In-shoe and barefoot plantar pressure measurements show broadly consistent key loading areas, but barefoot data frequently identifies additional high-pressure regions not present in-shoe, suggesting that basing offloading insole design on threshold-based barefoot high-pressure regions could reduce specificity and limit pressure reduction for in-shoe high-pressure regions.
Key Findings
Results
In-shoe high-pressure regions were typically observed in similar locations to barefoot walking, but barefoot maps often identified additional high-pressure regions in the toes and lateral forefoot.
Study included 25 feet from 16 individuals with high forefoot pressures.
In-shoe threshold used was >200 kPa; barefoot threshold used was >450 kPa.
Additional regions identified in barefoot data were particularly located in the toes and lateral forefoot.
Unmatched regions were common, particularly in barefoot data, reflecting greater sensitivity to localized pressures.
Results
For matched high-pressure regions, in-shoe data showed lower peak pressures and larger contact areas compared to barefoot data.
In-shoe regions corresponding to barefoot high-pressure zones had lower peak pressures.
In-shoe regions had larger contact areas than their barefoot counterparts.
This pattern was consistent across matched regions in the forefoot.
Results
Centroid locations of matched high-pressure regions differed between in-shoe and barefoot systems by 0.23 to 0.60 cm.
Centroid positions were compared for all matched regions between in-shoe and barefoot pressure maps.
The range of centroid differences was 0.23–0.60 cm across anatomical regions.
High-pressure regions were masked, grouped, and labeled by anatomical region before comparison.
Pressure maps were averaged over trials and overlaid for comparison.
Results
Barefoot pressure data may overestimate high-risk regions that do not display elevated in-shoe pressures.
Barefoot data identified regions exceeding its threshold (>450 kPa) that did not correspond to elevated in-shoe pressures (>200 kPa).
Unmatched regions were more common in barefoot data than in in-shoe data.
The authors note this reflects greater sensitivity of barefoot measurement to localized pressures.
This overestimation could reduce specificity of insole offloading design.
Discussion
Basing offloading insole design on threshold-based barefoot high-pressure regions could reduce specificity and limit pressure reduction for in-shoe high-pressure regions.
Custom accommodative insoles achieve greater pressure reductions when dynamic pressure data informs their design.
In-shoe and barefoot data are currently used separately to design insoles, without prior evaluation of their agreement.
The authors suggest findings have potential implications for streamlining clinical workflows during pressure-informed insole design.
Using barefoot data alone may result in targeting regions that are not actually high-pressure areas during shod walking.
Results
Key loading areas were consistent between in-shoe and barefoot pressure measurement systems.
Despite differences in threshold levels (>200 kPa in-shoe vs. >450 kPa barefoot), primary loading locations were broadly concordant.
Both systems identified high-pressure regions in the forefoot during walking.
In-shoe and barefoot pressure maps were overlaid and compared across 25 feet.
The study population was specifically individuals with diabetes and high forefoot pressures.
Heino D, Telfer S, Nagle-Christensen A, Ledoux W, Muir B. (2026). Quantifying differences in high-pressure region mapping between dynamic in-shoe and barefoot plantar pressure in diabetic subjects.. Journal of biomechanics. https://doi.org/10.1016/j.jbiomech.2026.113201