{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:50:41Z","timestamp":1792083041394,"version":"4.4.0"},"reference-count":52,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2015,8,18]],"date-time":"2015-08-18T00:00:00Z","timestamp":1439856000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Foot pathologies can negatively influence foot function, consequently  impairing gait during daily activity, and severely impacting an individual\u2019s quality of life. These pathologies are often painful and correspond with high or abnormal plantar pressure, which can result in asymmetry in the pressure distribution between the two feet. There is currently no general consensus on the presence of asymmetry in able-bodied gait, and plantar pressure analysis during gait is in dire need of a standardized method to quantify asymmetry. This paper investigates the use of plantar pressure asymmetry for pathological gait diagnosis. The results of this study involving plantar pressure analysis in fifty one participants (31 healthy and 20 with foot pathologies) support the presence of plantar pressure asymmetry in normal gait. A higher level of asymmetry was detected at the majority of the regions in the feet of the pathological population, including statistically significant differences in the plantar pressure asymmetry in two regions of the foot, metatarsophalangeal joint 3 (MPJ3) and the lateral heel. Quantification of plantar pressure asymmetry may prove to be useful for the identification and diagnosis of various foot pathologies.<\/jats:p>","DOI":"10.3390\/s150820392","type":"journal-article","created":{"date-parts":[[2015,8,18]],"date-time":"2015-08-18T10:31:11Z","timestamp":1439893871000},"page":"20392-20408","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":131,"title":["Identification of Foot Pathologies Based on Plantar  Pressure Asymmetry"],"prefix":"10.3390","volume":"15","author":[{"given":"Linah","family":"Wafai","sequence":"first","affiliation":[{"name":"College of Engineering and Science, Victoria University, Melbourne VIC-3032, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aladin","family":"Zayegh","sequence":"additional","affiliation":[{"name":"College of Engineering and Science, Victoria University, Melbourne VIC-3032, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Woulfe","sequence":"additional","affiliation":[{"name":"Boronia Podiatry, Melbourne VIC-3155, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9627-7594","authenticated-orcid":false,"given":"Syed","family":"Aziz","sequence":"additional","affiliation":[{"name":"School of Engineering, University of South Australia, Mawson Lakes SA-5095, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rezaul","family":"Begg","sequence":"additional","affiliation":[{"name":"Gait and Balance Research Group, Institute of Sport, Exercise and Active Living (ISEAL),  Victoria University, Melbourne VIC-3032, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2015,8,18]]},"reference":[{"key":"ref_1","unstructured":"Winter, D.A. (1991). The Biomechanics and Motor Control of Human Gait: Normal, Elderly and Pathological, Waterloo Press."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Perry, J. (1992). Gait Analysis: Normal and Pathological Function, Slack.","DOI":"10.1097\/01241398-199211000-00023"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1936","DOI":"10.1111\/j.1532-5415.2010.03061.x","article-title":"Foot pain, plantar pressures, and falls in older people: A prospective study","volume":"58","author":"Mickle","year":"2010","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"37S","DOI":"10.1016\/j.jvs.2010.06.007","article-title":"Off-loading the diabetic foot for ulcer prevention and healing","volume":"52","author":"Cavanagh","year":"2010","journal-title":"J. Vasc. Surg."},{"key":"ref_5","first-page":"25","article-title":"The study of plantar pressure distribution in normal and pathological foot","volume":"12","author":"Rai","year":"2006","journal-title":"Polish J. Med. Phys. Eng."},{"key":"ref_6","first-page":"130","article-title":"Measurement of Plantar Pressure Using Fuji Prescale Film\u2014A Preliminary Study","volume":"2","author":"Ralphs","year":"1990","journal-title":"JPO: J. Prosthet. Orthot."},{"key":"ref_7","unstructured":"Perttunen, J. (2002). Foot Loading in Normal and Pathological Walking, University of Jyv\u00e4skyl\u00e4."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/S0268-0033(99)00034-0","article-title":"Orthotic management of plantar pressure and pain in rheumatoid arthritis","volume":"14","author":"Hodge","year":"1999","journal-title":"Clin. Biomech."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1093\/rheumatology\/kei186","article-title":"Forefoot joint damage, pain and disability in rheumatoid arthritis patients with foot complaints: The role of plantar pressure and gait characteristics","volume":"45","author":"Steultjens","year":"2006","journal-title":"Rheumatology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1080\/003655099444533","article-title":"Plantar force distribution in parkinsonian gait. A comparison oetween patients and age-matched control subjects","volume":"31","author":"Nieuwboer","year":"1999","journal-title":"Scand. J. Rehabil. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1016\/S0268-0033(01)00069-9","article-title":"Heel to toe motion characteristics in parkinson patients during free walking","volume":"16","author":"Kimmeskamp","year":"2001","journal-title":"Clin. Biomech."