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The needs for obtaining quantitative plantar force information range from basic research into foot function to assisting patients in the use of prosthetic devices. This project reviews present force monitoring techniques, describes the evaluation of a Force Sensing Resistor for monitoring plantar force and proposes a low power portable plantar force monitoring system utilizing an array of force sensing resistors. / Thesis / Master of Engineering (ME)

Estimates show that roughly 2 million people around the world present with chronic plantar heel pain each year, of which the number one cause is plantar fasciitis. The degree of this pain ranges from obnoxious to debilitating and often features a progressive worsening of symptoms. If mistreated or simply left untreated, it can leave athletes sidelined from their respective sports indefinitely, and anyone whose occupation requires extended weight bearing activity fighting through enormous levels of pain to perform their duties. Plantar fasciitis arises more often in certain populations than others, and the reasons behind these correlations are highlighted and explored here. This condition causes a significant amount of frustration from both patients and physicians alike, because it is difficult to diagnose as a variety of differential diagnoses cause a similar type of pain. This paper discusses the most critical signs in determining whether or not a patient is dealing with plantar fasciitis, as well as reviewing the treatment options recommended, which depend on the extent to which microtear damage has occurred. A hindrance to appropriate care for patients exists, perhaps due to inconsistencies in the understanding of plantar fasciitis and the language used to describe it. Here the ability of physicians to eliminate almost entirely the use of painful, costly procedures and help patients return to weight bearing activities pain-free is discussed.

Submitted by LAÍS REGINA FAGANELLO null (laisfaganello@hotmail.com) on 2016-04-20T13:09:58Z No. of bitstreams: 2 DIssertação Laís pdf.pdf: 4039139 bytes, checksum: acabf0d0276662841fbe012c9eebca07 (MD5) DIssertação Laís pdf.pdf: 4039139 bytes, checksum: acabf0d0276662841fbe012c9eebca07 (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-04-26T14:52:07Z (GMT) No. of bitstreams: 1 faganello_lr_me_bauru.pdf: 4039139 bytes, checksum: acabf0d0276662841fbe012c9eebca07 (MD5) / Made available in DSpace on 2016-04-26T14:52:07Z (GMT). No. of bitstreams: 1 faganello_lr_me_bauru.pdf: 4039139 bytes, checksum: acabf0d0276662841fbe012c9eebca07 (MD5) Previous issue date: 2016-02-22 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A pesquisa pretende avaliar a percepção de desconforto e atividade dos músculos da perna, de usuárias de calçados com salto que possuem hiperidrose plantar. Para isto, discutem-se os aspectos ergonômicos aplicáveis ao design de calçados para pessoas com esta disfunção. A amostra do estudo foi composta por 20 mulheres divididas em dois grupos: com e sem hiperidrose plantar. Foi avaliada a atividade elétrica dos músculos por meio da eletromiografia de superfície (não invasiva) e a percepção de desconforto nos pés através do questionário de mapa plantar. Todos os sujeitos realizaram um circuito de caminhada composto de movimento em terreno plano, inclinado e em escadas. Desta forma, foi possível avaliar, comparando os achados dos dois grupos de sujeitos, a influência da transpiração excessiva dos pés nas atividades dos músculos da perna e na percepção de desconforto. Este estudo contribuirá para o conhecimento científico dos aspectos ergonômicos do design de calçados femininos. / The research aims to evaluate the perception of discomfort and activity of the leg muscles, users of shoes with heels that have plantar hyperhidrosis. For this, discusses the ergonomic aspects applicable to shoe design for people with this disorder. The study sample will consist of 20 women divided into two groups: with and without plantar hyperhidrosis. It was evaluated the electrical activity of the muscles through surface electromyography (no invasive) and the perception of discomfort in the feet through the survey map of the feet. All subjects will conduct a walking circuit composed of movement on flat ground, bent and stairs. In this way, you can evaluate by comparing the findings of the two group of subjects, the influence of excessive sweating of the feet in the activities of the leg muscles and perception of discomfort. This study will contribute to the scientific knowledge of the ergonomic aspects of the design of women´s shoes.

