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Background. Although previous studies have generally reported increased plantar pressure values with obesity, none of these studies has classified the obesity. Our aim in this study was to compare the plantar pressure distribution in obese and control adults during standing and walking. Methods. This study was performed on 100 feet of 50 study participants. The subjects gathered in two groups, each containing 25 study participants, as non-obese and class 1 obese according to their body mass index values. Static and dynamic pedobarographic evaluations were performed during standing and walking. The findings were compared between the groups and also the correlation of body mass index with the pedobarographic parameters was assessed. Findings. The static pedobarographic evaluation revealed significantly higher values in terms of forefoot peak pressure, total plantar force and total contact area in the feet of class 1 obese subjects when only middle foot peak pressure was found to be higher in class 1 obese subjects than controls as a dynamic pedobarographic parameter. Among the static parameters body mass index was found to have positive correlation with total plantar force ( r = 0.50, P = 0.000) and total contact area ( r = 0.33, P = 0.019). Only middle foot peak pressure ( r = 0.32, P = 0.025) among the dynamic pedobarographic parameters had positive correlation with body mass index. Interpretation. This study may be a first step to evaluate the effect of different obesity categories on the plantar pressure values. Further studies are needed to investigate the effect of different obesity grades.

Alignment of a lower limb prosthesis refers to the spatial orientation of the prosthetic components and socket with respect to one another. During the process of dynamic alignment, a prosthetist repeatedly modifies this spatial orientation and observes the amputee's resulting walking pattern, eventually arriving at an alignment that is judged to be optimal. Quantification of the effect of each alignment modification and correlation of the magnitude of modification with the changes in gait could improve understanding of the process and promote an evidential base for practice. This investigation quantified bilateral plantar foot pressures in six trans-tibial amputee subjects during the process of dynamic alignment at prosthetists' clinics during regularly scheduled appointments. Outcomes of changes in prosthetic alignment during the clinical dynamic alignment process were determined to be quantifiable via plantar pedobarography. Changes in the angle between the pylon and the socket in the frontal plane produced predictable shifts in foot pressure between medial and lateral foot regions under the prosthesis, and typically shifted pressure to the lateral region of the contralateral foot, regardless of the direction of the modification. Temporal parameters revealed that subjects initially adopt a conservative locomotor pattern after an alignment change but within a few steps begin to refine their gait and approach more symmetrical single limb support times. Plantar pedobarography provides the clinician with potentially useful information to augment dynamic alignment and provides a tangible record of the results of the process.

Aim The operative management of cavovarus foot deformity using soft tissue and bony procedures turns out to be difficult. The present study was undertaken to evaluate an individualised operative treatment and changes in pathologic peak pressure pattern. Method 38 patients (average age 29.6 years, follow-up 44.6 months) with 59 operated feet were examined pre- and postoperatively. The clinical assessment included a questionnaire, ankle ROM and evidence of callosities. Correction of the longitudinal arch was measured on lateral X-rays using Hibbs', calcaneal pitch and Meary's angles. Plantar peak pressures were analysed in 16 patients (21 feet) using dynamic pedobarography (EMED SF4 system). Results A good subjective functional and cosmetic result were achieved in 74.6 % of the feet. Walking distance, shoe wear and ankle ROM were improved. The height of longitudinal arch and calcaneal dorsiflexion decreased significantly (p = 0.001). An elevated first ray (overcorrection) was noted in 49.1 % of the cases. Postoperative plantar callosities occurred essentially under the lateral border of the foot but were improved compared to the preoperative situation. Dynamic pedobarography showed a significant postoperative (p = 0.002) decrease of loading under the lateral border, but peak pressures remained relatively high in the midfoot area. An increase of peak pressure under the great toe showed a functional improvement at push off. Conclusion The individualised operative concept has proved to be successful and leads to satisfaction with early improvement of foot function and shoe wear. Nevertheless it is difficult to restore muscular balance and normal foot posture in progressive neuromuscular disorders. A more selective use of the Jones procedure, an additional peroneus longus to peroneus brevis tendon transfer and a dorsal wedge extension osteotomy should prevent overcorrection of the first ray. To avoid a relapsed hindfoot varus deformity, a stabilising triple arthrodesis including lateral wedge resection should be performed early in severe deformities.

Feet problems are common in rheumatoid Arthritis (RA) and really contribute with pain and disability frequently associated with this disease. This article described a woman with rheumatoid feet treated with foot orthoses. The most frequent disturbances observed in RA were discussed, as well as the indication of insoles, its efficiency and the use of computerized dynamic pedobarography (F-Scan) as an accessory method to follow its orthotic treatment.

