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Abstract: The accurate identification of initial and final foot contacts is a crucial prerequisite for obtaining a reliable estimation of spatio-temporal parameters of gait. Well-accepted gold standard techniques in this field are force platforms and instrumented walkways, which provide a direct measure of the foot–ground reaction forces. Nonetheless, these tools are expensive, non-portable and restrict the analysis to laboratory settings. Instrumented insoles with a reduced number of pressure sensing elements might overcome these limitations, but a suitable method for gait events identification has not been adopted yet. The aim of this paper was to present and validate a method aiming at filling such void, as applied to a system including two insoles with 16 pressure sensing elements (element area = 310 mm2), sampling at 100 Hz. Gait events were identified exploiting the sensor redundancy and a cluster-based strategy. The method was tested in the laboratory against force platforms on nine healthy subjects for a total of 801 initial and final contacts. Initial and final contacts were detected with low average errors of (about 20 ms and 10 ms, respectively). Similarly, the errors in estimating stance duration and step duration averaged 20 ms and <10 ms, respectively. By selecting appropriate thresholds, the method may be easily applied to other pressure insoles featuring similar requirements. This work was supported by the Mobilise-D project that has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No. 820820. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation program and the European Federation of Pharmaceutical Industries and Associations (EFPIA). Content in this publication reflects the authors' view and neither IMI nor the European Union, EFPIA, or any Associated Partners are responsible for any use that may be made of the information contained herein.

Anatomical insoles and additions have a corrective action on the footwear user. They are intended to reduce and adequately distribute plantar pressure among support points, thus minimising the stress these points can undergo. Such customised components have traditionally been manufactured either handcrafted or by subtractive techniques, i.e. by milling a sheet of material. Latest advances in additive manufacturing (AM) techniques and, in particular, the popularisation of 3D printing by fused deposition modelling (FDM), have opened new ways for the production of anatomical insoles. These technologies allow additional functionalities to be added, as for instance the use of materials with antimicrobial properties, or, at a structural level, zonal control in 3D design to increase cushioning capacity. The latter cannot be achieved by traditional manufacturing techniques, in that the inside of the element is not accessible. However, there are no CAD tools available for the design and production of insoles, which are specifically oriented to take advantage of the benefits that AM can bring about. Based on a previous study about the possibilities for functionalisation of anatomical insole materials and structures, this paper intends to review certain CAD methodologies for the design and manufacture of insoles by means of additive manufacturing techniques. These techniques will be employed to design and produce prototypes through which it is possible to assess such techniques. In order to study the feasibility of using this technology for the manufacture of customised insoles in a real production environment, this paper presents a comparative analysis of the proposed technology and the technology that is currently being used. ; This paper has been prepared and published in the framework of the research project AMFAB II – Fabricación avanzada de productos manufactureros tradicionales mediante tecnologías de Additive Manufacturing (IMDECA/2016/2). The authors thank the Valencian Institute for Business Competitiveness (IVACE) and the FEDER European Union funds for their financial support to this project.

Innovations in material properties of goaltender skates have improved the protective characteristics of the boot, leading to redesign of the blade holder to resemble players' holders. The redesigned blade holder introduces the ability to customize blade alignment, which may grant a performance advantage. We investigated the effect of blade alignment on kinematics and plantar pressure during the execution of two different goaltender-specific movement patterns: (1) the butterfly drop to recovery and (2) the lateral butterfly slide to recovery. The main objective of this study was to investigate the effect of three blade alignment conditions. The secondary objective was to compare two neutral alignment conditions, which was facilitated by studying the effects of two different holders on kinematics and plantar pressure during two goaltender-specific techniques. A male goaltender with professional experience completed an A–B–A design, executing five trials of A, B, and A for both movements with each blade alignment condition (n = 30 per collection, n = 90 overall) on synthetic ice in a controlled lab environment. Blade alignment conditions were defined by the alignment of the blade holder on the boot and the type of blade holder. Kinematic and plantar pressure data were collected simultaneously using 3D motion capture and in-skate pressure insoles, respectively. Increased butterfly drop velocity (2.07 ± 0.09 m/s) and peak plantar pressure (77.19 ± 2.67 psi) were revealed when executing the butterfly drop with medial alignment. This work suggests medial blade alignment may enable the goaltender to drop into the butterfly position faster, potentially increasing the likelihood of making a save.

