Increased pressure on the heel apophysis is often implicated as a cause of paediatric heel pain. However, there are few reports on the causes of the increased pressure and its origin. Therefore, the aim of this study was to analyse the distribution of pressure on the feet in children with heel pain. The study included 33 paediatric patients with non-traumatic heel pain, i.e., 24 boys (73%) and 9 girls (27%), aged on average 11.2 years (±3 years). Pedobarographic diagnostics proved a decrease in the pressure on the heels in relation to the ground and the transfer of the projection of the centre of gravity to the forefoot. While standing, the average contribution of the pressure on the heel was 0.52, SD = 0.14 in children with normal and reduced weight. In overweight children, the average pressure on the heel was higher (0.60, SD = 0.08), but the small number of children with this characteristic (n = 4) did not allow conclusions to be drawn in this area. Heel underload was also demonstrated during gait. However, the assessment of this aspect requires additional observational analyses in the field of propulsion and gait phases. The reduced pressure on the heel promotes apophysis traction, causing intracanal compression. Studies have shown that the causes of apophysis traction may be postural defects (in particular, forward inclination of body posture) and overpronation of the foot, or defects in the metatarsal area.

Background. Considering the enormous risk of fractures in the course of osteoporosis in the area of the feet, an important aspect of prophylaxis is periodic and, in special cases, ongoing monitoring of defects and deformations as well as pressure distribution. The purpose of this article is to indicate the role of the examination of posture and pressure distribution during standing, postural balance, and gait, in the prevention of fatigue fractures in the course of osteoporosis, based on the literature review and examples of patients. Methods. The manuscript consists of two parts; it has a review-analytical character. The first part reviews the literature. The data were obtained using the MEDLINE (PubMed), as well as Cochrane and Embase databases. The database review was carried out focusing mainly on English-language publications, while taking into account the topicality of scientific and research works in the area of osteoporosis. The problem of multiaspects in the area of bone density was pointed out. Considering the above, in the second part, the authors analyzed 11 exemplary patients with osteoporosis, referring to the assessment of foot and lower limb defects using traditional posturological methods and including pedobarography to diagnostic procedures that are used in the assessment of pressure distribution, standing and moving, and an attempt to balance. Results. Analysis of the research and scientific literature proved the lack of unambiguous diagnostic procedures of the locomotor system recommended for the prevention of fatigue fractures in the course of osteoporosis. The main diagnostic recommendations are imaging tests (most often X-ray), which are recommended in the case of specific clinical symptoms. The analysis of exemplary patients with osteoporosis showed numerous disorders in the distribution of pressure in the plantar part of the feet, which are related, among other things, with their individual defects and lower limbs. Conclusions. Detailed posture diagnostics and gait estimation, along with the analysis of pressure distribution within the feet are a very important aspect of the prevention of structural degradation and fatigue fractures within the feet. An important postulate for further research and scientific work is the elaboration of the procedures that will serve the preventive diagnostics of the locomotor system, aimed at early detection of threats of fatigue fractures.

Cukrzyca to choroba stanowiąca jeden z głównych problemów zdrowia publicznego. Szacuje się, że około 15% pacjentów z cukrzycą – w wyniku neuropatii obwodowej oraz niewydolności naczyń obwodowych – zagrożonych jest zespołem stopy cukrzycowej (ZSC). Obydwa powikłania prowadzą do degradacji struktur anatomicznych stopy, tj.: układu kostno-stawowego, ścięgien i więzadeł oraz mięśni. Dysfunkcje i wady powstające w przebiegu cukrzycy powodują wadliwą dystrybucję sił i nacisków w obrębie stóp, co jest istotnym czynnikiem sprzyjającym powstawaniu ran przeciążeniowych, złamań zmęczeniowych itd. Obecnie strategie profilaktyczne ukierunkowane są głównie na profilaktykę nawrotów oraz na leczenie w celu uniknięcia amputacji. Mając na uwadze patofizjologię, ważnym aspektem wczesnej profilaktyki jest obserwacja kondycji układu neurologicznego oraz naczyniowego, co praktycznie realizowane jest przez zespoły interdyscyplinarne poprzez: obserwację, badanie czucia powierzchownego oraz przepływów (np. ABI), a tym samym znajduje odniesienie w licznych rekomendacjach. Niezbędną procedurą wczesnego wykrywania zagrożeń jest ocena stóp i kończyn dolnych w ujęciu anatomicznym oraz funkcjonalnym, uwzględniając w szczególności ocenę dystrybucji nacisków. Profilaktyczne znaczenie mają również niemedyczne usługi podologiczne. Istniejące rekomendacje i zalecenia w zakresie profilaktyki i terapii oraz edukacji pacjentów z grupy ryzyka, dotyczące wczesnej prewencji powstawania zmian przeciążeniowych, są zbyt ogólne, co wynika zarówno z doświadczenia praktycznego, jak i naukowego Autorów niniejszej publikacji. Natomiast obowiązujące przepisy oraz dokumenty normatywne w tym obszarze są wystarczające do wdrożenia procedur szczegółowych, co jest czynnikiem pozytywnym w procesie wdrożeniowym. Cel Wskazanie wczesnych i wtórnych procedur diagnostycznych, terapii oraz edukacji pacjenta, mających zastosowanie w profilaktyce ZSC.

