and impulse distributions comparable to retail and universal offloading footwear, without increasing hallux loading. Centre of pressure measures were generally consistent between side variability, indicating controlled rollover and preserved gait stability. These findings suggest that side-specific sole geometry can support balanced forefoot load management without introducing instability in healthy walking and provide a foundation for future bilateral testing in clinical populations at risk.

Device-dependent variability of plantar pressure thresholds : consequences for clinical decision-making in diabetic foot care

Thu, 01 Jan 2026 00:00:00 GMT

Title: Device-dependent variability of plantar pressure thresholds : consequences for clinical decision-making in diabetic foot care Authors: Chockalingam, Nachiappan; Giacomozzi, Claudia; Healy, Aoife; Monteiro, Renan L.; Ferreira, Jane S. S. P.; Sacco, Isabel C. N. Abstract: Background: Plantar pressure measurement is used to identify areas of high mechanical loading in people at risk of diabetic foot ulceration. Fixed thresholds, such as 200 kPa for in-shoe and 600 kPa for barefoot measurements, are commonly reported in the literature and applied in clinical decision-making in diabetic foot care. However, the validity of these thresholds across different measurement systems remains uncertain. Methods: Fifteen healthy adults walked under controlled conditions while plantar pressures were recorded using three platform systems and two in-shoe systems. Peak pressures were extracted for heel, midfoot, and forefoot regions. Analyses examined the frequency of exceeding 200 and 600 kPa thresholds, agreement across devices, the reliability of derived measures, including the rearfoot–forefoot ratio and identification of the region of maximum loading. Results: The 200 kPa threshold was exceeded in 99.3 % of heel and forefoot data, but distributions of values differed significantly across devices (p < 0.05). Agreement, defined as all devices classifying the same participant, foot, and region as either above or below 600 kPa, was low overall (5.4 %), higher in the heel than the forefoot, and differed significantly between platform systems (p < 0.05). In-shoe devices consistently reported values below 600 kPa. Limited reliability was observed with the rearfoot–forefoot ratio achieving only 53.6 % agreement across devices, and agreement in the most loaded in just 6.7 % of cases. Conclusions: Absolute thresholds such as 200 and 600 kPa are unreliable across commercial systems and foot regions. Common derived measures are also device dependent. Clinical guidelines should move beyond fixed thresholds and adopt device-specific or multidimensional approaches for risk assessment in diabetic foot care.