Tese de mestrado. Engenharia Biomédica. Faculdade de Engenharia. Universidade do Porto. 2012

Hallux valgus and hallux limitus are two common foot pathologies that may require surgical intervention. While the modified Austin bunionectomy and the Youngswick osteotomy/cheilectomy respectively, are often used to correct these conditions, insufficient research has been published regarding the effects of these procedures on plantar pressure distribution of the foot. This thesis involves a series of six studies investigating topics relating to radiographic measurements and plantar pressure distribution over a two-year period, in normal feet and in hallux valgus and hallux limitus feet before and after corrective surgery.A review of the literature is presented relating to the development of plantar pressure measurement technology, the aetiology and surgical management of hallux valgus and hallux limitus, the reliability of the EMED system used in the studies, and the related clinical uses of plantar pressure measurement.An initial study was designed to investigate the reliability measurements using a simplified two-step method of data collection as compared to the traditional mid-gait technique of ten normal asymptomatic subjects. Intra-class correlation coefficients were calculated and compared for the pressure variables of contact area, contact time, maximum force and peak pressure of ten regions of the foot.A study to determine normal reference range values for the EMED-SF system was then conducted using thirty healthy subjects and the two-step method of data collection. Descriptive statistical reporting of peak pressure, mean pressure and pressure-time- integrals were presented for ten regions of the foot.Three related studies on radiographic and plantar pressure measurement differences, and their relationships were made using thirty normal, hallux valgus and hallux limitus feet. Various angular and linear radiographic measurements were tested for intra-rater ++ / reliability of measurement and pressure variables of peak pressure, mean pressure and pressure-time-integral of 10 regions of the foot were recorded and one way analysis of variance employed to assess any significant differences.Finally, two independent two-year prospective studies were designed to investigate the effects of the modified Austin bunionectomy for hallux valgus and the Youngswick osteotomy/cheilectomy for hallux limitus on plantar pressure distribution of the forefoot. In addition, fundamental radiographic measurement changes of the forefoot of hallux valgus subjects and range of motion changes of the first metatarsophalangeal joint of hallux limitus subjects were conducted. Thirty-six healthy volunteers acted as control subjects, 31 subjects (44 feet) with hallux valgus and 17 subjects (23 feet) with hallux limitus were included in the study. Using an EMED-SF system, plantar pressure variables of peak pressure, pressure-time-integral, contact time, maximum force and force-time-integral were recorded at six regions of the forefoot, pre-operation and repeated at three, six, 12, 18 and 24-months post-operation for surgical subjects. Control subjects were tested at zero and 24-months. Descriptive statistics, multivariate and univariate analysis of variance with contrasts, t-tests of significance and correlations between certain measurement parameters were used in the analysis of the results.The findings of these studies suggest that the two-step method of data collection of plantar pressure measurements is more reliable that the traditional mid-gait technique for most pressure variables. Consequently, the two-step method was employed as the preferred method of data collection in this series of studies.With respect to radiographic differences between normal, hallux valgus and hallux limitus, it appears that hallux valgus feet have significant increases in ++ / metatarsus primus varus and first metatarsal protrusion distance, while hallux limitus feet have increased hallux abductus interphalangeal angles. Comparison of pressure variables between each group demonstrate hallux valgus feet have a medial localisation of peak pressure beneath the first, second and third metatarsal heads, suggesting that hyperpronation of the foot is associated with the development of hallux valgus. Hallux limitus feet on the other hand, show increased pressure beneath the hallux, third and fourth metatarsals and lesser toes, indicating a more lateral locus of pressure loading, suggestive -of the foot functioning in a more supinated position. No significant relationship was found between any radiographic parameter and pressure variable tested in either group of subjects.Plantar pressure measurement changes show the greatest variation during the initial three to six months following surgical treatment of hallux valgus and hallux limitus. The Youngswick osteotomy/cheilectomy for the treatment of hallux limitus produces near-normal range of motion of the first metatarsophalangeal