Im Zuge systematisch durchgeführter thermografischer Untersuchungen an 95 Asiatischen Elefanten in europäischen Zoos konnten physiologische Wärmeprofile aller nicht von Fußkrankheiten betroffener Elefanten erstellt werden. Um eine objektivere Befundung zu ermöglichen, wurden dafür definierte Messbereiche an den Füßen festgelegt und deren Temperaturdaten als Wärmekurven für jeden Zeh dargestellt. Es zeigte sich, dass die Bandbreite von Temperaturen gleicher Messbereiche starken individuellen Schwankungen unterliegt, weshalb eine Befundung nicht anhand absoluter Temperaturwerte erfolgen sollte. So wurden über gleichen Messbereichen unterschiedlicher Elefanten Temperaturunterschiede von bis zu 8 °C festgestellt. Auch die Umgebungsfaktoren während der Untersuchung tragen zu dieser Varianz bei. Bei Umgebungstemperaturen zwischen 17,5 °C und 23 °C stellt sich durch Erhöhung der Außentemperatur um 1 °C eine um 0,5 °C erhöhte Wärmeabstrahlung über der Haut dar. Eine Erhöhung der Luftfeuchte um 1 % verursacht eine um 0,03 °C vermehrte Wärmeabstrahlung. Die Wärmeprofile stellten sich für die Kronsaum- und Hufwandbereiche der Zehen eines Fußes von medial nach lateral in einem parabelförmigen Verlauf dar, wobei die höchsten Temperaturen an den kranialen Zehen gemessen wurden. Die Differenz zwischen Kronsaum- und Hufwandbereichen blieb dabei konstant. Die Temperaturen der Zehenregion oberhalb des Kronsaums folgten nicht dieser Parabelform, lagen aber, außer an der jeweils medialen Seite, konstant unterhalb der Kronsaumtemperaturen. Bei Vergleich mit thermografischen Befunden erkrankter Zehen zeigte sich meist ein starker Anstieg der Zehenregiontemperatur weit über die Kronsaumtemperaturen hinaus, weshalb sich dieses Verhältnis als Indiz für ein akutes Enzündungsgeschehen nutzen lässt. Ein gleichmäßiges Wärmeprofil, welches möglichst dicht dem in dieser Arbeit entwickelten Profil gleicht und konstante Temperaturdifferenzen zwischen den einzelnen Messbereichen aufweist, ist ein gutes Indiz für einen gesunden Fuß. Thermografische Befundungen sollten immer mit Hilfe herkömmlicher visueller Auswertung und zusätzlich der Erstellung eines Wärmeprofils vorgenommen werden, um die Subjektivität zu minimieren. Erstmalig wurden in dieser Arbeit drei Elefanten mittels Pedografie untersucht, um Aufschlüsse über die Druckverteilung unter dem Elefantenfuß zu erhalten. Wie bei Menschen und pedografisch vermessenen Rindern fanden sich auch beim Elefanten charakteristische Druckprofile. Druckspitzenwerte tauchten hierbei vor allem im kranialen Bereich der Füße als Druckleiste, aber auch im kaudalen Bereich in Form zweier Druckpfeiler auf. Experimente mit einer Methode zur Simulierung weicheren Untergrundes schienen die Druckspitzenwerte etwas abzuschwächen und das allgemeine Druckprofil einzuebnen, waren aber nur schwer auszuwerten. Die Methode eignet sich ebenso zur Erfassung der tatsächlich belasteten Fläche der Füße, welche sich bei stärkerer Belastung, beispielsweise dreibeinigem Stehen, vergrößerte. Trotz noch einiger methodischer und technischer Probleme, eröffnet sich mit der Pedografie ein sicherlich lohnenswertes Forschungsfeld für weitere Studien, die einen besseren Einblick in die Druckphysiologie des Elefantenfußes gewähren könnten. Weiterhin wurden in dieser Arbeit Daten der Elefantenhaltungssysteme von 17 besuchten europäischen Zoos, sowie Daten über Häufigkeit und Art der Gliedmaßenkrankheiten und anderer gesundheitlicher Parameter aller 95 untersuchter Elefanten ausgewertet. Hierbei zeigte sich immer noch starker Verbesserungsbedarf im Hinblick auf Innengehegegrößen und die verwendeten Bodenmaterialien. Auch Bewegungsprogramme für den Aufenthalt im Außengehege wurden nur in weniger als der Hälfte der Zoos eingesetzt. Positiv fiel auf, dass die Elefanten in den besuchten Zoos kaum noch angekettet werden und falls doch, nur kurzzeitig zu Untersuchungszwecken. Den Daten der Haltungsanalysen entsprechend, fielen die Auswertungen zur Fußgesundheit aus: Nur 36 % der untersuchten Elefanten litten bisher noch niemals unter Fußerkrankungen. Allein zum Zeitpunkt der Untersuchung wurden bei 27 % der Tiere akute Erkrankungen festgestellt, die unter Behandlung standen. Hierbei handelte es sich hauptsächlich um Abszesse oder andere entzündliche Veränderungen im Bereich des Nagelbetts. Weiterhin wurden 30 % der Elefanten als übergewichtig eingeschätzt und 36 % der Tiere zeigten stereotype Bewegungsmuster. / A total of 95 Asiatic Elephants in 17 European zoos were systematically examined using a high resolution thermographic camera and physiologic heat profiles of elephant’s feet without known foot diseases were established. To allow a more objective evaluation of thermographic findings, the feet and toes were divided schematically into defined areas for measurement purposes, based on anatomical features for which the temperature data was then plotted to produce heat curves for each area. Measurements of temperatures pertaining to similar areas of different elephants showed strong individual fluctuation. Temperature variation was as high as 8 °C in similar areas between elephants. Thus, evaluation of thermographic findings should never be based on absolute temperature readings alone. This strong variation is partly caused by environmental factors during the examination. With environmental temperatures between 17,5 °C and 23 °C, a one degree increase of this temperature