Made available in DSpace on 2016-12-06T17:07:16Z (GMT). No. of bitstreams: 1 RUDNEI PALHANO.pdf: 3683877 bytes, checksum: fe25b167aa6def43f3bead628f1850d4 (MD5) Previous issue date: 2008-04-25 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The aim of this correlational study was to analyze the plantar medial longitudinal arch during the stance phase of the gait. Thirty-two subjects of both genders (mean age 25,78±6,75 years) from Vale dos Sinos RS have participated of the research. The specific objectives was to describe the behavior of the plantar medial longitudinal arch during the gait in the initial contact and stance phase; identify the foot s angle with the surface in the initial contact; correlate the medial longitudinal plantar arch with the Ankle s angle during the contact phase; correlate the anthropometry variables with the dynamic behavior of the medial longitudinal plantar arch; correlate the plantar pressure distribution (peak pressure, plantar pressure mean, contact time and mean area) with the dynamic behavior of the kinetics and kinematics variables of the medial longitudinal plantar arch during the stance phase and relate the kinetics and kinematics variables with kinds of medial longitudinal plantar arch. The kinematics data has been acquired by the Spica Technology Corporation video system and for kinetic data was used the Novel Emed-XR system with a sampling rate of 100 Hz and the 3D Scanner INFOOT. Subjects were separate into three groups by the Cavanagh s arch index: Cavus foot; normal foot e planus foot. The variables analyzed were: medial longitudinal plantar arch angle in seated position, initial contact and stance phase, angle of the ankle in seated position and stance phase, plantar pressure of peak, mean plantar pressure, contact area, contact time and mean force. The Kolmogorov-Smirnov test has been applied for the statistical analysis to verify the normality of the data. The ANOVA One-Way test has been used to compare means intra-groups and to verify where were the differences was used the Scheffé`s Post Hoc test. Pearson test has been applied to verify the correlation. The level of significance adopted was p ≤ 0.05. There were no differences statistically significant when inter-groups kinematics and anthropometrics variables had been compared. Only in some regions of the plantar surface has shown differences statistically significant when the kinetics variables were compared inter-group. Analyzing the correlations between the dynamic arch index with kinematics variables, only the medial longitudinal plantar arch angle has shown a moderate correlation statistically significant, while others correlations had low relations. / O objetivo deste estudo correlacional foi analisar o Arco Plantar Longitudinal Medial durante a fase de apoio da Marcha. Com objetivos específicos: descrever o comportamento do Arco Plantar Longitudinal Medial durante a marcha nos períodos do Contato Inicial e Apoio Simples; Identificar o Ângulo do pé com a superfície no Contato Inicial; Correlacionar o Ângulo do Arco Plantar Longitudinal Medial com o Ângulo do Tornozelo durante a Fase de Contato; Correlacionar as variáveis antropométricas com o comportamento dinâmico do Arco Plantar Longitudinal Medial; Correlacionar as variáveis da Distribuição de Pressão Plantar (Pico de Pressão Plantar, Pressão Plantar Média, Tempo de contato e Área media) com o comportamento dinâmico das variáveis cinemáticas e cinéticas do Arco Plantar Longitudinal Medial durante a o apoio simples;Verificar diferenças nas variáveis cinemáticas e cinéticas relacionando com os diferentes tipos de Arco Plantar Longitudinal Medial dinamicamente. Participaram do estudo 32 sujeitos da região do Vale dos Sinos RS, ambos os sexos, idade entre 19 e 46 anos (25,78±6,75 anos). Utilizaram-se como instrumentos o Sistema de cinemetria da Spica Technology , Sistema cinético da Novel Emed e o Scanner 3D INFOOT. Os sujeitos foram classificados em três grupos através do Índice do Arco Plantar: Pés Cavos (PC); Pés Normais (PN) e Pés Planos (PP). As variáveis analisadas foram: Ângulo do Arco Plantar Longitudinal Média, na posição sentada, contato inicial e no apoio simples; Ângulo do Tornozelo, na posição sentada e apoio simples; Pico de Pressão Plantar; Pressão Plantar Média; Área de Contato; Tempo de Contato e Força Média. Na análise estatística foi aplicado o teste de Kolmogorov-Smirnov para verificar a normalidade nos dados. Na comparação das médias intra-grupos foi aplicado ANOVA One-Way e para verificar onde as diferenças encontravam foi utilizado o teste de Post hoc de Scheffé. Para verificar as correlações foi aplicado Pearson. O nível de significância adotado foi de p≤ 0,05. Na comparação inter-grupos para as variáveis cinemáticas e antropométricas, não apresentaram diferenças estatisticamente significativas. Apenas na comparação inter-grupos das variáveis cinéticas, em algumas regiões da superfície plantar apresentaram diferenças estatisticamente significativas. Ao analisar as correlações entre o Índice do Arco Plantar dinâmico com as variáveis cinemáticas, somente o ângulo do Arco Plantar longitudinal medial apresentou correlação moderada estatisticamente significativa, as demais variáveis cinemáticas apresentaram correlações baixas.

