To evaluate the therapeutic effect of botulinum toxin A (BTX-A) injection on spastic gastrocnemius (GCM) and tibialis posterior muscles (TPo) by using the foot pressure measurement system (FPMS).
Eighteen ambulatory CP patients were recruited in this study. BTX-A was injected into the GCM at a dose of 6-12 units/kg and TPo at a dose of 4-9 units/kg according to the severity of equinus and varus deformity. Foot contact pattern, pressure time integral (PTI), coronal index using the FPMS and Modified Ashworth Scale (MAS), and visual inspection of gait pattern were used for evaluation of the therapeutic effect of BTX-A injection. Clinical and FPMS data were statistically analyzed according to the muscle group.
A significant decrease in the MAS score of the GCM and TPo was observed, and spastic equinovarus pattern during gait showed improvement after injection. The GCM+TPo injection group showed a significant decrease in forefoot, lateral forefoot pad, and lateral column PTI, and a significant increase in hindfoot PTI and coronal index. In the GCM only injection group, forefoot PTI and lateral column PTI were significantly decreased and hindfoot PTI was significantly increased. The TPo only injection group showed a significant decrease in lateral column PTI and a significant increase in the coronal index. Change in PTI in the hindfoot showed a significant correlation with the change in MAS score of the GCM. Change in PTI of the lateral column and coronal index showed a significant correlation with the change in MAS score of the TPo.
The FPMS demonstrated the quantitative therapeutic effect of BTX-A on abnormal pressure distribution in equinovarus foot in detail. The FPMS can be a useful additional tool for evaluation of the effect of BTX-A injection.
Citations
Method: 16 hemiplegic patients who could walk without assistive devices were included in this study. We used insole foot-pressure system to measure weight bearing ratio of both feet during walking. We assessed walking speed and pressure ratio during straight or circular walking at their comfortable gait speed.
Results: Pressure ratio of affected foot showed negative correlation with walking time irrespective of walking direction. Pressure ratio of affected foot and walking time during circular walking to the affected side was significantly higher and slower respectively than that to the intact side.
Conclusion: Asymmetrical weight bearing of both feet during walking is highly correlated with walking ability in hemiplegic patients and pressure ratio of affected foot may be simple and useful determinant of walking ability. (J Korean Acad Rehab Med 2003; 27: 173-177)
Method: Twenty children with mild spastic diplegic cerebral palsy and fourteen normal children over 7 years old participated in this study. The foot was divided into 7 portions and then foot contact area, pressure of each foot portion and pathway of center of pressure (COP) were measured and analyzed by F-scan system (Tekscan Inc., USA)
Results: In children with cerebral palsy, first metatarsal area (MET1) showed the highest relative impulse followed by MET2/3, hindfoot and hallux. Relative impulse of hallux, MET1 and medial midfoot were significantly higher in cerebral palsied than in normal children, while that of hindfoot was significantly lower in cerebral palsied than in normal children. Anteroposterior ratio of COP and gait velocity were significantly lower in cerebral palsied than in normal children.
Conclusion: The characteristics of foot pressure distribution and the pathway of COP in children with mild spastic diplegic cerebral palsy were identified by quantitative analysis by F-scan system. Foot scan could be used for evaluating the foot pathology in children with cerebral palsy during gait. (J Korean Acad Rehab Med 2003; 27: 33-37)
Objective: To find out the characteristics of the foot pressure distribution and the path of center of pressure (COP) in the children with cerebral palsy, compared with normal control children.
Method: Twenty-four children with spastic cerebral palsy (CP) and 38 normal children were participated in this study. The parameters of foot contact, plantar pressure and COP were measured using F-scan system (Teksan Inc.) with pressure sensitive insoles inserted in the shoes.
Results: The total contact area, mid foot contact width and also the pressure of hallux and medial side of mid foot were significantly higher in the children with CP than in normal
controls. While the pressure of hind foot was significantly lower in the children with CP compared with normal controls. Anteroposterior distance and velocity of COP were significantly lowered in the cerebral palsied children. The paths of COP of both groups were directed inwardly without any significant differences between both groups.
Conclusion: We can identify the characteristics of the foot pressure distribution and the path of COP in the children with spastic CP using F-scan system. These quantitative data of foot scan may be useful for evaluating the foot pathology during the gait in the children with CP. (J Korean Acad Rehab Med 2002; 26: 127-132)
Objective: To find out the changes of the plantar pressure distribution of foot and the pathway of center of pressure (COP) in normal preschool children with age.
Method: Thirty-eight normal children aged 1 to 6 were participated in this study. We divided into three groups according to the age. Foot contact area, pressure of the foot and pathway of COP were measured using F-scan in-shoe measuring system (Tekscan Inc.) during the gait.
