--- title: "Plantar Pressure Offloading: How Do Clinical Insoles Help?" description: Learn how clinical insoles measure plantar pressure, identify loading hotspots, and help clinicians evaluate offloading and orthotic adjustments. image: https://blog.xsensor.com/hubfs/Clinical-Insoles-Gait-Assessment_1200x628.png --- [![XSENSOR](https://blog.xsensor.com/hubfs/raw_assets/public/XSENSOR_February2021/images/logo.svg "XSENSOR")](https://www.xsensor.com/) - [Solutions & Platform](https://xsensor.com/solutions-and-platform/solutions-platform-landing) - SOLUTIONS - - - [Continuous Skin Monitoring](https://www.xsensor.com/solutions-and-platform/csm/continuous-skin-monitoring) - [Patient Bed Monitoring](https://www.xsensor.com/solutions-and-platform/csm/patient-bed-monitoring) - [Wheelchair Seating](https://www.xsensor.com/solutions-and-platform/csm/wheelchair-seating) - [Surgical Table Monitoring](https://www.xsensor.com/solutions-and-platform/csm/surgical-table-monitoring) - - [Human Performance](https://www.xsensor.com/solutions-and-platform/human-performance/human-performance) - 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Published by [XSENSOR Marketing](https://blog.xsensor.com/author/xsensor-marketing) on Oct 23, 2026, 11:21:24 AM A patient with neuropathy might walk into your clinic with intact skin, perfectly reasonable footwear, and no pain. But put a pressure-sensing insole inside the shoe, and you may find the same small section of the shoe absorbing all the weight with every step. That doesn't mean an ulcer is on the way; it does provide data you are unlikely to get while the patient is sitting on an exam table, especially if reduced sensation prevents them from feeling excessive weight on their own. That makes plantar pressure useful for risk assessment, but not as a risk score on its own. Neuropathy, previous ulceration, deformity, skin condition, vascular status, and the rest of the clinical exam still matter, and research has found limited accuracy when plantar pressure measurement is used by itself to predict future ulceration.  ## **How Do Clinical Insoles Measure Pressure Injury Risk?** **![Intelligent-InsolesProResearch (1)](https://blog.xsensor.com/hs-fs/hubfs/Intelligent-InsolesProResearch%20(1).jpg?width=1080&height=1350&name=Intelligent-InsolesProResearch%20(1).jpg)** Checking skin integrity, testing protective sensation, looking for calluses, and reviewing previous ulcers are basic parts of an assessment. At the same time, footwear and foot structure add more information about where problems may develop. Add walking so you can observe how the body’s weight shifts in motion, how the shoes bend, how the orthotics compress, and where and when the patient falls into the gait pattern they use outside the clinic. Clinical pressure-sensing insoles are a great way to get all that information. Instead of a static snapshot from a seated or even standing patient, they record plantar pressure as the patient moves, which can reveal a region under the metatarsal heads taking more weight late in stance or an imbalance between the two feet that wasn't obvious during the physical exam. This can be particularly useful for patients with reduced sensation. A patient may tell you their shoe feels completely fine, while the pressure data shows the same area being pushed hard repeatedly. ### **Which Plantar Pressure Measurements Matter Most?** Peak plantar pressure is probably going to be the first thing you look at because it shows where the foot is taking the most pressure during a step. If the same spot keeps showing up under a metatarsal head, around a callus, or near an old ulcer site, you now have a specific area to address instead of just knowing the patient has a higher-risk foot. But the highest number is not always the whole problem. Look at how the weight is being spread across the rest of the foot, how long that area stays loaded, and what happens to it as the patient moves through their stance. A quick spike in pressure is different from having the same section of the foot loaded for much longer during each step. Center of pressure lets you follow where weight is actually traveling from the moment the foot hits the ground until push-off. Comparing the left and right sides can also show whether one foot is doing much more work than the other, but that doesn't automatically mean something needs to be corrected. Previous surgery, deformity, neurological problems, or even an old injury can all give someone a perfectly good reason to walk differently on one side. ### **Why Is In-Shoe Measurement Different From Barefoot Testing?