Smart Insole Visual Foot Pressure Feedback in Mixed Reality Environments: Impact on Gait, Heart Rate, Workload, and Engagement in Treadmill Walking

Abstract

Although orthotic footwear supports the rehabilitation of lower-limb injuries, it often impairs natural gait control. Due to the lack of additional feedback, patients are unaware of abnormal foot pressure distributions, which can hinder recovery. Prior work has demonstrated the potential of virtual and mixed reality (VR/MR) for gait training with visual feedback. However, it remains unclear how smart insole pressure feedback affects gait and user experience in VR/MR. We conducted a within-subject study with 24 participants, testing four visual feedback modalities across three virtual environments during treadmill walking. Quantitative and qualitative results showed that a virtual forest altered gait, increased engagement, and reduced workload, while a pressure heatmap influenced objective and subjective measures depending on the environment. We provide empirical insights on foot augmentation in immersive settings and contribute design recommendations for future VR/MR gait training applications.