Orientador: Jose Martins Filho / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T22:51:41Z (GMT). No. of bitstreams: 1 Filoni_Eduardo_M.pdf: 1810645 bytes, checksum: 81dd711bdd1ec2f217195d685ad014ea (MD5) Previous issue date: 2009 / Resumo: O arco longitudinal medial (ALM) desempenha funções na biomecânica do pé. O estudo teve como objetivo comparar os resultados da avaliação do ALM do complexo articular do tornozelo entre índice do arco plantar (IAP) e índice de Staheli, classificação de Viladot e linha de Feiss. Métodos que mais compatibilizaram foram o IAP e a classificação de Viladot, porém sem significância estatística, considerando o coeficiente de Kappa de 0,32 e 0,30 para os pés direito e esquerdo. Na comparação do IAP, linha de Feiss e índice de Staheli, o coeficiente de Kappa foi de baixa concordância, pois, não pode ser calculado pela ausência de pé plano nos dois últimos testes. Conclui-se que ocorreu incompatibilidade entre os métodos de avaliação / Abstract: The longitudinal plantar arch (LPA) perform biomechanics functions in the foot. The aim of this study was to compare the relationship between different index to measure the LPA of the foot. The arc in dex, Staheli index, Viladot classification and Feiss line were compared. Although non significant the higher agreement was reached between the arch index and Staheli index. This comparison presented a Cohen's Kappa coefficient of 0,32 and 0,30 for right and left foot respectively. The comparison between arch index either with Feiss line or Staheli index presented low agreement. In conclusion this study showed low agreement between methods to measure the LPA. / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

The use of computational modeling is an increasingly commonplace technique for the investigation of biomechanics in intact and pathological musculoskeletal systems. Moreover, given the robust and repeatable nature of computer simulation and the prevalence of software techniques for accurate 3-D reconstructions of tissues, the predictive power of these models has increased dramatically. However, there are no patient-specific kinematic models whose function is dictated solely by physiologic soft-tissue constraints, articular shape and contact, and without idealized joint approximations. Moreover, very few models have attempted to predict surgical effects combined with postoperative validation of those predictions. Given this, it is not surprising that the area of foot/ankle modeling has been especially underserved. Thus, we chose to investigate the pre- and postoperative kinematics of Adult Acquired Flatfoot Deformity (AAFD) across a cohort of clinically diagnosed sufferers. AAFD was chosen as it is a chronic and degenerative disease wherein degradation of soft-tissue supporters of the medial arch eventually cause gross malalignment in the mid- and hindfoot, along with significant pain and dysfunction. Also, while planar radiographs are still used to diagnose and stage the disease, it is widely acknowledged that these 2-D measures fail to fully describe the 3-D nature of AAFD. Thus, a population of six patient-specific rigid-body computational models was developed using the commercially available software packages Mimics® and SolidWorks® in order to investigate foot function in patients with diagnosed Stage IIb AAFD. Each model was created from patient-specific sub-millimeter MRI scans, loaded with body weight, individualized muscle forces, and ligament forces, in single leg stance. The predicted model kinematics were validated pre- and postoperatively using clinically utilized radiographic angle distance measures as well as plantar force distributions. The models were then further exploited to predict additional biomechanical parameters such as articular contact force and soft-tissue strain, as well as the effect of hypothetical surgical interventions. Subsequently, kinematic simulations demonstrated that the models were able to accurately predict foot/ankle motion in agreement with their respective patients. Additionally, changes in joint contact force and ligament strain observed across surgical states further elucidate the complex biomechanical underpinnings of foot and ankle function.

Title: Problems of the functional flatfoot Objective: The aim of this diploma thesis is problems of the functional flatfoot. Main goal is to describe relation between change of structure, disorder of foot function and development of flatfoot. The thesis tries to describe the behavior of foot and arch in standing and walking. Another goal is to summarize the diagnostic possibilities of flatfoot. Methods: The diploma thesis has descriptive-analytical character. It's written in form of literature review. Results: This thesis demonstrates the problem of disunity nomenclature concerning the problem of flatfoot. Specifically, it concerns the interpretation of the words of functional flatfoot, movement components in foot and laboratory diagnostic methods. There is offered an explanation of the concept of functional flatfoot. Further work indicated that the acquired flatfoot is a question of a functional disorder that may progress to structural changes. The static and dynamic loadings were confirmed by the role of small muscles of the foot in the role of dynamic stabilization and influence of femoral rotation on the foot arch. There were summarized methods used for the diagnosis of flatfoot including dynamic plantography. Keywords: flat foot, foot arch, kinesiology, diagnostics