will cause a 0,5 °C increase of the heat radiation of the feet. An increase of air humidity by 1 % will cause an increase of 0,03 °C of the measured thermographical heat radiation. The physiological heat profiles for coronary and hoof wall areas of the toes showed an arched, parable-like shape when plotted from the medial over the cranial to the lateral toes. The highest temperature readings were found on the cranial toes. The difference between coronary and hoof wall temperatures of similar toes were constant all over the foot. The physiological heat profiles of the toe areas above the coronary region did not show this arched shape but stayed below the coronary temperature readings except on the medial toe. On comparison with thermographic findings of inflammated toes, a strong increase of this area above the coronary band was found which exceeded the temperature of the coronary region. This characteristic can be used as an indicator for acute inflammations. A regular heat profile, which resembles closely the physiological heat profile created in this study and which shows constant temperature differences between the defined areas of the single toes, is a good indicator of healthy foot. It is recommended that thermographic examinations always are evaluated using conventional observation of the heat patterns in conjunction with the additional creation of a heat profile to minimize subjectivity by the clinician. For the first time three elephants were examined in this study using a new pedographic method to gain information on the pressure distribution below the elephant’s foot. As found in humans as well as in pedographically examined cows, the pressure distribution in elephant’s feet showed a characteristic profile. Pressure peaks showed up especially in the cranial area of the foot, possibly the border between sole and pad, as well as in the caudal region in the shape of two pressure pillars. Experiments with a method to simulate softer ground seemed to lower the pressure peaks slightly in favor of a broader distribution, but were very difficult to evaluate, especially considering the small sample size. This method is also suited to register the actual area size put under pressure by the elephant, which was shown to rise under increased pressure, e. g. three legged standing. Despite some encountered methodical and technical problems, pedography of elephants is going to be a very promising field for further scientific studies in order to acquire more information on the physiology of pressure distribution. Data on husbandry conditions of the 17 visited zoos and as well as data on frequency and type of foot diseases and other health parameters of all 95 examined elephants were also collected and evaluated. A strong need for improvement was observed in terms of enclosure sizes and the surface materials used in indoor enclosures. Also, daily routines to increase activity of the elephants in the outdoor enclosures were found to be carried out only in half of the visited zoos. On a positive note, elephants in the evaluated zoos were hardly ever chained and if so, only for examination purposes. According to the data of the husbandry evaluation the information on the current status of foot health showed the need for improvement: Only in 36 % of the examined elephants foot problems were so far not encountered. On the time of examination 27 % of the animals were found to be under ongoing treatment for foot diseases. Mostly these were abscesses or other inflammation processes in the area of the nail’s laminar tissue. Out of the study sample, 30 % of the elephants were estimated to be overweight and 36 % showed stereotypic movement patterns.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xiv, 99 leaves / Plantar Fasciitis (PF), also called ‘the painful heel syndrome’, is a common cause of heel pain (Barrett and O’Malley, 1999:2200), accounting for between 7% and 10% of all running injuries (Batt and Tanji, 1995:77; Chandler and Kibler, 1993:345). Primarily an overuse injury, resulting from tensile overload, it involves inflammation and micro-tears of the plantar fascia at its insertion on the calcaneus (Lillegard and Rucker, 1993:168; Barrett and O’Malley, 1999:2200). The body’s attempt to heal these micro-tears leads to chronic inflammation and the formation of adhesions (Ambrosius and Kondracki, 1992:30). Transverse friction massage has been found to be beneficial in the treatment of PF (Hyde and Gengenbach, 1997:478,481; Hertling and Kessler, 1996:137). Cyriax (1984) and Prentice (1994) state the effect of frictions to include the breakdown of adhesions (scar tissue), as well as preventing the formation of further adhesions. Graston Technique Instrument-assisted Soft Tissue Mobilisation (GISTM), based on the principles of frictions, aims to break down adhesions, realign collagen fibres and aid in the completion of the inflammatory process (Carey-Loghmani, 2003:31, 51-62; Hammer, 2001). Enabling us to see changes on ultrasonography, which has been found to be an objective, non-invasive way of evaluating PF (Wall and Harkness, 1993:468; Tsai et al, 2000:259; Cardinal et al, 1996:258). These changes include decreased thickness of the fascia. The aim of the study was to see the effect of GISTM on PF in runners, in terms of ultrasonography, and identify any correlation between these findings and other objective and subjective findings.

