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Pressure plate analysis

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Raphael1974, Jul 12, 2015.

  1. Raphael1974

    Raphael1974 Member

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    Hi all,

    Since shifting my lower limb biomechanical knowledge base up a gear or two I've noticed the impact on my own clinical assessment. Just taking the time to check a patients FPI, static stance and watch their gait adds another flavour to my medical assessment. Although I'm aware that the risk is seeing 'everything' and jumping to conclusions. A little arch drop here, bit of tibial rotation there, a little circumduction during walking and hey presto a completely irrelevant hypothesis for what's causing the patient's problem (since all that has been present for years prior to any current issues...).

    Anyhow, one of the big take home messages I've got from this site is that orthoses aren't the be all and end all and sticking foam under the foot to correct kinematic variants isn't a panacea, but it seems so often that's this is the approach taken.

    I was chatting to one of our fantastic podiatrists the other day and asking her whether it was worth investing in video gait analysis on an appropriate (slat driven) treadmill, she replied that she'd rather have a pressure plate walk way. Now I know the technology is wonderful and produces lots of colourful pictures but wondered what EXACTLY they add. I guess they show progression angle, weight transference and allow detection of subtle changes in stride length variation and early lift off etc...but wondered how that would add value to the larger biomechanical assessment.

    I guess my concern is that you send a patient down a walk way, note that they land more in pronation on one side than the other and then assume they need some form of arch support to correct the 'over pronation'. You stick the support in, send them down the walk way and hey presto the colours match up.

    But, like my own embryonic biomechanical assessments, just because you see something doesn't mean it's relevant.

    So are pressure plate systems just an expensive gadget or can they really add value?
  2. efuller

    efuller MVP

    How good, either a force plate or motion analysis, is depends on what you want to do with it. If you think the light of a computer monitor on your face, while you are staring intently at the monitor, makes you look really intelligent then it might help you a lot. But seriously, you do have to understand what you want it to do. How are you going to use it to change your treatment? I've said that a force platform is an expensive machine that tells you where the calluses are. (Or where the impressions in the sock liner of a well used shoe are.) However, I also have used an in shoe pressure system to assess how well an insert was off loading a foot belonging to a person with DM and neruopathy. I've changed my treatment based on that data. A force platform in a walkway won't let you do that. Motion analysis won't let you do that.

    I can also say that I learned a lot by looking at pressure map roll over processes. It does make you think about how forces are borne by the foot. It's a great educational tool. A large question is whether it is worth your time to use the tool.

    Hope this helps,

  3. Boots n all

    Boots n all Well-Known Member

    For my clinic where we see a lot of diabetics, the inshoe pressure plate measurement is of great value.
    A gait plate that people walk on bare foot and then not with the shoe on is marketing.
  4. Daniel Bagnall

    Daniel Bagnall Active Member

    Hi Raphael,

    I’ve never used this technology in any of my biomechanical assessments before. I would see it as more of an educational tool rather than something that would dictate orthotic prescription variables. In my opinion, I think there is far more value in having an understanding of what the internal and external forces acting on and within the foot and lower limb might be in order to help understand the mechanical pathology you are treating. I’ve found that this has led to more effective clinical decision making and improved patient outcomes. From a general perspective, I also don’t think a pressure plate would change my clinical decision making a great deal to warrant having it not to mention the outlay. If I was to consider using anything, I would perhaps consider in-shoe pressure analysis.

  5. Raphael1974

    Raphael1974 Member

    Hi all,

    Many thanks for your helpful input. Yes, from my reading here the in-shoe system appears to be the one which could actually add clinical value (in addition to visual/video gait analysis). However, I'm also hearing that good assessment and treating the patient as a whole is the skill that needs to be gained and certainly over trusting in technology can be to the detriment of a clinician's skills.

    It's a complex area and one-dimensional solutions are inadequate (kiosk orthotic dispensing anyone....) ;)
  6. Petcu Daniel

    Petcu Daniel Active Member

    Could you be so kind to describe the protocol you are using for inshoe pressure measurement ? Are you making these measurement with all patients or with those which are at risk? How much time it takes for one diabetic patient to make measurements ?
  7. Petcu Daniel

    Petcu Daniel Active Member

    There is a nice saying: "The eye sees only what the mind is prepared to comprehend"
    I would like, for example, to see what Dananberg is seeing when he is using a pressure analysis system...

  8. Boots n all

    Boots n all Well-Known Member

    Petcu, we only scan the at risk, there are cost involved and why do something that is not warranted.

