Proposal
The Effect of High-Heels Shoes on Posture.
Table of Contents
Introduction 3
Foot 3
Hip 5
Knee 5
Spine 6
pelvis 8
The effect of footbed on posture 8
Objective 10
Hypothesis 11
Phase 1: Survey 11
Phase 2: Experiment 11
Methodology 11
Phase 1: Survey 11
Phase 2: Experiment 11
Methodology 12
Participants 12
Equipment 12
Statistical analysis 12
Conclusion 16
References 17
Appendix 20
Introduction
Since the dawn of time, footwear has been used to protect foot against external threats. They are now touted to have performance, style, great slip resistance, low energy expenditure, protection, and comfy as well. In order to properly experience these claims, it is critical to have a suitable fit between the foot and the shoe. The footbed is the part of the shoe that comes into touch with the foot (Weerasinghe and Goonetilleke, 2011). It’s a reverse reproduction of a shoe last’s bottom design, with several variables incorporated in, such as heel height, seat length, toe spring, wedge angle, and shank shape, as shown in figure 1 (Goonetilleke, 2012).
Figure 1. shoe-last features that influence the shape of the bottom of the shoe-last (Goonetilleke, 2012).
Despite physicians’ warnings about the negative consequences of high-heeled shoes on functionality and comfort, a large majority of women continue to wear this type of shoe on a daily basis (Wiedemeijer & Otten, 2018). High-heeled footwear, which is popular among women, has an effect on posture and gait and is often related to back complaints. Moreover, Foot diseases such as musculoskeletal pain and hallux valgus have been linked to high-heeled footwear (Schroeder & Hollander, 2018). This proposal aims to provide a practical overview of the postural and the dynamic gait impacts high-heeled shoes have on patients.
Foot
Many orthopedic issues are caused by walking in high heel shoes (e.g., bunions, blisters, hallux valgus, lesser toe deformities, hyperkeratotic lesions). These types of disorders can have a significant influence on autonomy, well-being, and quality of life (López-López et al., 2018). High-heeled shoes should only be worn on occasion, according to orthopedic professionals, as they can cause major health issues such as muscle shortening, postural damage, and toe deformities, among other things. Increasing the height of the heel changes the distribution of body pressure in the feet, compromising body balance, walking safety, and changing the spine’s posture. A bad choice of footwear design and model might result in a variety of foot health issues. Dermatological, articular, and postural disorders are the most common diseases identified by orthopaedists. The use of uncomfortable shoes can exacerbate the appearance of foot problems and pains due to the use of inappropriate, poorly developed materials or improper modelling. These issues are exacerbated with women’s shoes, as improperly manufactured high heel footwear can result in foot abnormalities in addition to the aforementioned. The hallux valgus is a lateral displacement of the great toe associated with chronic pressure being applied to the large toe. The disease caused by wearing narrow, pointed shoes frequently necessitates surgical or orthopedic intervention (figure 2). By compressing the toes, pointed toe shoes cause the first and fifth fingers to flex outwards and inward, resulting in an overlapping finger, bunion, finger dislocations, ingrown nails, epithelial hardening, bursitis, and callus. Pressure in the feet’s arch might be caused by poorly constructed heels and footbed. The interior finishing of the footwear can also cause serious difficulties for the feet, such as coatings that restrict movement, and the low-quality of synthetic materials that do not absorb the sweat and can lead to fungal infections. The “hammer toe” is another issue related with wearing inappropriate footwear. The wearing of heel shoes causes this distortion because the posture enforced by high heels puts enormous pressure on metatarsal phalangeal joint. High heel changes the actual position of the feet, causing it to remain in a dorsal hyperflexion position, resulting damage to the joints between the proximal phalanges of the toes and the metatarsal. The total load of the body is thrust forward and redirected to the finger joints as a result of this change in foot posture (Broega, Righetto & Ribeiro, 2017).
Figure 2: hallux valgus and hammertoe (Broega, Righetto & Ribeiro, 2017).
While walking, the pressure underneath the metatarsal heads increases as the heel height rises. With high-heeled situations, the rate at which pressure is applied at metatarsals in the stance position is also increased (Wiedemeijer & Otten, 2018). Maximum pressure was found to be highest under the hallux, followed by the medial forefoot, central forefoot, and the lateral forefoot with the lowest pressure, and pressure grew under the forefoot as heel height increased. Furthermore, as the heel height increased, the rollover curve slipped down concerning the ankle marker on lateral malleolus (walker, 2018). The following are some of the unpleasant foot ailments linked to wearing high-heeled shoes: metatarsalgia, hallux abductovalgus deformity, plantar fasciitis, painful hyperkeratoses, and Haglund’s deformity (Wiedemeijer & Otten, 2018).