Body asymmetry is often analysed in the context of low back pain (LBP). To date, research has mainly focused on the general relationships between asymmetry and pain, with less attention paid to issues related to pressure distribution and its potential impact on the occurrence of LBP. The aim of this study was to compare biomechanical parameters in people with anatomical leg length discrepancy with and without LBP to identify overloads that may lead to pain. Early detection of common abnormalities in these parameters in both groups may influence the early prevention of 0LBP in the course of LLD. Materials and methods: This study included 60 patients with diagnosed LLD, of whom 30 had LBP (group 1, NP) and 30 were pain-free (group 2, NwP). Body weight distribution during standing and walking was analysed using pedobarography. The analysis was carried out in two stages, the first being the analysis of the biomechanical parameters for the whole study population, for group 1 with LBP and group 2 without LBP, while the second stage focused on the main issue, i.e., the comparison of the group with LBP with the group without LBP. The study included standing and walking tests. Left–right pressure distribution and ground contact time were analysed. In addition, the angle of foot abduction was analysed to indirectly assess compensatory mechanisms resulting from the asymmetry. Results: The standing test showed significantly greater pressure on the longer limb (p = 0.022) in the whole study population (N = 60). When divided into groups, it was found that in those with LBP (NP = 30), the difference was not statistically significant (p = 0.359), whereas in those without pain (NwP = 30), the pressure on the longer limb was significantly greater (p = 0.002). No differences were found between the groups in the comparative analysis. The angle of foot abduction was greater than normal across the study population (N = 60), with greater values in the shorter limb (12.83° vs. 11.04°), which was close to significance (p = 0.065). The group with LBP (NP = 30) showed a similar trend, also close to statistical significance (p = 0.054), with significantly higher values of abduction angle in both legs compared to the group without LBP (NwP = 30). In the walking test, the left–right load distributions were significantly dispersed. The mean pressure on the longer limb was significantly higher in group 1 (NP = 30) (p = 0.031), whereas this difference was not statistically significant in group 2 (NwP = 30). For mean peak pressure, there were no significant differences in any of the groups tested. In addition, the mean ground contact time during gait was longer for the longer limb in the whole study population (N = 60) (938.8 ms vs. 915 ms), but again, this difference did not reach statistical significance (p = 0.305). Comparative analysis showed no differences between the groups. Conclusions: This study showed that in people with anatomical LLD, both with and without LBP, most parameters reflected marked asymmetries in peak and mean pressures and abduction angles. A prolongation of ground contact time has also been shown, and even though some parameters were not statistically significant, it is important to note the high dispersion of left–right loading, which provides information on body load asymmetries in patients with anatomical LLD. Given that there were no differences between the groups for most of the parameters, it is important for both clinical practice and further research that the abnormalities observed in both groups (NP = 30, NwP = 30) may have been a significant predictor of the development of LBP, as the abnormalities preceded the onset of pain. This should be taken into account in diagnostic and preventive measures.

Zmiany w obrębie zespołu stopy cukrzycowej (ZSC), powstałe w wyniku wadliwej dystrybucji nacisków, w literaturze badawczo-naukowej dotyczą zmian neuropatycznych oraz ich następstw, tj. wad, uszkodzeń strukturalnych czy zwyrodnień. Istnieje wiele dowodów dotyczących przyczynowości wzmożonego nacisku na powstanie ran w obrębie części podeszwowej stóp.