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Digital video and pressure mapping in Private Practice

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Mark Egan, Aug 8, 2006.

  1. Mark Egan

    Mark Egan Active Member

    Members do not see these Ads. Sign Up.
    I am trying to track down any podiatrists who are using Silicon Coach and or FScan with the CoM additional program in the day to day running of their clinic/s and would be happy to talk about the pros and cons of these products.

    I would be happy to hear from anyone but I would be especially interested to hear from someone in Australia as I want to get the feel how the Fscan translates durability and costing wise when it comes from another country. The mobile FScan system which interests me costs $15 000 (US) and another $1500 (US) for the CoM system and $25 (US) for replacement innersoles, while the silicon pro system costs $1550 AUS.

    Thanks in advance
  2. admin

    admin Administrator Staff Member

    Mark - I have changed the title of the thread from Silicon Coach to Digital Video (as Silicon Coach is just one option) and from F-scan to Pressure Mapping (as F-scan is just one option). F-scan are the only ones with the CoM analysis.
  3. Craig Payne

    Craig Payne Moderator

    Mark .... obviously I know why you are asking as I discussed these at recent seminars. What I have to say won't add anything to what I said then, but for others I will mention it.

    The question I always ask, is that if I use any technology to assess a patient, then what is the potential for that investigation to potentially:
    1) Alter the treatment that the patient is given
    2) Improve the outcome for the patient

    If one of those is not met, then its a question of ethics ---- however I do acknowledge the marketing/ patient education side of the technology (but still ask ethical questions here).

    IMHO (in my humble opinion) until recently there was nothing I could see in a video gait analysis that I used to influence my orthotic prescription decision making - so am I being ethical by subjecting the patient to this test? (I do acknowledge its easy to convince them they need orthotics after showing them the video :eek: ). At the seminar I used two cases to illustrate where the use of digital video gait analysis (we use Silicon Coach for the analysis) did actually influence my decision making (both scenarios are now the genesis of 2 research projects). In one scenario, the position of the first ray during propulsion influences my casting position and in the other scenario, the symmetry/asymmetry of heel lift timing influences the heel post material.

    As for pressure mapping, the same applies - does the use of this technology have the potential alter the treatment (and hence the outcome). It does give you very pretty pictures (in 3D if you want), that really impresses the patient -- but what do you actually do with that information? (?ethics). We have used pressure mapping in-shoe (with both the F-scan and Pedar) with and without the use of foot orthoses to look at changes in what parameters are actually predictors of better outcomes (we started this after the research showed that changes in the kinematic pattern of rearfoot motion was not associated with outcomes). The f-scan CoM analysis module has given us some good data that appears to be not only predictive of outcomes, but also predictive of failed orthoses - we have also looked at many other parameters -- some from the TAM analysis module has also given up some good data - especially when it comes to the symmetry of velocity of the CoP (remember that girl I discussed with the SI pain?) and first met head pressures (remember that 13 yr old boy I discussed?).

    Where we are at with this is early days - we have not done the detailed analysis; we have not submitted this for publication (and had it subjected to peer review); hopefully we will get to report that hard data at the APodC conference in Hobart next year. This is why I showed that video of the cyclist who celebrated before crossing the finish line....

    I genuinely believe that in the future, in order to improve outcomes, all issues of foot orthoses to patients (whether prefabricated or custom) should be accompanied by in-shoe pressure mapping with and with out the use of foot orthoses to make final adjustments (such as, for eg, first ray cut outs and type of rearfoot post). I genuinely believe that this will eventually become the gold standard. I just do not think we are there yet with enough data and we got a long way to go.

    The dilemma for clinicians (and I assume the reason you asked this question here) is at what stage should clinicians implement these sorts of technology in the absence of good data??? Logically no clinical practice should change without hard data, but podiatry has a track record of not waiting for the research, so its a judgment call you have to make.

    A number of Podiatry Arena members do you pressure mapping. Bruce Williams uses more of the TAM module and uses it more with diagnosis as well as prescription. Bob Fleck uses the CoM a lot. Good clinical experience has taught these two that different things are important. I use it differently to them .... there is still a lot of work to be done to determine which parameters are more important..... God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.

  4. Mark Egan

    Mark Egan Active Member


    Thanks for the reply and I agree with everything you have stated about the technology and ethics etc..

    The seminar has made me feel more confident in what I was playing around in my own head as well as making me more intune with areas I had not placed enough importance on. Most notably the importance of the CoM and how that can be reflected in heel off (have a physio friend who has a similar Hx to the SIJ girl you spoke of who I have used similar Rx methodology with i.e. different density heel raises which had an immediate response of over 80% improvement), the lunge test and how to use cut-outs more effectively.

    Reading over a thread from last year with Kevin Kirby asking about the Fscan system also asked the same questions you have eg. will the technology change what you would do or is it just a way to get more patients to come and see you because you have this amazing machine that tells you so much about their feet. The physio friend I mentioned I diagnosed after I videoed her running barefooted on the treadmill and watched it a few times as well as listening strike patterns and considering your comments from the seminar. I realise at the end of the day my clinical skills are the key, the danger is potentially getting too caught up with the technology. With that said I am interested to see who is using such technology in their day to day practice, as I also agree that this is the way the profession is heading. I just hope I can afford it!!!! or perhaps can I afford not to ???

    Last edited by a moderator: Aug 9, 2006
  5. davidh

    davidh Podiatry Arena Veteran

    Hi Mark,
    I use a simple Tekscan mat (not an in-shoe system) in my daily Practice. I find that obvious data like early heel-lift, add/abduction angles, transfer of weight from the 1st MPJ to the 1st IPJ show up really well, and this is a good way to record this data.
    It does influence how I prescribe.

    Recently I saw two long-term ((4 and 5 years respectively) paediatric pts who initially presented with in-toe gait. The accompanying parents were delighted when I was able to show them "before and after" data.
    BTW I didn't claim to have influenced the improvement, since in most cases in-toe-ers will self-correct. I did however point out that with orthoses we probably halted any early compensatory changes in the feet which may have caused problems once the limbs corrected......

    Worthwhile investment, but don't buy into all the sales flim-flam :cool: .
  6. DaVinci

    DaVinci Well-Known Member

    CP - that a brave call...
  7. sathompson

    sathompson Welcome New Poster

    Australian Digital Video and pressure mapping equipment and suppliers

    Hello Mark Egan,
    May I have the complete name of the silicon pro system you are referring to for 1550. from Australia. I am interested in a comparison, and haven't been able to locate with this name.
  8. admin

    admin Administrator Staff Member


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