We collected high-resolution plantar pressure distributions of seven bonobos during terrestrial bipedal and quadrupedal locomotion (N = 146). Functional foot length, degree of hallux abduction, and total contact time were determined, and plots, showing pressure as a function of time for six different foot regions, were generated. We also studied five adult humans for comparison (N = 13). Both locomotion types of the bonobo show a large variation in plantar pressure distributions, which could be due to the interference of instantaneous behavior with locomotion and differences in walking speed and body dimensions. The heel and the lateral midfoot typically touch down simultaneously at initial ground contact in bipedal and quadrupedal walking of bonobos, in contrast with the typical heel-strike of human bipedalism. The center of pressure follows a curved course during quadrupedalism, as a consequence of the medial weight transfer during mid-stance. Bipedal locomotion of bonobos is characterized by a more plantar positioning of the feet and by a shorter contact time than during quadrupedal walking, according to a smaller stride and step length at a higher frequency. We observed a varus position of the foot with an abducted hallux, which likely possesses an important sustaining and stabilizing function during terrestrial locomotion.

The management of displaced intra-articular fractures of the calcaneum remains a contentious subject. Recent advances in the understanding of fracture anatomy have emphasized the fact that not all fractures are the same and therefore different management options should be considered for different patients. This review endeavours to highlight new developments in the assessment of the patient and his fracture and discusses new techniques for the operative management of some injuries. There is also considerable debate on how outcome should be assessed and the role of gait analysis and pedobarography is discussed. Undoubtedly some patients with a displaced intra-articular fracture of the calcaneum will benefit from a surgical procedure the skill, as always, is in deciding which fracture requires which treatment.

Summary Nationwide collecting evaluations for the foot surgical operation activity on orthopaedic clinics and departments in Germany are not available up to now. For extraction of a survey, we carried out this inquiry at German clinics and orthopaedic departments under two aspects: how great is the annual feet surgical operation appearing on orthopaedic clinics at all and which functional techniques come in case of specific – typical – clinical pictures to application? The data are based on own information of the clinics and offer a good survey of foot surgical activities at orthopaedic handles in Germany. At the most houses one carries out in 75% of cases forefoot surgery and in 25% of the cases, rearfoot surgery. The ambulant foot surgery is no emphasis at German clinics, the pedobarography is no means of routine diagnostic. The information confirms the variety of the functional therapy in treatment of classical forefoot surgical questions. Very obviously the well criticized resectionarthroplasty is still noticed as a good therapeutic option in all clinical pictures despite of the heaviness of forefoot malposition.

The use of optical pedobarography is presented in this article. The limitations of the analytical methods using peak pressures as a parameter for assessment of foot at risk of plantar ulcers are indicated. A new method, which takes into consideration the actual plantar pressure distribution using the power ratio PR (the ratio of high-frequency power to the total power in the walking foot pressure image distribution) and relates it to 3 levels of sensation loss is described. PR is able to detect early loss of foot sensation characterized by a loss of sensation level of 4.5 gm. The methods available in the literature for management of foot ulcers by proper footwear design, and their limitations, are discussed. A new method of individualized footwear based on matching the softness of the footwear insole with the softness of normal foot sole soft tissue (having durometer reading of 20° Shore) and optimum insole thickness (12 mm) is helpful in the prevention of plantar ulcers.

This study investigated the results of first metatarsophalangeal (MTP) arthrodesis in terms of clinical outcome measures, plantar pressure distribution, and gait patterns. Ten feet in nine patients with severe hallux rigidus (HR) who underwent first MTP arthrodesis were studied. The preoperative evaluation included a subjective questionnaire, physical exam, AOFAS hallux score, radiographs and dynamic pedobarography (EMED). At follow-up (average 34 months) these were repeated, and gait analysis studies were obtained. Patients showed significant clinical improvement based on the subjective criteria. The mean AOFAS score improved from 38 preoperatively to 90 postoperatively. Postoperative EMED analysis showed restoration of the weightbearing function of the first ray, with greater maximum force carried by the distal hallux at toe-off. Kinematic and kinetic gait analysis from each patient's operative limb were compared to the unaffected contralateral limb and to age- and sex-matched healthy subjects. The kinematic data indicated a significantly shorter step length with some loss in ankle plantar flexion at toe-off on the fused side. The kinetic data indicated a reduction in both ankle torque and ankle power at push-off. Clinical results indicated effective pain relief and a high level of patient satisfaction, consistent with previous reports in patients with symptomatic Hallux Rigidus.

Objectives To determine the effect kinesiotaping (KT) versus sham kinesiotaping (sham KT) in the repositioning of pronated feet after a short running. Design Prospective, randomised, double-blinded, using a repeated-measures design with no cross-over. Methods 116 amateur runners were screened by assessing the post-run (45 min duration) foot posture to identify pronated foot types (defined by Foot Posture Index [FPI] score of ≥6). Seventy-three runners met the inclusion criteria and were allocated into two treatment groups, KT (n = 49) and sham KT (n = 24). After applying either the KT or sham KT and completing 45 min of running (mean speed of 12 km/h), outcome measures were collected (FPI and walking Pedobarography). Results FPI was reduced in both groups, more so in the KT group (mean FPI between group difference = 0.9, CI 0.1–1.9), with a score closer to neutral. There were statistically significant differences between KT and sham KT (p Conclusions KT may be of some assistant to clinicians in correction of pronated foot posture in a short-term. There was no effect of KT, however on pressure variables at heel strike or toe-off following a short duration of running, the sham KT technique had a greater effect. Level of evidence Therapy, level 1b.

