Introduction: Off-the-shelf heel inserts are used widely without adequate scientific information regarding their effects under the forefoot and this study was aimed to fill this paucity.

Materials and Methods: Thirty-five asymptomatic volunteers consented to participate. Six brands of off-the-shelf heel inserts were tested. Subjects walked along a ten metre walkway with no inserts and then with each pair of inserts, in a randomised order. The Pedar® in-shoe pressure system was used to record data. The five areas of interest were the heel, lateral three and medial two metatarsals, lateral three and medial two toes.

Results: The mean peak pressure (PP) under the heel was significantly reduced with inserts whereas PP recorded under the medial and lateral metatarsal heads was higher. With inserts, the contact time (CT) and pressure time integral (PTI) had increased under the medial toes, lateral and medial metatarsal heads; while under the heel, the CT had increased and PTI had decreased. The percentage roll over process of beginning of contact (BoC) showed a generalized decrease in the values under the metatarsal heads and medial toes with inserts. Although the general trend was a decrease in contact area (CA) with inserts, little difference was seen in the areas of interest among both feet.

Discussion: A comparable CA and increased PP, CT and PTI under the metatarsal heads and a decreased PP under the toes suggest that the metatarsal heads are prone to increased risk of injury while using inserts. This is complimented by the hastened BoC of the forefoot. The decreased PTI and PP under the heels can be attributed directly to the use of inserts.

Conclusion: The heel inserts should be used with caution inspite of their beneficial effects under the heel. The classification of these inserts as an “over-the-counter” product may need to be reviewed.

Purpose of study: The aim of this study was twofold. Firstly, to compare a subjective clinical with an objective biomechanical assessment of operated clubfeet, using the optical Dynamic Pedobarograph foot pressure system. Secondly, to develop the latter into a classification system for future prospective studies and to complement clinical evaluation of patients, especially those with relapse.

Methods and results: Sixteen patients (21 feet) were randomly selected from a pool of patients that had undergone clubfoot surgery. The operations were carried out by a single surgeon and consisted of a lateral-posteromedial peritalar release utilising the Cincinnati incision. Post-operatively, all feet were independently classified using a modified functional outcome scoring system. After completion of treatment, patients were referred to the Foot Pressure Analysis Clinic in Dundee where a novel method has been developed for the evaluation of clubfeet, using a static and dynamic foot pressure analysis system which provide both a graphical and analytical model for comparison. A three point grading scale was developed. The correlation between clinical and biomechanical outcomes in the 21 feet was calculated using Kendall’s tau rank test for non-parametric data. The t value was 0.3524, which was significant (p < 0.05).

Conclusion: There is a significant correlation between the above mentioned subjective and objective outcome measurements. Biomechanical assessment can complement, support or change the line of management after clubfoot surgery. This technique has not only proven to be objective but also clinically valuable and cost effective. A prospective study to refine this biomechanical classification into a reliable predictor of relapse in surgically corrected clubfeet is currently being considered