Résumé : | Background and purpose: Elevated heel construction offloads the forefoot after surgery. However, side-to-side
height difference alters limb kinetics, whereas leg-length equalizing-sole at non-operated side may have beneficial
effects on foot loading. The purpose of this study was to characterize leg-length equalizing sole effect on
bilateral plantar pressures when using heel-lift forefoot-offloading shoe.
Materials and methods: Twenty men were tested walking. Plantar peak pressures (PP) and pressure-time integrals
(PTI) in the forefoot-offloading shoe and in contralateral running shoe were compared between two conditions:
one with- and the other without leg-length equalizing sole elevation at the running shoe.
Results: Adding leg-length equalizing sole to the running shoe resulted in the following changes in the forefootoffloading
shoe: increased lateral midfoot PP (8.7%, p = 0.03), increased lateral midfoot (11.3%, p = 0.05) and
lateral metatarsals PTI (10.3%, p = 0.04), and decreased medial and lateral heel PTI (> 5%, p = 0.02). These
changes were non-significant when applying a Bonferroni correction. Changes in the running shoe were: increased
medial midfoot (20.5%, p = 0.03) and decreased 2nd and lateral metatarsals PP (23%, p < 0.01). PTI
increased in medial and lateral heel (> 25%, p < 0.01), medial midfoot (63.2%, p < 0.01) and lateral midfoot
(9.2%, p = 0.04) and decreased in 2nd and lateral metatarsals (> 24.5%, p < 0.01).
Conclusion: Leg-length equalizing sole at contralateral running shoe in subjects wearing forefoot-offloading shoe
results in lateral load shift alongside heel pressure attenuation within the forefoot-offloading shoe, which is
beneficial during first month after medial forefoot surgery. Reciprocal medial load-shift in the elevated running
shoe itself should yet be considered when bilateral medial forefoot pathology is present |