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CSB523- Gait > wk 5- plantar pressure > Flashcards

wk 5- plantar pressure Flashcards

1
Q

difference between force and pressure measurement

A

f- a vector quantity which means that it has both magnitude and direction. allow measurmeent of the foot as a whole. measured in (N) newton.

p- measure of force per unit area. it shows the distribution of load across different regions. measured in (kPa) kilopascals

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2
Q

how can foot/body structure relate to plantar pressure

A

high arch, pes cavus = force over a smaller area = higher pressure

lower arch, pes planus = force over larger area = lower pressure

shape and BMI matters for plantar pressure

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3
Q

plantar pressure assessment refers to the study of

A

pressure acting between the
plantar surface of the foot and a supporting surface (ground, shoe or insole)
* Pedography (or pedobarography) is another term for this.

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4
Q

clinical applications include?

A

-sports biomechanics
-gait biometrics
-offloading diabetic feet

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5
Q

formula for pressure

A

force / contact area

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6
Q

pressure has a relationship with

A

force, stance time and contact area

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7
Q

different equipment for plantar pressure

A

pressure plates
instrumented treadmill
insole systems (in shoe)

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8
Q

outcome measures for plantar pressure assessment (7)

A

stance time
* Contact area
* Peak pressure
* Maximum force
* Pressure-time integral
* Force-time integral
* Centre of pressure line

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9
Q

what does the stance time tell you

A

shorter stance time = faster walk
faster walk= more pressure

same stance time for trials = consistent gaits

important that the stance time is consistent for your trials

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10
Q

what does contact area tell us and what can it be used for

A

pes cavus, high arch
pes planus low arch`

used for offloading high pressure areas by increasing contact area in the foot

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11
Q

what is peak pressure

A

indicates magnitude of peak pressure but not how long this pressure is applied to the foot

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12
Q

pressure time integreal and force time integral

A

area under the curve of the pressure time graphs and force time graphs

indication of magnitude and time in specific areas

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13
Q

what is centre of pressure pathway

A

also known as gait line. green dot is start, red dot is toe off. dots close together moving slowly through region, dots further apart moving quickly through region.

looking for sharp changes of direction or asymmetry between feet

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14
Q

what is the step to step variation of gait measures and how this is quanitfied

A

Normal amount of variation in gait due to
motor control / human factors

  • Also consider the amount of error/variation
    that might be introduced by the
    measurement procedure itself, e.g.
  • Skin movement
  • Marker placement
  • Targeting force plate
  • Calibration issues
  • Knowing how much variability to expect can
    help us determine the amount of difference
    is clinically significant
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15
Q

whats the clinical applications of plantar pressure analysis in podiatry 7

A

diabetes and other high risk populations

musculoskeletal deformities

pre/post surgery

effect of orthoses/footwear

gait analysis in neurological conditions

sport and biomechanics

running technique analysis

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16
Q

methodological considerations 7

A
  • Sensor size
    -(can underestimate peak pressure values due to the area its assessing)
  • data collection protocols and instrumentation
  • Frequency and responsiveness (sensor type)
    -ability of the sensor to change quickly

*calibration

  • Individual step-to-step variation (reliability/repeatability)
    -extent to which a consistent measure is obtained on different occasions
  • in shoe vs barefoot pressure plate

how many regions to mask for analysis

17
Q

different protocols for platforms

A

Mid-gait protocol
* Data are collected after the subject has taken a few steps (approx 5)
* Subjects may “target” the force or pressure plate
-most representative of a standard gait pattern
-can be fatiguing or difficult for patients

Two-step protocol
* Data are collected from the subject’s second step
* Reported to be almost as reliable as mid-gait method
-better protocol for those with difficulties of prolonged standing or understanding instructions

also 1 and 3 step protocols

and two step XL emed platform- overcomes targetting and measures TSP

and instrumented treadmill (zebris)-no targetting, but overground vs treadmill walking

18
Q

methodogical factors influencing plantar pressures (7)

A

gait speed

sensor size

reliability

contact area and site

walking protocol

instrumentation

population studied

19
Q

individual factors that influence plantar pressures

A
  1. body composition- extra pressure due to weight
  2. insensate or painful feet
  3. foot deformities

4.altered kinetics/kinematics

  1. atrophy of muscle/fat
  2. footwear and offloading
  3. walking speed
20
Q

the differences between 5x5mm and 10x10mm sensors

A

5x5- lesser toe error is still atleast 8%. used in most contemporary systems

10x10- may underestimate true pressure by between 17% and 70%, lesser toes, bony prominences, soft tissue atrophy

21
Q

frequency and responsiveness

A

frequency response - ability of sensor to change with force/pressure changes

scanning frequency- rate at which measurements are taken and recorded

22
Q

disadvantage of emed and pedar system with sensor type

A

sensor is larger than most other sensor types- can underestimate pressure in sites

23
Q

adverse effects of pressure on the diabetic foot

A

-pressure ischaemia
-tissue atrophy
-hypertrophy (callous formation)
-pain
-ulceration

24
Q

in diabetics how can injury form? 4

A

-high pressures over long period
-low pressure over very long duration
-moderate repetitive pressure
-shearing pressure

25
Q

reducing plantar pressure does what

A

interventions aim to reduce load or pressure in certain areas of the foot

26
Q

reliability of measures
what does it mean, what is it reported as, how to interpret this?

A

the extent to which a consistent measure is obtained on different occasions, commonly reported as intra class correlation coefficient (ICC)

ICC: >0.9 very good
>0.75 good
0.5-0.75 moderate
<0.5 poor

ICC does not help us determine how much variability to expect

27
Q

coefficient of variation

A

standard deviation of gait values

28
Q

coefficient of repeatability

A

variation less than 10% is considered a reliable measure

29
Q

why do patients with neuropathy have very high pressures

A

they do not feel the pain and therefore do not alter their gait to avoid the high pressure point

30
Q

ways you can reduce plantar pressure 6

A

Total contact insoles/orthoses
* Metatarsal pads
* Rocker sole shoes
* Footwear
* Felt pads
* Walking devices

CSB523- Gait (12 decks)

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