Orientador: Aparecido Augusto de Carvalho / Banca: Nobuo Oki / Banca: Josivaldo Godoy da Silva / Resumo: Neste trabalho, descreve-se um sistema eletrônico informatizado implementado com o objetivo de medir a distribuição do peso corporal na região plantar de pacientes, visando relacioná-la diretamente à tipologia e deformidades dos pés e associando-a, indiretamente, a eventuais deformidades dos membros inferiores, coluna vertebral, algias músculoesqueléticas e instabilidades da postura humana. O sistema é constituído por células de carga com extensômetros, montadas em uma base metálica, circuito de condicionamento de sinais, circuito de interfaceamento e um display de cristal líquido. Foi construída uma plataforma piloto com 4 células de carga, mas o projeto do sistema prevê a construção de duas plataformas com 45 células de cargas, cada uma. As células de carga apresentaram resposta linear, precisão superior a 2%, resolução inferior a 0,5 N e histerese desprezível. São apresentados os resultados de medições, efetuadas com o sistema, para medir a distribuição de forças nas quatro células de carga, quando se aplicou sobre elas um peso conhecido. As informações foram apresentadas em um display de cristal líquido e posteriormente serão apresentadas na tela de um computador, por meio de um programa desenvolvido em Delphi, facilitando a visualização para especialistas da área, principalmente médicos, fisioterapeutas e terapeutas ocupacionais. Com o equipamento proposto será possível investigar, clinicamente, patologias estudadas pela Podologia, Posturologia e Podoposturologia, viabilizando, com as informações captadas pelo sistema, metodologias mais adequadas de tratamentos. / Abstract: In this work we describe an electrical system implemented with the purpose of measuring the distribution of body weight in plantar region of patients, aiming to relate it directly to the typology and deformities of the feet and involving it, indirectly, to any deformities of the lower limbs, skeletal spine, muscle-skeletal pains and human posture instability. The system consists of load cells with strain gages within a metal base, signal conditioning circuit, interfacing circuit, and a liquid crystal display. A prototype platform with 4 load cells was built, but the system will have two platforms with 45 loads of cells, each one. The load cells presented linear response, precision better than 2%, resolution less than 0.5 N, and low hysteresis. We show the results of the force distribution when a know weight is applied over the four load cells. The informations have been presented in a liquid crystal display, but later they will be presented in the screen of a computer, facilitating the visualization for specialists, mainly doctors, physiotherapists and occupational therapists. With the proposed equipment it will be possible to investigate, clinically, pathologies studied by Podology, Posturology and Podoposturology making feasible, with the information obtained with the system, more appropriate methodologies of treatment. / Mestre

The main objective of this work is to give contribution in both additive manufacturing (AM) and tribometry derived from the application and study of materials available with the use of biomimetic designs. Additional contributions are determining what effects treatments for flooring surfaces may have on the dynamic coefficient of friction and the effects of these products on common surfaces. The validity of the proposed methodology for a proof of concept was demonstrated by comparing measured dynamic coefficient of friction for designs using standardized equipment and comparing these values to plantar skin tested using an accepted and standardized testing method that has been extensively researched and validated. Initial biomimetic designs and characteristics unique to each design were researched and compared. Eleven designs were selected to be fabricated, tested, and compared to select the most desirable applications for further investigation. Research into potential treatments commercially available for use was done to determine the efficacy of these products. Prototype sensor designs were selected and fabricated using direct light processing (DLP) technology. Examination of the measured values was done through an analysis of the variances in the response variable and comparisons using Fisher and Tukey pairwise comparison method. Future work recommendations are provided for further development and improvement of the topics presented in this thesis.

The first two chapters are devoted to general issues relating to the Achilles tendon and brings important insights that are required for subsequent practical part. To the practical part is also devoted the following chapter. The first chapter is more of a medical nature. It explains the function and location of the Achilles tendon. Above all, the nature of the examination. Then follow chapters dealing with the assembly of functional devices for sensing the Achilles tendon reflex. This section begins in the third chapter discusses the preparation and block diagrams for the sensor and its technical solutions. The following chapter is about constructing electrical circuits, calculation of component values for the device of Achilles tendon reflex. The fifth chapter deals with the ability to view the scanned signal and the final chapter is devoted to measurements of the device on a group of volunteers.

