• Sunil Wadkar

Significance of Plantar Pressure Analysis


What is Plantar Pressure Analysis? Plantar Pressure Analysis also known as Pedobarography ,is a study of the pressure area that acts between the plantar surface of the foot and the supporting surface during static and dynamic activities.


Figure 1: Pedobarographic analysis of the feet represented by pressure map/ heat map



The term 'pedobarography' is derived from the Latin word: pedes, referring to the foot and the Greek word: baros meaning 'pressure'. Pedboarography is used most often for pressure detection across foot,biomechanical analysis of gait and to supplement postural evaluation. It is employed in a varied population including People with Neuro problems, Musculoskeletal problems, pregnant womens, athletes & even normal people. It provides vital information with acceptable accuracy of the location and the extent of pressure distribution on the plantar surface.



Why Is It Important ?

Feet provides the primary surface of interaction with the environment during static weight bearing conditions as well as during dynamic conditions like locomotion. Measurements of plantar pressure provide an indication of how foot and ankle functions during standing, walking or any other weight bearing activities.

The foot and ankle provide both the necessary support and flexibility for weight bearing and weight shifting while performing these activities,any abnormal distribution of pressure across the foot can lead to injuries or changes in normal biomechanics.Thus, it is very important to diagnose foot problems at an early stage for injury prevention, risk management and general well-being of the person.

Moreover, barefoot walking practices are still common in Indian population. Majority of lower limb problems start with small mistakes like wrong choice of footwear. Lack of awareness about foot health can be a big reason for all of this.

One approach for measuring foot health, widely used in various applications, is examining Plantar Pressure characteristics.


How can we measure Plantar Pressure?


Following table shows different types of Plantar Pressure device available:


The assessment of plantar pressures can be included as part of a full laboratory gait analysis, or it can be done independently in either a laboratory or a clinical setting.



Portable wireless Plantar pressure system -

Portable, wireless plantar pressure systems can be used to overcome limitations of both (Platform Based and in-shoe sensor) systems. Being portable and wireless one can take it anywhere and carry out the assessment. & also it can provide the same resolution as the platform based systems. One of the classic examples being OHM 3000, OHM 3000 is a novel Portable wireless plantar pressure system built in India, focussing towards Indian Physiotherapists. Ohm 3000 captures the plantar pressure data instantly and precisely, and displays the same in a jiffy, while standing or while walking on the mat.




What does Plantar Pressure indicate ?

Data obtained from a plantar pressure assessment represented by a pressure map as shown in Figure 1 can be used for the evaluation and management of patients with a wide variety of conditions associated right from cervical spine to feet due to biomechanical linkage. Pressure map is simply the visual representation of the pressure measurement obtained between two contacting surfaces. Figure 1 depicts a normal pressure map with legend on the right side representing pressure values in kilopascals in relation with the color.

When plantar pressure values are determined to be atypical, the information can be used to modify a patient's management program through alterations in footwear, foot orthoses, exercise programs, postural corrections and restrictions in the amount of weight bearing. Information obtained from pressure systems is also useful from a research perspective, to address many questions regarding the relationship between plantar pressure and lower extremities. Standing and Walking are not the only activities in which plantar pressures are generated,thus allowing the Therapists to study various aspects of Cardiorespiratory fitness such as aerobic and functional activities. It provides insight into the stresses that these activities impart to the foot and lower extremity.

Information derived from Plantar Pressure Analysis is important in - 1. Biomechanics and Gait analysis 2. Diabetic Foot assessment and Footwear prescription 3. Sports performance analysis and injury prevention 5. Balance assessment and monitoring improvement 6. Rehabilitation support systems & engaging in Evidence based practice



Pedobarographs of two most commonly seen conditions- Plantar fasciitis and Diabetic neuropathy are listed below:

Plantar fasciitis -

Figure 2: Pressure map of subject with plantar fasciitis

In the above pressure map it is observed that the subject has flat feet posture. Area of maximum pressure is represented in pink color which denotes the area of potential ulceration/ soft tissue injury on the heel of the right foot. Legend on the right shows the pressure values in kilopascals.

Diabetic Neuropathy -

Figure 3: Pressure map of subject with diabetic neuropathy


In the above pressure map it is observed that the subject has high arch feet posture. Area of maximum pressure is represented in pink color which denotes the area of potential ulceration/ soft tissue injury on the left foot on the ball of the great toe(first metatarsal head).


Conclusion -


At present,since many Physiotherapists are inclined towards Evidence Based Practice. Plantar Pressure Analysis can be a useful adjunct to enhance the validity of practice and generate better patient outcomes.

Stay tuned to our website www.ohmsmat.com for further updates on more interesting topics related to Plantar Pressure analysis and its applications to the Patient population.



References

1.https://en.wikipedia.org/wiki/Pedobarography 2.Thompson DL , Hatley MR, McPoil TG, Cornwall MW. Vertical forces and plantar pressures in selected aerobic movements versus walking. J Am Podiatr Med Assoc.1993;83:504–508. 3.Albers D , Hu R, McPoil TG, Cornwall MW. Comparison of foot plantar pressures during walking and en pointe. Kinesiology and Medicine for Dance.1992/3;15(1):20–23. 4.Lundeen S , Lundquist K, Cornwall MW, McPoil TG. Plantar pressures during level walking compared with other ambulatory activities. Foot Ankle Int.1994;15:324–328. 5.Masson EA , Hay EM, Stockley I, et al. . Abnormal foot pressures alone may not cause ulceration. Diabet Med.1989;6:426–428. 6.Veves A , Murray HJ, Young MJ, Boulton AJ. The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. Diabetologia.1992;35:660–663. 7.Minns RJ , Craxford AD. Pressure under the forefoot in rheumatoid arthritis: a comparison of static and dynamic methods of assessment. Clin Orthop.1984;187:235–242. 8.Dhanendran M , Hutton WC, Klenerman L, et al. . Foot function in juvenile chronic arthritis. Rheumatol Rehabil.1980;19:20–24.

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