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Lower extremity injuries rank among the most common injuries affecting young population, and numerous factors affect the outcomes of plantar pressure and balance assessment. Does a correlation exist between plantar pressure and postural balance in healthy subjects and are there any difference in the results based on gender and limb dominance? This study involved thirty healthy recreationally active young adults (15 females, 15 males). Plantar pressures were analyzed using the MatScan Pressure Mat System, and postural balance was evaluated using Biodex Balance System. All assessments conducted under both static and dynamic conditions. Correlations were tested by Spearman Correlation Coefficient, and comparative tests were performed for gender and limb dominance. Correlations were observed between plantar pressure parameters and balance scores, particularly in the dynamic conditions (p < 0.05). Gender-based differences were noted in plantar pressure parameters (p < 0.05), with females demonstrating improved balance stability scores. No significant differences were found based on limb dominance in plantar pressure and postural balance data (p > 0.05). This study provides valuable detailed insights into the existing literature concerning plantar pressure and postural balance assessments within the healthy population. A strong correlation was observed between plantar pressure and postural balance, and the comparisons of these assessments were affected by gender but not by limb dominance. These results could lead the way for better rehabilitation approaches by considering the correlations and differences across diverse populations. • Plantar pressure parameters in young healthy adults are correlated with postural balance scores. • Plantar pressure and postural balance variables are affected by gender. • Limb dominance has no effect on plantar pressure and postural balance variables. [ABSTRACT FROM AUTHOR]

Background: Calcaneal fractures are among the most common foot injuries and sometimes develop manifold post-surgical complications. Restricted foot movement is one of the main functional limitations which often persists during long-term rehabilitation. Therefore, it is important to quantitatively monitor the biomechanical foot mobility after calcaneal fracture from an early stage in order to achieve an optimal therapeutic treatment.Research Question: Evaluation of the Center of Pressure velocity (vCOP) in patients after intrarticular calcaneal fractures during the healing progress from three to 24 months after surgery.Methods: A total of 20 patients with unilateral calcaneal fracture were investigated by means of pedobarography and marker-based gait analysis at three, six, 12 and 24 months after surgery. Data for vCOP [m/s], maximum external dorsal extension moments during stance (DEmomentstance) and tibiotalar range of motion during mid stance (MS) and terminal stance (TS) were obtained. Functional evaluation was performed using clinical examination (e.g. calf circumference measurements) and patient-reported outcome measures (SF-36).Results: When compared to the healthy side, vCOP of the injured side showed a significant reduction during MS (3 months: 48%, p < 0.001; 6 months: 13%; p = 0.040) and an significant increase during TS (3 months: 110%, p < 0.001; 6 months: 43%, p < 0.001; 12 months: 17%, p = 0.012). DEmomentstance of the fractured foot, showed a significant increase of 80% (p < 0.001) from three to 24 months after surgery, which correlated with vCOP at three and six months after surgery (p < 0.05; vCOP MS: 3 months: r = 0.876, 6 months: r = 0.685; vCOP TS: 3 months: r = -0.554, 6 months r = -0.626).Significance: vCOP might serve as an indicator for foot mobility and function during the early healing phase after calcaneal fractures. As vCOP can be obtained by pedobarography it is more readily accessible an less costly compared to foot function obtained by marker based gait analysis. [ABSTRACT FROM AUTHOR]

Background: Patients with severe haemophilia suffer from bleeding-related joint changes in which the ankle joint is most frequently affected. In the resulting gait changes, the forefoot is involved by reducing the foot pressure. However, it is unclear which changes in foot pressure are present in the individual's foot zones.Research Question: The aim of the study was to determine whether compensation mechanisms are present in the foot zones regarding the peak pressure under dynamic conditions and to identify possible underlying mechanisms for gait changes.Methods: In a controlled cross-sectional study, a pedobarography was performed during gait with a standardized speed (3 km/h) in patients with haemophilia (PwH;n = 40) and healthy controls (Con;n = 40). Pressure pain thresholds (PPT) were detected, and Haemophilia Joint Health Score (HJHS) was performed to determine the current joint status.Results: PwH showed a decreased peak pressure in metatarsals II-IV and heel compared to Con. Patients with major-affected ankle joints (determined with the HJHS) showed a decreased single-step length, stride-length and stride-time. Accordingly, the cadence was increased by 10 ± 11 steps/min in PwH compared to Con. Furthermore, PwH showed decreased ankle range of motion (ROM) in HJHS and an altered pain perception due to reduced PPT.Significance: PwH showed a changed gait pattern in peak pressure compared to Con. A restricted rolling behavior, which might be caused by movement restrictions and pain sensation, leads to reduced pressure in the center forefoot, resulting in a shorter stride-length. Future therapies should focus on maintaining joint mobility for better rolling behavior and improving ankle joints' stability to achieve a balanced load between the midfoot, heel, and forefoot. The use of insoles adapted to our data, based on group differences between PwH and Con, could be supportive in this case. [ABSTRACT FROM AUTHOR]

