Pressure-Relief Effect of Post-Op Shoes Depends on Correct Usage While Walking

Abstract

Post-op shoes (POSs) are commonly used after forefoot surgery to protect the surgical site. However, there are insufficient data on their impact on forefoot load during the rollover phase of walking. This study aims to analyze the effects of a commonly used POS on plantar pressures under the forefoot and to assess whether improper usage could affect pressure patterns. Sixteen healthy volunteers underwent three different walking tests on a straight tartan track. The test setting included walking barefoot, as well as normal walking and a modified heel-accentuated "limping" gait while wearing a common POS. The pressure distribution over the forefoot regions of interest was measured using sensor insoles and a pressure-measuring plate on the ground. Results show that only the heel-accentuated "limping" gait in the POS led to a significant reduction in pressure values over all anatomical regions compared to the normal barefoot gait. Furthermore, higher pressure values were found over the lesser toes during normal walking in the POS compared to normal barefoot walking. The findings highlight that the protective function of a POS relies on proper use, specifically the correct gait pattern. If used incorrectly, POS may even have unfavorable effects on the pressure on the operated forefoot and possibly even increase the risk of delayed healing or complications in comparison to barefoot walking. Therefore, strategies such as patient training in proper walking techniques should be incorporated into postoperative care.

Keywords: forefoot relief; forefoot surgery; gait and posture; motion analysis; musculoskeletal disorders; plantar pressure distribution; post-op shoe; quality of life.

Figure 1

Pressure-measuring insoles.

Figure 2

(I) Normal barefoot gait over a measuring plate placed on the track. (IIa) Normal gait in a POS with an inserted pressure measurement insole—putting weight on the whole foot. (IIb) Heel-accentuated “limping gait” in the POS without rolling over the entire foot.

Figure 3

Insole division into specific regions of interest. I: Hallux, II: Lesser toes, III: MTH 1, IV: MTH 2-3, and V: MTH 4-5 (VI: Midfoot and VII: Heel are not included in this study).

Figure 4

Bars illustrate the PP integral over the contact area divided by the contact area in kPa under each specific region during barefoot walking (blue), normal walking in the POS (red), and a heel-accentuated gait in the POS (green). (***: level of significance p < 0.001, **: p = 0.01, black dots: outliers).