0198-0211/92/1305-0263$03.
00/0
FOOT & ANKLE
Copyright © 1992 by the American Orthopaedic Foot Society, Inc.
A Method for Measuring Foot Pressures Using a High Resolution,
Computerized Insole Sensor: The Effect of Heel Wedges on Plantar Pressure
Distribution and Center of Force
Nicholas E. Rose, M.D., Lawrence A. Feiwell, M.D., and Andrea Cracchiolo, III, M.D.
ABSTRACT
A new, high resolunon, pressure-sensitive insole was
tested and found to provide reproducible measurements
of static and dynamic plantar pressures inside the shoe
of normal test subjects under certain conditions. However,
calibration between separate sensors was poor and the
sensor pads showed significant wear with use.
This system was also used to investigate the effect of
heel wedges on plantar foot pressure to determine
whether this system was sensitive enough to detect the
effect of a gross shoe modification on plantar foot pres-
sure. Medial heel wedges decreased plantar pressures
under the first and second metatarsals as well as under
the first toe, and shifted the center of force laterally in all
portions of the foot. Lateral heel wedges decreased pres-
sures under the third, fourth, and fifth metatarsals, in-
creased pressures under the first and second metatarsals,
and shifted the center of force medially in all portions of
the foot.
Our evaluations indicate that it is possible to measure
static and dynamic plantar foot pressures within shoes
and to study the possible effect of shoe modifications on
plantar pressures in controlled gait trials.
INTRODUCTION
An accurate device to measure plantar pressures
under the foot would playa key role in the evaluation
and treatment of foot disorders. Such a system would
also allow an objective assessment of foot function
before and after therapeutic intervention.
Systems such as the Harris Mat, the Polytechnic
modified force plate, and the pedobarograph require
barefoot pressure measurements, and most of these
systems only measure static pressures.Y" However,
an ideal device would allow plantar pressure measure-
From the Division of Orthpaedic Surgery, University of California,
Los Angeles School of Medicine, Center for Health Sciences, Room
76-125, 10833 Le Conte Ave., Los Angeles, California 90024-6902.
Address reprint requests to Dr. Rose.
263
Los Angeles, California
ments to be made inside a patient's shoe and would
also allow quantitative measurement of both static and
dynamic pressures. Several techniques for measuring
in-shoe, dynamic plantar pressures have been devel-
oped, including instrumented shoes, in-shoe pressure
transducers, and insole sensors. However, these sys-
tems may have certain technical problems. Many often
require a certain thickness to contain wiring and trans-
ducing cells, and an overly thick sensor could influence
the pressures generated on the surface of the foot as
well as interfere with gait. 2 In addition, electronic cir-
cuitry contained on the pressure-sensing device could
also be affected by moisture and temperature. Re-
cently, a pressure-sensitive insole sensor with accom-
panying software for gait analysis was developed that
allows static and dynamic measurement of plantar foot
pressures within a shoe. The purpose of this study was
twofold. First, we tested this system to characterize its
reproducibility, durability, variability, and overall useful-
ness in the evaluation of plantar foot pressures. Sec-
ond, to determine whether this system could detect
and measure a shoe modification, we investigated the
effect of heel wedges on the center of force and pres-
sure distribution on the plantar surface of the foot.
MATERIALS AND METHODS
Five control subjects who had no complaints of foot
problems and were considered to have normal feet
were used to test the pressure-sensing insole sensors
for durability, reproducibility, and pad to pad variability.
All studles were performed in a biomechanics labora-
tory and no financial support was received from Tek-
scan. All subjects used their own shoes and all gait
trials were performed on the exact same hard surface.
The FSCAN system (Tekscan", Boston, MA) consists
of: (1) a pressure-sensitive insole sensor, (2) a light-
weight, 9-V, battery-powered transducer unit that is
strapped to the subject's leg into which the sensor fits,
(3) a 9.25-m long coaxial cable that connects the trans-
264 ROSE ET AL.
ducer to the computer, (4) software (FSCAN version
1.20) for gait analysis, and (5) an IBM AT-compatible
computer with an interface board.