Background: An exact definition is lacking for the term "weight-bearing" or different standing modalities when implementing foot radiographs for children and adults; moreover, only few studies have investigated the relationship between radiographic and pedobarographic measurements.Research Question: We hypothesized that the method of weight-bearing in single-leg and both-leg standing positions could influence the measurement results in radiographs and the distribution of foot pressure.Methods: This prospective study evaluated 33 children (66 feet) with flexible flatfoot deformities scheduled for subtalar screw arthroereisis surgery. Radiographs in the lateral and anteroposterior (AP) views were assessed independently in the single-leg and both-leg standing positions. Static pedobarography was performed as that for measuring weight-bearing. Standardized radiographic angles and pedobarographic data were analysed and correlated.Results: There were differences in radiographic measurements between the single-leg and both-leg standing positions, including the AP talocalcaneal angle (p = 0.032), AP talus-first metatarsal base angle (p = 0.003), AP talus-first metatarsal angle (p = 0.003), lateral calcaneal pitch angle (p = 0.001), talus-first metatarsal index (p = 0.004), and talocalcaneal index (p = 0.029). Moreover, differences between these two standing modalities were found in most of the static pedobarographic data, including the contact area (p = 0001), maximal force (p = 0.001), and peak pressure (p = 0.007). Overall, medial foot pressure increased more in both-leg standing than in the single-leg standing position, whereas radiographic measurements showed a more pronounced flatfoot deformity in the single-leg standing position. The AP talus-first metatarsal angle was the only angle or index with a significant association to some pedobarographic measurements in both standing modalities.Significance: As there are significant differences between single-leg standing and both-leg standing radiographic and static pedobarographic values, observers have to be precise in the definition of "weight-bearing" to gain reproducible and comparable study values in children and adults. We recommend acquiring both-leg standing foot radiographs because children with flexible flatfeet can stand more steadily in this position than in the single-leg standing position. [ABSTRACT FROM AUTHOR]

Background: Dravet Syndrome (DS) is a developmental and epileptic encephalopathy characterized by severe drug-resistant seizures and associated with cognitive and motor impairments. Walking problems are frequently observed. As the foot plays a key role during walking, compromised foot function can be a feature of deviant gait.Aim: To investigate foot function in DS by characterizing foot-floor contact patterns using pedobarography.Methods: A total of 31 children and adults were included in the DS group (aged 5.2-32.8 years, 17 female, 174 steps) and 30 in the control group (aged 6.0-32.9, 16 female, 180 steps). The foot-floor contact pattern was evaluated based on progression, length and smoothness (spectral arc length) of the center of pressure (CoP). Linear mixed models were used to identify differences between non-heel strikes and heel strikes and between the DS and control group.Results: Fifteen participants with DS showed inconsistency in the type of foot-floor contact (heel strikes and non-heel strikes). Heel strikes of participants with DS had significantly reduced time of CoP under the hindfoot and increased time under the midfoot region compared to the control group. Significant time and age effects were detected.Conclusions and Implications: Deviant foot-floor contact patterns were observed in DS. Possible gait immaturity and instability as well as implications for interventions are discussed. [ABSTRACT FROM AUTHOR]

