The effect of shoe lacing on plantar pressure distribution and in-shoe displacement of the foot in healthy participants

Abstract

Aims: A proof of concept study to investigate the effect of shoe lacing on the plantar pressure distribution and in-shoe displacement of the foot during walking.

Methods: Three randomized shoe-lacing conditions, which differed in lacing tightness (comfortable, loosened, and completely loose) were investigated in 20 healthy adults. On a 10-m walking test, plantar pressures were assessed with the Pedar(®)-X in-shoe measurement system. Perceived in-shoe displacement was scored on a numerical rating scale.

Results: With respect to the pressure time integral statistically significant effects were found in the hallux, toes 2-5, first metatarsal head, and lateral midfoot regions. Post hoc comparison showed for the hallux: mean increase of 45.5 kPa s (95% confidence interval [CI]: 3.2-87.8 kPa s), and toes 2-5: mean increase of 23.5 kPa s (95% CI: 0.1-46.9 kPa s) between comfortably secured and completely loosened laces; lateral midfoot: mean decrease of -18.1 kPa s (95% CI: -31.5 to -4.8 kPa s) between comfortably secured and loosened laces. No significant effect was found on peak pressure, and average pressure. Participants reported a significant increase in heel slipping and in slipping back and forth of the foot as the laces were loosened.

Conclusions: Looser lacing techniques resulted in small peak and average plantar pressure changes (less than 3% and 6.5% respectively). Pressure time integral under the hallux and toes 2-5 increased 16.3% and 14.5% respectively, and perceived in-shoe displacement increased as compared to comfortably secured laces. These results suggest that diabetes patients should be advised to comfortably tighten their shoelaces during the whole day.