Title: Use of orthopaedic insoles in childhood Supervisor: PhDr. Tereza Nováková, PhD. Problem definition: The importance of the longitudinal arch is one of the most discussed topics in orthopaedics. Similarly important is the indication of orthopaedic insoles for flat feet especially in children. Experts have different opinions about what age insoles should be prescribed, and if their use is beneficial. So far, a clearly defined boundary has not been established between real pathology and a flexible flat foot formed on the basis of hypermobility which is to some extent physiological in childhood. Aim: To compare the plantograms of groups of six-year-old children with diagnosed pes planus/planovalgus before and after six month (or more) use of, individually prepared, insoles. To compare the results with a group of children that did not have insoles prescribed and on this basis to judge whether there was change (improvement) that can be proven with the use of a plantogram. Method: Two groups of six-year-old subjects were formed. The experimental group: subjects with prescribed orthopaedic insoles, and the control group: subjects that were not prescribed orthopaedic insoles. Plantograms were evaluated with the help of the Chippaux-Šmiřák index method. Conclusion: The results indicate a partial...

Title: The effect of the health-compensatory education program of foot position in aerobics-practicing adolescent girls Objectives: This undergraduate thesis is aimed to create the health-compensatory education program and test its effect and influence on the position, shape and stress of the foot of adolescent girls doing aerobics. Methods: It is a quasi-experiment study using a research method of a case study. The effect of the health-compensatory education program was tasted on 6 girls aged between 16 and 18 years and practicing aerobics. The research sample was divided into 2 groups - the experimental group, which completed the exercises, and the control group, which did not complete the exercises. The health-compensatory education program lasted 12 weeks, 4 times a week for 10-15 minutes. This program was including sensory and motor exercises. The methods of data collection during the entry examinations were kinesiological analysis and the examination on the podoscope. These examinations were repeated immediately after the end of the health-compensation program and subsequently two months after the end of the program. Furthermore, the subjective feeling of pain in the foot area was evaluated using the Visual Analog Scale (VAS). Results: After the 12-week health-compensatory education program,...

Several surgically corrective procedures are considered to treat Adult Acquired Flatfoot Deformity (AAFD) patients, relieve pain, and restore function. Procedure selection is based on best practices and surgeon preference. Recent research created patient specific models of Adult Acquired Flatfoot Deformity (AAFD) to explore their predictive capabilities and examine effectiveness of the surgical procedure used to treat the deformity. The models’ behavior was governed solely by patient bodyweight, soft tissue constraints, and joint contact without the assumption of idealized joints. The current work expanded those models to determine if an alternate procedure would be more effective for the individual. These procedures included one hindfoot procedure, the Medializing Calcaneal Osteotomy (MCO), and one of three lateral column procedures: Evans osteotomy, Calcaneocuboid Distraction Arthrodesis (CCDA), Z osteotomy and the combination procedures MCO & Evans osteotomy, MCO & CCDA, and MCO & Z osteotomy all used in combination with a tendon transfer. The combination MCO & Evans and MCO & Z procedures were shown to provide the greatest amount of correction for both forefoot abduction and hindfoot valgus. However, these two procedures significantly increased the joint contact force, specifically at the calcaneocuboid joint, and ground reaction force along the lateral column. With exception to the lateral bands of the plantar fascia and middle spring ligament, the strain present in the plantar fascia, spring, and deltoid ligaments decreased after all procedures. The use of patient specific computational models provided the ability to investigate effects of alternate surgical corrections on restoring biomechanical function in flatfoot patients.

Title: The effect of kinesiotaping for flat foot correction in association with selected parameters of gait for a specific group of people Objectives: The primary objective of this experiment was to determine whether and to what extent the application of kinesio tape to flat foot (utilising a functional correction technique) can influence the positioning of the specific segments of the body and thereby implement change to walking stereotype. Methods: Biomechanical measurement of the gait of eleven specifically selected people with the clinical symptoms of flat foot was implemented. First we recorded measurements prior to the intervention and then again, subsequent to the application of kinesio tape for a defined period. Probands retained the tape in place for the following four days and then the measuring was repeated both prior and subsequent to the removal of the tape. To determine any potential changes to the statics, initially the measuring of the postural stability prior to the intervention was first implemented in the experiment and subsequently again when the kinesio tape was removed after it had been worn for four days. This measurement was carried out using the Footscan apparatus (RSscan International, Belgium) and any potential differences in six variant modes of posture were determined....