Background: Abnormal foot posture is a common complaint presented in pediatric and pediatric orthopedic clinics. Functional, objective assessment of foot posture, with the potential for early identification of pathologic foot deformities, has, however, been lacking to date. While quantifying functional and regional impulses via dynamic pedobarography can improve the clinical assessment of children's feet, normative values have not yet been reported or characterized.Research Question: The objectives of this study were to: (1) quantify and characterize the pattern and spectrum of foot impulses in walking-aged, typically developing children; and (2) compare these to impulses from non-disabled adults.Methods: Foot impulses of 102 participants (52 female) in five pre-determined age groups (2-3, 4-6, 7-10, 11-14, 15-17 years) were examined using dynamic pedobarography. Each pressure map (3 per foot per child) was divided according to anatomical foot regions: the hallux, heel, medial forefoot, lateral forefoot, lesser toes (D2 to D5), and midfoot. The impulse was calculated for each region and used to generate regional percent impulses and impulse ratios to assess anteroposterior and mediolateral balance within the foot.Results: The impulse through the midfoot was highest in the youngest age group, with a corresponding lower impulse through the medial forefoot. As age advanced, the midfoot impulse decreased (p = 0.001), and the forefoot balance shifted slightly more medially (%Medial Forefoot: p = 0.004; Medial-Lateral Forefoot Balance: p = 0.019). When compared to adults, there were no significant differences between 15-17 year old children and adults in any of the regional percent impulses and impulse ratios. This indicates that skeletal maturity of the foot by late adolescence results in functional characteristics seen in adults.Significance: The age-standardized norms of functional and regional impulse measures in children reported in this study can be used as a comparative benchmark in the clinical assessment of children presenting with various foot deformities. [ABSTRACT FROM AUTHOR]

Background: There is considerable debate as to which parameters to include in the assessment of paediatric flatfeet. Dynamic pedobarography is an objective, dynamic method to measure foot function. Information about its associations to patient-reported measures may help to focus on the most relevant parameters.Research Question: What is the association between the Foot Function Index and pedobarographic assessments in flatfeet of children and adolescents?Methods: A consecutive clinical case series of 51 participants with idiopathic flexible flatfeet aged 7-17 years underwent barefooted pedobarography during gait and completed the Foot Function Index Questionnaire. Pedobarographic data categorized into values related to area, peak pressure and force with respect to the hind-, mid- and forefoot were extracted. To test the associations between the Foot Function Index and pedobarographic assessments, bivariate partial correlations were tested and contact times served as co-variate.Results: Several significant associations between peak pressure or forces beneath the hindfoot, midfoot and hallux to self-perceived function were found (|rho| = 0.28-.46, P < 0.05). In particular, reduced peak forces and pressures underneath the hindfoot and hallux, a lateral shift (smaller medio-lateral ratios) of hindfoot pressure and force and a medial shift (larger medio-lateral ratios) of midfoot pressure seem to be negatively associated with foot-related disability. Overall, less evidence was noted for associations to pain scores. Area related outcomes (including the arch index) contained no information for function while a larger BMI was the strongest thread for disability (rho = 0.42, P = 0.002) and pain (rho = 0.31, P = 0.027).Significance: When using pedobarography for the assessment of flexible flatfeet of children and adolescents, less attention should be paid to area related measurements which do not provide information about self-perceived function or disability. Instead, peak pressures or forces in the hind- or midfoot or beneath the hallux may be focussed. Weight reductions are potentially an effective strategy to reduce or prevent symptoms. [ABSTRACT FROM AUTHOR]

Background: Pedobarography is a commonly used testing procedure in clinical gait analysis, yet has limited roles in quantification for treatment planning, outcome assessment, and classification. Spatial registration between plantar pressure and motion capture data allows for accurate quantitative assessment and metric development based on a typically developing cohort.Research Question: This study assesses the validity of new center of pressure based metrics of anatomically registered pedobarography data by evaluating kinematic relationships over a broad spectrum of feet and by evaluating the sensitivity of these metrics to pathologies, interventions, and outcomes in two common clinical foot pathologies.Methods: 3D trajectories from retroreflective markers were recorded to establish a single foot axis simultaneous with plantar pressure mat data spatially calibrated to a global coordinate system. Indices for clinical populations were determined as mediolateral (MLI, |MLI|, MFI) and anteroposterior (API, |API|) deviations of center of pressure excursions from typically developing feet. 198 feet were retrospectively identified to evaluate relationships between mediolateral (ML) indices and foot kinematics over a spectrum of foot pathologies. Additional feet from two broad pathologic foot types, planovalgus (PV) and cavovarus (CV), were assessed pre and post-surgery to determine sensitivity to pathology, surgical intervention, and outcomes.Results: ML indices and supination were highly correlated (r2 > 0.5). Two mediolateral indices (MLI, MFI) and one anteroposterior index (|API|) demonstrated significant differences between typical and PV feet, with the MFI index also exhibiting significant improvement with surgery. All three mediolateral indices and |API| demonstrated differences between typical and cavovarus feet, with |API| significantly improving with surgery. Changes in API also correlated with patient goals.Significance: Spatial registration between plantar pressure center of pressure and motion capture data allows calculation of indices that reflect foot function and are sensitive to foot pathologies and treatment outcomes. [ABSTRACT FROM AUTHOR]