Hip
According to a recent study, in the high-heeled gait, a high hip extension moment maximizes hip flexor work throughout the swing phases of locomotion. In the loading response, the hip flexors play a minor role in hip flexion because the ground reaction forces transfer anterior to the hip joint. Similarly, the reduction in the hip flexor moment could be attributed to an increase in knee extensor action. In the the high-heeled gait, there is an increase in knee and hip varus moments. The hip abductors increase during the stance phase, counteracting the hip varus moment caused by the high-heeled gait. Another study that looked at muscle activity in the gait with increasing heel height discovered an additional phase of gluteus medius activity during a high-heeled gait. This may explain why the knees and hips have less varus torque, as the gluteus medius may largely prevent tilting (or falling) of the pelvis in the frontal plane compared to a barefoot gait (Cowley, Chevalier & Chockalingam, 2022).
High-heeled footwear seems to have little effect on stance phase hip movement in the sagittal plane. However, hip flexion decreases slightly during the swing moment with high heels (Wiedemeijer & Otten, 2018). During the late stance phase, studies found that the hip flexion moment increased in the high heel position in the sagittal plane. As a result, the work of concentric hip flexor muscles increased. In the frontal plane, the high heel situation caused a rise in peak hip abduction; however, this impact was not significant (walker, 2018). A comparable study discovered a significant hip abduction moment in midstance without any accompanying posture change (Wiedemeijer & Otten, 2018).
Knee
The knee must adjust for the ankle’s plantarflexion and restricted flexion in a high-heeled gait. During the stance phase, the overall flexion of the knee raises to compensate for the decreased ankle joint compliance. To compensate for the reduced possible ankle dorsiflexion during the stance phase, optimum knee flexion rises with increasing heel height, enabling forward motion throughout the foot. Knee flexion is reduced during the swing phase. To maintain upright posture, a higher net knee extensor moment is present due to the increased flexion of the knee in stance (Wiedemeijer & Otten, 2018).
Researchers found that when gait speed increased, high heels increased inclination amplitude to achieve dynamic balance and reduce knee position sensing. This result revealed probable injuries that can be noticed in the knee’s weakened position sensing. One of the important factors affecting gait pattern is shoe design and heel height. Foot pressure distribution and joint motion were found to vary significantly during gait, which predicts pathology associated with gait patterns. One of the essential factors of joint monitoring is the knee joint angle. Understanding the impact of the shoes is crucial for lower limb joint control. Altering the structure of the outsole can affect the function of the metatarsophalangeal and other lower limb joint mechanics. In other investigations, wearing high heels for an extended period of time was observed to cause knee and foot pain, as well as the possibility of osteoarthritis in the knee (Chhoeum, Kim, Min, Wang & Choi, 2020).
Spine
Studies have shown that long-term use of high heels is associated with ankle instability, repetitive strain and neck muscle activity, shortening of the gastrocnemius and decreased plantar flexor strength. Also, high-heeled shoes require more metabolic processes than low-heeled shoes because they increase heart rate and oxygen consumption. Additionally, wearing high heels is associated with changes in gait patterns and possibly knee osteoarthritis. Back pain has been related to wearing high-heeled shoes frequently. Several studies have examined the effect of high heels on spine-pelvic posture and muscle activation. Existing research on the effect of high heels on spinal curvature is equivocal. However, according to previous researches, wearing high heels tilts the pelvis, and flattens the lumbar spine’s curvature. Wearing high heels has been linked to greater lumber lordosis in women. As a result of the high heels, the application of an improper foot insole would enhance lumbar lordosis. Furthermore, a previous study found that the impact of high heels on spine-pelvic posture was largely dependent on how often they were worn. In non-users of high-heeled footwear, the pelvis tilts, and the lumbar spine flattens, but in people who wear high heels on a regular basis, the opposite occurs. There is some indication that standing in high-heeled footwear causes the lumbar paraspinal muscles and cervical to contract more. Walking in high heels caused the lumbar paraspinal muscles to activate earlier and more intensely (Walaa et al., 2017).