BACKGROUND:People who have extremely high arched feet or pes cavus often suffer from substantial foot pain. Custom-made foot orthoses (CFO) have been shown to be an effective treatment option, but their specificity is unclear. It is generally thought that one of the primary functions of CFO is redistributing abnormal plantar pressures. This study sought to identify variables associated with pain relief after CFO intervention.METHODS:Plantar pressure data from a randomized controlled trial of 154 participants with painful pes cavus were retrospectively re-analyzed at baseline and three month post CFO intervention. The participants were randomized to a treatment group given CFO or a control group given sham orthoses.RESULTS:No relationship between change in pressure magnitude and change in symptoms was found in either group. However, redistribution of plantar pressure, measured with the Dynamic Plantar Loading Index, had a significant effect on pain relief (p=0.001). Our final model predicted 73% of the variance in pain relief from CFO and consisted of initial pain level, BMI, foot alignment, and changes in both Dynamic Plantar Loading Index and pressure-time integral.CONCLUSION:Our data suggest that a primary function of effective orthotic therapy with CFO is redistribution of abnormal plantar pressures. Results of this study add to the growing body of literature providing mechanistic support for CFO providing pain relief in painful foot conditions. The proposed model may assist in better designing and assessing orthotic therapy for pain relief in patients suffering painful cavus foot deformity.TRIAL REGISTRATION:Randomized controlled trial: ISRCTN84913516

Thesis (MScPhysio)--Stellenbosch University, 2012 / ENGLISH ABSTRACT: SYSTEMATIC REVIEW ABSTRACT - BACKGROUND: Ankle Foot Orthoses (AFOs) are considered as the most suitable lower limb orthosis to correct gait deficits related to ankle instability. AFOs are recommended to minimize gait deviations and to correct drop foot or equinus foot in hemiplegic patients. OBJECTIVES - To identify the effectiveness of different ankle orthoses and/or supports on the temporal, spatial, kinetic and kinematic gait parameters. To critically appraise the methodological quality of the included studies and to provide a description of the studies with a view to identify opportunities to improve future research quality. METHODS - Search strategy A comprehensive search was conducted between March and October 2010, and updated in August 2011. Thirteen computerized bibliographic databases were individually searched, namely PubMed Central, Cohrane Library, CINAHL, OT Seeker, SPORTDiscus, PsyARTICLE, PEDro, Proquest, Biomed Central, Science Direct, Clinicaltrials.gov, Web of Science, and Ingenta Connect. All databases were searched since their inception. The following key terms were used: stroke, hemipleg*, assistive device*, ankle foot orthos*, AFO, (splint*), taping, and strapping. A secondary search (pearling) was conducted by screening the reference lists of all eligible full text studies. The authors of the unpublished studies were conducted to minimize publication bias. Selection criteria The following selection criteria applied: all relevant randomized and non-randomized controlled trails published in English; participants were post-stroke patients older than eighteen years; interventions included any type of ankle foot orthosis (AFO), ankle taping or strapping and ankle foot splint without any additional intervention and the comparison/control groups were limited to walking without support, either barefoot or walking with shoes only. Studies were excluded when the outcome measures did not focus on at least one of the following: temporal spatial gait parameters, kinetic gait parameters or kinematic gait parameters. Data collection and analysis Two reviewers independently selected trials for inclusion and assessed methodological quality. The data was extracted by the primary reviewer and validated by a second reviewer. In event of disagreement, a third reviewer was asked to re-evaluate until consensus could be reached. Homogenous data were statistically summarized in sub-group meta-analysis using Revman© Review Manager Software. The results of heterogeneous data were summarized in a narrative form. MAIN RESULTS - The search yielded 11134 initial hits. Sixteen studies met the inclusion/exclusion criteria. The studies investigated the immediate effect of various types of AFOs on a broad range of temporal spatial gait parameters mainly gait speed, cadence, stride and step length. Only two studies reported on the kinetic and six on various kinematic gait parameters. The meta-analysis yielded significant improvement in gait speed (0.06 m/s; 95% CI 0.04, 0.08. p < 00001), walking cadence (5.41; 95% CI 3.79, 7.03. p < 00001), stride length (6.67; 95% CI 3.29, 10.06. p < 00001) and step length (2.66; 95% CI 1.59, 3.72. p < 0.00001). CONCLUSION - AFOs are effective to improve mobility, gait speed, cadence, stride and step length for post-stroke patients and may have a positive impact on the daily function of post-stroke patients. . The long term benefit or adverse effects of AFOs are still inconclusive. The effectiveness of AFOs on the kinetic and the frontal- or transverse- plane joint kinematics is largely unresolved. There is insufficient evidence to either support or refute the effectiveness of taping/strapping and splinting of the ankle on hemiplegic gait. EXPERIMENTAL STUDY ABSTRACT - BACKGROUND: Temporal, spatial and affected ankle kinematic gait parameters of adults with hemiplegia are significantly different from the normal able-bodied population. Enabling hemiplegic patients to walk is a major goal of rehabilitation programs. Taping of the plegic ankle could be utilized by therapists as external support of the ankle to improve foot position and placement during gait rehabilitation. OBJECTIVE - The purpose of the study was to describe the immediate effect of neutral ankle taping on temporal spatial gait parameters and ankle joint kinematics of the affected ankle in ambulant adult hemiplegic patients. METHODS - A clinical trial using a crossover randomized testing order was conducted on a convenient sample of ten ambulant hemiplegic patients at the Physiotherapy and Motion Analysis Clinic, Faculty of Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa. The affected ankle joint was taped in a neutral talocrural dorsiflexion/ plantarflexion and neutral hindfoot inversion/ eversion position using rigid adhesive tape (5 cm). The gait parameters were analysed according to the Plug-In Gait Model using a motion analysis system (Vicon Nexus 1.1.7; Vicon Motion System Limited, Oxford, UK). The analyses were repeated six times for each testing condition and the average values were used for further analysis. The data were analyzed using Least Square Means tests and post hoc Fisher (Least Significant Difference) LSD multiple comparison tests to determine the significant differences at 95% confidence level. RESULTS - The main results of the study indicate that taping of the affected ankle joint in a neutral position does not significantly improve (p>0.5) temporal spatial gait parameters and ankle joint kinematics in ambulant adult hemiplegic patients. The following positive trends were however found and need to be further explored in larger homogeneous study samples: ankle taping of ambulant adult hemiplegic patients has limited benefits on selected temporal parameters as ankle taping could potentially improve cadence. Ankle taping could decrease plantarflexion of the plegic leg at initial contact. CONCLUSIONS - A systematic review revealed no conclusive evidence either to support or refute the beneficial effects of ankle taping on gait parameters of ambulant adult hemiplegic patients. Ankle taping of ambulant adult hemiplegic patients has potential clinical benefits on temporal, spatial and affected ankle kinematics, gait cadence and affected leg swing and stance duration.

