Reconstruction of a 3D Human Foot Shape Model Based on a Video Stream Using Photogrammetry and Deep Neural Networks

Reconstructed 3D foot models can be used for 3D printing and further manufacturing of individual orthopedic shoes, as well as in medical research and for online shoe shopping. This study presents a technique based on the approach and algorithms of photogrammetry. The presented technique was used to reconstruct a 3D model of the foot shape, including the lower arch, using smartphone images. The technique is based on modern computer vision and artificial intelligence algorithms designed for image processing, obtaining sparse and dense point clouds, depth maps, and a final 3D model. For the segmentation of foot images, the Mask R-CNN neural network was used, which was trained on foot data from a set of 40 people. The obtained accuracy was 97.88%. The result of the study was a high-quality reconstructed 3D model. The standard deviation of linear indicators in length and width was 0.95 mm, with an average creation time of 1 min 35 s recorded. Integration of this technique into the business models of orthopedic enterprises, Internet stores, and medical organizations will allow basic manufacturing and shoe-fitting services to be carried out and will help medical research to be performed via the Internet.

Using motivational interviewing combined with digital shoe-fitting to improve adherence to wearing orthopedic shoes in people with diabetes at risk of foot ulceration: study protocol for a cluster-randomized controlled trial

Background Diabetic foot ulcers have a high impact on mobility and daily functioning and lead to high treatment costs, for example, by hospitalization and amputation. To prevent (re)ulcerations, custom-made orthopedic shoes are considered essential. However, adherence to wearing the orthopedic shoes is low, and improving adherence was not successful in the past. We propose a novel care approach that combines motivational interviewing (MI) with a digital shoe-fitting procedure to improve adherence to orthopedic shoes. The aim of this trial is to assess the (cost-)effectiveness of this novel care approach compared to usual care (no MI and casting-based shoe-fitting) in promoting footwear adherence and ulcer prevention. Methods The trial will include people with diabetes, with IWGDF Risk categories 1–3, who have been prescribed orthopedic shoes. Participants will be randomized at the level of the podiatrist to the novel care approach or usual care. The primary outcome is the proportion of participants who adhere to the use of their orthopedic shoes, that is, who take at least 80% of their total daily steps with orthopedic shoes. A temperature microsensor will be built into the participants’ orthopedic shoes to measure wearing time continuously over 12 months. In addition, daily activity will be measured periodically using log data with an activity monitor. Data from the temperature microsensor and activity monitor will be combined to calculate adherence. (Re-)experienced complications after receiving orthopedic shoes will be registered. Questionnaires and interviews will measure the experiences of participants regarding orthopedic shoes, experiences of podiatrists regarding motivational interviewing, care consumption, and quality of life. Differences in costs and quality of life will be determined in a cost-effectiveness analysis. Discussion This trial will generate novel insights into the socio-economic and well-being impact and the clinical effectiveness of the novel care approach on adherence to wearing orthopedic shoes. Trial registration Netherlands Trial Register NL7710. Registered on 6 May 2019

Influence of orthopedic shoes on the indicators of the interzonal load distribution on the foot when walking patients with cerebral palsy

BACKGROUND: Clinical observations of patients with spastic forms of cerebral palsy and surveys showed the most commonly used technical rehabilitative device of this patient contingent are orthopedic shoes. However, almost no clinical and instrumental studies examine the effect of such shoes on the walking characteristics of patients with cerebral palsy (CP). AIM: This study aims to estimate the effect of orthopedic shoes on the interzonal load distribution on the plantar foot surface in children with CP and adolescents with different levels of gross motor function disorders (GMFCS). MATERIALS AND METHODS: Biomechanical studies were conducted in 42 patients with CP 5-16 years old with GMFCS 13 level while wearing standard and orthopedic shoes. In 14 healthy children controls while wearing standard shoes (a total of 112 feet). Biomechanical examinations were performed on the software and hardware complex DiaSled-M-Scan with matrix plantar pressure meters in the form of insoles. Statistical data analysis was performed using nonparametric methods via SPSS software for Windows. RESULTS: The use of complex orthopedic shoes in patients with level GMFCS 1 did not improve but worsened their foot loading parameters. The shoes reduced the loading of the heel, increased the toe-heel load ratio, and mediolateral load distribution in the fascicle area. In patients with GMFCS 2, the positive effect of orthopedic shoes was limited to improving the mediolateral load distribution in the fascicle area. In patients with GMFCS 3, the positive effect of orthopedic shoes was noted in the majority of the tested parameters. CONCLUSION: Thus, the study showed that in children and adolescents with CP using complex orthopedic shoes led to the most significant normalization of interzonal load distribution under the foot in GMFCS 3 patients, less significant in GMFCS 2 patients, and worsened the parameters in GMFCS 1 patients.