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.2337\/diacare.25.6.1066","article-title":"The forefoot-to-rearfoot plantar pressure ratio is increased in severe diabetic neuropathy and can predict foot ulceration","volume":"25","author":"Caselli","year":"2002","journal-title":"Diabetes Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1093\/ptj\/80.4.399","article-title":"Plantar pressure assessment","volume":"80","author":"Orlin","year":"2000","journal-title":"Phys. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"R16","DOI":"10.1088\/0957-0233\/10\/1\/017","article-title":"Plantar pressure-measurement sensors","volume":"10","author":"Urry","year":"1999","journal-title":"Meas. Sci. Technol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"9884","DOI":"10.3390\/s120709884","article-title":"Foot plantar pressure measurement system. A review","volume":"12","author":"Zayegh","year":"2012","journal-title":"Sensors"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1109\/TITB.2009.2038904","article-title":"In-shoe plantar pressure measurement and analysis system based on fabric pressure sensing array","volume":"14","author":"Lin","year":"2010","journal-title":"IEEE Trans. Inf. Technol. Biomed."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1002\/dmrr.2240","article-title":"Priorities in offloading the diabetic foot","volume":"28","author":"Bus","year":"2012","journal-title":"Diabetes\/Metab. Res. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.2337\/dc10-2206","article-title":"Evaluation and optimization of therapeutic footwear for neuropathic diabetic foot patients using in-shoe plantar pressure analysis","volume":"34","author":"Bus","year":"2011","journal-title":"Diabetes Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"226","DOI":"10.5694\/mja11.10347","article-title":"Australian diabetes foot network: Management of diabetes-related foot ulceration\u2014A clinical update","volume":"197","author":"Bergin","year":"2012","journal-title":"Med. J. Aust."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1679","DOI":"10.2337\/dc08-9021","article-title":"Comprehensive foot examination and risk assessment","volume":"31","author":"Boulton","year":"2008","journal-title":"Diabetes Care"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Veves, A., Giurini, J.M., and LoGerfo, F.W. (2012). The Diabetic Foot, Humana Press.","DOI":"10.1007\/978-1-61779-791-0"},{"key":"ref_22","first-page":"65","article-title":"Foot ulcers in the diabetic patient, prevention and treatment","volume":"3","author":"Wu","year":"2007","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_23","unstructured":"Rebolledo, F.A., Soto, J.M.T., and de la Pen, J.E. Global Perspective on Diabetic Foot Ulceration, Available online: http:\/\/www.intechopen.com\/books\/global-perspective-on-diabetic-foot-ulcerations\/the-pathogenesis-of-the-diabetic-foot-ulcer-prevention-and-management."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1590\/S0103-21002012000200010","article-title":"Root causes for the development of foot ulcers of people with diabetes mellitus","volume":"25","author":"Martin","year":"2012","journal-title":"Acta Paul. Enferm."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/S0966-6362(00)00070-9","article-title":"Symmetry and limb dominance in able-bodied gait: A review","volume":"12","author":"Sadeghi","year":"2000","journal-title":"Gait Posture"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1682\/JRRD.2006.07.0077","article-title":"Using effect size to quantify plantar pressure asymmetry of gait of nondisabled adults and patients with hemiparesis","volume":"44","author":"Potdevin","year":"2007","journal-title":"J. Rehabil. Res. Dev."},{"key":"ref_27","first-page":"172","article-title":"Use of force platform variables to quantify the effects of chiropractic manipulation on gait symmetry","volume":"10","author":"Robinson","year":"1987","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/j.gaitpost.2007.08.006","article-title":"The symmetry angle: A novel, robust method of quantifying asymmetry","volume":"27","author":"Zifchock","year":"2008","journal-title":"Gait Posture"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1249\/00005768-198902000-00020","article-title":"Asymmetries in ground reaction force patterns in normal human gait","volume":"21","author":"Herzog","year":"1989","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1080\/02640414.2011.647047","article-title":"Implications of intra-limb variability on asymmetry analyses","volume":"30","author":"Exell","year":"2012","journal-title":"J. Sports Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S0966-6362(96)01083-1","article-title":"Time and frequency domain analysis of ground reaction forces during walking: An investigation of variability and symmetry","volume":"5","author":"Giakas","year":"1997","journal-title":"Gait Posture"},{"key":"ref_32","unstructured":"Portney, L.G., and Watkins, M.P. (2009). Foundations of Clinical Research: Applications to Practice, Pearson Prentice Hall. [3rd ed.]."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1177\/107110079001100303","article-title":"Shoes for the insensitive foot: The effect of a \u201crocker bottom\u201d shoe modification on plantar pressure distribution","volume":"11","author":"Schaff","year":"1990","journal-title":"Foot Ankle Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.clinbiomech.2003.09.007","article-title":"The influence of walking speed and footwear on plantar pressures in older adults","volume":"19","author":"Burnfield","year":"2004","journal-title":"Clin. Biomech."