published_or_final_version / abstract / Zoology / Doctoral / Doctor of Philosophy

Tyrimo pagrindimas: sportininkų judėjimo gebėjimai vyksta dalyvaujant paskutiniai grandžiai pėdos lenkiamiesiems ir tiesiamiesiems raumenims (Нечаев, 2011). Didelio meistriškumo graikų-romėnų imtynininkų raumenų kraujotakos mobilizacijos ir atsigavimo ypatybės yra artimesnės ištvermės sporto šakų atstovams nei sprinto grupės sportininkų ypatybėms. (Ežerskis, 2009). Tikslas- išanalizuoti skirtingos adaptacijos fiziniams krūviams vyrų ir merginų pėdų lenkiamųjų raumenų funkcinius ypatumus. Hipotezė: pėdos lenkiamųjų raumenų ištvermė priklauso nuo maksimalios valingos jėgos dydžių, kuo didesnė jėga, tuo mažesnė ištvermė. Metodai: dinamometrija, literatūros šaltinių studija, statistinė analizė. Aptarimas ir Išvados: dvikovos sportininkių, ištvermės ir greitumo jėgos atstovų tarpusavyje kairės ir dešinės kojos jėga nesiskyrė yra proporcingų dydžių. Ištvermės sportininkų vyrų pėdos lenkiamųjų raumenų kojų jėga buvo ženkliai didesnė už dvikovos, sporto šakų, tačiau mažesnė nei greitumo jėgos atstovų. Dvikovos sporto šakų sportininkių ir ištvermės atstovų bei greitumo jėgos sportininkų MRI rodikliai skyrėsi neženkliai, tačiau jėga buvo mažesnė Nuo jėgos dydžio priklauso ištvermės trukmė. Esant didesnei jėgai ištvermės trukmė mažėja. Pagal santykio MVJ/MRI reikšmes visos priklauso stajerio tipui. Tyrimo uždaviniai: 1. Nustatyti dvikovos sporto šakų moterų ir vyrų, pėdos lenkiamųjų raumenų maksimalios valingos jėgos dydžius. 2. Nustatyti dvikovos sporto šakų moterų ir vyrų, pėdos... [toliau žr. visą tekstą] / Introduction: Atlete's movement depends on the activity of the foot flexor muscle strength and endurance. High craftsmanship Greco- Roman wrestlers muscle blood mobilization and recovery features are closer to endurance sports disciplines than sprint atlete properties. Aim: Analysis the different physical exertion adaptation of men and a girl's foot muscle flexion functional features. Hypothesis: foot flexor muscle endurance duel sport athletes are the same length as the representatives of the endurance strength but size was lager. Methods: dynamometry, literature study, a statistical analysis. Discussion and Conclusion: The duel athletes, endurance and speed power representatives each other left and right leg power is proportional not different sizes. Endurance representatives of men's foot flexor muscles leg strength was significantly higher than the duel sports, but less than the speed force representatives. Duel sport athletes and endurance representatives maximal muscle endurance characteristics differed slightly, but the force was smaller size of the force depends on endurance time. At higher power of endurance time decreases. According to the ratio of maximal voluntary contruction / maximal muscle endurance values all belong stajer type. Exploratory tasks : 1)set duel sports for men and women, foot flexion maximum voluntary muscle force figures. 2)Set duel sports for men and women, foot flexor muscle endurance for maximum muscle size. 3)Identify and analyze the duel... [to full text]

Author: Bc. Kateřina Kellerová Title: Foot Arch in Childhood Problem definition: The most often diagnosis related to the foot arch in childhood is definitely flexible flat foot also called pes planovalgus. Because of that this thesis will be mostly oriented on this diagnosis. There are many articles about flexible flat foot and many studies were oriented on this problem. The informations about etiology, influencing factors or therapy are sometimes discordant in different articles. But almost all of them contain one same statement which says that the prevalence of this diagnosis is decreasing as the foot arch is changing during the child's growth. It means in older children there is not flexible flat foot so often as in the younger ones. But there is no detailed description of the dynamics of these changes of the foot arch in childhood. Aim of this thesis: The aim of this thesis is to find out the development of the foot arch in children of pre-school age. In other words to run the survey to find out the changes of the foot arch in children of pre-school age which occurs in six months. Method: The survey contains anamnesis questionnare for parents and also these examinations: footprints, examination of joint laxity, mobility of hip joint, position of knee, patellae and heel, Jack's test, posibility...

