Therefore, the objective of this study was to create baseline data on the distribution of plantar pressure amongst female school teachers. The foot is the lowest region of the body that carries weight. The structure of bones, muscles and joints facilitates stability by sustaining and supporting vigorous strain or pressure during standing and walking. The physiological pattern of distribution of pressure on the sole is almost symmetrical and gives the foot, and hence our body, an optimum flexibility [21]. Most people comprise a significant part of their lives in a standing position. Walking is also known as a postural control and is one of human beings’ main locomotives, the most common in daily living. The ground surface and feet made contact with each other while we were standing. Upon landing on the ground, the sole of our foot had force. The force impact on foot sole or on the distribution of plantar pressure may be erratic and imbalanced, such impacts may exploit changes of stress, as results of severe applied to the foot, may trigger transient or long-lasting discomfort or foot pain and thus induce foot pressure. In the meantime, this can exacerbate foot disorders or negatively affect an individual’s overall health [17].
Prolonged standing for a significant period of time may lead to a gradual degradation of posture. In a standing lesson, teachers appear seems to be hunching and shifting their weight from one foot to the other in order to ease pain. Slouching promotes static posture that causes the person to become less conscious and therefore more passive. It will lead to poor circulation, along with swelling of the feet and legs, if this uncomfortable pose is maintained by long standing teachers. Prolonged standing often allows the joints to be partially immobilised or to stay in either the feet, knees or legs. Promptly, this disorientation may result to the degeneration of a rheumatic condition associated with tendons and ligaments. Long standing during the teaching process can allow blood to build up on the legs and feet without any relief when you walk. When extended standing with little or no rest during teaching time, this might lead to inflammatory response to the veins. Inflammation may prompt to a long-lasting, painful, persistent varicose vein [22].
Furthermore, feet have been detected as the highest MSD among all parts of the body, concerning 32.5% of female school teachers [23] as shown by latest observations in Terengganu. The research recently carried out in Kota Kinabalu confirmed this high prevalence of lower extremities among primary school teachers with 48.9% (hips, bottoms, legs and feet) [24]. Recent research has shown that knee (33.73%), ankle/foot (25.41%) and hip/thigh (7.01%) are experiencing discomfort as a result of long school standing for long hours without a break and repeated school stairs climbing among Indian teachers [19]. The prevalence of musculoskeletal pain affecting the knee was higher among teachers in Kenya who taught within 1 to 2 hours, was observed by Ndawa, Nyamari and Ireri study [25]. Besides that, study done by Leme and Maia [26] showed that at the end of working hours, 71% of the teachers did not showed disrupted productivity, however due to facilities they use and their posture at the time of the class, they do get discomfort and tired, specifically with the prevalence of pain in the legs (33%), tights (14%) and feet (43%).
The distribution of plantar pressure in various studies has generally been recognised as a critical evaluation for postures and movements of human. The variations and severity of plantar pressure would provide valuable analysis on musculoskeletal disorders especially on ankle and feet parts. Plantar pressure evaluations of walking, standing and sitting may show irregular foot path mechanics and provide quantitative metrics to monitor impairments of foot [27]. Several studies [27-29] on foot anatomy and physiology have stated that differences in plantar pressure are useful in assessing irregular posture. The pathological gait can be classified into either neuromuscular or musculoskeletal on the basis of basic etiology [30]. Harm to foot tissue depends not only on high strain or pressure, but also on the involvement of physical activity and footwear used by individuals [31]. If plantar pressure levels are found to be anomalous, the knowledge can be used to reconfigure the individual care regimen by adjustments in shoes, foot custom soles, workout schedules and body mass limits. Evidence gained from pressure systems is also beneficial from a scientific point of view to discuss a number of issues related to the relationship between plantar pressure production and lower limb’s posture [10].
Important distinctions were shown in the outcome as the right foot usually imposed more pressure in each area of the foot compared with the left foot among female school teachers in the classroom. In regular walking, the heel was the first part of the foot to bear body weight followed by midfoot and forefoot, eventually the load moved to the toe for the raise. Heel hit the ground on the posterolateral part of the heel, and the highest peak pressure occurred at roughly 18 to 36% of the standing period where heel, midfoot and forefoot were in touch with the ground [31]. According to many reports, natural forefoot pressure patterns are strongest under the 2nd and 3rd metatarsal regions and offer useful information when determining abnormal forefoot conditions. Studies have indicated that toes do not play a major role in the movement of load and produce lower pressure patterns relative to other foot areas [27, 31-32].