(thesis): Palmar-plantar erythrodysesthesia (PPE) frequently accompanies the therapy with a continuous 5-FU infusion or peroral capecitabine (5-FU prodrug). In the most severe cases this adverse effect leads to discontinuation of a needful therapy. Local 10 % uridine ointment is used to prevent and treat the said adverse event. Nevertheless, this method is not generally accepted as an effective one because it has never been proved in a randomized controlled clinical trial. Most probably, a direct effect of a cytostatic compound on the skin of hands and foots causes PPE. The toxicity of 5-FU is mediated primarily by its incorporation into RNA and by thymidylate synthase (TS) inhibition and subsequent DNA synthesis disruption. The importance of particular 5-FU toxicity mechanisms varies in different cell types. For choosing the best PPE local antidote it is necessary to find out which molecular mechanism applies in keratinocytes. We have chosen pyrimidine nucleosides as the most suitable compounds for the local PPE therapy because the uridine ointment is already being used in several oncology centers in the Central Europe. In order to find out the 5-FU toxicity mechanism, we further tested the effect of calciumfolinate (CF) which strengthens the TS inhibition by 5-FU. We studied also uracil and...

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Patients affected by Diabetes Mellitus have reduced tactile sensitivity and atrophy of the small muscles in the foot, resulting in high-pressure points that may remain unnoticed. The increased pressure can cause micro-trauma leading to wounds. Because of the Diabetes Mellitus, DFUs do not heal easily. Up to 25% of them will develop diabetic foot ulcers (DFU), and 25% of DFUs that do not heal ultimately result in amputation. This Master Thesis will describe and gather results of a newly acquired large international collaborative EU project (EIT Health 2020-2022) between three universities and three companies across Europe. This collaborative group will be the first to tackle the Diabetic Foot Ulcers problem preventatively with an innovative shoe concept, with seven different apex settings, which can be easily modified to avoid ulcerations in different areas of the foot. As an initial pilot, this master thesis project focuses on the analysis of the plantar pressure distribution by using the innovative shoes DR Comfort based on the adjustable rocker profiles, used as a prototype for the prevention of the Diabetic Foot Ulcer (DFU) formation in patients affected by Diabetes. This project captures the motion data of healthy people with different shoe soles while walking at different levels of speed and assess the values of the peak plantar pressure, with the use of the Pedar-X, a measuring system device for the in-shoe plantar pressure. The evaluation of the adjustable rocker profiles is made through the calculation and analysis of the significant differences and p-values in peak plantar pressure, as well as the analysis of the Mean Plantar Pressure (MMP). The results of this study show a reduction (although not pronounced) of the areas that are more affected by DFU. This study cannot be generalized to diabetic patients since ethical approval has not yet been received. / Patienter med DM har minskad taktil känslighet och atrofi i de små musklerna i foten, vilket resulterar i högatryckpunkter som kan för bli obemärkta. Det ökade trycket kan orsaka mikrotrauma som leder till sår. På grund av Diabetes Mellitus, läker inte DFU lätt. Upp till 25% av dem kommer att utveckla diabetiska fotsår (DFU), och 25% av DFU: er som inte läker leder slutligen till amputation. Detta examensarbete kommer att beskriva och samla resultat från ett nyförvärvat stort internationellt EU-projekt (EIT Health 2020-2022) mellan tre universitet och tre företag i hela Europa. Denna samarbetsgrupp kommer att vara den första att förebygga problemet med diabetiska fotsår med ett innovativt skokoncept diabetiska fotsår med ett innovativt skokoncept. De kommer utföras med sju olika inställningar som lätt kan modifieras för att undvika sår på olika områden i foten. Som en första pilot fokuserar detta examensarbete på analys av plantartryckfördelning genom att använda de innovativa DR Comfort-skorna baserade på de justerbara ”rocker”-profilerna, som används som en prototyp för att förebygga bildningen av Diabetic Foot Ulcer (DFU) hos patienter som drabbats av Diabetes. Den här avhandlingen fångar rörelsen hos friska personer med olika skosulor medan de går i olika hastighet och analyserar värdena för det maximala plantartrycket med användning av pedar-x. Pedar-x är en mätanordning för plantorns tryck i skon. Utvärderingen av de justerbara ”rocker”-profilerna gjordes genom beräkning och analys av de signifikanta skillnaderna i top plantartrycket samt analysen av plantartryckets maximala medelvärde (MMP). Resultaten av denna studie visar en minskning (även om den inte betydlig) av de områden som mest drabbats av DFU. Denna studie kan inte generaliseras till diabetespatienter eftersom etiskt godkännande ännu saknas.