In a previous study conducted on female volunteers (age > 21) by wearing high heel shoes, the following parameter were evaluated on the radiographs of the whole body: lumbar lordosis and cervical, spino-sacral angle, thoracic kyphosis, pelvic tilt, spinal tilt, sacral slope, pelvic incidence, knee flexion, femoral obliquity angle, and ankle flexion (Fig. 3). For radiographic quantification, imaging software was used.
Figure 3: Data acquisition by radiographic imaging software (Weitkunat et al., 2016).
The basis of the study was that wearing high heels resulted in more knee flexion and more ankle plantar flexion. Consequently, the lower extremity, particularly the knees, exhibited the majority of the adaptive mechanisms to the anterocranial shift of the center of gravity during high-heeled stance. The body’s center of gravity shifts antero-cranially when standing in high-heeled shoes. Correspondingly, degenerative changes in the spine cause the body’s center of gravity to shift forward. These include increased knee flexion, increased lumbar lordosis, hip hyperextension and pelvic tilt, decreased thoracic kyphosis, and increased ankle and knee flexion (Weitkunat et al., 2016).
pelvis
Findings of high-heeled-related lumbopelvic postural abnormalities described in the literatures can provide insight into the biomechanical effects of high-heeled gait; however, these findings are highly diverse and sometimes inconsistent. It has been hypothesized that disparities in biomechanical gait adjustments produced by high-heeled footwear exist among younger and older people. It has been previously shown that in the high-heeled gait, younger adults have higher lordosis and higher pelvic anteversion, whereas older adults have the opposite (reduced lordosis and higher pelvic tilt). The results of age-related changes in biomechanical accommodation are particularly interesting because the changes shown in older women may increase soft tissue mechanical loading and may accelerate degenerative changes, especially those with knee and low back problems (Mika, Oleksy, Mika, Marchewka & Clark, 2012).
The effect of footbed on posture
Because the sole of the foot bears the brunt of the body’s weight, a great fit between both the sole of the foot and the footbed is vital for functionality. As a result, the pressure distribution, perceived sensation, and gait characteristics can all be affected by the contact and distribution of force (Weerasinghe and Goonetilleke, 2011). This can be achieved using insoles or customised footbeds.
The insole has a mechanical impact on the foot throughout the weight-bearing process, by adjusting the foot and supporting and distributing pressure evenly across the entire plantar surface. The insoles may have an indirect influence on the body’s more proximal joints, such as the back and knees. One of the most common reasons for insole prescription is to improve function by relieving non-specific discomfort in the legs, feet or lower back. Pain relief has been found to improve performance in regular activities such as work and entertainment (Amer, Jarl & Hermansson, 2014). Wearing insoles is one of the most simple and cost-effective solutions to manage foot problems. Balance-improving insoles, which have been specifically intended to improve balance, could help elderly people avoid falling. (Park et al., 2021). Therefore, the focus in this study will be on the ideal design of the footbed, which is suitable for different ages and has comfortable properties.
When comparing between wearing commercially made high-heeled shoes and standing barefoot, the weight distribution and the center of pressure is different (Weerasinghe and Goonetilleke, 2011). Although there are international brands of shoes that are sold in large quantities at high prices, these shoes still cause problems and pain to the wearer. The reason for this is due to the design of the insole of these shoes. As a result of a poorly designed footbed, most high-heeled shoe wearers endure high pressures and great discomfort. (Weerasinghe and Goonetilleke, 2011). When the heel height rises, the pressure under the forefoot rises, the peak pressure shifts to the hallux and the first metatarsal. As a result of the increased heel height, the foot shape will change, influencing the fit around the entire foot (Witana et al., 2009). Now there is a patented device ( Goonetilleke and Witana ,2010) that can give an optimal shape for a footbed, and it is used to determine the shape of a comfortable footbed (Goonetilleke, Witana and Weerasinghe, 2010). The footbed simulator depicted in figure 4 was developed in recent years and enabled the study of various characteristics while standing quietly. It is used to assess how changes in heel seat length, height, wedge angle, material, and toe spring influence the perceived sensation and center of pressure.
Figure 4. A footbed simulator or Profile Assessment Device (PAD) which enables a participant to stand with one shoe on one foot while the other one is on the simulator platform in order to make comparisons (Weerasinghe and Goonetilleke, 2011).
The participant leaves the platform after she is satisfied with the sensation on the foot and the rest of the body. The footbed is then constructed after the shape is obtained digitally using specialized software (Weerasinghe and Goonetilleke, 2011). In the end, 3D printer technology will be used to design and print the final shape of the footbed.