Highlights • Dynamic pedobarography can be used to measure plantar pressure patterns in gait. • Current analyses lack functional, impulse-based measures and normative data. • A functional segmentation method was developed and impulse-based measures obtained. • Measure variability was acceptable and intra- and inter-rater reliability excellent. • A normative data set is given that can serve as a benchmark for clinical evaluation. Abstract Background Dynamic pedobarography is used to measure the change in plantar pressure distribution during gait. Clinical methods of pedobarographic analysis lack, however, a standardized, functional segmentation or require costly motion capture technology and expertise. Furthermore, while commonly used pedobarographic measures are mostly based on peak pressures, progressive foot deformities also depend on the duration the pressure is applied, which can be quantified via impulse measures. Research Question Our objectives were to: (1) develop a standardized method for functionally segmenting pedobarographic data during gait without the need for motion capture; (2) compute pedobarographic measures that are based on each segment's vertical impulse; and (3) obtain a normative set of such pedobarographic measures for non-disabled gait. Methods Pedobarographic data was collected during gait from sixty adults with normal feet. Using the maximum pressure map for each trial, an expert and novice rater independently identified the hallux, heel, medial forefoot, and lateral forefoot and computed nine normalized vertical impulse measures. Results From the computed impulse measures, the Heel-to-Forefoot Balance was 33.3 ± 5.5%, the Medial-Lateral Forefoot Balance (with hallux) 59.2 ± 8.0%, the Medial-Lateral Forefoot Balance (without hallux) 53.5 ± 7.7%, and the Hallux-to-Medial Forefoot Balance 21.0 ± 8.9% (mean ± standard deviation). The intra- and inter-rater reliability ranged between 0.93 and 1.00 and between 0.89 and 0.99, respectively (ICC(2,1)). Significance We developed a simple, stand-alone method for pedobarographic segmentation that is mechanistically linked to relevant anatomical regions of the foot. The normative impulse measures exhibited excellent reliability. This normative dataset is currently used in the clinical assessment of different foot deformities and gait impairments, and in the evaluation of treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: The measurement of plantar pressure distributions during gait can provide insights into the effects of musculoskeletal disease on foot function. A range of hardware, software, and protocols are available for the collection of this type of data, with sometimes disparate and conflicting results reported between individual studies. In this systematic review and meta-regression analysis of dynamic regional peak pressures, we aimed to test if 1) the system used to obtain the pressure measurements and 2) the characteristics of the study populations had a significant effect on the results.Methods: A systematic review of the literature was undertaken to identify articles reporting regional peak plantar pressures during barefoot walking. A mixed-effects modeling approach was used to analyze the extracted data. Initially, the effect of the system used to collect the data was tested. Following this, the effect of participant characteristics on the results were analyzed, using moderators of cohort type (defined as the primary health characteristic of the participants), age, sex, and BMI.Results: 115 participant groups were included in the analysis. Sufficient cohorts were available to test those that consisted of healthy individuals, and those with diabetes and diabetic neuropathy. Significant differences were found between results reported by studies using different pressure measurement systems in 8 of the 16 regions analyzed. The analysis of participant characteristics revealed a number of significant relationships between regional peak pressures and participant characteristics, including: BMI and midfoot plantar pressures; elevated forefoot pressures as a result of diabetic neuropathy; and sex-differences in regional loading patterns.Conclusions: At the level of the literature, we confirmed significant effects of disease status, age, BMI, and sex on regional peak plantar pressures. Researchers and clinicians should be aware that measurements of peak plantar pressure variables obtained from different collection equipment are not directly comparable. [ABSTRACT FROM AUTHOR]