The purpose of this study is to investigate the effects of inserts that are used for conservative treatment of excessive foot pronation, on plantar contact areas and pressure distribution. 27 subjects consisting of 6 men and 21 women, mean age 25.88±5.92, and having excessive foot pronation were included in this study. Demographic data were recorded. Short Form McGill Questionnaire, Navicular Drop Test, Foot Posture Index and Foot Function Index were performed for each subject. Subjects were evaluated with dynamic pedobarography (Rs Scan-Footscan ®), first barefoot, than with spesific inserts, to assess plantar contact area and pressure distribution. Findings from dynamic pedobarography indicated that there were significant increase at total contact area, contact area percents of midfoot, significant decrease at contact area percents of fore and rearfoot, at maximum plantar pressures on 2., 3., 4. metatars areas of left foot and on 2. and 3. metatars areas of right foot, on medial and lateral heel with insert according to barefoot (p=0.007, p=0.001, p=0.003, p 0,05). Excessive foot pronation, causes pathologic changes on proximal and distal subtalar joint, effects plantar pressures destroying load distribution. Using insert is the most common method to correct this deformity. The results of our study emphasizes, spesific inserts are effective to distribute plantar pressures and prevent excessive loading of specific areas increasing contact area.

Most pedobarographic studies of microsurgical foot reconstruction have been retrospective. In the present study, we report the results from a prospective pedobarographic study of a patient after microsurgical reconstruction of her foot with a latissimus dorsi flap and a cutaneous paddle, with a 42-month follow-up period. We describe the foot reconstruction plan and the pedobarographic measurements and analyzed its functional outcome. The goal of the present study was to demonstrate that pedobarography could have a role in the treatment of foot reconstruction from a quantitative perspective. The pedobarographic measurements were recorded after the initial coverage surgery and 2 subsequent foot remodeling procedures. A total of 4 pedobarographic measurements and 2 gait analyses were recorded and compared for both the noninvolved foot and the injured foot. Furthermore, the progress of the reconstructed foot was critically evaluated using this method. Both static and dynamic patterns were compared at subsequent follow-up visits after the foot reconstruction. The values and progression of the foot shape, peak foot pressure (kPa), average foot pressure (kPa), total contact surface (cm2), loading time (%), and step time (ms) were recorded. Initially, the pressure distribution of the reconstructed foot showed higher peak values at nonanatomic locations, revealing a greater ulceration risk. Over time, we found an improvement in the shape and values of these factors in the involved foot. To homogenize the pressure distribution and correct the imbalance between the 2 feet, patient-specific insoles were designed and fabricated. In our patient, pedobarography provided an objective, repeatable, and recordable method for the evaluation of the reconstructed foot. Pedobarography can therefore provide valuable insights into the prevention of pressure ulcers and optimization of rehabilitation.

Purpose To assess the effects of backpack carriage on plantar pressure distributions and spatio-temporal gait parameters among children. Participants Two hundred-eighteen schoolchildren, aged 6–13, and attending primary and secondary schools in the city of Cagliari (Italy). Methods Participants were tested at school, during regular days. A pressure plate and wearable inertial sensors were used to measure plantar pressures and spatio-temporal parameters of gait. Measures were obtained during both quiet standing and walking, and both with and without a backpack. The latter contained those items a child had on the testing day. Results Participants carried a mean mass in their backpacks of 5.2 kg, and more than half had a backpack/body mass ratio higher than 15%. While spatio-temporal gait parameters were not affected by backpack carriage, significant increases (up to 25%) in plantar pressures were found during both static standing and walking, especially in the forefoot. Conclusion Under realistic conditions, the impact of backpack carriage was more evident on foot-ground interaction than on gait features. However, long-term consequences of altered plantar pressure need to be assessed in future work, considering the actual durations typically spent carrying school items.

Assessment of gait and function might be as sensitive tool to monitor the progress of fracture healing. Currently available assessment tools for function use instrumented three dimensional gait analysis or pedobarography. The analysis is focused on gait or movement parameters and seeks to identify abnormalities or asymmetries between legs or arms. The additional inclusion of muscle function by electromyography can further elucidate functional performance and its temporal development. Alternative approaches abstain from directly assessing function in the laboratory but rather determine the amount of activities of daily living or the mere ability to perform defined tasks such as walking, stair climbing or running. Some of these methods have been applied to determine recovery after orthopaedic interventions including fracture repair. The combination of lab-based functional measurements and assessment of physical activities in daily live may offer a valuable level of information about the gait quality and quantity of individual patients which sheds light on functional limitations or rehabilitation of gait and mobility after a disease or injury and the respective conservative, medical or surgical treatment.

Background It is becoming increasingly common for pedobarography to be used to aid treatment planning. While there is some consensus on use of this data in specific populations (for example diabetes in adults) there is little information on how it should be interpreted in those with paediatric orthopaedic conditions, such as clubfoot. This is due in part to a scarcity in the literature of “normal” reference data for children, as well as a lack of consensus on the clinical interpretation of deviations from normal data. The aim of this study was to determine if the plantar pressure distribution in children with clubfeet can reliably be distinguished from an age-matched, typically developing population.