Objective
Even though the effects of high heels on posture has been evaluated, the effects of footbed on posture is still unknown. This study aims to investigate the effects of footbed on people’s posture, such as foot, spine, and pelvis. We will Compare commercial shoe with 3D printed and fabricated shoe, therefore this study will aim to design and extract the characteristics and standards of the optimal footbed, which is characterized by its ergonomic characteristics. The optimal design will be conducted after doing the experiment on the volunteers and after determining the effects on the posture. We will Compare the footbed modified shoe with commercial shoe and 3D printed shoe. The study will go through Institutional Ethics Review Board (IRB) for approval. The experiment will be done using foot pressure system (FSCAN) and with questionnaires for the participants.
Hypothesis
Phase 1: Survey
High heel shoes will cause pain in lower back and metatarsals of foot. This hypothesis will be tested using a survey. (Appendix A)
Phase 2: Experiment
The ideal footbed shape obtained from the Profile Assessment Device (PAD) will result in lower deformation on the spine and possibly pelvic tilt.
Ideal footbed shape will lower the peak pressures on the foot or change center of pressure to be close to standing without any shoes.
Methodology
Phase 1: Survey
The survey in the appendix was created after undergoing a study that I conducted on myself by choosing five high heel shoes of different heights. Each shoe was worn on a different day, and each shoe lasted five hours. I record my observations, and my sense of comfort or pain hourly and determine the level of pain.
In view of the results obtained during this study, I developed a survey that 20 participants will undergo to describe how they feel while wearing high-heeled shoes and to determine the areas they feel pain with determining the level of pain.
Phase 2: Experiment
This experiment will be done to compare the changes that occur in the body’s posture such as the spine and pelvis when using a motion analysis system such as x-sense for posture measurements and by using a digital camera. An F-Scan system will be used to measure the interface pressure between the foot and the footbed. Moreover, changes in posture such as pelvis and spine will be detecting using the X-sense system and camera.
Methodology
Participants
This study will target a group of ten to fifteen female volunteers whose ages will range between 20 and 30. In order to get accurate results, the study will be conducted with women free from any disorders or malformations of the feet, postural instability, spine, and knee, or surgeries. Prior to the experiment briefing, each participant will be required to fill out a consent form and they will be allowed to withdraw from the experiment at any time. Moreover, ethics approval will be requested from Khalifa University.
Equipment
The PAD to obtain the optimal shape, anthropometers and goniometers that are available at Khalifa University. Moreover, the contact area, center of pressure (COP) assessed from the back of the heel, and peak pressure will be determined using the F-Scan system.
Statistical analysis
Once standing on the simulator, the F-scan system will first be calibrated, and the software will be settled to record the pressure under the foot. Each subject will spend 30 seconds standing on a left and right simulator, and they will rate how they felt in comparison to when they were on the ground. The distance between the heel-to-heel will be regulated.
The contact area, center of pressure measured from the peak pressure and the back of the heel will be computed using the F-Scan system software. The number of active sensors in the F-Scan sensor will be used to determine the area of contact between the foot and the footbed.
Procedure
While standing on the simulator, the F-scan system will be adjusted, and the software will be configured to detect the pressure beneath the foot. The heel-to-heel distance will be regulated by the capabilities of the equipment. A Motion Analysis system will be used to track the subject’s movement, and the results will be provided elsewhere. The footbed simulator will be used to obtain the footbed shape for any given height, and that will be used in the modified shoe.
Depending on the heel height, the ideal footbed contour will change because the height difference between the forefoot and the hindfoot will cause differing levels of deformation in bones and soft tissues. Consequently, optimizing wedge angle, shank shape, and seat length to achieve a comfortable profile is difficult to accomplish manually. However, the electromechanical controls in the PAD can be used to get the desired shape in a matter of minutes. We are going to change the footbed shape, so that the center of pressure will change and once the central pressure change, the center of gravity will shift. This is where the pelvic tilt and the spine changes are going to be restored back close to as if the participant was standing on flat ground. The optimal footbed shapes and the corresponding pressure patterns will be tested in the lab at Khalifa University (figure 7).
The process will be as follows:
Each participant will wear their own shoe with the FSCAN sensors and record the interface pressure and posture during walking when wearing the X-SENS system. They will then complete the questionnaire (Appendix B)
Each participant will then be allowed to leave the lab without any measurement devices to go about their normal tasks. After walking for approximately 4 hours, they will return to the lab for re-evaluation of interface pressure and posture and record the questionnaire results.