Objective: The objective of this study is to evaluate the efficacy of indoor footwear with a textured surface to improve control of balance and reduce excessive plantar pressure in older women. Background: Balance instability is a common condition in older people. Textured insoles with protrusions on the entire insole have been examined for enhancing somatosensory feedback in the elderly to improve control over balance. However, these insoles have significant challenges in distributing the plantar pressure. Textured insoles with tailored protrusions should be therefore investigated for the same purpose but provide better plantar pressure distribution. Method: A total of 24 older women have undergone both static standing and walking tests with the use of the in-shoe Pedar® system. Results: The results indicate that wearing textured indoor footwear provides a significant reduction in postural sway, particularly in the medial–lateral direction during walking. As compared to walking barefoot, the center-of-pressure trajectory when wearing the textured indoor footwear remains supported with less variance among the steps, which is statistically significant in the medial–lateral direction. A significant reduction in the peak pressure is found in the forefoot and rearfoot regions as the plantar pressure is redistributed to the midfoot regions. Conclusion: The textured surface of the insole improves balance control of older women and effectively reduces foot pressure at high pressure areas. Application: The findings enhance current understanding on textured footwear as a form of intervention associated with changes in functional impairments, therefore providing basis for footwear design in balance control.

Para mantener el equilibrio el cuerpo utiliza los sistemas visuales, vestibulares y propioceptivos, que envían información al sistema nervioso central sobre las condiciones del cuerpo para estabilizarlo. Este estudio evaluó el efecto de las plantillas propioceptivas sobre el equilibrio postural estático y los dolores musculoesqueléticas después de dos meses de uso, a través de una investigación analítica longitudinal con 15 soldados sanos con una edad media de 34±7.5 años. Ellos fueron sometidos a evaluación de equilibrio a través de la plataforma Medicapteurs® y por el protocolo CNT. No hubo diferencia estadística para las desviaciones del cuerpo y para la velocidad del centro de presión. La presión plantar tuvo un cambio estadísticamente significativo para el pie izquierdo y el pie derecho correspondiente a p=0.0001 y p=0.0007, respectivamente. Hubo una reducción en las promedio de los dolores en las rodillas, pies y talones y una disminución significativa en el dolor lumbar, con p=0.0180. El equilibrio estático no se modificó significativamente con el uso de plantillas propioceptivas por los militares, sin embargo, proporcionaron una mejor redistribución de las presiones plantares y parecen ablandar los dolores musculoesqueléticas en las extremidades inferiores. Por lo tanto las plantillas pueden considerarse para ese grupo como una terapia de prevención contra lesiones relacionadas con su actividad laboral. ; Para a manutenção do equilíbrio, o organismo utiliza os sistemas visuais, vestibulares e proprioceptivos, que enviam informações para o sistema nervoso central acerca das condições do corpo com o objetivo de estabilizá-lo. Este estudo avaliou o efeito das palmilhas proprioceptivas sobre o equilíbrio postural estático e as dores musculoesqueléticas após dois meses de uso, por meio de uma pesquisa analítica longitudinal com 15 militares saudáveis do sexo masculino com média de idade de 34±7,5 anos. Eles foram submetidos à avaliação do equilíbrio por meio da plataforma Medicapteurs® e pelo protocolo CNT. Não houve diferença estatística para os desvios do corpo e velocidade do centro de pressão. A pressão plantar teve mudança estatisticamente significante para o pé esquerdo e o pé direito correspondendo a p=0,0001 e p=0,0007, respectivamente. Houve redução das médias de dores nos joelhos, pés e calcanhares e diminuição significativa da dor lombar, com p=0,0180. O equilíbrio estático não foi alterado significativamente com o uso das palmilhas proprioceptivas pelos militares, contudo elas proporcionaram melhor redistribuição das pressões plantares e parecem atenuar as dores musculoesqueléticas das extremidades inferiores. Por isso as palmilhas podem ser consideradas para esse grupo uma terapêutica de prevenção contra lesões relacionadas à sua atividade laboral. ; To maintain the balance, the body uses visual, vestibular and proprioceptive systems, which send information to the central nervous system about the body's conditions in order to stabilize it. This study evaluated the effect of proprioceptive insoles on static postural balance and musculoskeletal pains after two months of use, through a longitudinal analytical study with 15 healthy male soldiers with a mean age of 34±7.5 years. They were subjected to balance evaluation through the Medicapteurs® platform and by CNT protocol. There was no statistical difference for the deviations of the body and speed of the center of pressure. Plantar pressure had a statistically significant change for the left and the right feet, corresponding to p=0.0001 and p=0.0007, respectively. There was a reduction in the mean values of the pains in the knees, feet and heels and a significant decrease in lumbar spine pain, with p=0.0180. The static balance was not significantly altered with the use of proprioceptive insoles by the militaries; however, these insoles provided a better redistribution of plantar pressures and seem to attenuate the musculoskeletal pains of the lower extremities. Therefore, insoles can be considered as a prevention therapy against injuries for this group related to their work activity.