Background: Pedobarography produces large sets of plantar pressure samples that are routinely subsampled (e.g. using regions of interest) or aggregated (e.g. center of pressure trajectories, peak pressure images) in order to simplify statistical analysis and provide intuitive clinical measures.Research Question: We hypothesize that these data reductions discard gait information that can be used to differentiate between groups or conditions.Methods: To test the hypothesis of null information loss, we created an implementation of statistical parametric mapping (SPM) for dynamic plantar pressure datasets (i.e. plantar pressure videos). Our SPM software framework brings all plantar pressure videos into anatomical and temporal correspondence, then performs statistical tests at each sampling location in space and time. Novelly, we introduce non-linear temporal registration into the framework in order to normalize for timing differences within the stance phase. We refer to our software framework as STAPP: spatiotemporal analysis of plantar pressure measurements. Using STAPP, we tested our hypothesis on plantar pressure videos from 33 healthy subjects walking at different speeds.Results: As walking speed increased, STAPP was able to identify significant decreases in plantar pressure at mid-stance from the heel through the lateral forefoot. The extent of these plantar pressure decreases has not previously been observed using existing plantar pressure analysis techniques.Significance: We therefore conclude that the subsampling of plantar pressure videos - a task which led to the discarding of gait information in our study - can be avoided using STAPP. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to establish normative reference values for spatiotemporal and plantar pressure parameters, and to investigate the influence of demographic, anthropometric and physical characteristics.Methods: In 1000 healthy males and females aged 3-101 years, spatiotemporal and plantar pressure data were collected barefoot with the Zeno™ walkway and Emed® platform. Correlograms were developed to visualise the relationships between widely reported spatiotemporal and pressure variables with demographic (age, gender), anthropometric (height, mass, waist circumference) and physical characteristics (ankle strength, ankle range of motion, vibration perception) in children aged 3-9 years, adolescents aged 10-19 years, adults aged 20-59 years and older adults aged over 60 years.Results: A comprehensive catalogue of 31 spatiotemporal and pressure variables were generated from 1000 healthy individuals. The key findings were that gait velocity was stable during adolescence and adulthood, while children and older adults walked at a comparable slower speed. Peak pressures increased during childhood to older adulthood. Children demonstrated highest peak pressures beneath the rearfoot whilst adolescents, adults and older adults demonstrated highest pressures at the forefoot. Main factors influencing spatiotemporal and pressure parameters were: increased age, height, body mass and waist circumference, as well as ankle dorsiflexion and plantarflexion strength.Conclusion: This study has established whole of life normative reference values of widely used spatiotemporal and plantar pressure parameters, and revealed changes to be expected across the lifespan. [ABSTRACT FROM AUTHOR]

Pedobarography and the centre of pressure (COP) progression is useful to understand foot function. Pedobarography is often unavailable in gait laboratories or completed asynchronously to kinematic and kinetic data collection. This paper presents a model that allows calculation of COP progression synchronously using force plate data. The model is an adjunct to Plug-In-Gait and was applied to 49 typically developing children to create reference COP data. COP progressions were noted to spend 8% of stance behind the ankle joint centre, traverse lateral of the longitudinal axis of the foot through the midfoot for 76% of stance and finishing past the second metatarsal head on the medial side for 16% of stance. It is hoped the model will bridge the information gap for gait laboratories lacking pedobarography during foot assessments and will open up the possibility of retrospective research into COP progression based indices on kinematic data. [ABSTRACT FROM AUTHOR]