Plantar heel pain is commonly encountered by clinicians. Various conditions, such as plantar fasciopathy, myofascial syndrome and entrapment of the tibial, plantar and calcaneal nerves at the tarsal tunnel can cause plantar heel pain. This diversity in aetiology makes the diagnosis and treatment challenging. There are limited studies on pain mechanisms in patients with planter heel pain. There is no gold criterion standard for the diagnosis. Although various interventions have been reported, no specific treatment approach has yet been identified as being most effective. The first aim of this thesis was to critically appraise the literature on plantar heel pain of neural origin. Various databases were searched for peer-reviewed articles that predominantly focused on neurogenic plantar heel pain or that discussed relevant biomechanics of the tibial, plantar and calcaneal nerves. This review revealed inconsistency in the literature regarding the diagnosis and treatment of neurogenic plantar heel pain. There also was a lack of evidence for treatment approaches although the majority of patients with plantar heel pain are reported to improve with conservative treatment. The second aim of this thesis was to examine the biomechanical effects of clinical tests and combination of movements on various structures associated with plantar heel pain. This aim was achieved through cadaver studies (Study 1–3), in which strain in the plantar fascia and the nerves of the lower limb, and excursion of the nerves were measured during various movements and positions of the lower limb. Study 1 examined the Dorsiflexion-eversion test used to diagnose tarsal tunnel syndrome (TTS) and the Windlass test for plantar fasciopathy given the similarity between both tests. Both the Dorsiflexion-eversion and Windlass tests significantly increased strain in the structures that are commonly associated with plantar heel pain (the tibial and plantar nerves and plantar fascia). This suggests that the usefulness of the Dorsiflexion-eversion and Windlass tests in the differential diagnosis of plantar heel pain might be limited. Study 2 investigated the influence of different positions in adjacent joints on nerve biomechanics during ankle and toe movement. Increased strain in the tibial nerve at the ankle and plantar nerves associated with ankle and toe movement was significantly higher when the nervous system was pre-tensioned at a more proximal joint. Strain was even higher when the nerve bed was pre-tensioned at two joints. Study 3 examined a modified straight leg raising (SLR) test in which ankle dorsiflexion is performed before hip flexion. This test has been suggested to diagnose distal neuropathies such as TTS. During the modified SLR, the excursion and strain in the sciatic nerve associated with hip flexion were transmitted distally along the nerve from the hip to the foot. As a result, the strain in the nerves around the foot and ankle increased significantly during hip flexion. This movement did not affect plantar fascia strain. Consequently, the modified SLR may be a useful test to differentially diagnose plantar heel pain. This test warrants future research to evaluate its clinical use in patients with neurogenic plantar heel pain. The third aim of this thesis was to determine the reliability of high-resolution ultrasound for measuring the cross-sectional area of the tibial nerve at the tarsal tunnel and to compare the tibial nerve size between people with and without plantar heel pain. Study 4 investigated intra and intertester reliability in 10 participants without plantar heel pain by calculating intraclass correlation coefficients, measurement error and smallest detectable difference (SDD). Intra and intertester