This system utilizes an ultrathin (711000 in), pressure-
sensitive insole sensor. The insole sensor consists of a
Mylar substrate with 960 individual pressure-sensing
points. These pressure-sensing points are evenly dis-
tributed at 5-mm intervals. The sensing range of each
individual cell is 8 to 124 psi (56-868 kPa). The individ-
ual pressure-sensitive cells are aligned in a grid-like
configuration along the sensor pad and each is desig-
nated with an x- and a y-coordinate, with 0,0 being at
the center of the sensor pad, which closely corre-
sponded to the center of the foot, +x,+y being in the
anteromedial region, -x,+Y in the anterolateral, +x,-y
in the posteromedial, and -x,-y in the posterolateral
region of the foot (Fig. 1). This coordinate system allows
the investigator to identify pressures at specific areas
J'\
+Y
ANTEROLATERAL
-~
/
POSTEROLATERAL
--
Foot & AnklejVol. 13, No. 5/June 1992
of the foot. The pressure recordings are transduced
and stored on an IBM AT computer.
Once the pressure recordings are made by the insole
sensor and stored, the FSCAN 1.20 software allows
for a detailed evaluation of the data. FSCAN recordings
from separate trials can be analyzed individually or
compared side by side. With single trial analysis, the
data can be displayed in four different ways. (1) The
gait mode displays a two-dimensional representation of
the plantar pressures detected by the sensor as a
function of time, viewed sequentially from heel strike to
toe-off. Increasing pressure is depicted by color
changes in this mode. The plantar force in the forefoot,
midfoot, hindfoot, and the total area of the foot as a
function of time is graphically displayed in this mode as
well. (2) In the pressure area display mode, the pres-
sure/time relationship inside of four defined areas
(boxes) on the sensor can be analyzed. These four
areas can be of various sizes, from 15 x 15 mm to 105
AXJS
ANTEROMEDIAL
+X Axrs
<,
-/ Fig. 1 The FSCAN Coordinate System.
Foot & AnkleJVol. 13, No. 5/June 1992
x 105 mm, and can be moved about to analyze pres-
sures in various areas of the sensor. These four ad-
justable boxes allow the investigator to assess plantar
pressures in a particular area of the foot, for example,
under the heel or under the first metatarsal head. (3) In
the peak force display mode, the maximum force reg-
istered at a particular portion of the gait cycle can be
identified. The center of force path (the path that the
maximum pressure follows from the heel to the toes
during a single gait cycle) can be measured as well. (4)
Finally, one can view dynamic two-dimensional peak
pressures sequentially from heel strike to toe-off view-
ing a three-dimensional video of the step, which shows
pressures acting on the sensor at each moment of time.
Reproducibility of the Insole Sensor
A separate, new sensor was used for each subject.
The outer edges of the sensor were carefully trimmed
in order for the sensor to fit in the subject's shoe.
During trimming, care was taken to ensure that the 0,0
coordinate on the sensor still corresponded with the
center of the foot. The sensor was placed within the
individual subject's right shoe and attached to the
transducer unit and then, via coaxial cable, connected
to the computer. The subject walked 10 steps to get
acclimated to the feel of the sensor inside the shoe,
and then three gait cycles were recorded. The subject
always used the same shoe for each trial during the
study.
To investigate whether the location of maximal pres-
sure on the insole sensor could be accurately repro-
duced, the foot sensor was divided into four arbitrary
areas. A 35 mm x 35 mm area was measured under
the heel region and under the first metatarsal head. A
15 mm x 15 mm area was measured under the second
and third metatarsal heads and under the fourth and
fifth metatarsal heads. Since the pressures measured
after taking the mean of the second and third steps
was similar to the pressures measured on the second
step alone, we based the analysis on the evaluation of
the second step (variance estimate). Since the record-
ing from the insole sensor was started after the subject
took approximately two steps, the "second" step, which
was used for data analysis, was actually the third or
fourth step in the subject's gait cycle, so that normal
cadence was established. After a trial was run, the four
adjustable boxes were arranged to cover the maximal
pressures in each of the four areas. The coordinates
where maximum plantar pressure occurred in each of
these areas were then compared between trials.
