Best pressure plate?

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What is the best pressure plate on the market and why? I mean all the features, price etc. regardless whether you are told by the producer to be able to produce custom made orthotics based on the exam.

What gives you the best data?

 

NONE of them give any data to make foot orthotics with!

What are you wanting to use it for?

 

l have seen that many things referred to as a pressure plate it makes your head spin.

What do you call a pressure plate?

A unit like you might see in the Athletes type store, the type used to scan a foot for orthosis manufacture or the type that you place inside the shoe for pressure mapping?

What are you wanting from the device?

PS Looks like CP and were typing at the same time, same end question though.

 

First of all thank you very much for such a quick response. I am new at this forum, but you make very good first impressions so I admit that it makes me very optimistic about this forum.

I see that you try to be very specific in this forum (what is a really good idea), so I am going to write my questions accompanied by numbers.

I am thinking about using it in a rehabilitation process.

1) I am thinking about a pressure mapping plate (like RSScan, or the one used in Gaitscan). Which of this kind is the best one, and what are the differences between them?
2) Is it a good idea to implement it in a diagnostic process, of course accompanied by functional testing. Would it give me a reliable data to assess the biomechanics and hypothetical problems in the biomechanics?
3) I was told by one of the manufacturers that very good orthotics you can prescribe based on a footscan and a Sidas - Podiatech technology. What are your opinions about that?

 

There is probably no best one. They all have different characteristics; strengths and weaknesses. Depends exactly what you are trying to achieve. "Rehabilitation" is very vague. No research has shown that using one actually improves foot orthotic outcomes.

They won't give you a "diagnosis"; they will just tell you the pressure pattern and temporal events under the barefoot (NOT in the shoe and NOT how an orthotic will affect and has affected them) and give you pretty colored pictures of that --> patients do like the pretty colors and are usually gullible enough to believe any spin that gets put on the pretty picture.

They lied to you.
Ask them what foot orthotic design feature that they change based on the barefoot overground pressure pattern? You never get a good answer to that and they spin marketing BS ... like "its an algorithm" ... its nonsense.
They might say you can use it to identify high pressure areas in diabetes etc .... but any good clinician can do that without pressure platforms --> your clinical management is going to be the same with or without the platform in those situations, so what is the advantage?

 

Regardelss a potential in gaining more clients, based on "colourful reports" as you said, do you find such plates useful in diagnostic process and measurement of rehabilitation improvement?

 

They are only useful if they have the potential to change the treatment --> they don't --> no improvement in clinical outcomes

In-shoe pressure systems do have the potential to change the treatment as you can measure what the orthotic is doing and make changes to the treatment --> potential improvement in clinical outcomes (but no evidence)

There are ethical issues if you subject patients/clients to "testing" that does not have the potential to change the treatment.

 

Doesn't pressure mapping allow you to see some abnormalities that you won't be able to see without such equipment? If they do ----> there is a potential of treatment change.

Talking about in-shoe pressure mapping tools - which one do you find the best? I have read about Fscan, Parotec and Pedar. What are your opinions on these?

I know that I can ask all the companies about their products prices, but I believe it is going to be very useful for everybody if we can gather the prices in one thread. Therefore I would like to ask how much does Gaitscan, RSscan, F - scan, Parotec, Pedar and others that you know cost?

 

Sounds good Luz. Let us know the pros and cons of each system and the pricing.

Steven

 

When I was teaching the school bought an EMED. I learned a lot from it. It changed how I viewed biomechanics. However, I did joke that it was $40,000 machine that could tell you where the calluses are. You can get where the high pressure points have been over time by looking at the sock liner of the shoe. An individual step measured with a pressure mapping platform might not be representative of the average step that the person takes.

I did have a diabetic insensate patient with an ulcer who I made an insert for. The ulcer was still not healing. We put the in shoe sensor on that insert measured the pressure then modified the insert, remeasured the pressure, modified it again. The ulcer healed. I've also modified a lot of shoes and insoles that have allowed uclers to heal without using an in shoe sensor.

There is not enough data to know what a pressure pattern should look like. There might not be an optimal pressure pattern. So, if you bought the machine, you would have to be doing a lot of research to try and figure out whether the changes that you make to the pressure pattern are good or bad. There are a huge number of variables to control for when you decide to take that project on.