Objectives: The measurement of the medial longitudinal arch (MLA) of the foot is a controversial issue in orthopedics. Several methods have been developed to define and determine the MLA,but none of them are universally accepted. The purpose of this study was to compare some statically obtained radiographic angles with the dynamic plantar pressure distribution measurement system for the evaluation of the MLA in healthy individuals.Methods: A total of 95 subjects (72 females, 23 males; mean age 37.8 years; range 11 to 85 years) were retrospectively evaluated. All the subjects were referred to the pedobarography laboratory for varying causes, had foot radiographies, and were evaluated as having normal feet. On standard lateral weight-bearing radiographs of the foot, the lateral talocalcaneal angle, talo-first metatarsal angle, talohorizontal angle, and calcaneal pitch angle were measured. The plantar pressure distribution was measured by the EMED-SF system. To evaluate the MLA, the arch index method was used. The arch index was calculated by the ratio of the pressure area of the midfoot to the sum of the forefoot, midfoot, and the hindfoot areas. Correlations between the radiographic angles and the arch index were analyzed by the Pearson correlation test.Results: The mean values of the lateral talocalcaneal angle, talo-first metatarsal angle, talohorizontal angle, and calcaneal pitch angle were 43.2, 7.2, 29.5, and 41 degrees, respectively. The mean value of the arch index was 0.12 (range 0.04 to 0.17). There was no significant correlation between the arch index and gender (r=-0.10, p>0.05). The talo-first metatarsal (r=0.38) and talohorizontal (r=0.19) angles were found to be in significant correlation with the arch index (p0.05).Conclusion: The arch index method is a simple and reproducible pedobarographic measurement for the evaluation of the MLA. However, the angles measured on statically obtained radiographs and showing correlations with the arch index may give similar results concerning the MLA. Both static and dynamic methods can be utilized in the evaluation of the MLA.

Objectives: This study was designed to determine normal values of pedobarography during standing and walking in adolescents in our country and to investigate correlations between demographic data and pedobarographic values.Methods: Fifty volunteers (25 girls, 25 boys; mean age 14 years; range 13 to 15 years) who were found to have healthy foot according to the AOFAS (American Orthopaedic Foot and Ankle Society) clinical rating system for the ankle and foot were enrolled into the study. Plantar pressures were measured during standing and walking tasks with the use of the MiniEmed pedobarographic device.Results: Static measurements showed significantly higher pedobarographic values for right medial forefoot and toes in girls, and for left midfoot in boys (p, Amaç: Türk toplumunda ergenlik dönemi yaş grubunun statik ve dinamik pedobarografik normal verilerinin belirlenmesi ve bu değerler ile demografik veriler arasındaki ilişkilerin araştırılması amaçlandı.Çalışma planı: Çalışmaya, AOFAS’nin (American Orthopaedic Foot and Ankle Society) ayak bileği ve ayak klinik değerlendirme sistemiyle sağlıklı ayağa sahip oldukları belirlenen 50 gönüllü (25 kız, 25 erkek, ort. yaş 14; dağılım 13-15) alındı. Tüm olguların statik ve dinamik ayak basınçları Mini-Emed pedobarografi cihazı kullanılarak ölçüldü.Sonuçlar: Statik ölçümlerde kızlarda sağ ayağın ön-orta ve parmak kısımlarının, erkeklerde ise sol ayağın orta kısmının pedobarografik değerleri belirgin olarak diğer cinsten yüksekti (p

We applied pedobarography technic on 49 ballet students of whom we had examined the foot deformities in regard to ballet technique. We saw pedobarography as an efficient method in analyzing gait, foot pressure, foot morphology and deformities like pes cavus, hallux valgus, splayfoot and callus. We conclued it will be more efficacious in a broad spectrum should its evaluation difficulty overcome and reliability increased., Konservatuarda bale eğitimi gören ve daha önce bale tekniği açısından ayak deformitelerini incelediğimiz 49 öğrenciye pedobarografi tekniğini uyguladık. Pedobarografinin yürüme, ayak basıncı, ayak morfolojisi ve pes kavus, halluks valgus, splayfoot nasır gibi deformitelerin analizinde faydalı bir metod olduğunu gördük. Pedobarografik değerlendirmenin zorlukları aşılıp güvenilirliği arttırılırsa geniş bir sahada daha fonksiyonel hale geleceği kanaatine vardık.

