Carl Hans-Dieter, Pfander David, Swoboda Bernd
Division of Orthopaedic Rheumatology, Department of Orthopaedic Surgery, University of Erlangen-Nuremberg, Rathsbergerstrasse 57, D-91054 Erlangen, Germany.
Foot Ankle Int. 2006 Feb;27(2):117-20. doi: 10.1177/107110070602700208.
After reconstructive forefoot surgery, patients require complete or partial forefoot relief, which can be obtained with a variety of shoe designs. The aim of this study was to evaluate the effectiveness of two different types of forefoot-relief shoes frequently used after surgery, especially their safety against unintentional forefoot load.
Ten healthy volunteers were asked to perform five trials on a treadmill at self-selected speeds. In the first trial, mean peak pressure values in mass-produced shoes and insoles were evaluated and considered as 100%. Two different shoe designs (short heel-short sole, ii: short heel-complete sole) were compared in two trials each with appropriate and inappropriate use (attempting to put weight on the forefoot) gait pattern. Plantar pressure values were obtained using the Pedar cable system (Novel Inc., Munich, Germany). For analysis, pedobarographic pictures were subdivided into midfoot (31% to 60% of the total insole length) and forefoot (61% to 100% of the total insole length). ANOVA was used for statistical analysis, and p values less than 0.01 were considered significant.
With the short-soled shoe, forefoot and midfoot relief was 100% in both compliant and in noncompliant use. With wearing a complete sole, compliant use led to a significant reduction (p < 0.01) of mean peak pressure under the forefoot (34 +/- 13% remaining) and midfoot (47 +/- 13% remaining). Noncompliant use of the complete-sole shoe produced mean peak pressure values significantly higher (p < 0.01) than normal gait in mass produced shoes under the forefoot, but not under the midfoot.
Forefoot-relief shoes are effective in reducing both mean and peak plantar pressures. Shoes with a nonsupported midfoot and forefoot may be safer with inappropriate use than shoes with a complete sole. The kind of forefoot shoe should be carefully chosen to regulate weightbearing after reconstructive forefoot surgery.
在前足重建手术后，患者需要完全或部分减轻前足负担，这可以通过多种鞋类设计来实现。本研究的目的是评估两种术后常用的不同类型前足减压鞋的有效性，尤其是它们防止前足意外负重的安全性。
10名健康志愿者被要求在跑步机上以自选速度进行5次试验。在第一次试验中，评估量产鞋和鞋垫的平均峰值压力值，并将其视为100%。在另外两次试验中，分别比较了两种不同的鞋类设计（短跟-短底，ii：短跟-全底）在正确和不正确使用（试图在前足负重）步态模式下的情况。使用Pedar电缆系统（德国慕尼黑Novel公司）获取足底压力值。为了进行分析，将足底压力图像细分为中足（占鞋垫总长度的31%至60%）和前足（占鞋垫总长度的61%至100%）。采用方差分析进行统计分析，p值小于0.01被认为具有显著性。
对于短底鞋，无论是正确使用还是不正确使用，前足和中足的减压效果均为100%。穿着全底鞋时，正确使用可导致前足（剩余34±13%）和中足（剩余47±13%）下方的平均峰值压力显著降低（p<0.01）。全底鞋不正确使用时，前足下方产生的平均峰值压力值显著高于量产鞋正常步态时（p<0.01），但中足下方并非如此。
前足减压鞋在降低平均和峰值足底压力方面是有效的。对于不正确使用，中足和前足无支撑的鞋可能比全底鞋更安全。在前足重建手术后，应谨慎选择前足鞋类型以调节负重。
