A Pilot Study of a Tactile Measurement System Using Lateral Skin Stretch on Foot Plantar Surface

2017 ◽  
Vol 21 (1) ◽  
pp. 74-78 ◽  
Author(s):  
Shuichi Ino ◽  
◽  
Manabu Chikai ◽  
Emi Ozawa ◽  
Tadasuke Ohnishi ◽  
...  
Keyword(s):  
Metatarsal Head ◽  
Testing Equipment ◽  
Perception Threshold ◽  
Tactile Sensibility ◽  
Plantar Surface ◽  
Response Switch ◽  
Foot Problems ◽  
Tactile Threshold ◽  
Protective Sensation ◽  
Changes Over Time

The purpose of this study is to develop smart equipment to quantify plantar tactile sensibility for early diagnosis and tracking of peripheral neuropathy caused by diabetes mellitus. In this paper, we present new testing equipment composed of a plantar tactile stimulation platform with a moving contactor to stretch the skin tangentially, a response switch for each tactile stimulus, a motor control box, and a personal computer for psychophysical data processing. This testing equipment offers more precise measurements and is easy to use compared to conventional testing tools such as von Frey monofilaments, pin-prick testing devices, and current perception threshold testers. Using our testing equipment, we showed that the plantar tactile threshold for the tangential stretching stimulus on the first metatarsal head of the feet ranges from approximately 10 to 60 μm for subjects without diabetic foot problems. Meanwhile, the plantar tactile threshold of some subjects suspected of having diminished protective sensation by the Semmens-Weinstein monofilament testing is approximately 100 μm or more. These preliminary results suggest that our testing equipment based on the plantar sensation elicited by lateral stretching of skin has the potential for quantitative diagnosis in subjects suspected of suffering from neuropathy, and for monitoring changes over time to sustain quality of life.

Effect of Orthotic Therapy on Claw Toe Loading

2004 ◽  
Vol 94 (3) ◽  
pp. 246-254 ◽  
Author(s):  
Penny J. Claisse ◽  
Jodi Binning ◽  
Julia Potter
Keyword(s):  
Pressure Measurement ◽  
Plantar Pressure ◽  
Metatarsal Head ◽  
Plantar Surface ◽  
Time Integral ◽  
Pressure Time ◽  
Second Metatarsal ◽  
Plantar Pressure Measurement ◽  
Access To Data ◽  
Toe Deformity

This study demonstrates the effect of orthotic therapy for toe deformity on toe and metatarsal head pressures using a new analysis method facilitated by an in-shoe pressure-measurement system’s ability to export detailed data. Plantar pressure–time integrals in 11 individuals (22 feet) with claw deformity of the lesser toes were measured with and without toe props. Differences in pressure–time integrals at every individual sensor unit were then calculated for the two conditions, and significance was tested using the paired t-test. Plantar surface charts with contours of equal significant pressure–time integral change showed significant reduction under 17 second toes (77%), 22 third toes (100%), 15 fourth toes (68%), 13 second metatarsal heads (59%), 16 third metatarsal heads (73%), and 16 fourth metatarsal heads (73%). All 22 feet showed increases under the prop in the area of the third toe sulcus. This innovative approach to plantar pressure analysis could improve access to data that show significant pressure–time integral changes and, therefore, could advance the clinical application of plantar pressure measurement. (J Am Podiatr Med Assoc 94(3): 246–254, 2004)

Reduction of plantar pressure with the rigid relief orthosis

1993 ◽  
Vol 83 (3) ◽  
pp. 115-122 ◽  
Author(s):  
A Novick ◽  
J Stone ◽  
JA Birke ◽  
DM Brasseaux ◽  
JB Broussard ◽  
...  
Keyword(s):  
Mechanical Stress ◽  
Plantar Pressure ◽  
Pressure Transducer ◽  
Clinical Effectiveness ◽  
Metatarsal Head ◽  
Lesion Site ◽  
Measurement Systems ◽  
Plantar Surface ◽  
First Metatarsal

The rigid relief orthosis was developed to protect vulnerable sites on the plantar surface of the insensitive foot against reulceration by providing both a nonyielding relief under the healed lesion site and a total contact fit. Clinically, the rigid relief orthosis has been effective in protecting the foot against the trauma induced by the repetitive mechanical stress of walking. This study used both the Hercules and F-Scan pressure transducer systems to measure pressure at the first metatarsal head in three orthotic treatments. Both measurement systems recorded significant reductions in pressure at the first metatarsal head with the rigid relief orthosis, establishing a quantitative rationale explaining its clinical effectiveness. Significant pressure differences were also recorded at the secondary sites of the heel, midfoot, and third metatarsal head.

