EFFECT OF NEURAC THERAPY ON PLANTAR PRESSURES DISTRIBUTION AND THE CENTER OF GRAVITY OF THE HUMAN BODY

Nowadays, the pathophysiological posture is a problem for a large part of the population, which leads to a deterioration in the quality of life as a result of functional disorders of the human musculoskeletal system. The aim of the presented article is to point out the effectiveness of movement therapy for the correction of the pelvic position and subsequent adjustment of the body posture, which is evaluated by a change in the distribution of plantar pressures as well as the position of the center of gravity projection. Observations were made on three subjects who reported pain in different areas of the body as a result of incorrect body posture. Input and control measurements were performed on a baropodometer, and Neurac movement therapy in the Redcord system was applied between the individual measurements. The individual exercises were chosen specifically with regard to affect the specific muscle groups. After evaluating the measured data, it can be stated that the selected movement therapy has a significant effect on the correction of pathophysiological position, which is also demonstrated by changing the distribution of plantar pressures, adjusting the position of the center of gravity projection and also significantly eliminating painful symptoms and increasing movement comfort.

Static and Dynamic Plantar Pressure and Normalized Plantar Pressure Characteristics among Children, Adults, and the Elderly

Background: A better understanding of plantar pressure while standing and walking would help in improving balance and gait performance across different age ranges. Objective: To clarify the differences of plantar pressure while standing and walking among children, adults, and the elderly. Materials and Methods: Fifty-three participants including eleven aged 3 to 8 years, thirty aged 20 to 40 years, and twelve aged 60 to 90 years were included in the present study. Plantar pressure and related parameters while quiet standing and walking with self-selected speed were assessed. Results: In static plantar pressure, no significant differences were observed of mean different pressure and mean different contact area between dominant and non-dominant limbs among the three groups, while center of pressure (COP) displacement was shown as significantly greater between children and adults (p<0.05). For dynamic plantar pressure, no significant differences in COP velocity were found among the three groups. The elderly showed significant lower normalized maximum plantar pressure in areas of the second and third metatarsal, and internal heel compared with the young adults (p<0.05). Additionally, normalized maximum plantar pressures among children seemed to differ from adults. Conclusion: Plantar pressure characteristics could indicate that children develop gait ability in braking and propulsion phases with greater heel and toe function, while the ability of braking and propulsion declined with aging. These could reflect balance ability while standing or walking. Keywords: Foot pressure; Children; Elderly; Normalization

Enhancing the differentiation of walking and standing via the ratio of plantar pressures

Differentiation of standing and walking based on plantar pressures is helpful in developing strategies to reduce health risks in the workplace. In order to improve the differentiation ability, the paper proposes a new metric for posture differentiation, that is, the pressure ratio on the two anatomical plantar regions. The plantar pressures were collected from 30 persons during walking and standing. After verifying the normal distribution of the pressure ratio by the Monte Carlo method, two-way repeated-measures ANOVA was conducted for the pressure ratios. The advantage of the pressure ratio over two conventional pressure metrics (the average pressure and the peak pressure) is demonstrated by its much larger size effect. Furthermore, the pressure ratio permits to establish value ranges corresponding to walking and standing, which are less influenced by specific person factors, thus facilitating the design of a standardized posture recognition system. The underlying mechanism underlying the pressure ratio is discussed from the aspect of biomechanics of movement.

Impact of Asthma on Plantar Pressures in a Sample of Adult Patients: A Case-Control Study

Based on the high prevalence of asthma in the population, and its relationship with various musculoskeletal and postural disorders, the aim of this study was to evaluate the plantar pressures in asthmatic patients compared to a control group. A case-control study involving 90 participants was conducted, consisting of 45 asthma patients and 45 healthy paired controls. Static plantar pressure data were recorded using a portable pressure sensor platform. Statistically significant differences were shown in the body weight on the left heel (p = 0.031), and the right forefoot maximum peak pressure was lower in the case group (p = 0.042). The findings of this study show alterations in static plantar pressures in asthmatic patients compared to healthy individuals. Specifically, the subjects with asthma showed less maximum pressure in the right forefoot and less weight on the left heel, which appear to be associated with the asthma disease.