Aims: The concept of 'classification' has, similar to many other diseases, been found to be fundamental in the field of diabetic medicine. In the current study, we aimed at determining efficacy measures of a recently published plantar pressure based classification system.Methods: Technical efficacy of the classification system was investigated by applying a high resolution, pixel-level analysis on the normalized plantar pressure pedobarographic fields of the original experimental dataset consisting of 97 patients with diabetes and 33 persons without diabetes. Clinical efficacy was assessed by considering the occurence of foot ulcers at the plantar aspect of the forefoot in this dataset. Classification efficacy was assessed by determining the classification recognition rate as well as its sensitivity and specificity using cross-validation subsets of the experimental dataset together with a novel cohort of 12 patients with diabetes.Results: Pixel-level comparison of the four groups associated to the classification system highlighted distinct regional differences. Retrospective analysis showed the occurence of eleven foot ulcers in the experimental dataset since their gait analysis. Eight out of the eleven ulcers developed in a region of the foot which had the highest forces. Overall classification recognition rate exceeded 90% for all cross-validation subsets. Sensitivity and specificity of the four groups associated to the classification system exceeded respectively the 0.7 and 0.8 level in all cross-validation subsets.Conclusions: The results of the current study support the use of the novel plantar pressure based classification system in diabetic foot medicine. It may particularly serve in communication, diagnosis and clinical decision making. [ABSTRACT FROM AUTHOR]

Objective: Backward locomotion in humans occurs during leisure, rehabilitation, and competitive sports. Little is known about its general biomechanical characteristics and how it affects lower extremity loading as well as muscle coordination. Thus, the purpose of this research was to analyze in-shoe plantar pressure patterns and lower extremity muscle activity patterns for backward compared to forward running.Methods: On a treadmill, nineteen runners performed forward running at their individually preferred speed, followed by backward running at 70% of their self-selected forward speed. In-shoe plantar pressures of nine foot regions and muscular activity of nine lower extremity muscles were recorded simultaneously over a one-minute interval. Backward and forward running variables were averaged over the accumulated steps and compared with Wilcoxon-signed rank tests (p<.05).Results: For backward compared to forward running, in-shoe plantar pressure distribution showed a load increase under metatarsal heads I and II, as well as under the medial midfoot. This was indicated by higher maximum forces and peak pressures, and by longer contact times. Muscle activity showed significantly higher mean amplitudes during backward running in the semitendinosus, rectus femoris, vastus lateralis, and gluteus medius during stance, and in the rectus femoris during swing phase, while significantly lower mean amplitudes were observed in the tibialis anterior during swing phase.Conclusion: Observations indicate plantar foot loading and muscle activity characteristics that are specific for the running direction. Thus, backward running may be used on purpose for certain rehabilitation tasks, aiming to strengthen respective lower extremity muscles. Furthermore, the findings are relevant for sport specific backward locomotion training. Finally, results provide an initial baseline for innovative athletic footwear development aiming to increase comfort and performance during backward running. [ABSTRACT FROM AUTHOR]

The unilateral unaffected clubfoot has previously been used as a control in longitudinal studies of clubfoot outcomes. However, we have observed that the unaffected clubfoot does not necessarily exhibit the same pedobarographic measurements as seen in normal control subjects. The purpose of this study was to evaluate whether the unaffected foot is indeed normal or if there are differences in the pedobarographic measurements of the unaffected foot compared to healthy normal controls. The Tekscan HR Mat(tm) was used to dynamically test the walking pattern of 103 subjects with unilateral clubfeet and compare the results to our previously published series of normal controls. Patients were divided into three groups: Group 1 (<2 years), Group 2 (2-5 years) and Group 3 (>5 years). An unpaired t-test (p<0.05) was used to compare percentage of stance at initiation of force, the percentage of stance at maximum force, the percentage of stance at termination of force, the maximum percentage force and the average force/time integral between a group of normal age matched controls and the unaffected foot in patients with unilateral clubfoot. Significant differences were identified between the unaffected side and normal controls for the pressure distribution, order of initial contact and foot contact time. These differences evolved and changed with age. The pedobarographic measurements of patients with clubfoot are not normal for the unaffected foot. As such the unaffected foot should not be referred to as normal, nor should it be used as a control. [ABSTRACT FROM AUTHOR]

Highlights: [•] Foot kinematics and pedobarography can be used to identify 3 types of midfoot break. [•] Pronated MFBs have increased medial midfoot pressures and forefoot pronation. [•] Supinated MFBs have increased lateral midfoot pressures and forefoot supination. [•] Flat foot MFBs have evenly distributed midfoot pressures with forefoot pronation. [ABSTRACT FROM AUTHOR]