Le contrôle sensorimoteur du pied est le fondement des adaptations de l’Homme à son environnement. La station debout et la marche nécessitent l’intervention de toutes les composantes du contrôle sensorimoteur, les mécanorécepteurs plantaires renseignant le système nerveux central sur la position du corps dans l'espace. Notre travail de thèse a consisté en un premier temps à établir un protocole permettant de quantifier la sensation tactile plantaire qui nous a permis de nous intéresser à l’effet des orthèses plantaires sur la perception tactile plantaire. Nos résultats mettent en évidence chez la majorité de nos sujets, que les orthèses appliquées sur les seuls appuis rétrocapitaux augmentent la discrimination des plus faibles charges mécaniques après 30 jours de port de semelles. Ces variations dépendent de la position du pied lors de la station debout et du pattern de marche. Nous avons aussi exploré le contrôle moteur lors du maintien de la station debout et d’un exercice de course à vitesse maximale. Après un effort statique maximal recrutant de façon sélective les muscles inverseurs du pied (tibialis antérior, TA), les surfaces d’appui plantaires et la surface du trajet du barycentre augmentent, il existe une altération du réflexe myotatique dans le seul TA faisant suite à des signes de fatigue électromyographique (réduction de fréquence médiane) après appui maximal. Faisant suite à un effort dynamique maximal (course sur tapis roulant), nous observons les mêmes phénomènes : augmentation des surfaces d’appui plantaire et du trajet du barycentre des pressions, et diminution de la fréquence médiane dans le seul muscle TA aux vitesses de course les plus élevées. / The sensorimotor control of foot placement and motion plays a key role in the adaptive response of human being to his environment. The participation of both sensory and motor components is needed to control the foot placement during gait and posture and mechanoreceptors in the foot sole give major information on the body position. First, we established a protocol to quantify the sensation of foot sole pressure stimulation, which allowed us to examine the effects of metatarsal pads, and heel lifts in healthy subjects. We observed that 30-days of occupational activities with metatarsal pads elicited significant changes in sensation, lowering the threshold for the detection of the lowest pressure loads and, depending on the pattern of foot placement during upright standing and walking, modifying the global gain for the foot sensation. Second, we examined the consequences of fatiguing static contraction of foot invertor muscles (tibialis anterior or TA) and of maximal running exercise on a treadmill on post-test changes in foot placement using a baropodometer, maximal force production by TA. Power spectrum analyses of electromyographic (EMG) events were performed during both static and dynamic efforts and we also explored the myotatic reflexes through the recording of the tonic vibratory response (TVR) in foot muscles. Our results showed significant changes in post-test foot placement in the direction of foot eversion in both situations, significant decrease in maximal inversion force, a leftward shift of EMG spectrum in the sole TA muscle, indicating EMG signs of fatigue, and 4) significant reduction of TVR amplitude in the sole TA muscle after sustained static effort.