In order to investigate how consistent pressure
measurements were when taken on two separate days,
four subjects were measured once on each of two
FOOT PRESSURE MEASUREMENT 265
separate days and again two times on a third day, with
each subject using his own sensor for all measure-
ments. The variability between measurements made
with the same sensor on two separate days was com-
pared with the variability between the two measure-
ments made with the same sensor on the same day.
Durability of the Insole Sensor
In order to test the durability of the pressure-sensing
points within the sensor, each subject performed 12
sequential walking trials using one sensor for each
subject. Plantar pressures throughout the entire foot
were recorded for each trial and these pressure meas-
urements were then compared over the 12 trials to see
whether they decreased with use of that individual
sensor.
Since the insole sensor pad needed to be bent and
manipulated in order to be placed into or removed from
a shoe, it was felt that this action could possibly damage
the sensors and affect pressure recordings. To inves-
tigate this possibility, we performed three consecutive
walking trials leaving the insole sensor in the subject's
shoe between the three walking trials. Alternatively, the
sensor was removed from the subject's shoe and sub-
sequently reinserted for each of the three walking trials
(this was considered manipulation of the sensor). The
average standard deviation among the three trials was
then calculated and used as an estimate of the varia-
bility between the trials. Recordings with manipulation
of the insole sensor between trials were compared with
those in which the insole sensor was not removed
between trials.
Variability of the Insole Sensor
In order to investigate how well-calibrated separate
sensors were, we tested the variability between sepa-
rate, new sensors. Each of the control SUbjects per-
formed five runs on a single sensor (pad A). Then, each
SUbject performed five runs on five separate sensors
(pads A through E). The standard deviation using a
single sensor was then compared with the standard
deviation using five separate sensors to assess varia-
bility among pads.
Finally, we tested the effect of shoes with different
amounts of padding (a tennis shoe versus a stiffer
fashion shoe) on pressure measurements. We com-
pared recordings made from the same subject using
the sensor wearing these two different pairs of shoes.
Heel Wedge Trials
To investigate the effect of heel wedges on plantar
pressure distribution and center of force, 11 normal
subjects were used, six men and five women ranging
266 ROSE ET AL. Foot & Ankle/Vol. 13, No. 5/June 1992

in age from 25 to 45 years. A new sensor was used for

each subject. In order to eliminate the variable of differ-
ent shoes on pressure measurements, appropriate-
sized extra-depth, medium-width shoes (P.W. Minor &
Son), provided by the Sobel Shoe Co. (Jenkintown,
PA), were utilized.
Each SUbject performed six trials: one trial before
any wedges were externally applied to the shoe, one
trial each with a quarter-inch lateral then medial heel
wedge applied to the bottom of both shoes, and one
trial each with a half-inch lateral then medial heel wedge
applied to the bottom of each shoe. The heel wedges
were placed and changed without removing the sub-
ject's shoe. A final trial was then performed with the
wedges removed and was compared with the initial trial
to assess any insole sensor wear that may have oc-
curred.
The FSCAN 1.20 software was used to evaluate
maximum average pressures in six areas of interest in
evaluating the heel wedges: the first toe, the second
toe, the medial metatarsal area (first and second meta-
tarsals), the lateral metatarsal area (third, fourth, and
fifth metatarsals), the medial heel, and the lateral heel
(Fig. 2). Also, ground contact time as a percentage of
entire foot contact time was recorded for each area.
The FSCAN software automatically calculates the
center of force path for each gait cycle, and the center
of force was also measured for each SUbject. The
center of force is the path that the maximum pressure
follows from the heel to the toes during a single gait
cycle. Furthermore, the effect of the lateral and medial Fig. 2. Areas of interest inside of which maximum average pres-
sures were measured. LM, lateral metatarsal region (55 x 55 mm);
heel wedges on the center of force path was also
MM, medial metatarsal region (35 x 55 mm); T1, area under big toe
investigated. (35 x 55 rnm): T2, area under second toe (25 x 35 mm); LH, lateral
Statistical significance was assessed using the t-test. heel (35 x 55 mm); MH, medial heel (35 x 55 mm).