Each participant will repeat steps 1 and 2 with the 3D printed shoe.
Figure 7. The simulator can be adjusted to modify the foot pressure profiles. The left foot demonstrates the pressure profile while wearing a regular shoe. The right foot is on the modified simulator, which displays a more uniform distribution pressure pattern (Weerasinghe and Goonetilleke, 2011).
Figure 7. The simulator can be adjusted to modify the foot pressure profiles. The left foot demonstrates the pressure profile while wearing a regular shoe. The right foot is on the modified simulator, which displays a more uniform distribution pressure pattern (Weerasinghe and Goonetilleke, 2011).
Conclusion
To conclude, the difference in this study is that we will use an existing shoe and modifying it to have the optimal footbed shape. The optimality will be assessed using postural changes when the participant is wearing the high heel shoes. Therefore, my expectation in this study is that we will find differences and effects on the body’s posture when comparing the commercially manufactured high-heeled shoes, footbed modified high-heeled shoes and barefooted. Moreover, the improvement is hypothesized to be not just posture, but comfort as well.
References
Amer, A., Jarl, G., & Hermansson, L. (2014). The effect of insoles on foot pain and daily activities. Prosthetics &Amp; Orthotics International, 38(6), 474-480. doi: 10.1177/0309364613512369
Broega, A., Righetto, M., & Ribeiro, R. (2017). Female high heel shoes: a study of comfort. IOP Conference Series: Materials Science And Engineering, 254, 232001. doi: 10.1088/1757-899x/254/23/232001
Chhoeum, V., Kim, Y., Min, S., Wang, C., & Choi, M. (2020). The Effect of Shoe Heel Types and Gait Speeds on Knee Joint Angle in Healthy Young Women – A Preliminary Study. Internet Computing And Services, 21(6), 41-50.
Christovão, T., Neto, H., Grecco, L., Ferreira, L., Franco de Moura, R., & Eliege de Souza, M. et al. (2013). Effect of Different Insoles on Postural Balance: A Systematic Review. Journal Of Physical Therapy Science, 25(10), 1353-1356. doi: 10.1589/jpts.25.1353
Cowley, E., Chevalier, T., & Chockalingam, N. (2022). The Effect of Heel Height on Gait and Posture. Retrieved 7 May 2022, from
Goonetilleke, R., (2012) The science of footwear. 1st ed. London: CRC Press.
Goonetilleke, R.S. Witana C. P. and Weerasinghe, T. W. (2010) Customised shoe and insole, method and apparatus for determining shape of a foot and for making a shoe or insole. U.S. Patent Number US 7,854,071 B2 21 Dec 2010.
Goonetilleke, R.S. and Witana C. P. (2010) Method and apparatus for determining comfortable footbed shapes. U.S. Patent Number US 7,685,728 30 March 2010.
Horng, M., Kuok, C., Fu, M., Lin, C., & Sun, Y. (2019). Cobb Angle Measurement of Spine from X-Ray Images Using Convolutional Neural Network. Computational And Mathematical Methods In Medicine, 2019, 1-18. doi: 10.1155/2019/6357171
López-López, D., Marañon-Medina, J., Losa-Iglesias, M., Calvo-Lobo, C., Rodríguez-Sanz, D., Palomo-López, P., & Vallejo, R. (2018). The influence of heel height related on quality of life on the foot in a sample of women. Revista Da Associação Médica Brasileira, 64(4), 324-329. doi: 10.1590/1806-9282.64.04.3242
Mika, A., Oleksy, Ł., Mika, P., Marchewka, A., & Clark, B. (2012). The Effect of Walking in High- and Low-Heeled Shoes on Erector Spinae Activity and Pelvis Kinematics During Gait. American Journal Of Physical Medicine &Amp; Rehabilitation, 91(5), 425-434. doi: 10.1097/phm.0b013e3182465e57
Park, J., Jeon, H., Kim, J., Yoon, H., Lim, O., & Jeon, M. (2021). Immediate effect of insoles on balance in older adults. The Foot, 47, 101768. doi: 10.1016/j.foot.2020.101768
Schroeder, J., & Hollander, K. (2018). Effects of high-heeled footwear on static and dynamic pelvis position and lumbar lordosis in experienced younger and middle-aged women. Gait & Posture, 59, 53-57. doi: 10.1016/j.gaitpost.2017.09.034
Subramaniam, S., Majumder, S., Faisal, A., & Deen, M. (2022). Insole-Based Systems for Health Monitoring: Current Solutions and Research Challenges. Sensors, 22(2), 438. doi: 10.3390/s22020438
Tannast, M., Murphy, S., Langlotz, F., Anderson, S., & Siebenrock, K. (2005). Estimation of pelvic tilt on anteroposterior X-rays—a comparison of six parameters. Skeletal Radiology, 35(3), 149-155. doi: 10.1007/s00256-005-0050-8
Walaa, H., Elsayed, A., Asma, A., Alhufair, B., Seham, J., & Alghamdi, C. (2017). Impact of different heel heights on spinal posture and muscle activity in young adult women. Bulletin Of Faculty Of Physical Therapy, (22), 118-123. doi: 10.1016/j.gaitpost.2011.12.001
walker, s. (2018). Effects of high heeled shoes on gait. A review. Gait & Posture, 4(28). doi: 10.1016/j.gaitpost.2018.01.036
Weerasinghe, T. and Goonetilleke, R., (2011) Center of Pressure Variations in High-Heeled Shoes. Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 55(1), pp.1640-1643.
