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									      Proc. of the 5th Symp. on Footwear Biomechanics, 2001, Zuerich / Switzerland, (Eds. E. Hennig, A. Stacoff)   64


              A. Mündermann, B.M. Nigg, D.J. Stefanyshyn, R.N. Humble
       Human Performance Laboratory, University of Calgary, Canada, AB T2N 1V7

Comfort has been proposed as one of the most important factors for footwear in physical
activities (Nigg et al., 1999). However, to date a reliable measure to assess comfort has not
been developed. In this study, the reliability of comfort measured on a visual analogue scale
(VAS) was determined based on data collected for ten sessions per subject.

                                  REVIEW AND THEORY
Sport shoes, shoe inserts and orthotics should be comfortable. However, little is known about
footwear comfort. Comfort has been associated with fit, additional stabilizing muscle work,
fatigue, and damping of soft tissue vibrations (Nigg et al., 1999), plantar pressure distribution
(Chen et al., 1994) and subject characteristics such as skeletal alignment (Miller et al., 2000).
A valid relationship between footwear comfort and biomechanical variables can only be
obtained if comfort can be assessed in a reliable way.

Visual analogue scales (VAS) have been proposed as a reliable measure for subjective
footwear comfort since they have been proven as a reliable measure to assess subjective pain
(Gramling & Elliott, 1992). VASs that are 100 to 150 mm in length have been shown to have
the greatest sensitivity and were the least vulnerable to distortions or biases in rating (Stevens
& Marks, 1980). The ratio scale property of VAS will allow quantification of the difference
in comfort between two or more footwear conditions. Therefore, the purpose of this study
was to determine the reliability of comfort of shoe inserts using visual analogue scales.

Nine volunteers (4 females, 5 males, age 26.7 ± 4.9 yrs; height 171.2 ± 7.1 cm; weight 71.7 ±
8.5kg) gave informed consent and participated in this study. All subjects were free of lower
extremity injury or pain. The four shoe insert conditions tested were (a) a control insert (3
mm EVA, 3 mm spenco), (b) a soft insert (3 mm poron, 3 mm spenco), (c) a hard insert (3
mm EVA, 3 mm korex), and (d) a posted insert (6 mm medial EVA post, 3 mm spenco) with
the following shore C values: EVA: 73; spenco: 40; poron: 28; korex: 76. All shoe inserts
had no visually noticeable difference and were tested in a standard running shoe (Adidas
Super Nova). A 150 mm VAS (left end = ‘not comfortable at all’; right end = ‘most
comfortable condition imaginable’) was used to assess footwear comfort. Data for each
subject were collected in ten sessions on ten consecutive workdays. In each session, subjects
ran two laps on a 450 m indoor running track to warm up. Subjects were instructed that the
first, third, fifth and seventh condition were the control condition but were unaware of the
order of the test inserts. They then ran one lap using the insert conditions C-Ii-C-Ij-C-Ik-C-R
where C corresponded to the control condition, I to an insert condition and R to an arbitrarily
chosen repeat insert condition. The sequence of the insert condition was randomly varied.
After each lap, the subjects assessed footwear comfort for the tested shoe insert condition.
Pearson product moment correlation coefficients (R) for repeated comfort ratings were
determined for all subjects and sessions and individually for subjects and sessions.
                                 Proc. of the 5th Symp. on Footwear Biomechanics, 2001, Zuerich / Switzerland, (Eds. E. Hennig, A. Stacoff)                                                           65

                                                                    RESULTS AND DISCUSSION
                        15                                                           15                                                                     2.5
comfort points repeat

                                                                    Comfort points

                                                                                                                                           Comfort points
                                                                                          1   2      3   4      5   6   7   8    9    10
                         0                                                                                                      session                     0.0
                                                                                                  Control Insert        Soft Insert                                1      1 to 3   4 to 6    7 to 9
                             0          5          10         15
                                                                                                  Hard Insert           Medial Wedge
                                            comfort points test 1                                                                                                                           sessions
                  Figure 1. Comfort ratings for                     Figure 2. Comfort ratings for subject 1                                                   Figure 3. Average distance from
                  repeated conditions.                              for all insert conditions and sessions.                                                   “true comfort rating”.
   The Pearson’s correlation                                  Sessions 1 to 3 Sessions 4 to 6 Sessions 7 to 9
   coefficient for within session Average Variability               1.89           1.28            1.28
   repeatability for all subjects     [comfort points]

   and sessions was R = .799       Table 1. Average variability for all subjects.

   (Figure 1). After exclusion of subjects with R < .400 (n = 3), the within session repeatability
   was R = .911. The average difference in the repeat assessments following different preceding
   conditions was 0.5 for all subjects with an average difference of up to 1.6 comfort points for
   some subjects. Thus, an insert condition can affect the comfort rating of the following insert
   condition and, therefore, a control condition should be included for comfort assessment.

   Comfort ratings of sessions 1 to 3 varied more than comfort ratings of sessions 4 to 10
   (Figure 2, Table 1). Therefore, a “true comfort rating” was defined as the average of the
   ratings of sessions 4 to 10 for each subject and condition. The comfort rating of session 1
   differed in the average by more than 2 comfort points from the “true comfort rating” (Figure
   3). Thus, the first assessment of footwear comfort does not represent the “true comfort
   rating”. The average comfort rating for session 4 to 6 differed less than 0.5 comfort points
   from the “true comfort rating”. The average comfort rating for sessions 7 to 9 did not provide
   any improvement (Figure 3). Thus, the average comfort rating for session 4 to 6 represents
   the “true comfort rating” most accurately and is proposed for comfort assessments.
   The results of this study showed that VASs provide a reliable measure to assess footwear
   comfort under the conditions that (a) a control condition is included, (b) subjects with low
   repeatability are excluded, and (c) the average comfort rating of sessions 4 to 6 is used. In
   this study, subjects were tested on ten days with one session per day. Future research should
   be conducted to determine the optimal combination of number of conditions per session,
   running distance per condition, total running distance per day, and number of test days.

   Chen H. et al. Clin. Biomech., 9, 335-341, 1994.
   Gramling S.E. & Elliott T.R., Behav. Res. Ther., 30, 71-73, 1992.
   Miller J.E. et al., Foot & Ankle Int., 21, 759-767, 2000.
   Nigg B.M. et al. Med. Sci. Sports Exerc., 31, 421-428, 1999.
   Steven J.C. & Marks L.C., Percept. Psychophys., 12, 417-434, 1980.

   This work was supported by the Canadian Department of Foreign Affairs and International Trade and NSERC

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