Because the sample size is small, nonparametric statis-
tical studies have very little power. The t-test requires
an assumption of normality of the data that cannot be The insole sensors were tested for durability by
evaluated. However, with this assumption, the t-test is observing whether there was a decline in pressure
more powerful than corresponding nonparametric sta- measurements when several trials were run on one
tistical studies. Using the t-test, differences at less than single sensor. It was found that in all areas of the
the 5% level were considered statistically significant (P sensor, pressures showed a slight decline of only 3.5%
< .05). between the first and fifth trials (about 30 gait cycles).
By the twelfth trial, the pressures decreased in all
RESULTS regions of the sensor by 20.5%.
Removing the insole pad and subsequently replacing
Testing the Insole Sensor
it into the shoe also affected the pressure measure-
To test how reproducible pressure measurements ments. The average standard deviation between sep-
made by the sensor were on 2 separate days, four arate trials was calculated and used as an estimate of
subjects were measured once on each of 2 separate the variability between separate measurements. Over-
days and again two times on a third day. The variability all, the pressures from three subsequent trials were
based on measurements made on separate days (SO more consistent when the insole was left in the shoe
= 41.3 kPa) was similar to the variability of measure- (average SO, 20.0), as compared with when the insole
ments made on the same day (SD = 28.0 kPa). was removed after a trial and then placed back into the
Foot & AnkleJVol. 13, No. 5jJune 1992 FOOT PRESSURE MEASUREMENT 267

shoe (average SD, 71.7) in all areas of the foot (Table Effect of Heel Wedges on Pressures in Six Designated
1). This was also seen when values for the forefoot, Plantar Areas
midfoot, and hindfoot were calculated. Half-inch lateral heel wedges significantly decreased
The center coordinates of the four adjustable boxes
pressures by an average of 24.3% under the third,
used to mark the areas on the pad where maximal
fourth, and fifth metatarsal heads (P < .02) and in-
pressure was occurring showed remarkable consist-
creased plantar pressures by an average of 20.8%
ency for each subject. However, for the x-coordinate,
under the first and second metatarsal heads (P < .02).
the average standard deviation was 1.45 mm and for
Half-inch medial heel wedges significantly decreased
the V-coordinate, it was 1.94 mm.
pressures by an average of 27.7% under the first and
In order to test the amount of variability between
second metatarsals (P < .05) and decreased plantar
separate sensor pads, plantar pressure measurements
were made with one subject doing five runs on a single pressures under the first toe by an average of 31.4%
pad (pad A) and compared with the same subject doing (P < .01). Half-inch medial heel wedges increased pres-
five runs on five separate pads (pads A through E). The sures under the third, fourth, and fifth metatarsals by
mean plantar pressure using the single pad (pad A) was an average of 10.0%, but this was not significant at the
632.8 ± 20.2 kPa. The mean plantar pressure using P < .05 level. Quarter-inch wedges did not have a
five separate pads (pads A through E) was 786.8 ± significant effect on plantar pressures in any area of
159.0 kPa. The standard deviation with five separate the foot at the P < .05 level (Table 3).
pads was 7.9 times greater (159.0/20.2) than with a Heel wedges had no significant effect on the
single pad. Therefore, pressure measurements were amount of ground contact time in any region of the
more consistent when a single insole sensor was used. foot.