joint. Pressures of the first metatarsal head remain relatively constant over the period of measurement, while a significant reduction of the hallux and lateral metatarsals were noted, related to increased dorsiflexion of the hallux. Pressures of the second metatarsal head remained significantly above pre-operation levels. The modified Austin bunionectomy for the treatment of hallux valgus produced 24-month radiographic changes consistent with accepted values. Pressure variables of the hallux reduced to normal values, with the first metatarsal head demonstrating an initial significant decrease and subsequent increase by twelve months post-operation to remain with the second metatarsal head at relatively similar values to pre-operation measurements.The research demonstrates ++ / the two-step method of data collection is a viable means of obtaining reliable plantar pressure measurement data in the clinical situation. The investigations into radiographic and plantar pressure distribution indicate that structural radiographic and functional differences exist between normal, hallux valgus and hallux limitus feet. However, no relationship could be found between any of the radiographic parameters and pressure variables tested.The modified Austin bunionectomy for hallux valgus significantly reduced fundamental radiographic measurements to accepted post-operative values, while the Youngswick procedure for hallux limitus significantly increased the amount of post-operative dorsiflexion of the hallux to normal values. The research demonstrates that immediate and longer-term functional changes to the forefoot occur following the surgical treatment of hallux valgus and hallux limitus, however plantar pressure measurements do not return to normal values. No correlation was found between plantar pressure measurements and post- operative radiographic measurements in the hallux valgus group. However, the increased amount of dorsiflexion of the hallux post-operatively in the hallux limitus group was correlated with reduced lateral loading of the forefoot. Post-operation changes of plantar pressure distribution indicate that the rehabilitative period required to achieve stable foot function is between twelve to eighteen months. Furthermore, plantar pressure measurement technology offers the clinician a useful tool to monitor foot function prior to and following therapeutic intervention.

The aim of this thesis is to evaluate the short and long term effectiveness of foot orthoses in the treatment of plantar fasciitis.Three studies were undertaken, the first two informing the third. The aim of the first study was to establish prescription habits of Australian and New Zealand podiatrists in order to ascertain the most commonly prescribed foot orthoses. The second study was conducted to establish the most appropriate outcome measure to assess the effectiveness of foot orthoses in the treatment of plantar faciitis. The main study, a pragmatic single-blind randomised control trial, was conducted to evaluate the effectiveness of three types of foot orthoses in the treatment of plantar fasciitis. The research concluded that provision of appropriate foot orthoses produces small short-term benefits in function for people with plantar fasciitis, but no effect is apparent at twelve months. / Doctor of Philosophy (PhD)

Categories and frequencies of leisureactivities employed by 156 randomly selected males and females aged 40-44, 50-54, 60-64 were investigated by structured interviews and were related to leisuresatisfaction, to experienced health and socio-economic status. In equal numbers (15) of males and females from each group and in 24 males (60 +_6 years) with intermittent claudication (Cl) isokinetic plantar flexion performance was investigated with registrations of peak torque (PT), contractional work (CW), active range-of-motion (RoM) and integrated electromyograms from all threee triceps surae heads. Subjects performed a few maximum plantarflexions at different velocities of angular motion and also up to 200 consecutive plantar flexions at 60 °/s. The males aged 40-44 were re -investigated after two years additionally using electromyographic power frequency analyses. Leisure choice was mainly age and sex independent and extensively included outdoor activities. Leisure satisfaction was positively associated with relative frequency of activities. Symptoms of bodily discomfort, in particular backpain, were quite common and apparently caused relatively low level of mutual leisure activities. Thus, with in this age span, leisure activities appear rather rigid but often successfully, adhered to . Common ailments influence partnership mutuality negatively. Plantar flexion PT and CW are adequately p re dicta ble by sex, age and crural circumference. Uniformly a 3:2 male/female ratio characterizes mechanical output and iEMG. The latter is velocity independent. Output decreases with increasing age. Hence the output/excitation balance (CW/iEMG) is