In Vivo Plantar Pressures in Adult-Acquired Flatfoot Compared to Control Using an Intraoperative Pedobarographic Device



Intraoperative pedobarography has the potential to aid surgical decisions, but no parameters exist to guide its use.


This study compared supine plantar pressures between flatfoot patients and controls using a previously validated intraoperative pedobarographic device and examined associations between supine, walking, and standing plantar pressures.


Ten preoperative patients with stage II adult-acquired flatfoot deformity (AAFD) were compared to ten healthy controls. Supine plantar pressures were assessed using the pedobarographic device. Standing and walking plantar pressures were assessed with an EMED-XT sensor array (Novel). Maximum force (MF) and peak pressure (PP) were calculated for nine anatomical foot regions adjusting for age and BMI.


No differences in plantar pressures were found between flatfoot patients and controls in the supine or standing positions. During walking, flatfoot patients had greater MF of the first, second, and third metatarsals (p ≤ 0.018) and greater PP of the first and second metatarsals than controls (p ≤ 0.010). Supine MF and PP were both strongly positively correlated with their respective pressure measurements for both standing and walking in multiple foot regions (p ≤ 0.05, all analyses). Correlations in the first metatarsal region were generally weak and not statistically significant.


This device did not show differences in supine plantar pressures of flatfoot patients and healthy subjects, highlighting the limitations of intraoperative devices in guiding flatfoot correction. The differences between flatfoot and controls during walking and the correlations between supine and walking conditions suggest that dynamic plantar pressures are a more useful parameter in guiding flatfoot reconstruction.

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Corresponding author

Correspondence to Aoife MacMahon BA.

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Conflict of Interest

Aoife MacMahon, BA, Howard J. Hillstrom, PhD, Jeremy Y. Chan, MD, and Scott J. Ellis, MD, have declared that they have no conflict of interest. Huong T. Do, MA, reports grants from Clinical and Translational Science Center, outside the work. Jonathan T. Deland, MD, reports personal fees from Arthrex, Zimmer, and Integra and personal fees and other from Tornier, outside the work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

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Informed consent was obtained from all patients for being included in the study.

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Level of Evidence: Level III: prospective case-control study.

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MacMahon, A., Hillstrom, H.J., Do, H.T. et al. In Vivo Plantar Pressures in Adult-Acquired Flatfoot Compared to Control Using an Intraoperative Pedobarographic Device. HSS Jrnl 13, 136–145 (2017).

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  • intraoperative pedobarography
  • adult-acquired flatfoot deformity