BackgroundFor several years, confectioned or customized interdigital silicone orthoses have been used to treat toe malformations; however, long-term clinical and biomechanical studies are missing. The aim of this study was to evaluate the biomechanical effects of these orthoses and their clinical acceptance.MethodsIn 2008, 46 patients (30 women and 16 men; average age, 56.8 years) received interdigital silicone orthoses. All of the patients were included in the biomechanical and clinical study. Compliance and acceptance were measured by the Muenster shoe and foot questionnaire, which includes 13 items on pain, activities of daily living, satisfaction, and activity. Mean follow-up was 18 months. Ten feet (eight patients) were chosen by random and underwent pedobarography. One forefoot sensor and two single sensors were attached between the skin and the orthosis. Measurements were performed in-shoe three times with and without the orthosis without removal of the sensors.ResultsForty-four of the 46 patients (95.7%) were included. At the 18-month investigation, 19 patients no longer used their orthoses, most commonly because of pain and failure of the material. Twenty-two patients regularly used their orthoses (8 h/d on average). In-shoe peak pressure lowered significantly with orthosis use (P < .04). Patients who used the orthoses were mostly satisfied.ConclusionsInterdigital silicone orthoses reduce in-shoe peak pressure. Patient satisfaction was good. The durability of the material has to be optimized, and manufacturing remains difficult. The effect on ulcer reduction must be evaluated in a large prospective study.

Analyse operativ behandelter Vorfußdeformitäten unter besonderer Berücksichtigung der Pedobarographie Theo Jan Bernhardt Fragestellung Die rheumatische Vorfußdeformität bedarf im fortgeschrittenen Stadium oftmals einer operativen Korrektur. Die elektronische Fußdruckmessung ist aktuell nicht als Standarduntersuchung zur Erfolgsbeurteilung solcher Operationen etabliert. Die vorliegende Arbeit sollte im Rahmen einer retrospektiven Analyse operativ behandelter rheumatischer Vorfußdeformitäten klären, inwieweit klinische und pedobarographische Parameter in der Erfolgsbeurteilung miteinander korrelieren und die Methode der Pedobarographie damit zur Erfolgsbeurteilung nach Korrekturoperationen am rheumatischen Vorfuß nutzbar ist. Methodik: Es wurde eine klinische und pedobarographische Untersuchung bei 29 Probanden mit insgesamt 34 operierten Vorfüßen durchgeführt. Der funktionell-klinische Befund wurde anhand 3 etablierter klinischer Scores erhoben (AOFASHallux, AOFASKleinzehen, FFI). Die Fußdruckmessung erfolgte mit einem mobilen „Im-Schuh-Messsystem“ der Firma T&T medilogic. Es wurde die Lokalisation des Spitzendrucks im Vorfußbereich und die Lokalisation des subjektiven Schmerzmaximums erfasst. Weiterhin wurden 5 pedobarographische Parameter hinsichtlich einer Korrelation mit den klinischen Scores statistisch ausgewertet (Rangkorrelation; Signifikanzniveau 95%). Ergebnisse: Es konnte eine statistisch gesicherte Korrelation der untersuchten pedobarographischen Parameter mit den klinischen Scores nachgewiesen werden. Dabei korrelierten mit tendenziell besseren klinisch-funktionellen Befunden ein höherer summierter Vorfußdruck (FFI - R: -0,395; AOFAS - R: 0,354), ein höherer Vorfußdruck im Verhältnis zum Rückfußdruck (FFI - R: -0,455; AOFAS - R: 0,340), eine kürzere Standphasendauer (FFI - R: 0,351; AOFAS - R: -0,423), eine größere Doppelschrittlänge (AOFAS - R: 0,324) sowie eine größere effektive Fußlänge (FFI - R: -0,327; AOFAS - R: 0,469). Der Spitzendruck im Vorfußbereich wurde überwiegend unter dem 1. Strahl gefunden (n=24), wobei nur wenige Patienten das subjektive Schmerzmaximum im Vorfußbereich genau lokalisieren konnten (n=7). Schlussfolgerungen: Um den klinisch-funktionellen Befund der Patienten nach einer komplexen Vorfußkorrektur beim Rheumapatienten zu erheben, ist die Verwendung von klinischen Scores zu empfehlen, da die Erfassung des subjektiven Schmerzlokalisation nicht ausreichend ist. Die untersuchten pedobarographischen Parameter sind in der Lage Unterschiede des postoperativen subjektiven Beschwerdebildes sowie zu erwartende Gangbildverbesserungen widerzuspiegeln und können damit perspektivisch als Kriterien zur Erfolgsbeurteilung operativer Maßnahmen am rheumatisch deformierten Vorfuß herangezogen werden. Eine Bestätigung der Ergebnisse in prospektiven Studien ist notwendig.

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™ 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 (p0.05) 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.

BackgroundJoint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type (JHS/EDS-HT) is a rheumatologic condition characterized by generalized joint hypermobility and musculoskeletal and nonmusculoskeletal findings related to congenital laxity of connective tissue. Because foot pain and other foot problems are reported to make daily life problematic to manage for individuals with JHS/EDS-HT, and thanks to the availability of modern technology, the aim of the present study was to quantitatively characterize foot type in individuals with JHS/EDS-HT during upright standing.MethodsForty feet of 20 women with JHS/EDS-HT (mean ± SD age, 36.03 ± 14.01 years) were assessed clinically and with a pressure-sensitive mat during upright standing.ResultsForty-five percent of feet had a high arch (pes cavus), 27.5% had a normal arch, and 27.5% had a low arch (pes planus or flatfoot).ConclusionsFrom a clinical perspective, the characterization of foot type in JHS/EDS-HT is important to identify, develop, and enhance the rehabilitative options. An understanding of the relationship between pes cavus and foot pain in these patients could, in fact, improve the clinical management of these patients.