age, but not sex, dependent. CI-patients produce less PT and CW than do controls. Independently of this disease, of age and sex, PT and CW describe parallel negative exponential functions of velocity. During repeated manoeuvres plantar flexion output and iEMG initially drop, there after to maintain nearly steady-state levels. Throughout up to 200 contractions CW/iEMG was unaltered in the clinically healthy. Test/re-test with two years interval yielded nearly identical results. Leftshifts in mean power frequency in parallel with output-drop imply that the latter probably is due to FT-motor unit fatigue. For CW, but not for PT, the drop became slower and the (relative) steady-state level higher with increasing age, indicating significant increase in endurance with age. In the Cl-patients, output, but not excitation, decreased after a few repititions. Therefore, CW/iEMG fell dramatically, implying intramuscular fatigue. Taken together with findings of close associations between total cumulated work and measured/expected maximum walking tole rance it is suggested that measurements of CW and calculations of CW/iEMG are of clinical value. / <p>Härtill 5 uppsatser</p> / digitaliserinlg@umu.se

Esta Tesis Doctoral tiene como finalidad principal estudiar la fórmula metatarsal, de la huella plantar; en el podoscopio, de la pedigrafía, del fotopodograma, la baropodometría y aquellas que se derivan del análisis radiológico dorso plantar en posición bipodal y, finalmente la determinación del ángulo de rodación transmetatarsal.La presente memoria doctoral se ha centrado en el estudio de los métodos de registro podográfico con el fin de comparar distintos procedimientos. La importancia clínica de este estudio descansa en el hecho de que una buena práctica diagnostica en las primeras etapas de la vida, redundará muy posiblemente en una reducción de problemas clínicos de índole traumatológica en las etapas avanzadas de la vida. En poblaciones como la europea, en que la edad media de la población aumenta de forma continua, la prevención de las lesiones crónicas de cadera, rodilla dígito-metatarsales etc. constituirán posiblemente una de las zonas de acción más importantes de la medicina preventiva. Esta idea viene además reforzada por los criterios de coste económico; particularmente si se tiene en cuenta el valor de las prótesis, y el costo de las hospitalizaciones y la práctica quirúrgica necesarias para asegurar la calidad de vida en una proporción considerable de las personas de edad en las sociedades avanzadas. La hipótesis que se plantea en este trabajo de investigación consiste en la idea de que la secuencia y empuje de apoyo metatarsal influyen en factores estructurales y funcionales que hacen más complejo el desarrollo del tipo de marcha a nivel individual. Se pueden definir prácticamente tantas representaciones de secuencias en la rodación como individuos se estudien. La fórmula metatarsal y su interrelación con la pelvis y el raquis forma parte de la base de conocimiento de cara a establecer categorías con interés biomecánico y ergonómico. Fórmula metatarsal: Denominamos fórmula metatarsal a un criterio (en realidad no es una fórmula) que nos permite, como hemos indicado anteriormente clasificar todos los pies en tres categorías en función de la longitud del primero y segundo metatarsianoIndex Minus: el primer metatarsiano es más corto que el segundo. En tercero, cuarto y quinto de longitud decrecienteIndex Plus Minus: el primer metatarsiano y el segundo son iguales. El tercero, cuarto y quinto de longitud decreciente.Index Plus: el primer metatarsiano es más largo que el segundo. El tercero, cuarto y quinto de longitud decreciente.El estudio de la huella plantar ha evolucionado a lo largo de la historia, buscando siempre el establecimiento de parámetros de normalidad mediante el estudio y la somatometría de la impronta plantar. Nosotros hemos incluido en este estudio el ángulo de rodación determinado a través del triángulo de apoyo plantar metatarso-digital. Este ángulo nos informa y ayuda a predecir los eventuales trastornos futuros de la marcha, así como al diagnostico de alteraciones actuales. Tipómetro gravitatorio y rotacional:Para ello se ha diseñado un dispositivo mediante un goniómetro gravitatorio y una brújula, este tipómetro se ha construido para este trabajo, para las mediciones de las rotaciones,torsiones,inclinaciones y angulaciones. Mediante este instrumento de diseño original de diseño propio, se midieron los valores de las rotaciones verticales,las horizontales e inclinaciones. Con este trabajo de investigación se ha pretendido confirmar cómo varía, de un individuo a otro, las distribuciones de las presiones plantares cuando el pie esta en el máximo apoyo plantar y en el máximo apoyo metatarsal, y cómo se distribuyen estas presiones plantares, puesto que pueden condicionar la dinámica de la marcha toda vez que al utilizar diferentes técnicas de medición en una misma persona estos factores suelen variar.