Pedographic assessment of the impact of off-the-shelf orthopedic shoes on the load distribution under the feet in patients with a high risk of developing diabetic foot syndrome

BACKGROUND: It is known that the so-called “rocker” outsole helps to reduce the load on the forefoot and toes. Such an outsole is available in ready-made orthopedic shoes of some Russian manufacturers, however, an objective assessment of their impact on the load distribution under the foot during walking has not been carried out.AIMS: To study the pressure distribution inside the off-the-shelf orthopedic shoes“Sursil-Ortho” in comparison with the load inside the shoes used by patients on a daily basis.METHODS: We studied 20 patients (40 feet) with a high risk of diabetic foot syndrome. According to clinical data, a risk regions were determined on the plantar surface of the feet. In-shoe pedography (pedar, novel,Germany) was performed in shoes usually worn by the patients, and in orthopedic shoes“Sursil-Orto”(Moscow). The maximum peak pressure (MPP) was calculated. Criterion of efficiency: MPP in the risk region<200 kPa or reducing it by 25% or more.RESULTS: There was a significant decrease of the median MPP in the forefoot and in the risk region. The percentage of feet with MPP >200 kPa in the risk region decreased from 58% to 30% (p=0,014), in any area of the forefoot — from 63% to 30% (p=0,04). The increase in MPP under the midfoot and hindfoot did not exceed +14% (ns). Tested footwear was effective in 71% of cases. Predictors of the insufficient effect were: higher initial MPP in the risk region, risk region on the hallux or in the lateral part of the forefoot.CONCLUSIONS: Shoes with a rigid rocker outsole significantly reduce the pressure under the forefoot and under the toes during walking. The degree of load reduction varies: the lateral part of the forefoot and 2-5 toes are most unloaded, and the hallux and medial forefoot are slightly less.

Analysis of type and frequency dynamics of rehabilitation assistive devices in children with cerebral palsy

Background. Currently, cerebral palsy is the most common neuromuscular disease in the pediatric population. Spastic forms of cerebral palsy are characterized by secondary musculoskeletal complications. They are corrected by the use of assistive devices and, especially, orthoses, along with surgical treatment, botulinum toxin, and others. Aim. The aim of this study was to assess the type and frequency dynamics of rehabilitation assistive devices in children with spastic forms of cerebral palsy, depending on the level of the gross motor function of the patient. Materials and methods. A prospective analysis was conducted by questioning 214 parents of children with spastic forms of cerebral palsy who were treated for the period from 2017 to 2019. The patients were divided into five groups according to the gross motor function classification (GMFCS). The statistical processing was performed using the application package Statistica 10 and Microsoft Excel. Results. Statistically significant differences in variances (p 0.05) were obtained between the number of rehabilitation assistive devices used in the anamnesis in the year before the questionnaire (period I) and assistive devices used in the last six months before the questionnaire (period II). Repeatedly, patients used orthopedic shoes the most often, and the trunk-hip-knee-ankle-foot orthoses the most rarely. We found five main causes groups of assistive device use failure for children with cerebral palsy. Conclusion. Statistically significant differences in variances were obtained between the frequency of rehabilitation assistive devices used in the anamnesis and during the last six months before the questionnaire was obtained. It has been confirmed that patients used orthopedic shoes most regularly; of all functional orthoses, hip adductor orthosis was used most often repeatedly, whereas the trunk-hip-knee-foot orthoses were the least common. Factors such as a negative attitude of the child towards the orthosis, uncomfortable in life, the presence of construction errors of the product, the absence of appropriate appointments in the individual rehabilitation and habilitation programs for the patient, have led to the most frequent rejection of the reuse of the technical device for rehabilitation. At the same time, positive or negative dynamics on the condition of the patient affected the regularity of the use of a technical device for rehabilitation in only one in six patients.

