February 2011

Data indicate looser lacing increases pressure time integral under forefoot

In the moment: Footwear

When it comes to shoe lacing, looser is not necessarily better for patients with diabetes.

Loose laces are associated with higher pressure time integrals under some regions of the foot than comfortably tightened laces, according to research from the Netherlands e-published in January by Gait & Posture.

Researchers from Vrije University in Amsterdam analyzed pressure patterns analyzed in 20 healthy volunteers during a 10-meter walking task, while subjects wore shoes laced with varying degrees of tightness. The looser lacing techniques were associated with PTI increases of 16.3% under the hallux and 14.5% under the remaining toes compared to comfortably tightened laces. By contrast, significant decreases in PTI were seen under the lateral midfoot with the looser laces. Not surprisingly, participants also reported higher levels of perceived in-shoe foot displacement when shoes were laced more loosely.

The results suggest that extra-loose lacing may put patients with diabetes at increased risk of forefoot ulceration.  This, however, may present something of a clinical dilemma in patients with diabetic neuropathy, who may not be able to accurately perceive lace tightness.

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