O presente estudo objetivou analisar a relação do índice do arco plantar com o equilíbrio postural e com a frequência do uso do salto alto entre mulheres de diferentes faixas etárias. Participaram do estudo 60 mulheres, 20 no grupo jovem (GJ), 20 no grupo adulto (GA) e 20 do grupo idoso (GI), as quais foram separadas em subgrupos com 10 indivíduos cada de acordo com a frequência do uso do salto alto. A avaliação da frequência do uso do sapato de salto alto foi realizada através do número de vezes que o indivíduo utilizava esse tipo de calçado. Para o cálculo do índice do arco plantar (IAP) utilizou-se o método de impressão plantar, por meio de um pedígrafo. Para a aquisição dos dados referentes ao equilíbrio postural foi utilizada uma plataforma de força AMTI; as variáveis utilizadas a partir do Centro de Pressão (COP) foram: amplitude de deslocamento ântero-posterior do centro de pressão (COPap), amplitude de deslocamento médio-lateral do COP (COPml), velocidade média de deslocamento do COP (COPvel) e área da elipse (elipse). Os resultados apontam que não houve correlações entre as variáveis do COP (COPap, COPml, velocidade e elipse) e o IAP na condição de olhos abertos e olhos fechados. Ao se tratar da faixa etária, houve diferença estatisticamente significativa entre o índice do arco plantar do GJ e GI e do GA e GI, indicando que o grupo de mulheres idosas possui um maior índice do arco plantar, ou seja, um rebaixamento no arco longitudinal medial. Com relação à frequência do uso do salto alto, não houve diferença estatisticamente significativa do índice do arco plantar entre os grupos. Concluiu-se que o índice do arco plantar não altera o controle postural em mulheres jovens, adultas e idosas deste estudo e que o grupo idoso apresenta um rebaixamento do arco longitudinal medial quando comparado com o grupo jovem e adulto. / The present study aimed to analyze the relationship between plantar arch index and postural balance and the frequency of use of high-heeled shoes among women of different age groups. The study included 60 women, 20 in the young group (GJ), 20 in the adult group (GA) and 20 in the elderly group (GI), which were separated into groups with 10 individuals each according to frequency of use of high-heeled shoes. The evaluation of the frequency of use of the high heel shoe was performed using the number of times that the person use this kind of footwear. To obtain the plantar arch index (IAP) was used the method of printing plant, with a plantar foot pressure. For acquisition of postural balance data was used a AMTI force plate and variables from the center of pressure (COP) used were: range of anteroposterior displacement of the center of pressure (COPap), range of displacement of the medial-lateral COP (COPml) and average speed of displacement of the COP (COPvel). The results showed that there were no correlations between the variables of COP (COPap, COPml, speed and ellipse) and IAP on eyes opened and eyes closed conditions. When dealing with the age group, there were statistically significant differences between the plantar arch index of the GJ and GI and of the GA and GI, indicating that the group of older women have an increased plantar arch index or a presents lower medial longitudinal arch. It was concluded that the plantar arch index does not alter postural control in young, adult and elderly people and that the elderly group presents lower medial longitudinal arch when compared with the young adult group showing.