Weerasinghe, T. and Goonetilleke, R., (2011) Getting to the bottom of footwear customization. Journal of Systems Science and Systems Engineering, 20(3), pp.310-322.
Weitkunat, T., Buck, F., Jentzsch, T., Simmen, H., Werner, C., & Osterhoff, G. (2016). Influence of high-heeled shoes on the sagittal balance of the spine and the whole body. European Spine Journal, 25(11), 3658-3665. doi: 10.1007/s00586-016-4621-2
Wiedemeijer, M., & Otten, E. (2018). Effects of high heeled shoes on gait. A review. Gait & Posture, 61, 423-430. doi: 10.1016/j.gaitpost.2018.01.036
Witana, C., Goonetilleke, R., Au, E., Xiong, S. and Lu, X., (2009) Footbed shapes for enhanced footwear comfort. Ergonomics, 52(5), pp.617-628.
Witana, C., Goonetilleke, R., Xiong, S. and Au, E., (2009) Effects of surface characteristics on the plantar shape of feet and subjects’ perceived sensations. Applied Ergonomics, 40(2), pp.267-279.
Appendix
Survey
Despite physicians’ warnings about the negative consequences of high-heeled shoes on functionality and comfort, a large majority of women continue to wear this type of shoe on a daily basis (Wiedemeijer & Otten, 2018). High-heeled footwear, which is popular among women, has an effect on posture and gait and is often related to back complaints. Moreover, Foot diseases such as musculoskeletal pain and hallux valgus have been linked to high-heeled footwear (Schroeder & Hollander, 2018). This survey aims to test the effect of high heels on posture.
Your role in this study is to wear high heels and mark the areas of your body where you feel the pain and determine the level of pain.
Heel length: ———–
Total time spent wearing the shoes: ———–
Description:
Brand: Zara, size 40 , 359AED
A piece of black leather covers the Toebox.
A piece of plastic covering the heads of metatarsals.
Lining covers the sides of metatarsals.
Sling back covers the calcaneus.
Lined with sock insole.
stiletto high heel, 11.2 cm high.
Results after wearing the shoes for five hours.
Comfortable in the first hour.
In the second hour, the shoes began to bother the toes, Pain level 4.
Pain in metatarsals, pain level 8.
Stiff and contracted toes.
Burning feeling in the toes, pain level 3.
– In the third hour, a feeling of strain on the knee, Pain level 3.
– The calf muscles contract and stayed in the same situation for a long time, pain level 5
– It affected the balance of the body, which led to stumbling and spraining the ankle, pain level 6.
– In the last two hours, lower back (pain level 7) and shoulder pain (level 5).
The toenails bended, which leads to the implantation of the nail into the skin, and thus it is accompanied by severe pain, Pain level 8
The appearance of blisters and a burning feeling in the skin on the toes in particular, in addition to the swelling of the hallux, Pain level 7.
Bruising under the nails caused redness, pain level 6.
Inability to walk due to pain after five hours.
Total pain level: 8
5h/6P
5h/6P
2h/6P
2h/6P
5h/7P
5h/7P
3h/6P
3h/6P
3h/6P
3h/6P
2h/6P
2h/6P
5h/7P
5h/7PSample survey
H: Hours
P: Pain level
APPENDIX B
Data Collection form
Number:
1.