A lot of people say that pressure mapping is an objective measurement. It's not really objective if you don't actually look at the numbers if you compare a before to an after. "Well, that center of pressure line looks more lateral in this after treatment step". That is subjective. There is between step variability, so you have average steps together. And there is the problem of does the gait cause the pain, or does pain cause the gait. Both are true. Are you measuring the "limping" step or the pathology causing step?

Eric

 

We use Fscan in shoe system from Tekscan, have done since 2009, it is not for making an orthosis, rather measure, modify and report.

We use it for those where pressure areas need off loading, fantastic for Diabetic at risk feet.

We are also finding it good for those with balance issues during gait e.g Muscle dystrophy and CMT. The reports pretty colours allow us very quickly to show a visiting clinician and the client what needs to be done to the sole and orthosis and the results can then be seen after an adjustment and re testing.


Its a great system to guide you and then report the end results via a report of what you have achieved to other members of the treating team and or insurance provider.

 

I have used F-mat and in-shoe F-scan from Tekscan, but can not comment on others. I believe the F-mat is much more affordable than their in-shoe system. However, I agree with above comments regarding in shoe system giving more information and it might provide information to suggest changes in treatment or orthotic modifications. If you only have a mat for your patients to walk across, how will you monitor changes in gait? Are you back to the old school TSPs? Velocity, cadence, etc?

I am still waiting to see an evidence based protocol where pressure mat or in-shoe pressure based interventions (surgery, orthotics) demonstrate improved outcomes. Right now if you ask 10 different doctors, you will get 10 different opinions.

 

I have used inshoe pressure analysis for the best part of 20 years and used the Pedar X system. Eric is correct regarding objectivity and I advise my patients that we are providing a subjective interpretation of objective data as the evidence behind the optimum step and loading pattern is not available.

Has it helped my practice and thus my patients, subjectively without a doubt.
I do use it for assessment of function as it can give me an idea how early or late in a step someone is pronating, how early or late there is heel lift (or indeed if there is any heel contact), the foot strike pattern/loading pattern on running (what appears to happen to the shoe does not always happen to the foot), identify any excessive effects of orthoses (i.e. high loading points in the arch, increased or prolonged lateral load, reduced central load beneath the heel indicative of narrow heel cup etc.), step to step variation or early hallux plantarflexion commonly seen in patients with poor proximal control, the relative effects of leg length control to name a few. I have had instances whereby whatever orthotic modification I have tried, there has been no significant effect on function in which case orthoses were not issued. I regularly see examples of orthoses resulting in an early heel lift requiring a heel raise to offset the effect. Many of these modifications are achieved by clinicians over time, this process has simply allowed me to reduce the trial and error time.

I will freely admit that these observations are based on my experience with the system in much the same way an experienced clinician uses their biomechanical assessment and particular approach to orthotic management.
When choosing your system you will need to consider the relative costs, sampling frequency, Sensor resolution, ease-of-use of sensors, ongoing costs.
The Novel software used with the Pedar X probably has the greatest range of analysis options but the more you have, the more the cost.

I do try and use the data where possible and the software I have allows one to average steps )which is not always an advantage). I recently had a case of a patient with a repaired Achilles tendon but excessive length. The injured side was a short leg requiring raise which may have adversely affected loading (patient preferred heel raise inshoe) due to the lengthening of the tendon. Analysing the averaged force/time curve at the rearfoot bilaterally pre-and post raise indicated this was not the case.

I would agree that further research is required but as we cannot agree on a biomechanical model, this is somewhat difficult. However, this should not stop us trying validate practice and hopefully, we will see evidence one way or the other in due course.

The relative ethics are, as always, how the particular assessment, treatment etc. are applied by the individual clinician and what claims are made. I do not agree that this assessment cannot change management but I do agree that the manufacture of orthoses based on this data alone is dubious at best.