    If the client is a referral to us with existing footwear and TCO, we do a scan for the purpose of a base line, we can then report what we started with and what we ended with.

    We scan the client again with our new shoes and TCO, pending what we see, we may adjust the sole fulcrum and or the orthoses.

    This could take three or four reading/adjustment until we are happy with what we see.

    For each recording, they will do three or four laps of our 8 meter gait room, it is time consuming.

    Attached Files:

  9. Petcu Daniel

    Petcu Daniel Active Member

    One more question: how do you define the patient at risk ? Do you take into considerations values of pressure as in Armstong and colab. work ( http://www.jfas.org/article/S1067-2516(98)80066-5/abstract?cc=y= )?
    Thank you,
  10. Boots n all

    Boots n all Well-Known Member

    With regards to Howard's paper, how would you identify they were high peak pressure if you didn't measure them to start with?

    So no, to us if they have peripheral neuropathy they are at risk and need to be managed.

    Foot note; We had a promotion for Diabetes awareness week, good resposne to free footwear and foot check up, but l am still amazed at the number of people who claim "If l didnt have feeling in my foot l would know" only to do a PN test to find they do have PN
  11. Petcu Daniel

    Petcu Daniel Active Member

    Are the diabetic people walking barefoot at risk ( http://www.ncbi.nlm.nih.gov/pubmed/12941724 ) ? Could a footwear reduce the plantar pressure and barefoot walking increase it putting the foot at risk?
    I think both systems (pressure plate and in-shoe systems) are useful!

    In my opinion Dananberg's work is a good argument for using pressure measurement systems ! Especially from a functional point of view !
  12. Boots n all

    Boots n all Well-Known Member

    We, and everyone else in allied health, recommend high risk Diabetics dont walk barefoot at all, infact we at our clinic recommend diabetics dont walk barefoot if they have PN or not.

    Mainly for the fear they may step on something that will damage the foot, there are many reports of diabetics coming into clinics unaware they had an item in-bedded in the foot, from a 20mm nail to an earring, pain protects us, if they have PN they dont have that protection.

    As to peak pressure of walking barefoot V' wearing footwear, if the shoe is right, the shoe would assist in better distributing the pressure and better function e.g rocker sole.
  13. efuller

    efuller MVP

    Without his recipe, you are just making the measurements. I wish he had published what orthotic modifications he would make when he sees certain things with the pressure distribution. I've asked, and he said it was complicated.

  14. Ben Lovett

    Ben Lovett Active Member

    My case load is ¾ musculoskeletal and ¼ off-loading diabetic foot wounds all in a public hospital here in Tasmania. We’ve had the F-Scan in-shoe system for a year now and overall I would say that it’s had a very big impact on our approach to off-loading ulcers and relatively little impact on my management of musculoskeletal conditions (for the reasons Eric mentioned above).
    In my experience so far it’s had three main areas of impact in my work with diabetic foot wounds.
    1. It allows “tuning” of the orthotic and shoe combination to effect minimal and even pressure distribution over the wound site.
    2. It’s fantastic for patient education helping to demonstrate to patients what can be achieved in a CAM walker Vs their slippers and convincing them that they really do need to keep that CAM walker on ALL the time.
    3. It’s also been great for changing practice in the podiatry department here, helping to convince practitioners of the need to get patients into total contact casts or at least CAM walkers early in the history of the ulcer before it becomes chronic. This is especially true for heel and 1st IPJ ulcers where it can be impossible to manage pressure effectively without casting. Once the patient and podiatrist have seen how ineffective many of the less inconveniencing interventions can be, they are usually much more willing (even enthusiastic) to accept the CAM walker or total contact cast. It allows us to say to the patient with confidence “this ulcer is unlikely to heal unless you go into a cast or CAM walker” and to say this when the ulcer has been present for 2 or 3 weeks rather than trying felt padding and wound shoes for 6 months because the patients worried about not being able to drive etc.
    This third effect has been particularly true for knowing when and when not to use a total contact orthoses as while these usually reduce pressure at the 1st MPJ they tend to increase it at the 1st IPJ often 2 or 3 fold. (Presumably due to direct tensioning of the plantar fascia and blocking of 1st metatarsal plantar flexion). In some instances 6mm of flat poron has been more effective with regards pressure at the 1st IPJ than a TCO. Even with the normal modifications aimed at reducing tension in the plantar fascia and the introduction of a rocker sole the benefits are often minimal until the ankle joint is immobilised.

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