Fragestellung: Die Studie soll die Frage klären, ob sich mit der elektronischen plantaren Fußdruckmessung (elektronische plantare Pedobarographie) bei Probanden mit Rheumatoider Arthritis Veränderungen der Druckverteilung an der Fußsohle nachweisen lassen. Obwohl sich Geräte zur elektronischen Fußdruckmessung seit einigen Jahren auf dem Markt befinden, gehört ihr Einsatz bei weitem noch nicht zum Standard bei der Optimierung und Kontrolle der Therapie von Fußerkrankungen. Methode: In dieser Studie werden die statischen und dynamischen Druckverteilungsmuster einer Gruppe von dreiunddreißig Rheumatikern erfasst. Diesen wird eine Vergleichgsgruppe Fußgesunder mit einunddreißig Probanden gegenübergestellt. Die Messung des Plantardruckes erfolgte mit dem elektronischen Parotec(R) – System. Ergebnisse: Die Ergebnisse der statischen Messungen zeigen eine deutliche Tendenz der Rheumatiker zur Ausbildung eines Pes planovalgus. Über eine Quotientenbildung aus zu Sensorgruppen zusammengefasstem Druckarealen können als Spreiz-, Senkfuß- und Valgusindex die entsprechenden pathologischen Veränderungen quantifiziert werden. In der dynamischen Belastung zeigt sich im Längsgewölbebereich eine Annäherung der Plantardrücke beider Gruppen. In der Referenzgruppe treten sogar vereinzelt höhere Mittelwerte auf, als bei den Rheumatikern. Dies wird hauptsächlich durch eine räumliche und zeitliche Modifikation der Gangkinematik durch den Rheumatiker erzielt: ein langsameres Gehen; eine kleinere Schrittlänge; die relative Vergrößerung der plantaren Druckverteilungsfläche durch relativ verkürzte monopedale bzw. verlängerte bipedale Belastung ; eine Modifikation der Abrollbewegung des Rheumatikers mit Reduktion der Belastung in drucksensiblen peripheren, insbesondere distalen Bereichen, vor allem im Bereich des Metatarsalköpfchen I. Folgerung: Die Ergebnisse zeigen, dass es deutliche Plantardruckunterschiede in beiden Gruppen gibt, mit Tendenz zur aequibaren Plantardruckverteilung des Rheumatikers im Sinne eines Pes planovalgus. Die funktionelle Auswirkung struktureller Veränderungen des rheumatischen Fußes lassen sich mit dem von uns verwendeten Meßsystem quantifizieren. Durch die Quantifizierbarkeit der pathologischen Veränderungen eignet sich dieses Messverfahren zur Optimierung und Kontrolle der operativen und konservativen Therapie nicht nur von rheumatischen Veränderungen des Fußes. / Question: The study shall clarify the question, whether changes of the pressure distribution at the sole of the foot can be verified by means of electronic plantar foot measurement (electronic plantar pedobarography) in probands suffering from rheumatoid arthritis. Although there are devices of electronic foot measurement on the market, the use is not standard yet in view of the optimisation and check of pedopathy therapies. Method: This study includes the static and dynamic pressure distribution patterns of a group of thirty-three rheumatics. A comparing group of thirty-one probands with healthy feet is compared with it. The measuring of the plantar pressure took place by means of the electronic Parotec(R) system. Results: The results of the static measuring turn out a clear tendency of the rheumatics to the formation of pes planovalgus. The appropriate pathologic changes can be quantified as splayfoot, flatfoot, and valgus index by means of a quotient formation of pressure areas combined in sensor groups. In the event of dynamic load, a convergence of the plantar pressures of both groups is noticed in the area of the longitudinal arch of the foot. The reference group even shows isolated higher mean average values compared with the rheumatics. This is mainly obtained by means of a spatial and temporal modification of the rheumatic’s gait kinematics: slower walking; shorter length of stride; relative increase of the plantar pressure distribution area by means of relatively shortened monopedal, resp. lengthened bipedale load; a modification of the rheumatic’s heel-toe walking motion with reduction of the load in peripheral and distal areas in particular that are sensible to pressure, especially within the area of the metatarsal head I. Conclusion: The results turn out that there are clear differences regarding the plantar pressure of both groups with a tendency to aequibar plantar pressure distribution of the rheumatic within the sense of pes planovalgus. The functional effect of structural changes of the rheumatic foot can be quantified by means of our used measuring system. This measurement method also is suitable for the optimisation and check of operative and conservative therapies other than rheumatic changes of the foot because pathologic changes are quantifiable.