Wearing different style shoes had a marked effect on
insole sensor pressure readings. In comparing tennis Effect of Heel Wedges on Center of Force
shoes with a firm rubber sole with flat shoes with a Both quarter-inch and half-inch lateral heel wedges
more flexible sole, the peak pressure values for the displaced this center of force path medially, with maxi-
latter were 13.6% lower for the total area of the foot,
mum displacement occurring in the midfoot and meta-
10.4% lower for the forefoot, 51.4% lower for the
tarsal regions and minimal displacement occurring in
midfoot, and 6.7% lower for the hindfoot (Table 2).
the heel region. In the metatarsal region, quarter-inch
lateral heel wedges displaced the center of force path
TABLE 1
Pressure Measurements· medially up to 7 mm, whereas half-inch lateral heel
Without removal of in- wedges displaced it up to 10 mm medially (Fig. 3).
sole sensor between Results were similar for the medial heel wedges,
Removal and reinsertion
measurements with both quarter-inch and half-inch wedges displacing
of insole sensor be-
SUbject
Trials tween measurements the path laterally. Once again, maximum displacement
(kPa) SD SD occurred in the midfoot and metatarsal regions, with
1 2 3 minimal displacement in the heel region. In the metatar-
1 959 952 973 10.7 63.7 sal region, quarter-inch medial heel wedges moved the
2 875 854 910 28.3 112.7 center of force path laterally by as much as 2.5 mm
3 637 595 602 22.5 63.7
and half-inch medial heel wedges moved it up to 5.0
4 994 973 959 17.6 55.5
5 644 623 602 21.0 63.1 mm laterally (Fig. 3).
Average SD 20.0 71.7
• To determine whether removing and subsequently reinserting the TABLE 2
insole sensor between trials affected pressure measurements, the Effect of Different Shoes on Plantar Pressure Measurements·
following was performed on five subjects: either the insole sensor Type of sole Total Forefoot Midfoot Hindfoot
was left inside the subject's shoe between the three pressure meas-
Firm 875 ± 42 805 ± 33 259 ± 43 630 ± 41
urements, or the insole sensor was removed and subsequently
Flexible 756 ± 80 721 ± 90 112 ± 25 588 ± 26
reinserted in the subject's shoe between the three pressure meas-
Percentage of decrease 13.6 10.4 51.4 6.7
urements. The average standard deviation was then calculated as an
estimation of the variability between measurements. As can be seen, e Peak plantar pressure measurements (±SD) in forefoot, midfoot,
the effect of removing and replacing the insole sensor greatly in- hindfoot, and throughout total area of the foot were made with five
creases the variability between measurements. Data represent pres- normal subjects wearing shoes with a firm rubber sole and then shoes
sures (kPa) for each of three trials and standard deviation. with a flexible soft sole. Pressure in kilopascals (kPa).
268 ROSE ET AL. Foot &AnkleJVol. 13, No. 5/June 1992
TABLE 3
Effect of Heel Wedges on Plantar Foot Pressures
1.4-in Lateral V2-in Lateral 1.4-in Medial Y2-in Medial
Plantar area No wedge
wedge wedge wedge wedge
First and second metatarsals
Peak pressures 96.4 ± 43.1 113.0±50.1 116.5 ± 49.0 97.3 ± 46.9 69.7 ± 47.5
% Chanqe" +17.2% +20.8% +0.9% -27.7%
P value" =.13 <.02 =.94 <.05
Third, fourth, & fifth metatarsals
Peak pressure 92.9 ± 28.1 83.6 ± 39.2 70.3 ± 37.1 97.3 ± 32.2 102.2 ± 33.6
% Change -10.0% -24.3% +4.7% +10.0%
P value =.16 <.02 =.31 >.10
Great toe
Peak pressure 73.5 ± 39.0 74.5 ± 39.2 77.3 ± 42.0 66.5 ± 42.0 50.4 ± 32.2
% Change +1.4% +5.2% -9.5% -31.4%
Pvalue >.10 >.10 >.10 <.01
Second toe
Peak pressure 46.9 ± 24.5 42.0 ± 23.7 37.5 ± 21.7 44.1 ± 26.6 38.5 ± 25.9
% Change -10.4% -20.0% -6.0% -17.9%
P value >.10 <.05 >.10 >.10
Lateral heel
Peak pressure 101.2 ± 25.8 101.2 ± 20.2 91.0 ± 20.3 91.7 ± 25.9 90.3 ± 32.2
% Change 0.0% -10.1% -9.4% -10.9%
P value >.10 >.10 >.10 >.10
Medial heel
Peak pressure 98.0 ± 25.6 90.0 ± 21.0 85.9 ± 26.6 92.4 ± 28.7 84.0 ± 30.1
% Change -8.2% -12.3% -5.7% -14.3%
P value >.10 >.10 >.10 >.10
a Peak pressure is expressed as kPa ± SO.
b Percentage of increase (+) or decrease (-) in peak pressure with heel wedge as compared with peak pressure with no wedge.