Tactile Sensibility of Natural Teeth and Osseointegrated Dental Implants to Loading

2015 ◽  
Vol 15 (1) ◽  
pp. 58-62
Author(s):  
Linards Grieznis ◽  
Peteris Apse ◽  
Leons Blumfelds
Keyword(s):  
Dental Implants ◽  
Vertical Axis ◽  
Point Of View ◽  
Endodontically Treated Teeth ◽  
Tactile Sensibility ◽  
Mean Values ◽  
Osseointegrated Implants ◽  
Tactile Threshold ◽  
Natural Teeth ◽  
The Mean

SummaryIntroduction. Dental implant therapy has become a popular method of replacing one or more missing teeth. Osseointegrated dental implants have been studied from histological, microbiologic and biomechanical point of view, but the neurophysiologic integration of the implants and the supported prostheses has received less attention. The sensory mechanism of dental implants is qualitatively different from that of natural teeth. Psychophysiological tests are used to determine the tactile sensibility perceived with the implants and teeth.Aim of the study. The purpose of this study was to compare tactile sensibility of natural teeth and osseointegrated dental implants.Material and methods. Forty-three patients were included in the study. Natural teeth were divided into two groups: non endodontically treated teeth (NETT) and endodontically treated teeth (ETT). Load tests were done by a computer-controlled pressure sensitive device („Power Lab“ Data Acquisition System - model 4/25T, sensor - model MLT003/D; ADInstruments), specially modified for intraoral use. Pushing forces were applied parallel to the vertical axis of teeth and implants. The patient held a signal button which he/she activated as soon as touch was sensed. At this moment the computer registered passive absolute tactile threshold - measured in Newtons. The mean values of passive absolute tactile threshold for natural teeth and dental implants were calculated. Comparison of the mean values was performed by the means of t-test.Results. Passive absolute tactile threshold for osseointegrated dental implants was 2.39 N (SD=1.92), and for teeth - 0.67 N (SD=0.72), for non endodontically treated teeth it was 0.63 N (SD=0.72) and for endodontically treated teeth - 0.73 N (SD=0.69). The differences in mean values were statistically significant (p<0,0001) except for mean values of NETT vs. ETT.Conclusion. This study shows that patients with osseointegrated implants subjectively feel “touch” sensation when greater force is applied compared with natural teeth.

scholarly journals Geometric Comparison of Second Metatarsal Shortening Osteotomy Variations Using 3D Printed Patient-Specific Models

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Eric Lukosius ◽  
Umur Aydogan ◽  
Gregory Lewis ◽  
Evan Roush
Keyword(s):  
Metatarsal Head ◽  
Patient Specific ◽  
Wedge Osteotomy ◽  
Metatarsal Osteotomy ◽  
Closing Wedge Osteotomy ◽  
Plantar Surface ◽  
Lateral Translation ◽  
Closing Wedge ◽  
Shortening Osteotomy ◽  
Second Metatarsal