reliability were excellent, with very small measurement error and SDD. Tibial nerve enlargement in an individual patient by as little as 1.8 mm2 can be detected reliably with high-resolution ultrasound. The use of average value of three scans is recommended to compare between the involved and uninvolved side. Differences in the nerve size between 26 patients with plantar heel pain and 20 control participants were also analysed. There was no significant difference in tibial nerve size between both groups. Future research is needed to investigate the tibial nerve size in patients with proven TTS using ultrasonography. The fourth aim of this thesis was to investigate the characteristics of plantar heel pain through Study 5 for the same group of patients and control participants as in Study 4. Several self-report measures on pain and quality of life were used. Clinical tests and quantitative sensory tests (QST) were performed at local and remote sites on the involved and uninvolved side in the patients and on one side in the control participants. In the patients, mechanical hyperalgesia was the main finding as demonstrated by changes in palpation and pressure pain threshold. Other findings were changes in current thresholds, vibration threshold and thermal perception thresholds. These results suggest the existence of sensory changes that likely indicates change in peripheral and central pain processing. It is recommended to utilise a multidimensional pain assessment for patients with plantar heel pain. The findings in this thesis are important for the diagnosis and treatment of plantar heel pain. For future research, the results suggest to use fresh cadavers when investigating biomechanics of the clinical tests and nerve gliding exercises that are used for patients with plantar heel pain. It is also suggested to evaluate the cross-sectional area of the tibial nerve at the tarsal tunnel, the QSTs and all other diagnostic measurements in this thesis in patients with neurogenic plantar heel pain or patients with TTS.

Der menschliche Gang und damit auch das Abrollverhalten und die Belastungssituation des Fußes wird von einer Vielzahl an extrinsischen und intrinsischen Faktoren beeinflusst. In dieser Arbeit soll der Einfluss des Körpergewichtes, im Speziellen der übermäßigen Körpermasse unter der Krankheit Adipositas sowie der Einfluss der plantaren, kutanen Sensorik auf den menschlichen Gang betrachtet werden. Die starken Auswirkungen von Übergewicht und Adipositas auf das muskuloskelettale System lassen sich vor allem an der hohen Prävalenz von Schmerzen an den unteren Extremitäten festmachen. Besonders häufig treten neben Schmerzen an Hüfte und Knie auch Beschwerden im Bereich des Fußes auf. Die Betrachtung kinetischer Auswirkungen von Übergewicht und Adipositas auf den Bewegungsapparat rückt daher zunehmend in den Fokus der bewegungswissenschaftlichen Forschung. Die aktuelle Studienlage lässt derzeit jedoch keine eindeutigen Schlussfolgerungen zu, in welcher Weise sich Adipositas mit steigendem Schweregrad auf das Gangmuster auswirkt. Besonders im Bereich des Fußes fehlen belastungsrelevante Informationen mit denen das Abrollverhalten des Fußes bestimmt und mögliche Fehlbelastungen erkannt werden können. Zur Behandlung von schweren Graden der Adiposits werden adipositaschirurgische Maßnahmen eingesetzt. Dadurch ist es möglich in kürzester Zeit einen starken Gewichtsverlust hervorzurufen. Unklar ist, ob sich das Gangbild nach einem entsprechenden Gewichtsverlust wieder normalisieren kann und Adaptationsvorgänge nach einem längeren Zeitraum nachweisbar sind. In zwei Studien soll daher das plantare Belastungsmuster unter Adipositas evaluiert werden. In Studie I wird dazu eine Kategorisierung