Ce travail de thèse vise à évaluer le rôle des afférences cutanées plantaires dans le contrôle postural et oculomoteur en manipulant l’extéroception plantaire à l’aide de stimulations mécaniques plantaires fines. La 1ère étude a montré que des éléments médio-plantaires fins externes (EME) et surtout internes (EMI) améliorent la stabilité orthostatique et postériorisent le CPP de sujets jeunes et sains lors de mouvements des yeux. Ils ont aussi une action spécifique sur la vergence (pas sur les saccades) : les EMI augmentent l’amplitude phasique de divergence et diminuent la partie tonique, autrement dit agissent surtout sur la composante pré-programmée du mouvement ; alors que les EME agissent sur la convergence en augmentant son amplitude tonique, composante contrôlée sous influence de la rétroaction visuelle. Les inserts influent de manière directe sur le contrôle postural et oculomoteur par des voies spécifiques et indépendantes. La 2ème étude explique la variabilité des réponses des sujets de la 1ère. Nous avons mesuré leur degré d’utilisation des afférences extéroceptives plantaires par la méthode du Quotient Plantaire (QP = Surface CPP mousse / Surface CPP sol dur X 100). Un QP<100 suggère une Inefficience des Afférences Plantaires (IAP) : les sujets IAP ne présentent plus d’amélioration de leur stabilité ni aucune modification de la vergence avec les inserts plantaires. Nous proposons que cette situation soit non physiologique et relève d’un dysfonctionnement non douloureux latent des récepteurs plantaires, opposant les sujets IAP aux sujets ayant un QP normal. La 3ème étude a investigué les rapports entre l’utilisation des afférences plantaires et visuelles chez de jeunes adultes sains avec la méthode du QP et du Quotient du Romberg (QR). Elle mis en évidence l’existence d’une utilisation synergique des afférences visuelles et plantaires en vision de près, uniquement chez les sujets au QP normal. Les sujets IAP ont un QR plus bas que les sujets au QP normal, en vision de près et sur sol dur uniquement. Sur mousse, leur QR des sujets IAP augmente ; les yeux fermés, leur QP augmente, ce qui objective une asynergie visuo-podale. La 4ème étude, sur la même population, a montré qu’un EME bilatéral augmente l’esophorie, uniquement de loin et chez les sujets IAP. La 5ème étude a révélé l’influence de l’extéroception plantaire sur la perception de la Verticale Visuelle Subjective (VVS) sur la même population. Elle a montré une diminution de l’erreur vers la gauche de près chez les sujets au QP normal avec un EME droit, ainsi qu’une diminution de l’erreur absolue de loin chez les sujets IAP avec un EMI bilatéral. L’ensemble de ces travaux consolide au plan théorique l’importance des afférences plantaires aussi bien pour le contrôle orthostatique, le contrôle de la vergence, la perception de la VVS et l’alignement des yeux (phories). Ils démontrent que l’utilisation de ces afférences est variable selon les sujets et ont des implications cliniques pluridisciplinaires. / This thesis aims at assessing the role of plantar cutaneous afferents in postural and oculomotor control by manipulating plantar exteroception with thin mechanical plantar stimulations. The 1st study showed that lateral, and even more medial mid-foot plantar inserts (LAS / MAS) improve stability in quiet stance and induce a backward shift of the CoP of young healthy subjects during eye movements. They also have a specific action upon vergence (not saccades): MAS increase the phasic amplitude of divergence and decrease its tonic part, in other words they mainly act on the pre-programmed component of the movement; whereas LAS act upon convergence, increasing its tonic amplitude, which is under the influence of visual retroaction. The inserts have a direct influence upon postural and oculomotor control through specific and independent paths. The 2nd study explained the variability of the subjects’ answers of the former. We measured their degree of reliance upon plantar cutaneous afferents with the Plantar Quotient method (PQ = Surface CoP foam / Surface CoP firm gorund X 100). A PQ<100 suggest a Plantar Extercoeptive Inefficency (PEI): PEI subjects do not show any improvement of their stability or any modification of vergence with the inserts. We propose that this situation is non-physiological and results from a non-noxious latent dysfunction of the sole receptors, opposing the PEI subjects to those who have a normal PQ. The 3rd study investigated the relationship between the use of plantar and visual afferents in young healthy subjects with the method of the PQ and Romberg Quotient (RQ). It has evidenced the existence of a synergic use of visual and plantar afferents in close-distance vision, only among normal PQ subjects. The PEI subjects have a significantly lower RQ than the others only at close distance on firm ground. On foam, their RQ increases; eyes closed, their PQ increases, which objectifies a visual-podal asynergy. The 4th study, on the same population, showed that a bilateral LAS increase esophoria only at far distance and among the PEI subjects. The 5th study revealed the influence of plantar exteroception upon the perception of verticality on the same population. It has brought out a decrease of the leftward error at near distance among the normal PQ subjects with a right LAS, and a decrease of the absolute error at far distance among the PEI subjects with a bilateral MAS. Taken together, these studies support, from a theoretical point of view, the importance of plantar afferents for postural control as well as vergence control, SVV estimation and eyes alignment (phorias). They demonstrate that the use of these afferents depends on the subjects and have multidisciplinary clinical implications.