Category: Midfoot/Forefoot Introduction/Purpose: Second metatarsal shortening osteotomy is frequently used in the treatment of metatarsalgia and aims to decrease metatarsophalangeal joint and plantar pressures. Although various proximal, midshaft, and distal metatarsal osteotomy methods have been described for surgical treatment of metatarsalgia, to our knowledge no studies quantitatively compared their resulting geometric corrections. The purpose of our study was to investigate how much each osteotomy variation changed the length of the metatarsal as well as the height and relative location of the metatarsal head (MH) itself. Methods: Following Institutional Review Board approval, three-dimensional computer models of second metatarsals of 5 deidentified clinic patients were extracted from CT scans using Mimics software. Fixed points were plotted on the printed models and a 3D coordinate digitizing arm (Microscribe) was used for precisely determining the 3D (x-y-z) coordinates of each point before and after the osteotomies. Six variations of second metatarsal osteotomies were performed using microsagittal saw and fixed using a 2.4 mm cannulated screw. The following osteotomy variations were performed with 3 and 5 mm translation or wedge resection for each patient model: (1) Classic Weil osteotomy performed at 15° and 25° to the plantar surface; (2) Classic Weil osteotomy performed at 15° and 25° using a double saw blade technique; (3) Classic Weil osteotomy performed at 25° and then a parallel block of 3 or 5 mm was removed; (4) Distal closing wedge osteotomy of the MH at 25°; (5) Proximal closing wedge osteotomy of the MH made at 45° removing a 3 and 5 mm wedge; (6) 45 degree oblique, midshaft, metatarsal osteotomy with 3 and 5 mm of translation. The change in the length of the metatarsal, and vertical and medio-lateral translation of the metatarsal head was calculated then normalized by the osteotomy translation distance. A general linear model with correlated errors and Bonferroni correction was used to assess differences between osteotomies. Results: The maximum metatarsal length shortening per millimeter translation was observed in osteotomy 3- 5 mm block (2.6 mm STD=2.1), while osteotomy 1- 15° caused the least (1.1 mm STD=0.6). Maximum dorsiflexion of the MH occurred with osteotomy 5- 5 mm wedge, 13.2 mm (STD= 4.9 mm) and minimum with osteotomy1- 25°, 0.5 mm (STD= 1.4 mm). No MH plantarflexion was noted with any of the osteotomies. The oblique midshaft osteotomies caused lateral translation of the metatarsal head significantly different from the controls (P <0.05) although not statistically different from one another (2.4 mm vs 4.3 mm). Conclusion: Discussion: Our data shows maximal change in length/millimeter translation by performing a classic Weil osteotomy at 25° to the plantar surface of the foot, 5 mm block resection and then translating 4 mm. This osteotomy also caused the most effective dorsal translation of the MH, thereby making it the most effective osteotomy in terms of affecting both length and MH vertical orientation. Should dorsiflexion of the MH be the surgeon’s only goal, then the proximal closing wedge osteotomy had the greatest impact while minimally changing overall length. With this knowledge, surgeons can tailor operations based on the direction and degree of correction needed to be achieved.

scholarly journals Tibial Sesamoidectomy: Indications and Outcomes

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0020
Author(s):  
Jun Kit He ◽  
Matthew Christie ◽  
Joseph Robin ◽  
Haley McKissack ◽  
Ashish Shah
Keyword(s):  
Case Series ◽  
Retrospective Chart Review ◽  
Metatarsal Head ◽  
Complete Healing ◽  
Safe Procedure ◽  
Retrospective Case ◽  
Plantar Surface ◽  
Radiographic Measurements ◽  
Fracture Nonunion ◽  
Operative Findings

Category: Midfoot/Forefoot Introduction/Purpose: Tibial sesamoidectomy has been reported to be a safe and effective procedure of treating a range of sesamoid pathologies including chronic sesamoiditis and fracture nonunion. The purpose of this retrospective case series was to determine common clinical indications for tibial sesamoidectomy and to evaluate the postoperative clinical course and outcomes. Methods: A retrospective chart review was conducted on patients who had isolated tibial sesamoidectomy after failed conservative treatment from 2009 to 2018. Demographics, comorbidities, physical exam variables, operative findings, radiographic measurements including hallux valgus angle (HVA) and intermetatarsal angle (IMA), and clinical outcomes including visual analog score (VAS), Foot Function Index (FFI), and complications were gathered. Results: Twenty-six patients (13 males and 13 females) were identified who have undergone tibial sesamoidectomy with a mean age of 49.8±18.5 years. For those 21 non-ulceration patients, VAS was significantly improved from 5.27±2.41 pre-operatively to 0.91±1.14 post-operatively (p<0.01). There was no statistically significant change in IMA (8.35±1.87º to 8.29±1.79º, p=0.93) or HVA (14.94±6.82º to 14.28±7.78º, p=0.79). Postoperative FFI was obtained for 10 patients with a mean of 132.75±50.68. For those five patients who had chronic ulceration on the plantar surface of the medial metatarsal head, four had complete healing at a mean of 15.6±5.37 weeks post-operatively. There was a 17% incidence of complications including neuritis, transfer metatarsalgia, and persistent cock-up deformity. Conclusion: When utilized judiciously and with the right indications, isolated tibial sesamoidectomy is a safe procedure which can improve pain and ulcer healing. HVA and IMA remained unchanged at final follow-up.

scholarly journals Reproducible measurements for radiographically assessing longitudinal tarsal axes of severe cavus or flatfoot deformity

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0028
Author(s):  
Masamitsu Kido ◽  
Kazuya Ikoma ◽  
Toshihiro Hosokawa ◽  
Kan Imai ◽  
Masahiro Maki ◽  
...  
Keyword(s):  
Correlation Coefficients ◽  
Metatarsal Head ◽  
Lateral View ◽  
Standardized Assessments ◽  
Foot Deformities ◽  
Radiographic Images ◽  
Inferior Surface ◽  
Plantar Surface ◽  
First Metatarsal ◽  
Reference Axis

