Immediate Effects of Footwear Design on In-Shoe Plantar Pressures, Impact Forces and Comfort in Women With Plantar Heel Pain.

Background: Footwear is often recommended in the management of plantar heel pain (PHP), theoretically to reduce tissue stress during standing and walking; however, limited data exist to guide footwear design and recommendations.

Methods: Plantar pressures, impact forces and comfort during walking were recorded in 29 women with PHP (mean age 47 ± 12 years) in six randomised shoe and insert conditions. A test shoe (polyurethane outsole, 14-mm heel-toe pitch) was compared to a control shoe (rubber outsole, 4-mm heel-toe pitch), and within the test shoe, five different insoles that varied by material, density and arch contouring were also compared.

Results: The test shoe reduced heel peak pressure (15%, p < 0.01) and reduced the loading rate but not the peak magnitude of the vertical ground reaction force (average loading rate reduction: 7%, p < 0.01; maximum loading rate: 29%, p < 0.01) and was more comfortable (47%-67%, p < 0.01) compared to the control shoe. Within the test shoe, dual-density inserts with arch contouring showed lower heel peak pressure compared to a lightweight flat insert (11%-12%, p < 0.03). The insert with the firmest material and higher arch contouring showed higher midfoot peak pressure (16%-21%, p < 0.01) compared to other inserts. Forefoot peak pressure did not differ between shoe or insert conditions (p > 0.05). There were no differences in impact forces or comfort between the different inserts within the test shoe (p > 0.05).

Conclusion: Findings suggest that shoe and insert properties are both important and provide data to guide footwear design and management recommendations for PHP.