Results: The ratio of midfoot contact width to forefoot contact width was decreased with age (p＜0.05). And the relative pressure of the medial midfoot was decreased with age (p＜0.05). In the analysis of COP, the ratio of anteroposterior length of COP to total contact length was significantly increased (p＜0.05), and the ratio of mediolateral width of COP to forefoot contact width was tend to decrease.
Conclusion: We can identify the characteristics and changes of the foot pressure distribution and the pathway of COP in preschool children with normal foot using F-scan system. These quantitative data of foot scan are useful for evaluating the foot pathology in preschool children during the gait.
Objects: The purpose of this study is to estimate the values of foot pressure of the stance phase during a gait cycle in hemiplegic gait.
Method: Thirty patients who had a stroke and forty healthy adults were evaluated by the EMED-SF system to analyze the stance phase of hemiplegic gait. The stance phase was evaluated by 6 points according to the foot pressure and center of pressure proposed by Lee et al.2)
Results:
1) In hemiplegics, the stance time of involved limb decreased compared with that of the uninvolved limb and increased that of control groups (p＜0.05).
2) In hemiplegics, the midstance time increased but the loading response and terminal stance decreased compared with the uninvolved limb and controls (p＜0.05).
3) In hemiplegics, the midstance time decreased and the loading response and terminal phase increased according to the increased Brunnstrom stage (p＜0.05).
Conclusion: The results showed that an analysis of stance phase by the measurement of plantar pressure was a valuable parameter in the gait analysis of hemiplegic patients.
Deformity due to the diabetic foot causes repetitive and excessive pressure to the certain areas of a foot, which may result in ulcers and pains. Therefore, it is necessary to measure the pressure of the sole for the prevention and management of the diabetic foot lesions. The computerized foot scan system is one of the direct methods to measure the excessive pressure from the deformity of a foot. However, it is not usually affordable in a developing country due to its high cost, space occupancy, and lack of trained personnel. Manual counting using Harris mat is another rather affordable method, however it has problem of the time consumption for a quantitative measure and poor in reproducibility. The purposes of this study were to obtain the objective and quantitative data from Harris mat footprints of diabetic patients by using Paint Shop ProⰒ and to apply the same method to the patients with other foot lesions. Fifty three cases(twenty four males and, twenty nine females) who were referred due to the diabetic foot lesions were evaluated. The average age was 56.62±8.03 years and the duration of diabetes mellitus was 104.93±79.53 months. By the Paint Shop ProⰒ, the highest pressure was recorded at the first toe(thirteen cases), followed by the calcaneal area (also thirteen cases) and the first metatarsal head area (seven cases) in order of the right foot. Of the left foot, the highest pressure was recorded at the first toe (fourteen cases), followed by the calcaneal area(twelve cases) and the third metatarsal head area(nine cases). By the manual analysis, the highest pressure was recorded at the calcaneal area (thirteen cases), followed by the first toe(ten cases) and the fifth metatarsal head area (six cases) in order of the right foot. Of the left foot, the highest pressure site was the first toe(fourteen cases), followed by the calcaneal area(fifteen cases) and the third matatarsal head area(seven cases) in order of pressure level.
Based on these results, we have concluded that the Paint Shop ProⰒ analysis method is an easy and inexpensive foot pressure measurement system which is clinically applicable. However further researches for the test-retest reliability and a comparison with the computerized foot scan system would be required for the standardization of this method.
The purpose of this study was to determine the effects of high heeled shoes on plantar pressure and muscle fatigue. The subjects were 36 women who were divided into three groups, i.e., high heel, middle heel and low heel. The mean height of each heel was over 7 cm, 5 cm and below 2 cm respectively. The plantar pressure was measured by F scan system.
The fatigue of subjects was evaluated with endurance time and voluntary maximal contraction that was measured by Cybex 6000 system and the degrees of foot pain and fatigue by visual analogue scale.
With high heeled shoes, the plantar pressure was shifted from hindfoot to forefoot, and from the lateral part to the medial part in forefoot. With all shoes, the plantar pressure was generally increased in the forefoot after 8 hours. Especially the pressure of medial and middle parts of forefoot was significantly increased on high heeled shoes. Voluntary maximal contraction and endurance time was significantly decreased in subjects with high heeled shoes for 8 hours. The degrees forefooot pain and fatigue by visual analogue scale were very significantly increased in subjects with high heeled shoes. With low heeled shoes, the fatigue was the least degree and the middle heeled shoes are recommendable for cosmetic needs and lesser fatigue and pain.
In conclusion, when women were in high heeled shoes for a long time, the pressure of forefoot and foot pain and fatigue were increased. Therefore, these effects of high heeled shoes on the plantar pressure and fatigue should be considered in women with high heeled shoes.
First
Prev