Category: Other Introduction/Purpose: Calcaneal pitch and Meary’s angles are commonly used to assess longitudinal foot arches on lateral-view radiographs. Several different methods have been described in literatures to obtain the talar, first metatarsal, calcaneal, and plantar axes, but their reliability and reproducibility still remain to be evaluated. The aim of this study was to determine the most reproducible methods for radiographically evaluating the longitudinal axes. Methods: Standing radiographic images of 40 feet from consecutive outpatients, 22 feet with a severe cavus deformity and 48 feet with a severe flatfoot deformity, were obtained to measure the longitudinal axes of the talus, first metatarsal, calcaneus and plantar surface by using six, five, four and three different methods, respectively, that were described in the previous reports (Figure). Interobserver and intraobserver correlation coefficients were calculated by three observers. Results: The best interobserver and intraobserver correlation coefficients were obtained for methods that used a line bisecting the angle formed by the lines tangential to the superior and inferior margins of the talus (Method B), a line connecting the center of the first metatarsal head and the midpoint of the visualized base of the first metatarsal (Method J), and a line drawn tangential to the inferior surface of the calcaneus (Method L). For the plantar axis, the method that used the horizontal plane [reference axis] was considered the best. Conclusion: The above mentioned methods were considered ideal for the radiographic assessment of longitudinal foot arches, even in severely deformed feet. This study could contribute to standardized assessments of foot deformities.

Comparison of Stability of Proximal Crescentic Metatarsal Osteotomy and Proximal Horizontal “V” Osteotomy

1994 ◽  
Vol 15 (5) ◽  
pp. 263-270 ◽  
Author(s):  
Leland C. McCluskey ◽  
Jeffrey E. Johnson ◽  
George T. Wynarsky ◽  
Gerald F. Harris
Keyword(s):  
Metatarsal Head ◽  
Metatarsal Osteotomy ◽  
Plantar Surface ◽  
Cortical Screw ◽  
Fixation Techniques ◽  
Fresh Frozen ◽  
Rapid Healing ◽  
K Wires ◽  
The Stability ◽  
Screw Group

Proximal metatarsal osteotomies are often performed in patients with hallux valgus and significant metatarsus primus varus. The crescentic osteotomy is popular; however, some authors have reported malunion of the metatarsal shaft caused by dorsal angulation of the osteotomy in a significant number of cases. Recently, proximal transverse “V” osteotomies have been reported to have good results, with rapid healing and no dorsal malunions. We compared the stability of a transverse, proximal “V” osteotomy, using two 0.062-inch K-wires or a 3.5-mm cortical screw for fixation, with that of the proximal crescentic osteotomy, using a 3.5-mm cortical screw fixation. The three osteotomy/fixation techniques were performed on 30 fresh-frozen cadaver feet. The specimens were loaded to failure at the fixation site by applying a load through the plantar surface of the first metatarsal head. Force versus displacement curves were obtained to calculate the failure load and stiffness. Statistical differences among the three groups were determined by the nonparametric Mann-Whitney U-test and the standard t-test. The “V” osteotomy/screw group was more stable than either the “V” osteotomy/pin group or the crescentic osteotomy/screw group. Differences in failure strength between the “V”/screw group and the other two groups were significant at the P < .01 level and the differences in stiffness were significant at the P = .05 level. No statistical differences were found between the “V”/pins and the crescentic/screw groups.

scholarly journals Study to assess neuropathy severity in patients with diabetic foot problems

2020 ◽  
Vol 7 (11) ◽  
pp. 3762
Author(s):  
Someshwara Rao Pallela Narayana
Keyword(s):  
Diabetic Foot ◽  
Sampling Technique ◽  
Foot Care ◽  
Perception Threshold ◽  
Vibration Perception Threshold ◽  
Charcot Neuroarthropathy ◽  
Painful Sensation ◽  
Foot Problems ◽  
Vibration Perception

Background: Diabetic neuropathy is the most common complication of diabetes affecting 50% of the patients with type 1 and type 2 diabetes. Its late sequelae which include foot ulceration, charcot neuroarthropathy and occasionally amputation, should in many cases be preventable. Biothesiometry is a device which can measure the vibration perception threshold and guide the treatment as well as prevent further foot problems in such patients.Methods: In this study we included 65 patients with diabetic foot symptoms by random sampling technique between the age group of 40-75 years. All these patients were subjected to biothesiometer testing. The response was measured as vibration perception threshold (VPT). The variation of VPT in different conditions was established.Results: Among 65 patients, 40(61%) patients had painful sensation, VPT ranging from 16 V to 25 V, 6 (0.09%) patients had callus, dry foot or pigmentation with VPT 25-35 V, 12 (18.4%) patients had callus ulcer with VPT 36-45 V, 3 (0.046%) patients had both ulcer and skin changes with VPT 45-50 V and 4 (0.06%) patients presented with deformity and VPT 50 V.Conclusions: The study concluded that risk of ulceration is high with increased VPT. Hence, early detection of raised VPT would help the clinicians not only to guide the patients about the high risk of ulceration but it as well will help in educating the patient and emphasizing the need for proper glycemic control, proper footwear and foot care.