The primary goal of researchers for plantar pressure measurements for discomfort of lower limb was to explore the effects of foot pain and footwear adjustment, shoe insoles and various products used to cushion the foot. Various types of insole materials and internal and external footwear modifications have been assessed by researchers using pressure measurement platforms. The results collected from these studies can be used to help clinicians assess the acceptable form and volume of posting needed for foot pain or discomfort, as well as the amount of pressure relief that can be anticipated by using different types of insole interventions [10, 33-34]. In comparison to an outsole that is in contact with the shoe and floor, the insole has a function as a substantial interface that has contact with the shoe and the plantar surface of the foot. While multiple insoles are used in everyday shoes, they are mostly used for foot comfort. A pair of insoles, inserted into the shoe, has the ability to influence the mobility of the whole body as well as the lower extremities by the movement of the foot. If this is actually the case, because an incorrect insole would have a negative influence on the foot [35].
The in-shoe pressure measurement device was used in this analysis and the pressure plantar distribution of the foot among female school teachers was observed. The in-shoe pressure sensor device contains sensing components in the insoles [10, 36] and has achieved an edge over platform applications due to their mobility. It has really enabled a wide variety of field studies and clinical trials. One of its biggest benefits when in-shoe devices are the capability of measuring and analyse consecutive movements, since the foot usually stays synchronised with the same sensors. Dependable pressure measurement can influence by both the movement of the soles and the movement of the feet inside the shoes. The accessibility of in-shoe devices has enabled the evaluation of gait habits and also facilitated the assessment and enhancement of footwear and insole intervention [37-38]. There has also been a great deal of curiosity in implementing in-shoe plantar pressure delivery techniques to help in the development of custom footwear and insole for the discharge of elevated plantar foot pressure [39-40].
In fact, 35% of the plantar pressure differences during the gait is due to anatomical foot composition, including soft tissue thickness and arch height. Pressure below the heel and midfoot are frequently caused by heel strikes and centre bearings, while flexibility, muscle strength and muscle mobilisations are the primary factors of pressure [41]. The age-related deterioration of soft tissue and bone structure can also reduce the ability to endure plantar foot loads [42]. Essentially, the plantar pressure analysis depends primarily on the level of pressure detected to determine the presence of a foot pathology. In particular, in circumstances of pressure transfer to alleviate foot discomfort and decrease the likelihood of plantar fracture, the diagnostic mechanism involved in the foot assessment has been eased and the therapeutic potential for pathogenic foot has improved dramatically [39,43-45]. Although pressure evidence is so very critical for the diagnosis of foot disorders, generalised conclusions or decisions based merely on plantar pressure thresholds cannot be made [46].
The application of pressure footwear insoles at different locations does not reflect the “day work” of the foot, since people walk at different speeds in everyday activity and use several types of footwear. Changes observed at the stand are often due to foot anatomy, although the abnormal foot pressure can be caused during walking disruptions such as knee, hip or foot pain [47]. Several experiments have shown that the findings are the same or even nuanced as the measurement of the static posture, as antalgic gaits are useful when walking, meaning that the real pressure of the individuals’ soles can be defined correctly [48]. A variety of experiments have been performed on the basis of a person’s foot. However, plantar pressure distribution is not evenly distributed in all foot regions. Researchers have their own field of interest in many studies. The foot was split into several regions and according to Gurney, Kersting and Rosenbaum [15], the regions were Hallux (HA), Second Toe (T2), Lateral Toes (T3-5), Lateral Forefoot (LF), Central forefoot (CF) and Medial Midfoot (MH). Similarly, according to the areas of concern of the Chun et al. [17], the foot was divided into 6 significant areas to allow an experimental recording of pressure which were Hallux (HA), Medial Forefoot (MF), Central Forefoot (CF), Lateral Forefoot (LF), Lateral Midfoot (LM), and Hindfoot (HF).
The information gained from the results of this study might be used to oblige clinicians and health practitioners in procurement of suitable type of materials in shoes and insoles provided for individuals with discomfort on feet and to decide the most cost-effective approach to treating musculoskeletal foot and ankle disorders in patients. Nevertheless, evidence derived from a plantar pressure appraisal can be used by the physical therapist in the evaluation and management of adult and paediatric patients with a wide spectrum of foot and lower extremity conditions involved with the neurological, integumentary and musculoskeletal structures. Plantar pressure distribution systems provide the clinicians or researchers with information and guidance on the results of various interventions, including the development of footwear, use of foot orthotics, physical gait training and surgical assistance, the pressure and strength applied to particular regions of the foot [10].