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AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32044                                                                    

1 

 
OPEN  ACCESS 

 

AOPA’S 101 ST NATIONAL ASSEMBLY ABSTRACTS, SEPTEMBER 26-29, VANCOUVER, CANADA, 2018 
 

ABSTRACT (ORAL PRESENTATION) 

WHAT IN THE “HEEL” DO THEY FEEL? 15303 
Megan Smith,  

Surestep, South Bend Indiana, USA.  

Email: megans@surestep.net                                                                                  DOI: https://doi.org/10.33137/cpoj.v1i2.32044  

 

INTRODUCTION 

A typical gait pattern includes a heel strike, followed by 

a smooth transition to foot flat through loading response. 

Children with poor postural control and related gait 

deficits often present with anterior weight lines, which 

result in loss of first rocker and/or a fast transition from 

initial contact to foot flat. The foot has many important 

jobs, including providing proprioceptive feedback. There 

are 104 cutaneous mechanoreceptors on the plantar 

surface of the foot.1 While most of the sensors are in the 

metatarsal/tarsal and toe regions, we cannot forget the 

role of the mechanoreceptors in the heel.  

 

Figure 1. Location of mechanoreceptors in the 

foot 

 

Standard orthotic designs typically 

encompass the heel with plastic. This may accelerate 1st 

rocker and result in more inclined tibia during mid-

stance. This design can also reduce typical sensory input 

a child receives through his or her heels. When providing 

orthotic solutions, we should consider the patient’s 

postural control and weight lines as well as ensure we are 

not hindering the foot’s natural ability to “feel” and 

provide feedback to the rest of the body. The ability to 

feel changes in terrain to adjust and build a repertoire of 

motor and postural strategies is a vital part of typical 

development.2,3 A new modification, the open heel, was 

designed and evaluated for function. The hypothesis was 

that the open heel modification would restore 1st rocker 

timing by slowing the transition from initial contact to 

foot flat, slow down overall gait velocity and increase 

integrated pressure.  

METHODS 

11 children (4.4 ± 1.8 years old) were included in this 

retrospective study. Each participant presented with 

anterior weight lines and poor postural control. Primary 

diagnoses included Down syndrome, Autism and toe 

walking. Each was fit with an orthosis with an open heel  

modification. Four patients (Group 1) had also 

previously been fit with the same orthosis (i.e. SMO or 

AFO) with a standard heel post and had direct 

comparison data with the open heel modification. Seven 

patients (Group 2) were fit only with an orthosis with the 

open heel modification. 

        (A)                               (B) 

 
Figure 2. (A) Open Heel modification and (B) Standard Heel 

Post design4. 

 

Data from the Zeno Walkway and Protokinetics 

software5 was analyzed to assess changes in velocity, 

integrated pressure and time from initial contact to 

footflat (IC – FF). For time to footflat, 4 right footfalls 

were analyzed.  

RESULTS 

Group 1: Data from the standard heel post (HP) design 

and open heel (OH) modification were compared. 

Secondly, data from the OH modification and Barefoot 

(BF) were compared for reference for Group 2 data. Data 

is reported as percent change between conditions. 

Velocity decreased and integrated pressure and IC-FF 

time increased in both comparisons. Group 2: Percent 

changes from the OH modification and BF were 

calculated and compared to Group 1 data. Velocity 

decreased and integrated pressure and IC-FF time 

increased. Changes in Group 2 were similar to changes 

in Group 1 (OH:BF). 

Table 1. Percent changes in data for Group 1 and Group 2 

 Group 1 Group 2 

OH:HP              

% change 

(SD) 

OH:BF              

% change 

(SD) 

OH:BF              

% change 

(SD) 

Velocity -19% (0.14) -10% (0.26) -7% (0.16) 

Integrated 

Pressure 25% (0.16) 29% (0.19) 37% (0.27) 

IC – FF  26% (0.24) 103% (0.54) 84% (0.47) 

mailto:megans@surestep.net
https://doi.org/10.33137/cpoj.v1i2.32044


 

 

Smith M.  WHAT IN THE “HEEL” DO THEY FEEL? 15303. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE 
AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32044                                                                    

2 

 
OPEN  ACCESS 

 

AOPA’S 101 ST NATIONAL ASSEMBLY ABSTRACTS, SEPTEMBER 26-29, VANCOUVER, CANADA, 2018 
 

ABSTRACT (ORAL PRESENTATION) 

DISCUSSION 

When children have anterior weight lines, velocity tends 

to be increased – they are essentially falling down with 

each step. In order to work on postural control, slowing 

down is important. The comparison of the open heel data 

to Barefoot of the children in Group 1 and Group 2 were 

very similar. This suggests that the OH modification in 

their orthoses had positive changes compared to barefoot 

and heel post designs. The open heel modification 

dampens the ground reaction forces at initial contact and 

slows 1st rocker compared to orthoses with a heel post 

and barefoot conditions. The increase in amount of 

pressure over the time spent in stance suggests that the 

participants put more pressure through the orthosis and 

may be feeling more input back from the ground. The 

open heel modification should be considered for patients 

with sensory deficits and/or anterior weight lines.   

REFERENCES 

1. Kennedy PM, Inglis JT. Distribution and behavior of 

glabrous cutaneous receptors in the human foot sole. J Physiol. 

2002; 538(Pt 3): 995-1002. 
doi: 10.1113/jphysiol.2001.013087 

2. Dusing SC, Harbourne RT. Variability in Postural Control 

During Infancy: Implications for Development, Assessment, 

and Intervention. Phys Ther. 2010; 90:1838-1849. 
DOI:10.2522/ptj.2010033 

3. Fetters L. Perspective on Variability in the Development of 

Human Action. Phys Ther. 2010; 90:1860-1867. 

DOI:10.2522/ptj.2010090 

4. Surestep Products. www.surestep.net 

5.Protokinetics Software and Zeno Walkway. 

www.protokinetics.com 
 
 

 

https://dx.doi.org/10.1113%2Fjphysiol.2001.013087
https://doi.org/10.2522/ptj.2010033
https://doi.org/10.2522/ptj.2010090