** Taking the shoe off changes what you are measuring. That can be fine if you want to know how the foot moves barefoot, but it doesn't show what happens once the patient puts their regular shoes back on, stands on the orthotic, and starts walking again. An in-shoe system keeps it all where it belongs. The shoe bends, the insert compresses, the foot moves around inside it, and you can see what happens while the patient uses the setup they'll actually leave the clinic wearing. It also makes testing an adjustment pretty straightforward. Get a reading from what they are wearing now, make the change you wanted to try, and then have them walk again to see if anything happened under the area you were trying to take weight off. Sometimes the difference will be obvious. Other times almost nothing changes, or the pressure drops exactly where you wanted it to and then shows up somewhere else on the foot, which is why you still need to look beyond that one spot. If you want to learn more about clinical gait assessment, we have some great posts that go into more detail: - [Clinical Assessment of Walking and Running Gait](https://blog.xsensor.com/clinical-assessment-walking-running-gait). - [Clinical Gait Analysis Insoles](https://www.xsensor.com/solutions-and-platform/human-performance/clinical-gait-analysis-insoles) ## **How Can Clinical Insoles Identify Pressure Hotspots & Evaluate Offloading?** **![Intelligent-Insoles-2 (1)](https://blog.xsensor.com/hs-fs/hubfs/Intelligent-Insoles-2%20(1).png?width=1080&height=1350&name=Intelligent-Insoles-2%20(1).png)** Say a patient with peripheral neuropathy comes back wearing the therapeutic shoes you recommended. Their skin looks fine, nothing about the shoe looks wrong, and they tell you everything feels comfortable, but when someone has reduced sensation, that can only tell you so much. Get them walking with pressure-sensing insoles, and you may see the same small section of the forefoot taking much more weight than everything around it. If it keeps happening step after step, you now have something specific to investigate even though the patient doesn't have an open wound and hasn't complained about pain. That doesn't mean the hotspot will turn into an ulcer. It does tell you that one area is being loaded repeatedly, and now you can compare that with the skin, callus, deformity, previous ulcer history, and everything else you found during the exam. Then change something. Adjust the orthotic, move the offloading around that area, or try another footwear setup and get the patient walking again. If the pressure comes down where you wanted it to, great, but look at what happened everywhere else too. You don't want to take weight off one problem area only to find that you dumped it onto another part of the foot and created a second problem you didn't have before. ### **Can Patient Comfort Tell You the Same Thing?** Sometimes it can tell you plenty. Somebody with normal sensation may know almost immediately that the orthotic is pushing into the side of the foot, that the shoe suddenly feels tight, or that something doesn't feel the way it did before. A patient with neuropathy may not give you that warning. They can tell you the shoe feels completely fine while one part of the forefoot is being hit hard every time they put the foot down. It can go the other way too. You might get exactly the pressure reduction you wanted on the screen and still end up with an orthotic the patient hates because it feels unstable or changes the way they walk. You need both pieces. The patient can tell you whether they can actually use what you gave them, while the insole shows what happens to the weight under the foot once they start moving. ## **Can Plantar Pressure Alone Predict a Foot Ulcer?** No. A high-pressure area can be part of the risk picture, but one reading won't tell you a patient will develop an ulcer. A systematic review and meta-analysis on foot pressure and later ulceration found limited predictive accuracy when pedobarography was used alone. \[1\] Pressure matters, but too many other factors affect the patient for one measurement to give the full answer. Take two patients with almost identical pressure under the forefoot. One has normal sensation, no previous ulcer and no obvious vascular problems, while the other has neuropathy, a deformity and a history of tissue breaking down in the same place. The number on the screen may be almost the same. The patients clearly aren't, and neither is the amount of concern you'll have about that pressure reading. ### **How Should Pressure Data Be Combined With Other Risk Factors?