O objetivo deste trabalho foi investigar a influência da neuropatia diabética e da presença da ulceração plantar na história clínica de diabéticos neuropatas, como conseqüência desta doença, na sensibilidade somatossensorial plantar e nas variáveis cinéticas e eletromiográficas do membro inferior durante a marcha descalça em grupos de diabéticos neuropatas com e sem história de ulceração plantar. Os grupos estudados foram formados por 45 voluntários adultos, não idosos, de ambos os sexos, divididos em três grupos: GD - grupo de diabéticos neuropatas sem úlceras plantares (n=19), GDU - grupo de diabéticos neuropatas em cuja história clínica houve pelo menos ocorrência de uma ulceração plantar nos últimos dois anos (n= 10) e GC - grupo controle (n= 16) constituído de sujeitos assintomáticos, não diabéticos, da mesma faixa etária que os grupos GD e GDU. Os resultados da avaliação sensorial mostraram uma piora progressiva do déficit sensorial com a piora da neuropatia. Os indivíduos do GDU apresentaram maior déficit de sensibilidade plantar que os do GD. O GDU também apresentou maior tempo de apoio em comparação com o grupo não ulcerado (GC=693,1 ± 65,98; GD=681,5 ± 51,2; GDU=758,5 ± 105,1, em milisegundos) indicando que estes sujeitos apresentam um maior tempo de exposição do pé às pressões exercidas com o contato com o solo durante a marcha. Houve uma redução gradativa dos valores de segundo pico da FRS vertical do GC para o GD e deste para o GDU, que foi significativa destes últimos em relação ao GC (GC=1,09 ± 0,06; GD = 1,05 ± 0,08; GDU = 1,02 ± 0,06). Dentre as alterações eletromiográficas apresentadas pelos diabéticos ulcerados, destacam-se: o atraso do pico de ativação dos músculos vasto lateral, logo após o contato do calcanhar (GC=10,82 ± 3,33; GD=11,97 ± 2,31; GDU=14,83 ± 3,53,% do tempo de apoio) e o atraso do gastrocnêmio lateral na fase de propulsão (GC=63,53 ± 3,65; GD=62,84± 5,06; GDU=68,00± 4,78, % do tempo de apoio). Essas alterações biomecânicas sugerem que os diabéticos neuropatas ulcerados apresentam uma ineficiência do sistema musculoesquelético tanto na fase de absorção do choque no momento do contato do calcanhar quanto na fase de propulsão. Embora sem diferenças significantes, observou-se também maior atividade do tibial anterior entre os sujeitos do GD, sugerindo a presença de um mecanismo compensatório para diminuir a sobrecarga do antepé na fase de aplainamento. As alterações encontradas, associadas aos outros sinais da neuropatia, como o déficit de sensibilidade plantar, podem ser fatores predisponentes para a formação ou recorrência de úlceras plantares. / The aim of this work was to investigate the influence of diabetic neuropathy and the clinical history of plantar ulceration in the somatossensorial plantar sensitivity and in kinectic and electromyographic lower limb variables during gait of diabetic neuropathic subjects with (UDG) and without (DG) history of plantar ulceration. The casuistics was composed by 45 gender and age matched adult subjects, who were divided into three groups: DG - diabetic neuropathic group (n=19), UDG - diabetic neuropathic group composed by diabetic neuropathic subjects who presented at least one foot ulceration in the past two years (n=10), and a control group (CG) composed by non-diabetics asymptomatic adults. The results of somatossensorial tests showed a gradual loss of plantar sensitivity with the neuropathy progression. Subjects from UDG had worse plantar sensitivity than the DG. UDG also showed higher total contact time than DG (CG=693,1 ± 65,98; DG=681,5 ± 51,2; UDG=758,5 ± 105,1, in miliseconds). These numbers indicate that UDG subjects have a longer exposition time of the plantar surface to the pressures made by the contact with the ground durint gait. There was a gradual reduction of the vertical GRF second peak, from CG to DG, and from this last group to the UDG (CG=1,09 ± 0,06; DG = 1,05 ± 0,08; UDG = 1,02 ± 0,06). The main electromiographic changes found in UDG were: a delayed peak of activation of vastus lateralis muscle, right after the heel contact (CG=10,82 ± 3,33; DG=11,97 ± 2,31; UDG=14,83 ± 3,53,% of contact time), and a delayed peak of activation of gastrocnemius lateralis muscle (CG=63,53 ± 3,65; DG=62,84± 5,06; UDG=68,00± 4,78,% of contact time). These biomechanical changes suggest that diabetic neuropathic subjects with history of foot ulceration have a muscleskeleton system inefficacy during the shock absorption phase and during the propulsion phase of the gait. Although there were no significant differences in tibialis anterior muscle activity, DG subjects showed higher TA EMG activity, which suggests a compensatory mechanism to diminish overload on the forefoot during flat foot phase. The biomechanical changes found, associated with other sign and symptoms of neuropathy, like the loss of sensitivity, could be considerate predisposable factors for plantar ulcers formation or its recurrence.