Aim of this thesis is to evaluate distribution of plantar pressure and the movement of spine and pelvis in patients diagnosed with femoroacetabular impingement syndrome. The results were obtained using Diers pedoscan system which can record the pressure distribution of feet during stance and motion. Also Diers formetric III 4D system was used to obtain photogrammetic records of spine and pelvis movement. We use rasterstereography based on Moiré topografy. Measured data represent three dimensional model of back surface during static or dynamic analysis. In addition we evaluated the effect of treatment using Dynamic neuromuscular stabilization. Obtained results were statistically processed. Powered by TCPDF (www.tcpdf.org)

BACKGROUND The aim of our study was to introduce a so-called "neutral shoe" as a tool to assess reference values for dynamic pedobarographic investigations. MATERIALS AND METHODS Twelve healthy volunteers were asked to participate. During the first trial the participants were asked to walk with a neutral shoe (Breidbach, Germany). The second trial was performed with the running shoe "Faas 500" (Puma SE, Germany). Peak plantar pressure values were analyzed from nine foot regions using the Pedar® X system (Novel Inc., Munich, Germany). RESULTS The mean peak pressure reduction for the total foot was 36% under the left (non-preferred) foot and 32% for the right (preferred) foot. A statistically significant reduction of peak pressure was observed for eight regions, from a mean 14% peak pressure reduction under the right metatarsal head 1 up to a 41% peak pressure reduction under the right big toe. CONCLUSIONS The neutral shoe is a feasible tool to assess reference values for dynamic pedobarography. Such a reference tool may help to standardise several steps in the development and construction of shoes and orthotic devices.

SUMMARY Aims This study analysed the effects of specially manufactured insoles on foot pressures in diabetic patients during a 1-year prospective observation period. Methods We studied 81 type 2 diabetic patients without foot lesions. Using pedobarography three different regions of interest were examined: maximum peak pressure (MPP) of the total foot area, heel region and head of metatarsal bone I-III. Eighteen patients with high risk pressure (MPP of total foot 474 ± 183 kPa; heel region 278 ± 147 kPa, metatarsal 389 ± 222 kPa) received optimal insole support. Sixty-three patients as a control group (MMP of total foot 367.7 ± 157 kPa; heel 263.1 ± 127 kPa, metatarsal 339.9 ± 171 kPa) received conventional footwear. Results After insole support a 30% pressure reduction of total foot MMP (474 ± 183 kPa vs. 290 ± 106 kPa) was achieved in the treatment group. After 6 months (324 ± 127 kPa) and 1 year (380 ± 190 kPa) a pressure reduction was found. Between the 6- and 12-month controls plantar pressures again increased. In the control group a significant increase of all peak pressures occurred. Conclusions Early insole support is successful in reducing plantar pressure. A repeated adjustment should be performed every 6 months to prevent foot pressure increases. The comparison of foot pressure development between the two groups showed constant levels in the treatment group. In the control group a marked increase of the pressure values was found. Identification and subsequent support of patients with high ulceration risk may help to reduce the high amputation rate.

The main purpose of gait analysis laboratories is to measure and study human gait walking patterns in order to better understand and treat gait abnormalities. Gait analysis involves the measurement of kinetics/kinematics of joint move- ment, muscular activity, stride characteristics, pedobarography, and energy consumption. Kinetic data are measured with a force platform that provides information about ground reaction forces and when combined with kinematic data, can yield joint forces and moments. Joint angle and limb segment motion data or kinematic data are obtained by motion analysis systems such as electrogoniometers or photographic systems. Electromyography is used to identify muscle tim- ing and relative muscle intensity. Stride characteristics are used to measure gait timing events. Pedobarography deals with plantar pressure under the foot and the efficiency of gait can be measured with oxygen consumption analysis. Gait analysis is useful for research on normal and abnormal walking patterns, gaining a better understanding of a subject's gait, and planning treatment strategy. Index W

Plantar pressure measurements have many potential clinical applications in the field of orthopaedics. However, the only current routine clinical application of pedobarography is for the identification of high pressure zones in diabetic patients with neuropathy who are at risk from foot ulceration. For pedobarography to become a routine clinical tool in orthopaedics, a thorough knowledge of normal plantar pressure distributions would be required. To date, no large scale studies to define population norms have been conducted, probably because of the high cost associated with analysing large quantities of plantar pressure data. Plantar pressure distributions display a high step-to-step variation and, therefore, it is necessary to conduct multiple trials. Comparison between these trials is difficult, somewhat subjective, and slow, because it must be conducted manually. The present authors have developed a technique to align automatically the spatial components of a series of datasets. The technique then allows predefined parameters to be automatically extracted from the data, hence greatly reducing analysis time. The authors believe that not only does the technique make large scale studies economically viable but that it could also form the basis for expert systems for the diagnosis of foot pathologies and the prescription of orthoses.