Although somewhat old, this paper may give you an idea of some considerations:

West,S. & Barnett,S. Foot pressure measurement: which system? The Diabetic Foot. 1999; 2: 108-110 Barnett,SJ. Footpressure Interest Group Bulletin. The Diabetic Foot. 1999; 2: 142

Trevor

 

As I said above, I have no issues re the in-shoes systems as you can measure what you have done; you can't do that with a pressure platform

 

l love how the "Athletic" type stores here in Melb use a pressure plate.
They ask you to walk by so only one foot lands on the pressure plate, that sits 4-5cm higher than the ground you walk on and say "You pronate":wacko:

If you use a pressure plate to assist in some way, make sure it sits level with the walk way, they are a good marketing tool and are very low cost to purchase and run compared to the in shoe system.

Its all about what you want from a system and how it can deliver it to you to change or make your prescription.

Find a local Podiatrist, Pedorthist or Orthotist that has one of the systems and go visit them, see how it works.

 

Agree with all comments above regarding the capabilities and the limitations of these technology “tools”. Like any “tool” the results are greatly influenced by the person using it (for better or worse).

The three main "tools" described in this thread are a pressure plate, an in shoe pressure measurement system and an orthotic production system…each should be viewed separately to understand what they can realistically achieve and their limitations. I think you also need to separate out the three main decision criteria of most people considering buying one of these three "tools"…1. the clinical outcomes, either directly from use of the technology tool or indirectly as a result of more “points of reference” for the pods reasoning, 2. The cost: a pressure plate will cost about one quarter to one fifth the cost of an in shoe pressure system, and as noted above neither by itself will produce an orthotic; and 3. The business case or revenue side of the equation…how much will implementing one of these technologies increase my business revenue, which for many pods in private practice is important.

At this point I should be clear and disclose that Paromed has all of the aforementioned technology: pressure plates, in shoe pressure measurement, and orthotic production systems…BUT each is a separate technology and has different profiles based on the three decision criteria I outlined above.

One thing that does make Paromed / Parotec unique is that we can integrate the two separates of in shoe pressure measurement (Parotec) with Paromed CAD/CAD modelling (starting from a 3D scan using a scanner), so that we get the individual benefits of each of these technologies, as well as the benefit from being able to combine the two during the orthotic modelling process. To illustrate this, I have attached a patient case study on this point, and please read this for what it is….not a scientific case study, but simply a patient as seen in private practice. This patient was seen by Andrew Barlow, our Clinical Director, who also operates the podiatry clinic “Andrew Barlow Podiatry” in Brisbane.

I would like to add that there is definitely a place for the technology of a pressure plate. It can certainly be used as a diagnostic tool, as a patient education tool and can be used to cover some of the financial or business considerations being weighed when deciding if you want to introduce a new clinical tool to your practice. However, anyone considering an investment in technology should really understand their decision criteria: usually being both clinical and business considerations; and understand the capabilities and limitations of each of these (pressure plate vs. in shoe pressure measurement vs. orthotic production system) as a clinical tool. Any real investigation by someone considering new technology will reveal all they need to know to make an informed decision against the criteria of what they are hoping to achieve.

Dieter Stahmer
Paromed Australia

 

Hi Luz,

I have been following the treads and in addition to the information provided suggest you identify to yourself what you seek/mean as "best pressure plate"?

For example, here are some parameters related to "best":
- accuracy in the measures
- precision in the measures
- reliability in the measures
- repeatability in the measures
- clinical use
- clinical need
- desired clinical outcome
- nature/outcome of treatment
reduce pressure soreness
re-absorb ulcers
foot/ankle/knee/hip/low back pain
biomechanical dysfunction
- comfort/over-the-shelf/accommodative/custom made insoles/orthotics

I will end here on the list above.

Pending your needs, type of practice and desired treatment outcomes, these will guide you to a pressure plate "best" meeting your needs.

You can also search the scientific and medical literature.
There you will find pressure plates used.
Most often, these authors have done homework on "best", per some of the parameters listed above, in addition to quality/price.

Please remember:
Pressure plates are measurement devices (tools).
They do not assess situation in-shoe (with wear of footwear).
They do not make diagnosis (regardless who says so and software).
Diagnosis comes from your or human analysis/interpretation of the data (measures) relative to the patient situation at hand.
Mode of treatment/prescription is based on your analysis/interpretation/diagnosis and desired treatment outcome per the nature of the treatment modes in your arsenal of treatments.

Norman