O presente estudo objetivou analisar a relação do índice do arco plantar com o equilíbrio postural e com a frequência do uso do salto alto entre mulheres de diferentes faixas etárias. Participaram do estudo 60 mulheres, 20 no grupo jovem (GJ), 20 no grupo adulto (GA) e 20 do grupo idoso (GI), as quais foram separadas em subgrupos com 10 indivíduos cada de acordo com a frequência do uso do salto alto. A avaliação da frequência do uso do sapato de salto alto foi realizada através do número de vezes que o indivíduo utilizava esse tipo de calçado. Para o cálculo do índice do arco plantar (IAP) utilizou-se o método de impressão plantar, por meio de um pedígrafo. Para a aquisição dos dados referentes ao equilíbrio postural foi utilizada uma plataforma de força AMTI; as variáveis utilizadas a partir do Centro de Pressão (COP) foram: amplitude de deslocamento ântero-posterior do centro de pressão (COPap), amplitude de deslocamento médio-lateral do COP (COPml), velocidade média de deslocamento do COP (COPvel) e área da elipse (elipse). Os resultados apontam que não houve correlações entre as variáveis do COP (COPap, COPml, velocidade e elipse) e o IAP na condição de olhos abertos e olhos fechados. Ao se tratar da faixa etária, houve diferença estatisticamente significativa entre o índice do arco plantar do GJ e GI e do GA e GI, indicando que o grupo de mulheres idosas possui um maior índice do arco plantar, ou seja, um rebaixamento no arco longitudinal medial. Com relação à frequência do uso do salto alto, não houve diferença estatisticamente significativa do índice do arco plantar entre os grupos. Concluiu-se que o índice do arco plantar não altera o controle postural em mulheres jovens, adultas e idosas deste estudo e que o grupo idoso apresenta um rebaixamento do arco longitudinal medial quando comparado com o grupo jovem e adulto. / The present study aimed to analyze the relationship between plantar arch index and postural balance and the frequency of use of high-heeled shoes among women of different age groups. The study included 60 women, 20 in the young group (GJ), 20 in the adult group (GA) and 20 in the elderly group (GI), which were separated into groups with 10 individuals each according to frequency of use of high-heeled shoes. The evaluation of the frequency of use of the high heel shoe was performed using the number of times that the person use this kind of footwear. To obtain the plantar arch index (IAP) was used the method of printing plant, with a plantar foot pressure. For acquisition of postural balance data was used a AMTI force plate and variables from the center of pressure (COP) used were: range of anteroposterior displacement of the center of pressure (COPap), range of displacement of the medial-lateral COP (COPml) and average speed of displacement of the COP (COPvel). The results showed that there were no correlations between the variables of COP (COPap, COPml, speed and ellipse) and IAP on eyes opened and eyes closed conditions. When dealing with the age group, there were statistically significant differences between the plantar arch index of the GJ and GI and of the GA and GI, indicating that the group of older women have an increased plantar arch index or a presents lower medial longitudinal arch. It was concluded that the plantar arch index does not alter postural control in young, adult and elderly people and that the elderly group presents lower medial longitudinal arch when compared with the young adult group showing.