Insoles to ease plantar pressure in people with diabetes and peripheral neuropathy: a feasibility randomised controlled trial with an embedded qualitative study

Background: Therapeutic footwear and insoles are preventative strategies to reduce elevated plantar pressures associated with diabetic foot ulcer risk. An insole intervention appropriate for chairside delivery optimizing plantar foot pressure reduction in people with diabetes has been developed. Aim: To explore the feasibility and acceptability of testing an optimized insole compared with an active control insole to reduce plantar pressures for people with diabetic peripheral neuropathy.Methods: A double-blinded multicentre feasibility RCT with an embedded qualitative study. In addition to usual care, participants were randomized to either an optimized insole group (Intervention) or a standard cushioned insole group (Active control). Participants were assessed at baseline, 3, 6 and 12 months with clinical outcome of mean peak plantar pressure (MPPP) reduction. An embedded qualitative study involved semi-structured interviews with 12 study participants and three podiatrists to explore their experiences of the intervention and trial procedures. Data were analyzed using descriptive statistics (quantitative data) and thematic analysis (qualitative data).Results: Screened were142 patients from which 61 were recruited; 30 participants were randomized to the Intervention group and 31 to the Active control group. Forty-two participants completed the study. At 12-months, 69% of the patient-reported questionnaires were returned and 68% of the clinical outcomes were collected. Mean difference in MPPP between the Intervention and Active control groups for all regions-of-interest combined favoured the Intervention, with increases from 87kPa at post-randomization to 255kPa at 12-months. Thematic analysis revealed three themes; accepting the study, behaviour and support during study procedures, and impact from study participation. Conclusion: The results of the feasibility RCT suggest that the optimized insole holds promise as an intervention, and that a full RCT to evaluate the clinical and cost-effectiveness of this intervention is feasible and warranted for people with diabetic peripheral neuropathy. Trial registration: International Standard Randomized Controlled Trial Number: ISRCTN16011830. Registered 9th October 2017, https://www.isrctn.com/ISRCTN16011830

Clinical foot measurements as a proxy for plantar pressure testing in people with diabetes

Background High plantar pressures are associated with increased foot ulcer risk in people with diabetes. Identification of high plantar pressures in people with diabetes is clinically challenging due to time and cost constraints of plantar pressure testing. Factors affecting foot biomechanics, including reduced joint range of motion and foot deformity, are implicated in the development of high plantar pressures and may provide a method to clinically identify those at risk of pressure related complications. The aim of this study was to investigate the contribution of joint range of motion and foot deformity measures on plantar pressures in a community dwelling group with diabetes. Methods Barefoot (Tekscan HR Mat™) and in-shoe (Novel Pedar-X®) plantar pressure variables, weight bearing ankle dorsiflexion, hallux range of motion, lesser toe deformities and hallux abductus (HAV) scale were assessed in 136 adults with diabetes (52.2% male; mean age 68.4 years). Multivariate multiple linear regression was used to assess the effect of the four biomechanical factors plus neuropathy and body mass index on plantar pressure variables. Non-parametric bootstrapping was employed to determine the difference in plantar pressure variables for participants with two or more foot biomechanical pathologies compared to those with less than two pathologies. Results Almost one third (32%) of the cohort had two or more foot biomechanical pathologies. Participants with two or more foot biomechanical pathologies displayed significant increases in all barefoot plantar pressure regions (except forefoot), compared to those with less than two pathologies. No significant changes were found for the in-shoe plantar pressure variables. The regression model explains between 9.9% (95%CI: 8.4 to 11.4%) and 29.6% (95% CI: 28.2 to 31%), and between 2.5% (1.0 to 4.0%) and 43.8% (95% CI: 42.5–44.9%), of the variance in the barefoot and in-shoe plantar pressure variables respectively. Conclusions Participants presenting with two or more factors affecting foot biomechanics displayed higher peak pressures and pressure time integrals in all foot regions compared to those with less than two factors. The tests used in this study could help clinicians detect elevated plantar pressures in people with diabetes and present an opportunity for early preventative interventions.

Accuracy of Foot Pressure Measurement on Predicting the Development of Foot Ulcer in Patients with Diabetes: A Systematic Review and Meta-Analysis

Objective: Areas of the foot with diabetic ulcers have been observed to have greater plantar pressures compared to non-ulcerated. Pressures play an essential role in the mechanism of lesion, and their reduction is effective in prevention. We conducted a systematic review to evaluate pedobarography as a predictive tool for ulcer development, since there is still no consensus on this aspect. Methods: We searched PUBMED (MedLine), EMBASE, Scopus, Web of Science, CINAHL and Scielo for cohort studies that measured plantar pressure at baseline and verified ulcer development on follow-up. Pooled effects of accuracy, sensitivity, specificity and relative risk were calculated using the inverse variance method. Risk of bias was assessed using the QUADAS-2 tool. Results: Three studies ( n = 2000) had enough information on accuracy to be included into a meta-analysis, and 4 ( n = 2651) were analyzed using qualitative methods. Pooled sensitivity and specificity were found to be 0.63 (Confidence Interval (CI) 0.58-0.68) and 0.42 (CI 0.27-0.58), respectively. Pooled relative risk was 1.95 (CI 1.09-3.51). Risk of bias was low to uncertain. Conclusions: Pedobarography in itself appears to have low accuracy in evaluating risk of ulceration. Several methodological heterogeneities were found, and the most optimal cut-off value is yet to be determined.