nach dem Schweregrad der Adipositas vorgenommen und das plantare Belastungsmuster der jeweiligen Gruppen gegenüber dem einer normalgewichtigen Gruppe gestellt. Ein besonderes Augenmerk soll hier auf Belastungen im Fersen- und im Mittelfußbereich gelegt werden, da hier Schmerzen am häufigsten auftreten. Der Kenntnisgewinn aus dieser Studie soll vor allem zur theoretischen Herleitung der Entstehungsmuster von Schmerzen im Bereich des Fußes dienen, aber auch typische Gangmuster der einzelnen Adipositas Grade festhalten. In Studie II erfolgt die Betrachtung der plantaren Belastung nach einem adipositaschirurgischen Eingriff. Ziel dieser Studie ist es, Anpassungsprozesse nach einem massiven Gewichtsverlust im Gangverhalten zu bewerten und Faktoren, welche wesentlich zur Veränderung des Gangbildes beitragen, auszumachen. Die Ergebnisse können weiterhin Hinweise auf eine mögliche Notwendigkeit einer bewegungstherapeutischen Begleitung nach einem adipositaschirurgischen Eingriff liefern. Studie III beschäftigt sich mit den Auswirkungen einer Desensibilisierung der plantaren kutanen Sensorik auf das plantare Abrollmuster beim Gehen. Die kutanen Mechanorezeptoren sind wesentlich an der posturalen Kontrolle beim Stehen und bei dynamischen Bewegungsvorgängen beteiligt. Beeinträchtigungen in der Funktionsweise der plantaren kutanen Mechanorezeptoren bspw. in Folge einer diabetischen Polyneuropathie können zu Gangpathologien, einer erhöhten Sturzgefahr oder auch der Entstehung von Druckulzerationen führen. Die Stärke der Beteiligung der plantaren Sensorik am plantaren Belastungmuster ist jedoch nicht ausreichend erschlossen und soll daher in Studie III betrachtet werden.

Introduction: Instrumented gait analysis and inverse dynamics are commonly used in research and clinical practice to calculate lower extremity joint kinetics, such as power and work. However, multisegment foot (MSF) model kinetics have been limited by ground reaction force (GRF) measurements. New technology enables simultaneous capture of plantar pressure and shear stress distributions but has not yet been used with motion capture. Integrating MSF models and pressure/shear measurements will enhance the analysis of foot joint kinetics. The purpose of this study was to develop methodology to integrate these systems, then analyze the effects of speed on foot joint kinetics. Methods: Custom software was developed to synchronize motion capture and pressure/shear data using measured offsets between reference frame origins and time between events. Marker trajectories were used to mask pressure/shear data and construct segment specific GRFs. Inverse dynamics were done in commercial software. Demonstrative data was from 5 healthy adults walking unshod at 3 fixed speeds (1.0, 1.3, and 1.6 m/s, respectively) wearing retroreflective markers according to an MSF model. Plantar shear forces and ankle, midtarsal, and first metatarsophalangeal (MTP) joint kinetics were reported. Speed effects on joint net work were evaluated with a repeated measures ANOVA. Results: Plantar shear forces during stance showed some spreading effects (directionally opposing shear forces) that relatively were unaffected by walking speed. Midtarsal joint power seemed to slightly lag behind the ankle, particularly in late stance. Net work at the ankle (p = 0.024), midtarsal (p = 0.023), and MTP (p = 0.009) joints increased with speed. Conclusions: Functionally, the ankle and midtarsal joints became more motorlike with increasing speed by generating more energy than they absorbed, while the MTP joint became more damperlike by absorbing more energy than it generated. System integration appears to be an overall success. Limitations and suggestions for future work are presented.