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.clinbiomech.2004.02.010","article-title":"Pressure relief and load redistribution by custom-made insoles in diabetic patients with neuropathy and foot deformity","volume":"19","author":"Bus","year":"2004","journal-title":"Clin. Biomech."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"26","DOI":"10.2337\/diacare.6.1.26","article-title":"Dynamic foot pressure and other studies as diagnostic and management aids in diabetic neuropathy","volume":"6","author":"Boulton","year":"1983","journal-title":"Diabetes Care"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1302\/0301-620X.67B1.3968150","article-title":"Plantar pressure measurements and the prevention of ulceration in the diabetic foot","volume":"67","author":"Duckworth","year":"1985","journal-title":"J. Bone Joint Surg.-Br."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/S1067-2516(98)80066-5","article-title":"Is there a critical level of plantar foot pressure to identify patients at risk for neuropathic foot ulceration?","volume":"37","author":"Armstrong","year":"1998","journal-title":"J. Foot Ankle Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1590\/S1807-59322009000200008","article-title":"Plantar pressure distribution patterns during gait in diabetic neuropathy patients with a history of foot ulcers","volume":"64","author":"Bacarin","year":"2009","journal-title":"Clinics"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1714","DOI":"10.2337\/diacare.21.10.1714","article-title":"Role of neuropathy and high foot pressures in diabetic foot ulceration","volume":"21","author":"Frykberg","year":"1998","journal-title":"Diabetes Care"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1007\/BF00400259","article-title":"The risk of foot ulceration in diabetic patients with high foot pressure: A prospective study","volume":"35","author":"Veves","year":"1992","journal-title":"Diabetologia"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Wafai, L., Zayegh, A., Begg, R., and Woulfe, J. (2013, January 17\u201320). Asymmetry Detection during Pathological Gait Using a Plantar Pressure Sensing System. Proceedings of the 2013 7th IEEE GCC Conference and Exhibition (GCC), Doha, Qatar.","DOI":"10.1109\/IEEEGCC.2013.6705772"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1007\/s00167-012-1929-2","article-title":"Symmetry restoration and functional recovery before and after anterior cruciate ligament reconstruction","volume":"21","author":"Logerstedt","year":"2013","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"135","DOI":"10.2519\/jospt.2012.3773","article-title":"Functional and biomechanical outcomes in a patient after total knee arthroplasty: Biofeedback for retraining symmetrical movement patterns","volume":"42","author":"McClelland","year":"2012","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1302\/0301-620X.82B7.0821001","article-title":"Improvement in function after valgus bracing of the knee: An analysis of gait symmetry","volume":"82-B","author":"Draper","year":"2000","journal-title":"J. Bone Joint Surg. Br."},{"key":"ref_46","first-page":"135","article-title":"Standardization of gait kinematic data using a gait symmetry index and fourier analysis","volume":"Volume 1","author":"Huiskes","year":"1982","journal-title":"Biomechanics: Principles and Applications"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/S0003-9993(97)90079-4","article-title":"Asymmetry of gait initiation in hemiparetic stroke subjects","volume":"78","author":"Hesse","year":"1997","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.gaitpost.2007.09.006","article-title":"A test of the functional asymmetry hypothesis in walking","volume":"28","author":"Seeley","year":"2008","journal-title":"Gait Posture"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.foot.2005.05.003","article-title":"Footedness as a potential factor that contributes to the causation of corn and callus formation in lower extremities of physically active individuals","volume":"15","author":"Grouios","year":"2005","journal-title":"Foot"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/S0966-6362(02)00089-9","article-title":"Local or global asymmetry in gait of people without impairments","volume":"17","author":"Sadeghi","year":"2003","journal-title":"Gait Posture"},{"key":"ref_51","first-page":"29","article-title":"Comparison of four methods of calculating the symmetry of spatial-temporal parameters of gait","volume":"16","author":"Wiszomirska","year":"2014","journal-title":"Acta Bioeng. Biomech."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.gaitpost.2009.10.014","article-title":"Evaluation of gait symmetry after stroke: A comparison of current methods and recommendations for standardization","volume":"31","author":"Patterson","year":"2010","journal-title":"Gait Posture"}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/15\/8\/20392\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T20:46:55Z","timestamp":1760215615000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/15\/8\/20392"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,8,18]]},"references-count":52,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2015,8]]}},"alternative-id":["s150820392"],"URL":"https:\/\/doi.org\/10.3390\/s150820392","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,8,18]]}}}