The present study investigated the effects of two different surgical procedures for the treatment of chronic ankle instability. Ten patients treated with an anatomic reconstruction using a periosteal flap were compared with a second group that received an Evans tenodesis. All patients were evaluated before and after surgery with clinical and radiographic examinations as well as dynamic pedobarography. Patient satisfaction and radiographic and functional results were comparable in both groups and revealed a good restoration of joint stability and gait symmetry. Our results indicate that both methods of ankle ligament reconstruction achieve a comparable clinical and functional outcome within 1 year after surgery.

A new method has been designed, developed and pioneered in Dundee, UK for the construction of thin, small, flexible, reliable, repeatable and cheap transducers to measure the vertical pressure under the plantar surface of the foot. The transducers are constructed from a piezoelectric film which consists of a mixture of polyvinylidene fluoride and polymethylmethacrylate resin (90% to 10% by weight). The size of the transducers is scalable from 4 cm 2 down to 25 μm 2 .

Adult acquired flatfoot deformity is a degenerative disease causing medial arch dysfunction. Surgical correction has typically involved tendon reconstruction with calcaneal osteotomy; however, the postoperative changes have not been fully characterized. The present study assessed the success of surgical correction of Stage IIb adult acquired flatfoot deformity through changes in plantar pressures and patient-generated outcome scores. With Institutional Review Board approval, 6 participants were evaluated before and after surgery using pedobarography, the Foot and Ankle Outcome Score, and the Medical Outcomes Study 36-item short-form questionnaire. The plantar pressures were recorded using a TekScan HRMat during walking and in a 1- and 2-foot stance. The resulting contour maps were segmented into 9 regions, with the peak pressure, normalized force, and arch index calculated. Surgical effects were analyzed using paired t tests. Postoperatively, the Foot and Ankle Outcome Score and Medical Outcomes Study 36-item short-form questionnaire scores increased significantly from 180 � 78 to 360 � 136 (p < .03) and 47 � 18 to 71 � 19 (p ¼ .06), respectively. During the 2-foot stance, the normalized force had increased significantly in the lateral midfoot (p < .03), although no significant differences were found in peak pressures. No significant differences were observed in the 1-foot stance. During walking, the normalized force increased significantly in the lateral midand forefoot (p < .05). The peak pressure increased significantly in the lateral forefoot (p < .01). The arch index values demonstrated no significant changes. The increased questionnaire scores indicated that surgical correction improved the self-perceived health of the participants. Lateral shifts in the peak pressure and normalized force suggest that forefoot and midfoot loading is altered postoperatively, consistent with the goal of offloading the dysfunctional arch. Thus, the present study has demonstrated that surgical treatment of adult acquired flatfoot deformity can be accurately assessed using patient-reported outcome measures and plantar pressures.

At our institution surgical correction of symptomatic flat foot deformities in children has been guided by a paradigm in which radiographs and pedobarography are used in the assessment of outcome following treatment. Retrospective review of children with symptomatic flat feet who had undergone surgical correction was performed to assess the outcome and establish the relationship between the static alignment and the dynamic loading of the foot.A total of 17 children (21 feet) were assessed before and after correction of soft-tissue contractures and lateral column lengthening, using standardised radiological and pedobarographic techniques for which normative data were available.We found significantly improved static segmental alignment of the foot, significantly improved mediolateral dimension foot loading, and worsened fore-aft foot loading, following surgical treatment. Only four significant associations were found between radiological measures of static segmental alignment and dynamic loading of the foot.Weakness of the plantar flexors of the ankle was a common post-operative finding. Surgeons should be judicious in the magnitude of lengthening of the plantar flexors that is undertaken and use techniques that minimise subsequent weakening of this muscle group.Cite this article: Bone Joint J 2013;95-B:706–13.

Background. The wearing of personal equipment can cause specific changes in muscle activity and posture. In the present study, we investigated the influence of differences in equipment related weight loading and load distribution on plantar pressure. In addition, we studied functional effects of wearing different equipment with a particular focus on relevant changes in foot shape.Methods. Static and dynamic pedobarography were performed on 31 male soldiers carrying increasing weights consisting of different items of equipment.Results. The pressure acting on the plantar surface of the foot increased with higher loading, both under static and dynamic conditions (p< 0.05). We observed an increase in the contact area (p< 0.05) and an influence of load distribution through different ways to carry the rifle.Conclusions. The wearing of heavier weights leads to an increase in plantar pressure and contact area. This may be caused by flattening of the transverse and longitudinal arches. The effects are more evident in subjects with flat feet deformities which seem to flatten at an earlier load condition with a greater amount compared to subjects with normal arches. Improving load distribution should be a main goal in the development of military equipment in order to prevent injuries or functional disorders of the lower extremity.