Trigeminal neuralgia: a quantitative sensory perception threshold study in patients who had not undergone previous invasive procedures

1997 ◽  
Vol 86 (2) ◽  
pp. 190-192 ◽  
Author(s):  
David Bowsher ◽  
John B. Miles ◽  
Carol E. Haggett ◽  
Paul R. Eldridge
Keyword(s):  
Trigeminal Neuralgia ◽  
Sensory Perception ◽  
Gasserian Ganglion ◽  
Invasive Procedures ◽  
Perception Threshold ◽  
Content Type ◽  
Idiopathic Trigeminal Neuralgia ◽  
Tactile Threshold ◽  
Fine Print ◽  
Von Frey Filaments

✓ The authors investigated 28 patients with “idiopathic” trigeminal neuralgia who had undergone no previous invasive procedures; together these patients had a total of 50 affected trigeminal divisions. Quantitative sensory perception thresholds were measured before operation. Preoperative measurements in the affected divisions indicated raised thresholds for touch (von Frey filaments) and temperature, but not for pinprick or heat pain, in agreement with the findings of Nurmikko. Only the tactile threshold was also significantly affected in the unaffected divisions on the affected side. The authors discuss their findings in relation to the pathophysiology of trigeminal neuralgia, concluding that the origin of the condition is almost certainly central to the gasserian ganglion.

scholarly journals An Improved Smart Ankle Foot Othosis Design Using Dual Fluid Power Cylinders

2010 ◽  
Vol 4 (2) ◽  
Author(s):  
Ricky Mehta ◽  
Eric L. Rohrs ◽  
Katarina F. Lipat ◽  
Evan C. Reed ◽  
Manish Paliwal
Keyword(s):  
Hydraulic Cylinder ◽  
Metatarsal Head ◽  
Foot Drop ◽  
Heel Strike ◽  
Neutral Position ◽  
Foot Orthoses ◽  
Ankle Foot Orthosis ◽  
Plantar Surface ◽  
Ankle Foot Orthoses ◽  
Foot Orthosis

To design a smart ankle-foot orthosis (SAFO) that improves upon current ankle-foot orthoses used to treat steppage gait. Current ankle-foot orthoses are subjected to significant stresses on the ankle region of the structure, causing discomfort and the possible failure of the AFO. Although these AFOs have a constant stiffness, they do not reduce the occurrence of slap foot, where the foot slaps on the ground rather than gradually lowering it. The SAFO is an active ankle-foot orthosis that allows the user’s foot to follow a normal gait cycle. It is designed to reduce stress at the ankle by allowing for movement of the foot beyond a 90 deg angle for plantarflexion. The hinged ankle-foot orthosis is incorporated with a novel dual hydraulic-cylinder system, two tension springs, and force sensitive resistors. The force sensors are placed at the hallux, first metatarsal head, fifth metatarsal base, and heel. The foot movement actuation follows the force applied to the plantar surface of the foot during gait. The sensor outputs are fed to a signal processor and control interface to coordinate the motor actuation with the forces exerted by the user. The motor turns the screw attached to the hydraulic cylinders, which, thereby, control the orifice size by moving a plate in the cylinder, thus, changing the resistance. The cylinder filled with air will be pressurized during the lean phase, as the orifices will be closed and will provide power just as a spring would during the heel-off phase. After the heel strike, the resistance of the fluid-filled cylinder is decreased to slowly lower the foot. Once the foot is flat, the resistance of the fluid-filled cylinder is increased to keep the foot in a position to allow for toe clearance. During the heel-off event, the air-filled cylinder will assist the user with the power to push off. When toe-off occurs, the fluid-filled cylinder will decrease the resistance to allow the tension springs to bring the foot back to neutral position. To power the motor and sensors, a rechargeable battery pack is placed in a waist bag. The SAFO’s flexible design uses a novel combination of hydraulic-pneumatic cylinders to prevent foot drop, and restore the user’s sense of normalcy by providing late stance plantarflexion and a return to neutral position in early swing phase.

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