Orthopedic Boot-Tree 3D Design by means of the Integral Curves of Solutions of Differential Equations

For the preparation of orthopedic shoes, it is necessary to design boot-trees, where pathological abnormalities of club feet are taken into account as much as possible. For the normal functioning of the club foot, we have to develop such an internal shape of special-purpose footwear, which is comfortable for the patient. This paper describes the methods and issues of the 3D design for constructing the geometric shapes of the main cross sections of the orthopedic boot-tree. In the research process, the authors’ team of this article relied mainly on the patient database, containing the anthropometric, strain-gauge, and pedographic data on club and pathological feet. To construct the shapes of the main cross sections of the orthopedic boot-tree, we have used the integral curves to the suitable second-order differential equations. By means of a computer program, we executed turning and connection of sections of the obtained curves, on the basis of which we have the shapes of transverse-vertical cross sections of the orthopedic boot-tree. This paper also describes the main longitudinal-vertical section and the print of the orthopedic boot-tree in 3D format. By using a program of 3D design (Delcam), a skeleton of the orthopedic boot-tree was constructed in the spatial format.

The attitude of doctors of various specialties to the problem of flatfoot

Purpose: to assess the subjective perception of flatfoots prevalence in children, its age dynamics and the main approaches to the diagnosis and treatment by doctors of various pediatric specialties with different medical experience and working in medical facilities at various levels by anonymous questionnaire. Materials and methods. Questionnaire data from 80 orthopedists (50 outpatient doctors, 30 doctors from a specialized scientific research institute and orthopedic departments of city hospitals (research institutes / hospitals) and 30 neurologists (polyclinic). Results: our study demonstrated that outpatient orthopedists diagnose the flatfoot on average in half of the cases. The orthopedists diagnose flatfoot only by means of visual examination in 46.1% of cases (neurologists in 85.7% of cases). According to our data, 58.9 % of outpatient doctors recommend wearing special orthopedic shoes (46.1 % only if the foot alone is affected) and 95.1 % of specialists recommend wearing individual orthopedic insoles (53.6 % if there are complaints). While 88.2 % of the orthopedic surgeons from specialized research institutes and hospitals do not recommend wearing orthopedic shoes; 26.7 % of experts recommend wearing individual orthopedic insoles only in the presence of complaints. On the other hand, the neurologists recommend wearing orthopedic shoes 5.3 times more often than the orthopedists do. Conclusion: our study demonstrates that the specialty of the doctor (orthopedist, neurologist) and the type of health care facilities in which the specialist works have the greatest impact on his subjective perception of the prevalence and age dynamics of flatfoot in children, tactics of diagnostics and treatment. The outpatient orthopedists diagnose flatfoot 4.2 times more often than the orthopedic surgeons from the specialized research institute and hospitals. Also, the outpatient orthopedists prescribe wearing orthopedic shoes 4.9 times more often (insoles 3.6 times more often) in comparison with the orthopedic surgeons of the specialized research institute and orthopedic hospitals. Summarizing the above mentioned, we would like to note that due to the fact that the current assessment of the age limits of the arch height feet is ambiguous, there is a need to introduce a unified system for assessing the foots shape and posture with defining the concepts of average height and typically developing foot.

Approaches to the technical means of rehabilitation selection using the ICF

The international classification of functioning, disability and health (ICF)is a classification of health components, allows to objectively determine the health status of patients, make a forecast of impaired functions and helps to assess the effectiveness of rehabilitation activities. The article describes the approach to the choice of technical means of rehabilitation with the help of ICF. UF allows you to objectively determine the health status of patients and to choose technical means of rehabilitation depending on the degree of disability: if an absolute dysfunction (96-100%) - functional beds, anti-bedsore mattress, gel cushion, wheelchair with headrest and armrests, the absorbent means absorbent diaper, chair - chair with sanitary equipment, a rigid splint with fixation of multiple joints, etc.; in severe functional disorders (50-95%) - anti-bedsore mattress, wheelchair with manual drive to move at home, wheelchair with manual drive to move on the street, anti-bedsore pillow, chair-chair with sanitary equipment, adsorbing agents, absorbent diapers, orthopedic shoes with a hard back, hard splint with fixation of several joints, walkers, anti-bedsore pillow, chair - chair with sanitary equipment, absorbent means absorbent diaper, orthopedic shoes with a hard heel, a hard splint with fixation of multiple joints, etc.; at moderate impairments (25-49%) - cane 4-point with a wide base, the axillary crutches with the device anti-skid bandage on the shoulder and the knee joint, the splint on the hand, stopiteration, etc.; in milder disorders (5-24%) - cane single-bearing alternator, the functional brace with shoulder and ankle etc.