Highlights: [•] This is the first study to explicitly examine short-term gait-cycle correlations. [•] Step-to-step autocorrelations in plantar pressure distributions were calculated. [•] Step-to-step correlations were weak across the whole plantar surface. [•] Support is provided for regarding neighboring footsteps as independent samples. [Copyright &y& Elsevier]

Abstract: Analysis of pedobarographical data requires geometric identification of specific anatomical areas extracted from recorded plantar pressures. This approach has led to ambiguity in measurements that may underlie the inconsistency of conclusions reported in pedobarographical studies. The goal of this study was to design a new analysis method less susceptible to the projection accuracy of anthropometric points and distance estimation, based on rarely used spatio-temporal indices. Six pedobarographic records per person (three per foot) from a group of 60 children aged 11–12 years were obtained and analyzed. The basis of the analysis was a mutual relationship between two spatio-temporal indices created by excursion of the peak pressure point and the center-of-pressure point on the dynamic pedobarogram. Classification of weight-shift patterns was elaborated and performed, and their frequencies of occurrence were assessed. This new method allows an assessment of body weight shift through the plantar pressure surface based on distribution analysis of spatio-temporal indices not affected by the shape of this surface. Analysis of the distribution of the created index confirmed the existence of typical ways of weight shifting through the plantar surface of the foot during gait, as well as large variability of the intrasubject occurrence. This method may serve as the basis for interpretation of foot functional features and may extend the clinical usefulness of pedobarography. [Copyright &y& Elsevier]

Abstract: Pedobarographic images reflect the dynamic interaction between the plantar foot and supporting surfaces during gait and postural activities. Since intra-foot and inter-subject contact geometry are grossly similar, images may be spatially registered and directly compared. Previously arbitrary subjects have been selected as registration templates, but this can conceivably introduce anatomical bias. The purposes of this study were: (i) to compute an unbiased pedobarographic template from a large sample of healthy young adult subjects, and (ii) to demonstrate how the resulting template may be used for practical clinical and scientific analyses. Images were obtained from N =104 subjects and were registered (10,712 pairs) using (i) an optimal linear scaling technique and (ii) a nonlinear, locally affine, globally smooth technique. The nonlinear technique was found to offer biomechanically non-trivial advantages over the linear technique, most likely due to non-proportional inter-subject geometry. Specifically, the nonlinear template was able to detect morphological signals in a hallux valgus sample with greater sensitivity than the linear template. Validity of the approach was confirmed by independently assessing left and right feet, through a statistical comparison of local maximal pressures, and also through examination of random subject subsets. The current template, representative of an average healthy foot, could be a valuable resource for automated clinical and scientific analyses of foot morphology and function. [Copyright &y& Elsevier]

Abstract: In order to establish the clinical utility of pedobarography in the treatment of childhood foot pathology, a reliable set of pedobarograph data describing non-pathologic feet is required. The purpose of this study was to describe the pedobarographic profiles of normal children across all ages, with specific focus on young children and explore age-related differences in foot pressure patterns. The Tekscan HR Mat™ pressure measurement system was used in a protocol involving a dynamic test at self-selected speed and walking pattern of 146 normal children (age range 1.6–14.9 years). Relative force and timing data were obtained across five foot segments (heel, lateral midfoot, medial midfoot, lateral forefoot, and medial forefoot). Analysis of variance (ANOVA) techniques were applied to determine if there were any age-related differences in foot pressure profiles in children across four a priori pedobarograph variables: % of stance at initiation at the heel, % of stance at initiation at the medial midfoot, maximum % force at the heel, maximum % force at the medial midfoot. Differences in foot pressure profiles were distinguished across three age groups: (1) Group 1: <2 years; (2) Group 2: 2–5 years; and (3) Group 3: >5 years. Age-related differences in initiation patterns, force transmission, and the amount of time spent on each foot segment provide evidence for maturation of children''s foot pressure profiles from a flatfoot pattern in the young child to a curvilinear pattern in the older child. [Copyright &y& Elsevier]