ARCH TYPE
Flat/Normal/High(Take a picture)
2
Foot illness
Y/N
Screening test: Line length estimation
Stimuli
Reference
A(3)
B (10)
C(20)
D(35)
E(50)
F(150)
G(200)
H(250)
I(300)
Response
100
P value: , Pass/Fail
Data and Measurement of foot:
Age(years)
Weight(kg)
Height(cm)
Foot
Left
Right
Length from pterion to head of 5th metatarsal
d’ distance
Seat length
Foot length
Foot width
Questionnaire
Commercial Shoe
Assume that comfort feeling you have in your feet can be rated as 100 while standing on a flat floor with equal body weight distribution. The rating can be considered 50 if you stand on flat floor only with one foot. When compared with that feeling how do you rate the current feeling of comfort for overall, mid-foot/arch, heel, fore-foot and upper for left and right foot?
Do you like the comfort of the shoe (yes/no/neutral)? Give a rating (L & R)
Do you like the feel of the mid-foot/arch region (yes/no/neutral)? Give a rating (L & R)
Do you like the feel of the heel region (yes/no/neutral)? Give a rating (L & R)
Do you like the feel of the fore-foot region (yes/no/neutral)? Give a rating (L & R)
Do you like the feel of the upper of the shoe (yes/no/neutral)? Give a rating (L & R)
Comfort rating
Activity
Region
Yes/No/Neutral
Left(L)
Right(R)
Standing
Overall comfort
Mid-foot/arch
Heel
Fore-foot
Upper
Walking
Overall comfort
Mid-foot/arch
Heel
Fore-foot
Upper
Pressure file names
Standing:
Walking:
3D Printed Shoe
Assume that comfort feeling you have in your feet can be rated as 100 while standing on a flat floor with equal body weight distribution. The rating can be considered 50 if you stand on flat floor only with one foot. When compared with that feeling how do you rate the current feeling of comfort for overall, mid-foot/arch, heel, fore-foot and upper for left and right foot?
Do you like the comfort of the shoe (yes/no/neutral)? Give a rating (L & R)
Do you like the feel of the mid-foot/arch region (yes/no/neutral)? Give a rating (L & R)
Do you like the feel of the heel region (yes/no/neutral)? Give a rating (L & R)
Do you like the feel of the fore-foot region (yes/no/neutral)? Give a rating (L & R)
Do you like the feel of the upper of the shoe (yes/no/neutral)? Give a rating (L & R)
Comfort rating
Activity
Region
Yes/No/Neutral
Left(L)
Right(R)
Standing
Overall comfort
Mid-foot/arch
Heel
Fore-foot
Upper
Walking
Overall comfort
Mid-foot/arch
Heel
Fore-foot
Upper
Pressure file names
Standing:
Walking:
Modified Shoe
Assume that comfort feeling you have in your feet can be rated as 100 while standing on a flat floor with equal body weight distribution. The rating can be considered 50 if you stand on flat floor only with one foot. When compared with that feeling how do you rate the current feeling of comfort for overall, mid-foot/arch, heel, fore-foot and upper for left and right foot?
Do you like the comfort of the shoe (yes/no/neutral)? Give a rating (L & R)
Do you like the feel of the mid-foot/arch region (yes/no/neutral)? Give a rating (L & R)
Do you like the feel of the heel region (yes/no/neutral)? Give a rating (L & R)
Do you like the feel of the fore-foot region (yes/no/neutral)? Give a rating (L & R)
Do you like the feel of the upper of the shoe (yes/no/neutral)? Give a rating (L & R)
Comfort rating
Activity
Region
Yes/No/Neutral
Left(L)
Right(R)
Standing
Overall comfort
Mid-foot/arch
Heel
Fore-foot
Upper
Walking
Overall comfort
Mid-foot/arch
Heel
Fore-foot
Upper
Pressure file names
Standing:
Walking:
Questionnaire
Assume that comfort feeling you have in your feet can be rated as 100 while standing on a flat floor with equal body weight distribution. When compared with that feeling how do you rate the current feeling of comfort for overall, mid-foot/arch, heel, fore-foot and upper for left and right foot?
Regions of foot
Regions of foot
Heel
Heel
Fore-foot
Fore-foot
Mid foot
Mid foot