Dissertação (mestrado)—Universidade de Brasília, Faculdade Gama, Programa de Pós-Graduação em Engenharia Biomédica, 2017. / Submitted by Fernanda Percia França (fernandafranca@bce.unb.br) on 2017-03-03T19:01:42Z No. of bitstreams: 1 2017_GustavoAdolfoMarcelinodeAlmeidaNunes.pdf: 2967055 bytes, checksum: 8323f546fde9265c097b08fe9f675568 (MD5) / Approved for entry into archive by Ruthléa Nascimento(ruthleanascimento@bce.unb.br) on 2017-03-08T21:11:09Z (GMT) No. of bitstreams: 1 2017_GustavoAdolfoMarcelinodeAlmeidaNunes.pdf: 2967055 bytes, checksum: 8323f546fde9265c097b08fe9f675568 (MD5) / Made available in DSpace on 2017-03-08T21:11:09Z (GMT). No. of bitstreams: 1 2017_GustavoAdolfoMarcelinodeAlmeidaNunes.pdf: 2967055 bytes, checksum: 8323f546fde9265c097b08fe9f675568 (MD5) / A neuropatia diabética periférica é considerada um problema de saúde pública. Uma das consequências mais importantes desse distúrbio se manifesta, principalmente, devido à associação de danos neurais aos danos vasculares, ocorridos nos membros inferiores, onde os pés são os mais afetados pelos efeitos das distribuições anormais de pressão. O presente estudo visa demonstrar a validade da utilização de palmilhas personalizadas, confeccionadas com látex natural, como uma ferramenta importante na redução da pressão plantar, no tratamento de pacientes com pé diabético, através da caracterização mecânica, química, microscópica e macroscópica das palmilhas confeccionadas. Através desse estudo pretende-se obter uma evolução contínua no processo de confecção das palmilhas, otimizando, assim, a distribuição da pressão plantar em pacientes diabéticos. Os resultados adquiridos serão comparados com dados obtidos por outros autores, com o intuito de discutir as técnicas aplicadas, considerando a grande diversidade de equipamentos e metodologias utilizadas na literatura. A proposta é estabelecer um padrão de confecção das palmilhas, que será formalizada, considerando as características das técnicas e do material utilizado, de modo a definir os benefícios do modelo proposto na prevenção e tratamento do pé diabético. / The diabetic peripheral neuropathy is considered a public health problem, due to the association of neural damage to vascular damage in the lower limbs, in which the feet are susceptible to abnormal weight discharge. This study aims to demonstrate the validity of the use of custom made natural latex insoles as an important tool in reducing plantar pressure in the treatment of patients with diabetic foot, through mechanical, chemical, microscopic and macroscopic characterization of the insoles. A continuous evolution in the manufacture of custom-made insoles process is intended so that the reduction of plantar pressure in diabetic patients is optimized. The results will be compared with data obtained by other authors, in order to discuss the techniques applied, considering the wide variety of equipment and methods used in the literature. The proposal to establish a manufacturing protocol of insoles will be formalized, considering the characteristics of the techniques and materials used in order to define the benefits of the model in the prevention and treatment of diabetic foot.

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Educação Física, Programa de Pós-Graduação Stricto-Sensu em Educação Física, 2015. / Submitted by Fernanda Percia França (fernandafranca@bce.unb.br) on 2016-03-17T19:20:38Z No. of bitstreams: 1 2015_PaulaRibeiroMesquita.pdf: 1579664 bytes, checksum: b29bd26fdf5e8763e3a5205a558172f9 (MD5) / Approved for entry into archive by Guimaraes Jacqueline(jacqueline.guimaraes@bce.unb.br) on 2016-04-02T12:46:31Z (GMT) No. of bitstreams: 1 2015_PaulaRibeiroMesquita.pdf: 1579664 bytes, checksum: b29bd26fdf5e8763e3a5205a558172f9 (MD5) / Made available in DSpace on 2016-04-02T12:46:31Z (GMT). No. of bitstreams: 1 2015_PaulaRibeiroMesquita.pdf: 1579664 bytes, checksum: b29bd26fdf5e8763e3a5205a558172f9 (MD5) / A distribuição da pressão plantar tem sido descrita como uma indicadora das cargas impostas ao sistema musculoesquelético durante as atividades dinâmicas e pode fornecer informações a respeito do funcionamento do pé durante o deslocamento. Objetivo: Descrever e comparar a distribuição da pressão plantar durante o andar e o correr em crianças eutróficas de 4 a 10 anos. Métodos: Foram coletados os dados da pressão plantar de 103 crianças eutróficas entre 4 e 10 anos de idade, utilizando a plataforma Emed n-50® (Novel, Alemanha) durante o andar e o correr em velocidade auto selecionada. O tempo de contato relativo, o pico de pressão e a força máxima e a área de contato absolutas e relativas foram analisados em 5 regiões (calcanhar, mediopé, antepé, hálux e dedos), além da área total do pé. Resultados: As variáveis morfológicas