** Loss of protective sensation is a major concern because the patient can keep walking on an overloaded area without the pain that would normally make them stop, shift their weight, or change how they move. Previous ulceration tells you something different because now you already know that tissue in that part of the foot has broken down before. Foot deformity can put more weight through one small section of the foot, while a callus can also show that the area has been under repeated stress for a while. Then consider the skin itself, vascular status, footwear fit, how much the person actually walks, and whether their gait has changed recently. This is also where a pressure map can be very easy to overread. A bright red area on the screen looks dramatic, but it doesn't suddenly give you a percentage telling you that this patient has a 60% or 80% chance of developing an ulcer. You still have to put everything together. The insole shows what the foot is doing as the patient walks, while the rest of the assessment tells you what that finding means for the person sitting in front of you. ### **Should Clinicians Chase Thresholds or Compare With Baseline?** Researchers have long tried to identify useful [plantar pressure thresholds](https://pubmed.ncbi.nlm.nih.gov/38390156/), especially in diabetic foot care. A 2024 systematic review found several thresholds in use, but the variation between studies is still too great to apply a single pressure number in every clinic to every patient.  Systems can differ, walking tests can differ, and researchers don't always divide the foot into the same regions when they analyze the results. So a number that worked as a threshold in one study doesn't automatically become the point where loading suddenly turns dangerous on a completely different system. For one patient, their own baseline can be a lot more useful. If you are trying to take pressure off a particular metatarsal head, record what is happening now, change the orthotic, and then test the same area again. Now you have a before-and-after from the same person. You can see whether the pressure actually came down where you wanted it to and, just as importantly, whether you pushed more of that weight somewhere else instead. That same baseline can become useful again months later. If the patient comes back wearing new shoes, has developed a callus, or suddenly isn't walking the same way, you have an older recording to compare it with instead of treating every pressure map like you have never seen their foot before. ## **Why Do Repeatability & Calibration Matter in Clinical Monitoring?** If you took a pressure map six months ago and want to compare it with one today, you need to be reasonably sure the equipment isn't creating the difference for you. Sensor design, calibration, sampling, and even how the data is analyzed can vary between systems, and a 2024 review found considerable variation across [in-shoe plantar pressure technologies](https://pubmed.ncbi.nlm.nih.gov/38699042/).  Simple factors can also throw things off. Maybe the patient is walking faster this time, wearing different socks, using different shoes, or you collected a different number of steps than at the last appointment. And real patients don't come back in the same condition every time. Somebody may be walking slower because their knee hurts, their orthotic may have been adjusted somewhere else, or the shoes they wore last time may have been replaced months ago. You don't need to turn every follow-up into a biomechanics study, but you do need to know what changed. Keep the walking task as similar as possible and note what isn't the same before you decide the patient's pressure has actually gone up or down. ### **When Should a Patient Be Reassessed?** No single schedule works for everyone. Sometimes you'll repeat the test five minutes later because you just changed an orthotic and want to know whether you actually took pressure off the area you were trying to protect. Other times the reason doesn't show up until months later. The patient buys different shoes, develops a new callus, starts walking differently, or comes in with new skin irritation, and now you have a reason to check whether anything has changed underneath the foot as well. Risk matters too. Somebody with neuropathy and a previous ulcer obviously isn't going to be looked at the same way as a patient with intact sensation who is being assessed for a much less serious gait problem. So reassess when there is something worth checking. What you changed, what happened to the patient, and what you are worried about should determine when you measure again instead of putting everybody on the same timetable. ### **Where Do XSENSOR Intelligent Insoles | Clinical Fit?