Title: Ranges of joint mobility in the hip and ankle joints and evaluation of flat feet on a podoscope when finding hallux valgus in classical ballet dancers Objectives: The aim of this thesis is to evaluate if selected parameters: passive range of motion (ROM) of rotations in hip joints, Q angle, passive range of motion of plantar flexion in ankle joints and the foot index are connected with the finding of hallux valgus (HV) diagnose. These factors will be compared between two groups of ballet dancers, one with HV and one without the HV diagnose. Methods: This observational case control study involved 30 probands between the age of 20-40 years. The experimental group consisted of classical ballet dances with the HV angle (HVA) >15ř at least on one foot (n1 = 19), in the control group were classical ballet dancers with the HVA <15ř bilaterally (n2 = 11). The HVA, ROM of the rotations in the hip joints, ROM of the plantar flexion in the ankle joints and Q angle were measured by a goniometer. The plantogram was captured by a photograph of the foot while standing on a podoscope and then it was evaluated by the Sztriter-Godunov method. Analysis of the data was done in R software by means of a Welch's Two-Sample t-Test and the correlation was given by Pearson's Correlation Coefficient. Results: Contrary...

Le pied plat valgus dynamique idiopathique est une déformation touchant un grand nombre d’enfants. Il fait l’objet de la plupart des consultations d’orthopédie pédiatrique et donne communément lieu au port d’orthèses plantaires correctives. Le pied étant un segment dont l’architecture lui confère des propriétés de souplesse et de robustesse, une altération de sa structure, en particulier touchant à la forme de la voute plantaire, peut engendrer des modifications de la marche. Les atteintes de cette déformation sont au cœur de beaucoup d’études mais la littérature reste toujours parcellaire et centrée sur quelques variables mesurées sur le membre inférieur. En revanche, s’il est important d’évaluer la déformation localement, la marche reste une coordination de l’ensemble des segments corporels hautement hiérarchisée, dont l’évaluation de la performance nécessite des analyses plus globales. Le travail de cette thèse s’attachera à effectuer une caractérisation de l’effet de la présence d’un pied plat valgus dynamique sur la marche de l’enfant, mêlant des méthodes issues de la biomécanique classique, aux analyses de données et aus théories des systèmes dynamiques non linéaires.Les principaux résultats de ce travail concernent la multiplicité des atteintes biomécanique et les nombreuses modifications que le pied plat valgus dynamique engendre au niveau musculaire et cinématique sur le membre inférieur. Les mouvements intrinsèques du pied s’avèrent refléter particulièrement le défaut de maitrise de la marche à l’échelle du patient. Enfin, le pied s’avèrera jouer un rôle protecteur du centre de masse vis-à-vis du maintien de la stabilité dynamique lors de la marche. / The pediatric flexible flat foot is a common deformation. It is the reason of most pediatric orthopedic consultations and commonly leads corrective foot orthotics prescription. The specific architecture of the normal foot gives it properties of adaptation, strength and flexibility. Any alteration of its structure, particularly related to the shape of the plantar arch can cause modifications in gait. A lot of studies investigated the effects of this deformation, but are generally centered on a small number of variables, only at the level of the lower limb. However, if the local deformation is important to assess, it is unlikely to represent the complex non-linear coordination of the whole body segments related to gait performance. This thesis aims at characterizing the effect of flexible flat foot on gait in children, from a biomechanical point of view at the lower limb level as well as at the global coordination level, using methods from classicla biomechanics, data analysis and non linear dynamical systems theories.The major outcomes of this work are the multiplicity of biomechanical effects and the numerous changes on muscles activities and kinematics of the lower limb caused by flexible flat foot. The intrinsic foot movements particularly reflect the lack of control of gait at the patient's level. The particular role of the trunk and contralateral leg regarding the specific locomotor pattern of patients will be detailed. Finally, the foot will appear to have a protective role of the center of mass concerning resistance to perturbations and maintaining gait dynamic stability.

Title: The Evaluation of the Current Situation of Posture and Flat Foot Occurrence among the Young, Engaged in the Sports and not Engaged in the Sports, in the West Bohemia Objectives: The main objective of this thesis is to find out the current situation of posture and flat feet occurrence and to evaluate these findings together with a questionnaire survey, focused on the physical activity among a representative sample of young people. Methods: The main methods used to find out the current state of posture were a Matthias' posture test and a diagnostic device for flat feet examination with a polarized light called a podoscope. Plantographs had been evaluated according to the Kapandji score (1985). By the means of the written questionnaire, a basic data about the probands were found out, especially about their interest in the physical activity and their involvement in the sport activity. To determine the optimal weight or overweight, the body mass index BMI was used. By the probands, the BMI was calculated from their recorded body weight and height, using the personal scale Salter 9204WH3R and standalone measure Tanita HR-001. Results: It was discovered 68 % of the tested probands have a faulty posture, and by 32 % of the probands, a flatfoot among 1ř to 3ř occurred. Next, it was found out that a...