Submitted by Sara Ribeiro (sara.ribeiro@ucb.br) on 2017-07-05T17:09:15Z No. of bitstreams: 1 TelmaElisaBrescoviciDissertacao2016.pdf: 997949 bytes, checksum: 13012bfc59d4e58864e422afd35bafff (MD5) / Approved for entry into archive by Sara Ribeiro (sara.ribeiro@ucb.br) on 2017-07-05T17:09:55Z (GMT) No. of bitstreams: 1 TelmaElisaBrescoviciDissertacao2016.pdf: 997949 bytes, checksum: 13012bfc59d4e58864e422afd35bafff (MD5) / Made available in DSpace on 2017-07-05T17:09:55Z (GMT). No. of bitstreams: 1 TelmaElisaBrescoviciDissertacao2016.pdf: 997949 bytes, checksum: 13012bfc59d4e58864e422afd35bafff (MD5) Previous issue date: 2016-03-21 / UCB / Introduction: The foot plantar arch is essential to maintain a correct body biomechanics. However, due to aging, changes occur in the foot anatomical and physiological structures, which can hinder ambulation and interfere in the individual's quality of life. It is important to remind that currently one of the main concerns related especially to the elderly is the occurrence of falls. Objective: This study aimed at determining whether there is correlation between the plantar arch type and the risk of falls in sedentary elderly women. Methods: A cross-sectional, quantitative study with 47 elderly women between 60-69 years old, attending a support group called Programa Idade Viva in the municipality of Barreiras/BA. It was used the Functional Reach Test (FRT) and the Timed Get Up and Go (TUG Test) to evaluate the balance, along with the plantar evaluation test through a Pedigraph. Results: The results showed that among the subjects who presented risk of falls through the Functional Reach Test (FRT), most of them had an intermediary type of plantar arch. According to the TUG test, most elderly were considered fragile (with low risk of falling), and none had increased risk of falling. Conclusion: There was no significant correlation between the plantar arch and the risk of falls, it is suggested further research with a larger number of subjects to identify the influence of the plantar arch on the elderly balance. / Introdu????o: O arco plantar do p?? ?? essencial para a manuten????o de uma correta biomec??nica corporal. Por??m, em fun????o do envelhecimento, acontecem modifica????es nas estruturas anat??micas e fisiol??gicas do p??, as quais podem atrapalhar a deambula????o e interferir na qualidade de vida do indiv??duo. Vale lembrar que atualmente uma das principais preocupa????es relacionadas, em especial, aos indiv??duos da terceira idade ?? a ocorr??ncia de quedas. Objetivo: Esse estudo teve como objetivo verificar se h?? correla????o do tipo de arco plantar com o risco de quedas em idosas sedent??rias. M??todo: Foi realizado um estudo transversal, quantitativo, com 47 idosas de 60 a 69 anos de idade, participantes do Programa Idade Viva, no munic??pio de Barreiras/BA. Utilizou-se o Teste de Alcance Funcional (TAF) e o Timed Get Up and Go (Tug Test) para avalia????o do equil??brio, al??m do exame da avalia????o plantar por meio de um Ped??grafo. Resultados: Os resultados demonstraram que dos sujeitos que apresentaram risco de queda atrav??s do Teste de Alcance Funcional (TAF), a maioria deles possu??am tipo de arco plantar intermedi??rio. De acordo com o TUG teste, a maioria dos idosos foram considerados fr??geis (com baixo risco de queda), sendo que nenhum apresentou risco de queda aumentado. Conclus??o: N??o houve rela????o significativa do tipo de arco plantar com o risco de quedas, sugere-se mais pesquisas, com um maior n??mero de sujeitos, para identificar a influ??ncia do arco plantar no equil??brio de idosos.

Purpose: Due to the vital role that blood flow plays in maintaining tissue health, compromised blood flow can prevent effective tissue healing. An adducted hallux, as often seen inside a narrow shoe, may put passive tension on the abductor hallucis, consequently compressing the lateral plantar artery (LPA) into the calcaneus and thus restricting blood flow. The purpose of this study was to compare blood flow within the LPA before and after passive hallux adduction (PHA). Methods: Forty-five healthy volunteers (20 female, 25 male; age = 24.8 ± 6.8 yr; height = 1.7 ± 0.1 m; weight = 73.4 ± 13.5 kg) participated in this study. Blood velocity and vessel diameter measurements were obtained using ultrasound imaging (L8-18i transducer, GE Logiq S8). The LPA was imaged deep to abductor hallucis for 120 seconds: 60 seconds at rest followed by 60 seconds of PHA. Maximal PHA was performed by applying pressure to the medial side of the proximal phalanx of the hallux. Blood flow was then calculated in mL/min, and pre-PHA blood flow was compared to blood flow during PHA. Results: Log transformed data was used to run a paired t-test between the preadduction and postadduction blood flow. The volume of blood flow was 22.2% lower after PHA compared to before (–0.250 ± 0.063, p < 0.001). Conclusion: Although PHA is only a simulation of what would happen to the hallux inside of a narrow shoe, our preliminary findings of decreased blood flow through PHA suggest blood flow in narrow footwear and its effects on tissues within the foot are worth investigating.