peso, estatura, índice de massa corpórea (IMC) e comprimento do pé apresentaram aumentos graduais e contínuos, enquanto o índice do arco plantar (IAP) sofreu decréscimos com o aumento da idade. As cargas plantares e a área de contato do pé foram maiores durante o correr em relação ao andar, entretanto, foram observados alguns aumentos das variáveis para o andar na região do calcanhar. As diferenças entre o andar e o correr puderam ser observadas tanto para variáveis absolutas quanto para aquelas com valor normalizado. Na análise da correlação entre a pressão plantar e a idade, foi encontrada influência da idade sobre a pressão plantar, com tendência a aumento das variáveis nas regiões do calcanhar, antepé, hálux e dedos, e reduções na área do mediopé. As variáveis morfológicas também apresentam correlações significativas com a distribuição da pressão plantar, principalmente com as variáveis absolutas força máxima e área de contato. A força máxima relativa apresentou correlações negativas com a idade, o peso e a estatura e as correlações significativas com o índice do arco plantar foram encontradas principalmente para a área de contato relativa em todas as regiões do pé e para as demais variáveis na região do mediopé. Conclusão: Os resultados indicam que os valores das variáveis de pressão plantar são mais altos para o correr em relação ao andar em crianças de 4 a 10 anos. Maiores cargas plantares podem estar associadas aos aumentos no peso corporal e estatura dos participantes e as tendências de valores crescentes das variáveis plantares no calcanhar, antepé, hálux e dedos, e decrescentes no mediopé, estão possivelmente associadas ao processo de maturação das crianças. Essas relações entre a pressão plantar e o processo maturacional ocorrido com o aumento da idade são corroboradas pelas correlações significativas encontradas entre a pressão plantar, a idade e as variáveis morfológicas. Os dados podem ser utilizados como referência para comparação com estudos que avaliem o andar e o correr de crianças e adultos. ______________________________________________________________________________________________ ABSTRACT / Plantar pressure distribution has been described as an indicator of the load patterns imposed on the musculoskeletal system during dynamic activities and can provide information regarding foot function during motion. Objective: Describe and compare plantar pressure distribution during walking and running in eutrophic children aged 4 to 10 years old. Methods: Plantar pressure distribution data from 103 eutrophic children aged 4 to 10 years old were acquired using the Emed n-50 ® (Novel, Germany) platform during walking and running on self-selected speed. The relative contact time, peak pressure and absolute and relative values of maximum force and contact area were analyzed under 5 foot regions (hindfoot, midfoot, forefoot hallux and toes) and the total area of the foot. Results: Body weight and height, body mass index (BMI) and foot length showed gradual and continuous increases while arch index (AI) was reduced with increasing age. Plantar loads and contact area were higher during running in comparison to walking, however, increases were also observed under the hindfoot during walking. Differences between walking and running could be observed both for absolute and normalized variables. In the analysis of correlation between plantar pressure and age, it was found that age influenced plantar pressure, tending to increase variables values under the heel, forefoot, hallux and toes, and reduce them under the midfoot area. Morphological variables also showed significant correlations with plantar pressure distribution, especially with absolute maximum force and contact area. Relative maximum force showed negative correlations with age, body weight and height. Significant correlations with the plantar arch index were mainly found with relative contact area under all regions of the foot and under the midfoot region with the other plantar pressure variables. Conclusion: Results indicate that running has higher values of plantar pressure variables than walking in children aged 4 to 10 years. Increases in plantar loads may be associated with increasing body weight and height and trends of variables increasing variable values under the hindfoot, forefoot, hallux and toes, and decrease under the midfoot, are possibly associated with the maturation process of children. These associations between plantar pressure and the maturation process that occurs with increasing age are supported by the significant correlations that were found between plantar pressure, age and morphological variables. Data may be used as reference for comparison with studies evaluating walking and running in children and adults.