A fasciite plantar, terceira lesão mais comum em corredores, apresenta como principais fatores etiológicos o alinhamento do retropé, o arco longitudinal plantar e a carga mecânica dos pés. Os únicos dois estudos que investigaram estes fatores, durante a corrida, permanecem controversos e ainda não claros, principalmente, em relação ao efeito da dor. Outra questão importante é o suporte teórico da associação entre as medidas clinicas dos pés com a carga mecânica no calcâneo, porém sem evidência científica comprovada. A compreensão dos padrões dinâmicos da carga plantar e a sua associação com as medidas clínicas do pé poderão perpetuar uma maior efetividade de recursos terapêuticos como calçados e palmilhas direcionadas a essa população. Portanto, o objetivo geral desse estudo foi avaliar o padrão de carga plantar e impacto dos pés em contato com o solo durante a corrida de corredores com fasciite plantar aguda e crônica e sua associação com o arco longitudinal medial e ângulo do retropé. Foram estudados 75 corredores adultos de ambos os sexos entre 20 a 55 anos. Destes 45 apresentavam fasciite plantar (30 com dor - FPA e 15 sem dor - FPC) e 30 eram corredores controles - GC. Para responder a questões específicas foram realizados dois experimentos. O primeiro teve como objetivo analisar e comparar as taxas de impacto estimadas e as cargas em três regiões distintas dos pés de corredores com fasciite plantar na fase aguda e crônica e corredores controle. A pressão plantar foi avaliada por meio de palmilhas capacitivas (Pedar X System) durante uma corrida de 40m a uma velocidade de 12±5%km/h, utilizando um calçado esportivo padrão. A dor foi mensurada pela escala visual analógica. As taxas de impacto e a carga plantar em retropé, mediopé e antepé foram analisadas em série temporal. Os dados foram processados no Matlab e comparados por ANOVAs (p<0,05). Os principais resultados indicam que a força máxima e integral da força no retropé e as taxas de impacto (20-80%; 10-100%) apresentam-se maiores em corredores com fasciite plantar em relação aos corredores controle (p<0,01). Porém, corredores com fasciite plantar na fase aguda apresentaram menores taxas de impacto e cargas plantares no retropé em relação à fase crônica (p<0,01). O segundo experimento teve como objetivo investigar a relação entre o arco longitudinal medial, o alinhamento do retropé e a dinâmica da pressão plantar em corredores com fasciite plantar: aguda e crônica. O índice do arco plantar e o alinhamento do retropé foram calculados no AutoCAD por meio de imagem fotográfica digital. Para análise da pressão plantar foi utilizado os dados previamente coletados no experimento 1 pelo sistema de palmilhas capacitivas (Pedar X System) durante a corrida. Uma análise de regressão múltipla foi realizada (p<0,05). Os resultados indicam que o arco plantar elevado pode predizer a integral da força (R=0,35, R2=0,15) e a força máxima (R=0,59, R2=0,35) no antepé na fase aguda e crônica, respectivamente. O alinhamento valgo do retropé prediz a força máxima no retropé na fase aguda (R=0,42, R2=0,18) e crônica (R=0,67, R2=0,45), além de predizer o aumento das taxas de impacto do pé na fase crônica da fasciite plantar, 20-80% (R=0,44, R2=0,19) e 10-100% (R=0,63, R2=0,40). Conclui-se que corredores com fasciite plantar aguda e crônica apresentam maiores cargas plantares no retropé e aumento das taxas de impacto do pé no solo. No entanto, a condição fasciite plantar aguda mostrou-se com menores taxas e cargas plantares no retropé em relação à fase crônica, possivelmente, devido ao mecanismo de proteção a dor na região do calcâneo. Além disso, o arco plantar prediz as cargas plantares do antepé de corredores com fasciite plantar e o alinhamento em valgo do retropé demonstrou