C Based on paired t-test versus no wedge.

ALL SUBJECTS shown to be an important factor in the development of

MEDIAL ulcers in diabetic patients as well as in the development
20 I 1/2 L --......' :/" . ." .. of painful disorders in patients with known foot pathol-
I " / \~ ogy, such as in rheumatoid arthritis.?·8.10 Perhaps of
I .' II I
I 1/4 L ~ even greater interest is the possible relationship be-
I '><,/ / '- -'
/....-1/4M ....
tween plantar pressures and foot pain in patients with-
I / /
mm 0
~ -----~~~_:_~7~~::~~~/~~
~:"._ ....._:;...... ....._ ~ 1/2 M
out obvious mechanical abnormalities.
A system that could accurately and reproducibly
,'>,., - ..... --1---..... . . measure the plantar foot pressures in shoes during a
... 'l':':":~.':'".-:':-... .., .••..•. -1" •••
gait cycle could potentially provide considerable clinical
I
LATERAL information in patients with foot pathology. Such a
-20 L------l -l.-_ _- L_ _-----::'-:-_ _----L,.---_
50 100 system could identify areas of increased plantar pres-
mm sures and correlate these pressures with foot pathology
Fig. 3. Effect of lateral and medial heel wedges on center of force as an aid to diagnosis and treatment of foot pathology.
path in the right foot in 11 control subjects (1/4 L, quarter-inch lateral Moreover, it could monitor the effect of shoe modifica-
heel wedge; 1/2 L, half-inch lateral heel wedge; 1/4 M, quarter-inch
tions or even surgical treatment to change these pres-
medial heel wedge; 1/2 M, half-inch medial heel wedge).
sures. Previous investigators have had some success
measuring plantar pressures; however, this has most
DISCUSSION frequently been done in subjects without shoes. Since
everyone usually requires some sort of footwear, as-
In recent years, there has been a resurgence in sessing foot pressures while wearing shoes may have
interest in measuring foot pressures brought on by the practical applications.
development of sophisticated microelectronic and com- The FSCAN system appears to be useful for meas-
puter equipment and by a perceived clinical need for uring plantar pressures of the foot inside a shoe. The
this information. Increased plantar pressures have been thinness of the sensor (711000 in) eliminates any signifi-
Foot & AnklejVol. 13, No. 5/June 1992
cant influence it may have on plantar pressures gener-
ated in the shoe, and its Mylar substrate insulates the
electronic circuitry inside the sensor from moisture. The
system appears to be reliable in measuring plantar foot
pressures. Pressure recordings are remarkably similar
between subsequent steps within a trial and also when
pressure recordings are made with the same sensor on
the same patient on different days. Furthermore, in
separate trials with the same subject, the location of
peak pressures as well as the overall distribution of
pressure on the sensor show little variability.
However, there are certain limitations to this system.
It appears that the system is excellent in providing
qualitative information. However, although the insole
sensors are calibrated after being manufactured, there
still appears to be some discrepancy between the pres-
sure recordings made by two separate sensors. Thus,
one needs to use one insole sensor for each subject.
The sensor is also affected by use. Each sensor ap-
pears to show consistent pressure recordings for about
five or six trials (about 30 gait cycles), but then pressure
recordings begin to drop off steadily due to wear on
the individual pressure-sensing cells. Currently, there-
fore, one is limited to running small trial numbers (five
trials or fewer) to eliminate confounding variables
among trial runs due to this sensor wear.
