Plantar Pressure Measurement (Pedobarography) –  A Review

Arcs of foot

The foot is a complex structure comprised of 28 bones and 30 joints. There are numerous muscles, tendons and ligaments that help in stability, mobility and balance of the body. The foot is divided into forefoot, mid-foot and hind foot. It consists of medial and lateral longitudinal arches and a transverse arch. These arches help in distribution of body weight to the supporting structures (heel & ball of toes) and help in shock absorption.

The prevalence of foot pain across the globe ranges from 13%- 36% among adults above 18 years¹. Prevalence of heel pain in population above 40 years was found to be 80%2. Studies have reported that pain is more prevalent among women in comparison to men, in overweight and obese in comparison to normal weight and in older age than in younger1, 2, 3. 

Plantar Fasciitis

There are many causes for foot dysfunction and pain. Plantar fasciitis is a common cause of heel pain. Bruising and shoe bites due to improper footwear are other causes. Physical Injury to the ankle and foot due to overuse or accidents are other reasons for foot pain.

 

Biomechanical and musculo-skeletal changes are caused by ageing². Orthopaedic conditions such as spinal issues, arthritis and other injuries to bone, tissue and ligaments, systemic diseases like diabetes mellitus and rheumatoid arthritis4, neuro-muscular conditions such as cerebral palsy5 that cause spasticity and altered gait are some of the many causes of foot deformity and pain.

These problems cause changes in foot structure and biomechanics in weight bearing positions and locomotion. Careful clinical observations can help understand these changes by looking for presence of bunions, corns, deformities, hammer toes, antalgic gait and foot arches. However, the plantar pressure changes due to these problems cannot be visualized. Hence the use of a plantar pressure mapping system is significant in analyzing the pressures of the foot.

Plantar Pressure Mapping or Pedobarography assesses the distribution of plantar pressure in relation to the surface. A Pedobarograph can provide vital information with near pinpoint accuracy of the location and extent of anomalies in the distribution of pressure. Any abnormal distribution of pressure across the foot can lead to injury or change in normal biomechanics. 

Compact Plantar Pressure Management systems are capable of measuring the distribution of weight, and consequently pressure in various positions - barefoot bipedal stance and gait.  
Understanding these changes helps in detecting and/or confirming the diagnosis of foot conditions. Clinical observations coupled with the metrics and patterns provided by the Pedobarograph, can help in understanding the various foot pathologies and effectively directing the therapy.

In a bipedal (static) position, one can observe the distribution of pressure across the two feet as well as anterior-posterior distribution. 

 

During the gait analysis, the Pedobarograph provides visualization of pressure distribution across the various phases – heel strike, foot flat, single leg stance, heel off and toe off. A Pressure Transfer Tracker helps in understanding the pressure (weight) transfer during all the phases of stance in gait with respect to time. Abnormalities can be quickly observed and detected and also explained easily to the affected person with Pedobarograph in motion. Important metrics of the gait include various parameters relating to time, pressure, peak pressure, location of peak pressure, center of pressure and its deviation.
 

Additionally, some Pedobarographs conduct Stabilometry tests that help understand the stability of patients having neuromuscular problems such as the direction, extent and speed of sway and movement in the center of pressure helps provide appropriate metrics and visualization in the nature of problems in stability.

 

The degree of pronation or supination of the foot can be seen with the help of an image. This further assists in correlating the findings of assessment with the data available.

There are many clinical applications of a Pedobarograph.

Here are a few key ones:

Knowing Foot Types
 

Instant visualization of normal, high arched or flat foot, pronated or supinated foot, hallux valgus and splaying of feet.

Identify Plantar Pressure Asymmetries 
 

Pedobarography aids in determination of appropriate correction, support and comfort foot orthotics. 
Also, suggestion for appropriate exercises and other lifestyle adjustments can be quickly made.

Assessing Risk of Diabetic Foot Ulcers
 

Diabetes Mellitus is the leading cause of foot ulcers. Predicting risk and early detection of foot ulcers can be done using Pedobarography.
Areas of increased pressure amongst diabetics can indicate higher risk of diabetic ulcers as well as presence of ulcers.
Early detection of Diabetic Charcot Foot is possible.
Diabetic patients can regularly assess their Diabetic Foot risk status to avoid morbid complications.

Get an In-depth Analysis of Foot Function
 

Orthopaedic conditions such as TMJ dysfunction, lower back pain, knee injuries including ACL injuries, recurrent ankle sprains and others, result in compensation postures which result in direct changes in location, metrics and distribution of pressure in a bipedal position and during gait.
Use the same metrics for comparing treatment outcomes.

Determine Fall Risk in Elderly and in Pregnancy
 

Higher arched foot in elderly increases the risk of fall, which can be detected by using a pressure platform. 
Similarly in pregnant women, there is a surge in risk of fall due to drop of the plantar arch.

Assess Stability in Neuromuscular Conditions
 

Amongst other conditions, hemiplegics can undergo Stabilometry tests that provide metrics and visualization of the compromise in stability in bipedal and gait (if possible).
In Rheumatoid arthritis cases, changes in foot shape and structures can be studied through stereo-geometry of the foot along with pressure
changes. 

1. International Diabetes Federation. IDF Diabetes Atlas, 8th edn. Brussels, Belgium: international Diabetes Federation, 2017. http://www.diabetesatlas.org
 

2. Pengzi Zang, et al. Global Epidemiology of Diabetic Foot Ulceration: a Systematic Review and Meta-analysis. Journal Annals of Medicine, 2017: Volume 42, Issue 2: page106-116.  http://doi.org/10.1080/0753890.2016.1231932
 

3. International Diabetes Federation. Clinical Practice Recommendations on Diabetic Foot: A guideline for healthcare professionals : International Diabetes Fedaration, 2017

4. Gendla Kiran Kumar, Caren D Souza and Erel Al Diaz. Incidence and Cause of Lower-limb Amputations in a Tertiary Care Center: Evaluation of Medical Records in a Period of 2 Years. International Journal of Surgery Science, 2018; 2(3): 16-19

 

5. Andrew J. Rosenbaum, John A. DiPreta. Classification in Brief: Eichenholtz Classification of Charcot Arthopathy. Clinical Orthopaedics and Related Research, 2014; 
doi 10.1007/s11999-014-4059-y

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