Abstract: Background: The growing popularity of endurance sports activities is associated with a growing number of metatarsal stress fractures in recreational runners. Excessive foot loading has been suggested as a potential cause for these problems [Bennell, K, Matheson G, Meeuwisse W, Brukner P. Risk factors for stress fractures. Sports Med 1999;28(2):91–122]. Therefore, the question arises whether long distance running affects foot loading characteristics like ground reaction forces and peak pressure in specific areas of the foot. Purpose: To investigate the effects of long distance running on plantar pressure patterns before and after a marathon race. Study design: Repeated measurements of recreational runners before and after a marathon race. Methods: Two hundred participants of the third Muenster marathon, 2004, were measured before and after the race with plantar pressure measurements during barefoot walking on a capacitive platform. The ratio between forefoot and toe loading was calculated to assess a suggested loading shift between these areas. Results: The results of the whole group of participants revealed a significant difference in foot loading characteristics before and after the race. Post-race peak pressure and impulse values were higher in the forefoot regions and reduced under the toes. Conclusions: The increased peak pressure under the metatarsal heads after the race indicates a load shift from the toes to the metatarsal heads. This suggests an increased loading of the metatarsal bones and could explain the increased incidence of metatarsal stress fractures in long distance runners. [Copyright &y& Elsevier]

Abstract: Objectives: Impaired foot function may jeopardize the mobility of patients with rheumatoid arthritis (RA). However, there are still no guidelines concerning the adequate early treatment of painful rheumatoid feet which do not yet require surgery. An assessment method for RA feet appears necessary in order to detect foot problems before functional limitations develop. Therefore, the aim of the present study was to evaluate the use of pedobarographic measurements for detecting changes in plantar loading characteristics and their relationship to foot pain in patients with RA. Methods: One hundred and twelve patients with RA (55.0±11.0 years of age) were divided into three groups according to their Health Assessment Questionnaire (HAQ) Score and compared to a control group of 20 healthy adults (CG). Thirty-six patients with good physical capacity belonged to group 1 (RA1; HAQ-score: 0–1.0), 38 patients with moderate capacity to group 2 (RA2; score: 1.1–2.0) and 38 patients with low capacity to group 3 (RA3; score: 2.1–3.0). Each patient''s foot pain was clinically assessed. Pedobarography was used to analyze foot loading parameters while walking barefoot. Results: In the forefoot, average pressures under the lateral forefoot were higher in RA1 patients than in RA2 patients and controls (p <0.05) despite an inconspicuous clinical examination of the foot in RA1 patients. RA1 patients also demonstrated higher plantar pressures than RA2 under the second metatarsal head (p <0.05). In contrast, no significant differences in maximum force could be demonstrated between patient groups. Furthermore, in RA3 patients with lower physical capacity, foot pain was increased as compared to RA1 and RA2 patients. Conclusion: In RA patients, pedobarographic patterns show specific changes which characterize the level of functional capacity. In patients with foot involvement, pedobarographic measurements can be useful during the earlier stages of the disease, when clinical examination does not yet indicate the need for more aggressive treatment or orthopedic interventions. [Copyright &y& Elsevier]

Abstract: Foot-function parameters (foot-contact patterns, oscillations of the centre of pressure (COP), peak pressures, relative vertical impulses and foot shape indices) were characterized in 10 toddlers at 1, 2, 3, 4, 6, 8, 10, 12, 16 and 20 weeks after the onset of independent walking. Significant changes were found in foot-contact patterns and COP oscillations. Improvements in balance, reflected in the decreased oscillations of the COP, coincided with changes in foot roll-over. These findings suggest that the development of a “heel-to-toe” roll-over pattern after 1 year of walking already starts early after the onset of independent walking. We could not identify any changes in load distribution underneath the plantar surface of the foot, suggesting that maturation of foot loading develops at a slower pace. [Copyright &y& Elsevier]

Highlights: [•] Plantar pressure patterns were investigated in children walking with normal, slow and fast gait speed. [•] Foot loading is affected by gait speed changes but the effects are not uniform across the whole plantar surface. [•] The load is transferred more toward the medial forefoot with faster gait speed. [•] These mechanisms should be kept in mind when comparing results from repeated measurements. [Copyright &y& Elsevier]

Highlights: [•] Plantar pressure patterns were investigated in out-toeing and in-toeing gait. [•] Foot loading may be deliberately altered by in-toeing or out-toeing gait. [•] In-toeing increased loads in the lateral midfoot and forefoot areas. [•] Out-toeing intensified medial loading. [•] These mechanisms might be used for off-loading specific plantar regions. [Copyright &y& Elsevier]