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Educação Física, Programa de Pós-Graduação Stricto-Sensu em Educação Física, 2014. / Submitted by Albânia Cézar de Melo (albania@bce.unb.br) on 2014-10-14T15:23:19Z No. of bitstreams: 1 2014_AndreaGomesMoraes.pdf: 4828849 bytes, checksum: 3aee48a07d247eab70c308962ec10f94 (MD5) / Approved for entry into archive by Tania Milca Carvalho Malheiros(tania@bce.unb.br) on 2014-10-15T13:24:21Z (GMT) No. of bitstreams: 1 2014_AndreaGomesMoraes.pdf: 4828849 bytes, checksum: 3aee48a07d247eab70c308962ec10f94 (MD5) / Made available in DSpace on 2014-10-15T13:24:21Z (GMT). No. of bitstreams: 1 2014_AndreaGomesMoraes.pdf: 4828849 bytes, checksum: 3aee48a07d247eab70c308962ec10f94 (MD5) / Paralisia Cerebral (PC) é uma desordem de tônus, movimento e postura devido à lesão ao cérebro imaturo. É comum a realização de tratamentos, como equoterapia, para minimizar esses acometimentos. Objetivos: Verificar se a equoterapia promove alterações no equilíbrio postural, no desempenho funcional e na distribuição de pressão plantar durante a marcha após12 e 24 sessões. Métodos: Pesquisa pré-experimental com 14 sujeitos com PC de 5 a 10 anos de idade classificados pelo GMFCS. Para a coleta de dados foram utilizados a plataforma de DPP emed/Novel, plataforma de força AMTI, Escala de Equilíbrio de Berg (EEB) e PEDI. Os testes foram realizados antes das intervenções e após 12 e 24 sessões, exceto para EEB e PEDI que foram aplicados antes e após 24 sessões. O atendimento seguiu protocolo e ocorreu duas vezes por semana com duração de 30 minutos. A DPP foi analisada por meio de estudos de casos. Para as demais variáveis foi realizado teste ANOVA ou Friedman, post hoc Bonferroni, teste t ou Wilcoxon, de acordo com o teste de normalidade dos dados. Resultados: Após a prática de equoterapia verificou-se melhorias no tempo de contato e área de contato para a DPP. Foram encontradas diferenças estatisticamente significativas para os escores da EEB e PEDI e para todas as variáveis do COP, exceto COPap para a posição sentada e na postura ereta quieta apenas para COPml. Conclusão: A equoterapia parece proporcionar benefícios aos sujeitos com PC nos aspectos analisados, sendo que 24 sessões apresentam melhores efeitos que 12 sessões no equilíbrio postural e DPP. __________________________________________________________________________ ABSTRACT / Cerebral Palsy (CP) is a disorder of tone, movement and posture caused by damage to the immature brain. Certain treatments, such as hippotherapy, are common to minimize these affections. Objectives: Verify if hippotherapy promotes changes in the postural balance, in the functional performance and in the plantar pressure distribution during gait, after 12 and 24 sessions. Methods: Pre-experimental study on 14 subjects with CP aged 5 to 10 years, classified by the GMFCS. For data collection, the DPP emed/Novel platform, the AMTI force platform, the Berg Balance Scale (BBS) and the PEDI were used. The tests were conducted before the interventions and after 12 and 24 sessions, except for BBS and PEDI, which were applied before and after 24 sessions. The treatment followed protocol and took place twice a week with duration of 30 minutes. The DPP was analyzed by means of case studies. For the other variables, an ANOVA or Friedman test, post hoc Bonferroni, t-test or Wilcoxon was performed, in accordance with the data normality test. Results: Statistically significant differences in the BBS and PEDI scores were found, as well as for all variables of COP in the seated position, except for COPap. In the standing posture only COPml decreased after 24 sessions.There was improvement in the contact time and contact area for the DPP. Conclusion: Hippotherapy appears to provide benefits to the subjects with CP in the aspects analyzed, with 24 sessions having shown better effects on postural balance and DPP than 12 sessions.