** XSENSOR Intelligent Insoles collect pressure and gait data while the patient walks. The system provides up to 235 sensels per insole, sampling rates up to 150 Hz, pressure and load distribution, center of pressure, and gait visualization. That gives you more to work with than one pressure number. You can see what the patient is doing now, change the footwear or orthotic, and then put them straight back into another walking trial to see what actually happened. It can work the same way at a later appointment. If you already have a recording from that patient, the new test can show whether their pressure pattern has stayed pretty similar or whether something has moved as their shoes, gait, or condition changed. This also has a practical side. If checking an orthotic means turning every appointment into a huge setup, you probably won't do it often, so collecting the data with the patient walking in their normal footwear makes a difference in day-to-day use. ## **What Else Should Clinicians Know About Pressure-Sensing Insoles?**   **![intelligent insoles system\_03](https://blog.xsensor.com/hs-fs/hubfs/intelligent%20insoles%20system_03.png?width=800&height=630&name=intelligent%20insoles%20system_03.png)** ### **Can Pressure Insoles Predict Diabetic Foot Ulcers?** Not by themselves. They can [show where pressure is building](https://pubmed.ncbi.nlm.nih.gov/34590893/) and whether the same part of the foot keeps taking that weight again and again, but the research doesn't support using a single pressure measurement to predict who will develop an ulcer.  Put that alongside neuropathy, previous ulceration, deformity, vascular status, and skin appearance, and the reading becomes much more useful. The insole gives you another piece of information about the patient, not the whole answer. ### **Are Clinical Pressure Insoles Diagnostic Devices?** No. Pressure-sensing insoles show what is happening underneath the foot while the patient walks. They can give you pressure, loading, and gait information, but the map itself doesn't tell you why that hotspot is there. You still need to work that out. A shoe that doesn't fit properly, a rigid deformity, and a neurological change in how someone walks can all leave you staring at a high-pressure area for completely different reasons. ### **Can Insoles Evaluate Orthotics?** Yes. Test the patient in the orthotic they are wearing now, make your adjustment, and then have them walk again under roughly the same conditions. You can see whether the pressure came down in the area you were trying to protect. Just don't forget the rest of the foot, because taking weight away from one place can sometimes mean putting more of it somewhere else. ### **Can Clinicians Compare Pressure Before & After Footwear Changes?** Yes. Because the measurement happens inside the shoe, you can test the patient in the old pair, then have them walk again in the new ones. Try not to change everything else at once. If the shoe, orthotic, walking speed, and how you run the test all change together, it becomes much harder to figure out which one actually changed the pressure pattern. ### **Are Pressure Measurements Comparable Between Different Insole Systems?** Not necessarily. Different systems can use different sensors, calibration methods, layouts, sampling rates, and data-analysis approaches, so the same-looking number on two reports doesn't automatically mean the same thing.  That matters even more when you are following the same patient over time. If the baseline came from one system and the next test was done on another, some of the difference you are seeing may be coming from the equipment instead of the patient's foot. 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[Read More](https://blog.xsensor.com/webinar-creating-a-confident-clinical-practice-part-1) ## [Optimize Sport Rehab Outcomes with Plantar Pressure Mapping](https://blog.xsensor.com/how-to-optimize-sport-rehabilitation-outcomes-using-plantar-pressure-mapping) Sports rehabilitation is a multifactorial and complex process that requires a team approach where... [Read More](https://blog.xsensor.com/how-to-optimize-sport-rehabilitation-outcomes-using-plantar-pressure-mapping) ## [Webinar (Part 2): Pressure Mapping & sEMG in Practice](https://blog.xsensor.com/webinar-plantar-pressure-mapping-complementary-technologies-part-2) In the second webinar of XSENSOR Technology's “Plantar Pressure Mapping & Complementary Technologies [Read More](https://blog.xsensor.com/webinar-plantar-pressure-mapping-complementary-technologies-part-2) ![XSENSOR](https://blog.xsensor.com/hubfs/raw_assets/public/XSENSOR_February2021/images/logo.svg "XSENSOR") 133 12 Avenue SE Calgary, AB, T2G 0Z9 CANADA ‍ [+1 (403) 266-6612](tel:14032666612) Copyright 2023 XSENSOR Technology Corporation. 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