Orientador: Manoel Barros Bertolo Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Resumo: Objetivos: Avaliar a eficácia do uso das palmilhas em pacientes com Artrite Reumatóide (AR) na redução da dor, melhora da função e redução da média dos picos de pressão plantar. Material e Métodos: Vinte e sete pacientes com AR e dor nos pés foram avaliados em relação à dor, presença de deformidade e calosidades, incapacidade (Heath Assessment Questionnaire - HAQ-DI) e atividade de doença (Clinical Disease Activity Index - CDAI). Palmilhas foram prescritas de acordo com a necessidade de cada sujeito com objetivo de suporte articular e redução de dor. Os pacientes foram submetidos à avaliação pelo Foot Function Index (FFI) e podobarometria (Sistema F-SCAN) com a avaliação da média dos picos de pressão plantar em consulta inicial e após duas semanas de intervenção. Resultados: Houve redução do FFI após a intervenção em todas sub escalas. Os escores iniciais mais elevados do FFI total e suas subescalas de incapacidade (FFI-inc) e limitação da atividade (FFI-la) foram significativamente relacionados aos maiores escores do CDAI e HAQ-DI (p < 0.05). A melhora do FFI foi independente da idade dos sujeitos, tempo de doença, CDAI e HAQ-DI. Não houve redução significativa na média dos picos de pressão plantar após a intervenção, mesmo quando foram avaliados separadamente os pacientes com dor predominante em ante pé e retro pé. As palmilhas foram usadas em média 7,08 horas por dia. Efeitos adversos menores foram observados em sete pacientes, nenhum resultando em interrupção do tratamento. Conclusão: Foi observado redução de dor e incapacidade em indivíduos com AR após o uso de palmilhas, sem redução significativa das médias dos picos de pressão plantar. Os benefícios do uso das órteses em pés reumatóides podem ser multifatoriais, não somente relacionado à melhor distribuição da pressão plantar, mas à melhor acomodação do pé e aumento do estímulo proprioceptivo Abstract: Objective: To evaluate the efficacy of insoles in Rheumatoid Arthritis (AR) patients reducing pain, improving function and reducing the mean peak plantar pressure. Methods: Twenty-seven rheumatoid patients with foot pain were evaluated regarding foot deformity, disability (Health Assessment Questionnaire - HAQ-DI) and disease activity (Clinical Disease Activity Index - CDAI). Foot orthosis were prescribed according to each patient's needs aiming to provide a better joint support and to reduce pain. The Foot Function Index (FFI) and the mean peak plantar pressure (FSCAN system) were evaluated at baseline and after two weeks of intervention. Results: FFI values decreased in all subscales after intervention. Higher initial disability and activity limitation FFI subscales and FFI total scores were significantly related to higher CDAI and to higher HAQ-DI scores (p < 0.05). FFI improvement was independent from age, disease duration, CDAI and HAQ-DI. No significant reduction in the mean peak plantar pressure was noted, even if evaluating separately the patients with pain mainly on the forefoot or on the hindfoot. Orthosis were worn 7.08 hours-day on average. Minor adverse effects were noted in seven patients, none of them resulting in treatment interruption. Conclusion: Foot orthosis reduces patient's referred foot pain and foot disability with no significant reduction in the mean peak plantar pressure. The benefits of foot orthosis in RA may be multifactorial, not only related to plantar pressure distribution, but also to a better foot accommodation and increased proprioceptive stimulus Mestrado Clínica Médica Mestra em Clínica Médica

This article presents an enhanced methodology to align plantar pressure image sequences simultaneously in time and space. The temporal alignment of the sequences is accomplished using B-splines in the time modeling, and the spatial alignment can be attained using several geometric transformation models. The methodology was tested on a dataset of 156 real plantar pressure image sequences (3 sequences for each foot of the 26 subjects) that was acquired using a common commercial plate during barefoot walking. In the alignment of image sequences that were synthetically deformed both in time and space, an outstanding accuracy was achieved with the cubic B-splines. This accuracy was significantly better (p

This study aims to quantitatively characterize plantar pressure distribution in women affected by Ehlers–Danlos syndrome of the hypermobile type (EDS-HT) to verify the existence of peculiar patterns possibly related to postural anomalies or physical and functional lower limb impairments typical of this disease. A sample of 26 women affected by EDS-HT (mean age 36.8, SD 12.0) was tested using a pressure platform in two conditions, namely static standing and walking. Raw data were processed to assess contact area and mean and peak pressure distribution in rearfoot, midfoot and forefoot. Collected data were then compared with those obtained from an equally numbered control group of unaffected women matched for age and anthropometric features. The results show that, in both tested conditions, women with EDS-HT exhibited significantly smaller forefoot contact areas and higher peak and mean pressure than the control group. No differences in the analyzed parameters were found between right and left limb. The findings of the present study suggest that individuals with EDS-HT are characterized by specific plantar pressure patterns that are likely to be caused by the morphologic and functional foot modification associated with the syndrome. The use of electronic pedobarography may provide physicians and rehabilitation therapists with information useful in monitoring the disease's progression and the effectiveness of orthotic treatments.