Background: The aim of this paper was to create an updated Australian guideline on footwear for people with diabetes. Methods: We reviewed new footwear publications, (international guidelines, and consensus expert opinion alongside the 2013 Australian footwear guideline to formulate updated recommendations. Result: We recommend health professionals managing people with diabetes should: (1) Advise people with diabetes to wear footwear that fits, protects and accommodates the shape of their feet. (2) Advise people with diabetes to always wear socks within their footwear, in order to reduce shear and friction. (3) Educate people with diabetes, their relatives and caregivers on the importance of wearing appropriate footwear to prevent foot ulceration. (4) Instruct people with diabetes at intermediate-or high-risk of foot ulceration to obtain footwear from an appropriately trained professional to ensure it fits, protects and accommodates the shape of their feet. (5) Motivate people with diabetes at intermediate-or high-risk of foot ulceration to wear their footwear at all times, both indoors and outdoors. (6) Motivate people with diabetes at intermediate-or high-risk of foot ulceration (or their relatives and caregivers) to check their footwear, each time before wearing, to ensure that there are no foreign objects in, or penetrating, the footwear; and check their feet, each time their footwear is removed, to ensure there are no signs of abnormal pressure, trauma or ulceration. (7) For people with a foot deformity or pre-ulcerative lesion, consider prescribing medical grade footwear, which may include custom-made in-shoe orthoses or insoles. (8) For people with a healed plantar foot ulcer, prescribe medical grade footwear with custom-made in-shoe orthoses or insoles with a demonstrated plantar pressure relieving effect at high-risk areas. (9) Review prescribed footwear every three months to ensure it still fits adequately, protects, and supports the foot. (10) For people with a plantar diabetic foot ulcer, footwear is not specifically recommended for treatment; prescribe appropriate offloading devices to heal these ulcers. Conclusions: This guideline contains 10 key recommendations to guide health professionals in selecting the most appropriate footwear to meet the specific foot risk needs of an individual with diabetes. ; Australian Government's Cooperative Research Centres Program ; Open access journal. ; This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.

Wearable sensing systems are becoming widely used for a variety of applications including sports, entertainment, and the military. These systems have recently enabled a variety of medical monitoring and diagnostic applications. Such sensing systems have high potential to significantly improve the quality of life for large segments of the population and enable conceptually new types of applications. However, various research challenges including energy sensitivity and semantic complexity must be addressed before these devices can reach their full potential in improving our lives. The need for multiple sensors, high frequency sampling and constant monitoring leads these systems to be power-hungry and expensive with a short operation lifetime. In addition these systems generate a massive amount of data, where designing efficient and effective data mining algorithms to interpret and analyze the data is very costly due to field experts' involvement. This dissertation presents a methodology that takes advantage of contextual and semantic properties in human physiological behavior to enable efficient design and optimization of such systems from the data and information point of view. The methodology uses combinatorial modeling and simultaneous minimization to reduce the wireless communication and local processing power consumption. The effectiveness of this technique is shown on an insole instrumented with 99 pressure sensors placed in each shoe, which is used for human gait analysis. Further, the proposed methodology is used to design unsupervised data mining techniques to extract information such as frequent or rare events and patterns from collected multi-dimensional time series data of wearable sensing devices, where high level of noise and uncertainty is inherent. This approach transforms multi-dimensional time series data to combinatorial space and constructs behavior models, which is used for frequent and rare event detection and pattern classification. The effectiveness of this method is demonstrated by applying this technique to discovery and classification of frequent human activities and abnormalities.