The present work details the creation and analysis of a finite element model of the foot, wherein the plantar fascia was modeled as a viscohyperelastic solid. The objective of this work was to develop a fully functional CAD and Finite Element Model of the foot and plantar fascia for analysis by examining the transient stresses on the plantar fascia through the use of a viscohyperelastic material model. The model’s geometry was developed through the use of image processing techniques with anatomical images provided by the National Institutes of Health. The finite element method was used to analyze the transient response of the plantar fascia during loading. As a first step towards modeling the transient response of the mechanical behavior of the plantar fascia under dynamic loadings, standing conditions were used to analyze the relaxation of the plantar fascia over a time period of 120 seconds (which is the steady-state relaxation time of the plantar fascia). This study resulted in a fully functional model with transient stress data on the behavior of the plantar fascia during loading, along with stress and deformation data for the bones and soft tissue of the foot. The results obtained were similar to that recorded in literature. This model is the first step towards fully characterizing the mechanics of the plantar fascia so as to develop novel treatment methods for plantar fasciitis, and can be applied to future studies to develop novel orthotic devices and surgical techniques for the treatment of and prevention of plantar fasciitis.

Background Anticipatory and compensatory balance responses are used by the central nervous system (CNS) to preserve balance, hence they significantly contribute to the understanding of physiological mechanisms of postural control. It is well established that various sensory systems contribute to the regulation of balance. However, it is still unclear which role each individual sensory system (e.g. plantar mechanoreceptors) plays in balance regulation. This becomes also evident in various patient populations, for instance in diabetics with reduced plantar sensitivity. To investigate these sensory mechanisms, approaches like hypothermia to deliberately reduce plantar afferent input have been applied. But there are some limitations regarding hypothermic procedures in previous studies: Not only plantar aspects of the feet might be affected and maintaining the hypothermic effect during data collection. Therefore, the aim of the present study was to induce a permanent and controlled plantar hypothermia and to examine its effects on anticipatory and compensatory balance responses. We hypothesized deteriorations in anticipatory and compensatory balance responses as increased center of pressure excursions (COP) and electromyographic activity (EMG) in response to the hypothermic plantar procedure. 52 healthy and young subjects (23.6 ± 3.0 years) performed balance tests (unexpected perturbations). Subjects’ foot soles were exposed to three temperatures while standing upright: 25, 12 and 0 °C. COP and EMG were analyzed during two intervals of anticipatory and one interval of compensatory balance responses (intervals 0, 1 and 2, respectively). Results Similar plantar temperatures confirmed the successful implementation of the thermal platform. No significant COP and EMG differences were found for the anticipatory responses (intervals 0 and 1) under the hyperthermia procedure. Parameters in interval 2 showed generally decreased values in response to cooling. Conclusion No changes in anticipatory responses were found possibly due to sensory compensation processes of other intact afferents. Decreased compensatory responses may be interpreted as the additional balance threat, creating a more cautious behavior causing the CNS to generate a kind of over-compensatory behavior. Contrary to the expectations, there were different anticipatory and compensatory responses after reduced plantar inputs, thereby, revealing alterations in the organization of CNS inputs and outputs according to different task difficulties.