Finally, pressure recordings are influenced by the
type of shoe worn. A significant discrepancy occurs
between shoes with soft, flexible soles and those with
stiffer, firm soles. In general, the sensor records lower
plantar pressures when the same subject wears shoes
with softer, more flexible soles. As a result, it may be
necessary to use the same shoe when testing a patient
on more than one occasion. Moreover, it may also be
necessary to use one standard type of shoe if pressure
measurements are being compared among SUbjects.
After assessing the accuracy and reproducibility of
the FSCAN system, we used this system to evaluate
the effect of heel wedges on plantar pressure distribu-
tion and center of force. Since this was done using a
small number of trials in a well-controlled clinical setting,
accurate quantitative measurements were possible.
Half-inch heel wedges had a more significant influence
than quarter-inch heel wedges on redistributing plantar
pressures in the forefoot, particularly in the regions of
the metatarsal heads and great toe. However, we re-
alize that half-inch wedges may be unsuitable for clinical
shoe modifications and were used only to test the
sensitivity of the FSCAN system. Indeed, the half-inch
heel wedge significantly moved pressures to the op-
posite side of the foot. Quarter-inch wedges showed
similar changes in forefoot pressures, but were not
statistically significant.
FOOT PRESSURE MEASUREMENT 269
Though half-inch medial heel wedges increased pres-
sures by an average of 10% under the third, fourth,
and fifth metatarsals, this increase was not significant.
The reason for this may be because the lateral side of
the foot is more flexible than the medial side of the foot,
especially in normal SUbjects.Therefore, when a normal
subject walks with a medial heel wedge, the lateral
portion of the foot may be more adaptable to this
external shoe modification and as a result, no significant
increase in plantar pressures occurs in this region of
the foot.
Both heights of heel wedges also had an effect on
the center of force path during a gait cycle (Fig. 3). The
normal center of force path is initiated with heel strike
on the posterolateral region of the heel. The center of
force path decelerates quickly after heel strike and then
moves quickly across the midfoot, migrates medially
over the metatarsals, and terminates at the great and
second toe with push-off. 1 The low velocity of the
center of pressure path in the forefoot region indicates
the significant contribution to weightbearing of the
metatarsal heads, which are in contact with the floor
for approximately 60% to 80% of the stance phase."
The metatarsal region was where we found that heel
wedges most significantly displaced the center of force
path (Fig. 3). Lateral heel wedges result in a center of
force path that is, overall, more medial and medial heel
wedges move the center of force path more laterally,
particularly in the metatarsal area. Therefore, lateral
heel wedges appear to unload to lateral surfaces of the
foot and increase the load on the medial portions,
whereas the opposite is true for medial heel wedges.
By unloading areas of the plantar surface of the foot,
heel wedges may influence the clinical management of
patients. However, our subjects had no known foot
abnormalities and, therefore, it remains to be seen
whether the reductions in plantar pressures that were
found in our normal, symptom-free subjects will be
similar in patients with foot pain or foot deformities.
Recently, using another type of insole sensor, Schaff
and Cavanagh" found that rocker-bottom shoes re-
duced peak pressures by 30% in the medial and central
forefoot and in the toe regions as compared with con-
ventional shoes. However, since rocker-bottom shoes
resulted in higher pressures in some regions of the foot,
they concluded that attention to individual rocker shoe
design is crucial." Holmes and Timmerman" investi-
gated the effect of small metatarsal pads on pressures
transmitted to the metatarsal heads and concluded that
this method may be of benefit in reducing metatarsal
pressures, particularly in female subjects. However,
they utilized a pedobarograph and only barefoot pres-
sures could be measured. Our study also showed that
270 ROSE ET AL.
plantar foot pressures can be changed by a simple
shoe modification.
The FSCAN system, in its current state, could be
useful for making comparisons and evaluating changes
in a well-controlled clinical study. However, many
changes, including accurate calibration and more du-
rable insole sensors, may allow more accurate meas-
urements of foot pressures.
REFERENCES
1. Alexander, I.J., Chao, E.V.S., and Johnson, K.A.: The assess-
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