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1362576172 k d aout - plantar pressure - dfsi 2006

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k d aout - plantar pressure - dfsi 2006

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1362576172 k d aout - plantar pressure - dfsi 2006

  1. 1. Plantar pressure distributionPlantar pressure distribution in the normal and in the diabetic foot.in the normal and in the diabetic foot. An introduction to the use of plantar pressure data in clinical and scientific research. Kristiaan D’Août, PhD. University of Antwerp, Belgium and Centre for Research and Conservation, Belgium. in collaboration with Jain Institute of Vascular Sciences, Bangalore, India. Dr. Suresh, Dr. Vivekanand, Dr. Vinaya Diabetic Foot Society of India Mumbai, 13-15 October 2006
  2. 2. Biomechanics of the foot (healthy & diabetic)Biomechanics of the foot (healthy & diabetic) 1. Kinematics: movements, gait patterns 2. Kinetics: forces involved 3. Tissue properties 4. Plantar pressures • important in the diabetic foot Ulcer formation through ischemia and/or tissue damage • can be measured directly in a clinical setting
  3. 3. Pressure plate • mobile plate (approx. 42 x 56 x 1 cm) • contains discrete pressure sensors (0.5 x 0.7 cm) • static and dynamic measurements (300 fps) The « normal » human foot Pressure insoles • practical problems • mainly for footwear testing How to measure plantar pressure?How to measure plantar pressure?
  4. 4. Overview sequence (each 33th frame) Analysis: visual overview or focus on areas of interest
  5. 5. Time (s) Pressure(kPa) 2. loading time 3. pressure impulse 1. peak pressure
  6. 6. The three main pressure-related variables - clinical importanceThe three main pressure-related variables - clinical importance 1. Peak pressure May be most responsible for tissue damage. 2. Loading time May be most important in prolonged ischemia. Brief ischemia can not be avoided. 3. Pressure impulse Combines both; is recently shown to play a role in stress injuries, along with loading rate.
  7. 7. Pressure results with healthy subjects and with patientsPressure results with healthy subjects and with patients Three trials of the same subject There is considerable variation even within a standard protocol!
  8. 8. slow walking normal walking fast walking running turn left turn right standing sitting plantar sitting ball Peak P Time Impulse A case: First Metatarsal head during various tasksA case: First Metatarsal head during various tasks There is huge variation between different daily activities
  9. 9. Peak pressure Loading time pressure impulse Peak pressure seems high at the hallux only The metatarsal region is loaded longer Impulses at 3rd metatarsal are close to those of the hallux!
  10. 10. #141 #156 #022 Indian, barefoot Indian, barefoot Indian, shod
  11. 11. Discussion and conclusionsDiscussion and conclusions A pressure plate is a practical and highly useful tool in diabetic care: in prevention, treatment and follow-up. Yet, it is a recent technique and much research should be done. It is also very valuable in orthotic and prosthetic tuning. When time allows, normal daily behaviour of the patient should be mimicked. When time allows, peak pressure, loading time and pressure impulse are all informative. For a first screening, normal walking can be analysed in 5 minutes (one trial per foot, visual evaluation of the pressure profile). Plantar pressures are but one tool for the physician. Measurements should be combined with other data (e.g. sensitometry), as there are no unequivocal threshold « safe pressure » data to date.
  12. 12. kristiaan.daout@ua.ac.be Acknowledgements Dr. Suresh, Dr. Vivekanand, Dr. S. Praet, Dr. Rajendrakumar, Dr. Vinaya, Ms. Usha, Mr. Uday, Mr. Albert. The entire staff of the Jain Institute of Vascular Sciences, Bangalore. Thank you!Thank you!

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