ser uma medida clínica de fundamental importância para avaliação de corredores com fasciite plantar, pois permitiu predizer tanto o aumento das cargas e taxas de impacto na região do calcâneo e com isso, prevenir os sintomas e a progressão da fasciite plantar / The plantar fasciitis, the third most common injury in runners, presents as the main etiological factors rearfoot alignment, the longitudinal arch and mechanical load on the feet. The only two studies have investigated these factors during running and the results remain controversial and still not clear, specifically regarding the pain symptoms. Another important question is the theoretical support of the association between clinical measurements of the feet with the mechanical load on the heel, but without proven scientific evidence. Understanding the dynamic patterns of plant load and its association with clinical measures of foot may perpetuate more effective therapeutic resources, such as footwear and insoles that target this population. Therefore, the general objective of this study was to evaluate the load pattern and impact of plantar foot in contact with the ground during running in runners with acute and chronic plantar fasciitis and its association with the medial longitudinal arch and rearfoot angle. We studied 75 adult runners of both sexes between 20 and 55 years. Of these 45 had plantar fasciitis (pain-APF 30 with and 15 without pain - CPF) and 30 controls were runners - CG. To answer specific questions two experiments were conducted. The first aimed to analyze and compare the estimated impact rates and the plantar loads in runners with both acute and chronic PF, compared to controls. Seventy-five runners with heel contact running patterns were evaluated and divided into three groups: Acute PF (n=30); chronic PF (n=15); and controls (n=30). Pain was assessed by the Visual Analogue Scale. The plantar pressures was measured by X Pedar system during 40-meter running sessions at speeds of 12±5% Km/h with standard sport footwear. The impact rates and the loads over the rearfoot, midfoot, and forefoot were analyzed based upon temporal series. The data were processed in Matlab and compared by ANOVAs (p <0.05). The main results indicate that the maximum force and integral force in the rearfoot and impact rates (20-80%, 10-100%) were higher in runners with plantar fasciitis when compared with control runners (p <0.01). However, runners with plantar fasciitis in the acute phase showed lower impact rates and loads plantar on rearfoot in relation to chronic phase (p <0.01). The second experiment aimed to investigate the relationship between the medial longitudinal arch, rearfoot alignment and dynamic plantar pressure in runners with plantar fasciitis: acute and chronic. The plantar arch index and rearfoot alignment were calculated in AutoCAD using digital photographic image. For analysis of plantar pressure was used previously collected data in experiment 1 by the system of capacitive insoles (Pedar X System) during the running. A multiple regression analysis was performed (p <0.05). The results indicate that high plantar arch can predict the increase: integral force (R = 0.35, R2 = 0.15) and maximum force (R = 0.59, R2 = 0.35) in the forefoot in acute and chronic phase, respectively. The alignment of the rearfoot valgus predict the maximum force on rearfoot in the acute phase (R = 0.42, R2 = 0.18) and chronic (R = 0.67, R2 = 0.45), and predict increased rates impact of the foot during the chronic plantar fasciitis, 20-80% (R = 0.44, R2 = 0.19) and 10-100% (R = 0.63, R2 = 0.40). We conclude that runners with plantar fasciitis acute and chronic have higher plantar loads on rearfoot and increased rates of impact of the foot on the ground. However, the condition plantar fasciitis acute proved loads with lower impact rates and plantar load on rearfoot in relation to chronic phase, possibly due to the protective mechanism pain in calcaneal region. Moreover, the plantar arch predicts loads plantar in forefoot of the runners with plantar fasciitis and alignment in valgus rearfoot proved to be a measure of fundamental importance for clinical evaluation of runners with plantar fasciitis because it can predict the increase of the plantar loads and impact rates of calcaneal region and thus prevents the symptoms and progression of plantar fasciitis.