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www.footscan.com footscan ® Course 2006 Welcome
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www.footscan.com footscan ® Course 2006 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of RSscan International, info@rsscan.com
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www.footscan.com Goals Optimal measuring Understand and use all features of the footscan ® 7 gait software Get more information out of footscan ®
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www.footscan.com Overview of the day Part 1: - What do we measure? - Anatomy of the foot - Procedures and analyzing static measurements - Procedures dynamic measurements Tea-break Part 2:- Biomechanics of gait - Analyzing dynamic measurements (1) Lunch Part 3: - Analyzing dynamic measurements (2)
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www.footscan.com “What is it about?” footscan ® = a dynamic plantar pressure measuring system with a high frequency Volunteers?
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www.footscan.com “What do we measure?” footscan ® measures local pressure during the total contact time of the foot with a high frequency Locally: Because footscan ® consist of a lot of small sensors with a density of almost three sensors per square centimetre
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www.footscan.com “What do we measure?” Highest pressure Lowest pressure
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www.footscan.com “What do we measure?” “pressure”: footscan ® consist out of small sensors which we call pressure sensors Pressure is not the same as force! Pressure is Force (N) divided by a certain surface (cm 2 ). Pressure = N / cm 2
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www.footscan.com “What do we measure?” Force Pressure
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www.footscan.com “What do we measure?” 100 N 1 cm²4 cm² Pressure 100 N / cm ² 25 N / cm ²
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www.footscan.com “What do we measure?” “Total contact time off the foot”: = STANCE PHASESWING PHASE
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www.footscan.com “with a high frequency”: 150 Hz – 300 Hz – 500 Hz “What do we measure?”
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www.footscan.com Conclusion Local pressure or total force During the complete stance phase With a high frequency Off the foot Complex structure
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www.footscan.com Basics of the anatomical terminology Building blocks of the body: Bones Ligaments Muscles Coupling the bones and directing joint movement Move bones or stabilize them by using the ligaments Building blocks of the body
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www.footscan.com Basics of the anatomical terminology Bones: femur patella fibula tibia femur Tibia en fibula
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www.footscan.com Calcaneus Talus Cuboid Navicular Cuneiforms Metatarsals 1 - 5 2 3 4 5 1 Hallux Toes 2 – 4 (phalanges) Basics of the anatomical terminology Sideway view of the left foot medial lateral
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www.footscan.com Basics of the anatomical terminology Calcaneus Talus Cuboid Navicular Cuneiforms Metatarsals 1 - 5 Hallux Toes 2 - 4 Top view of the foot Medial Lateral
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www.footscan.com Basics of the anatomical terminology Joints: Ankle joint Subtalar joint Transversal tarsal joint = Chopart’s line Tarsometatarsal joint = Lisfranc’s line MeTatarso- Phanlangeal joints (MTP)
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www.footscan.com Basics of the anatomical terminology Medial Lateral Rearfoot Midfoot Forefoot HL HM T1 M1 M5 M4 M3 M2 Most common terms in the footscan® software: T2 – T5 MF
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www.footscan.com Basics of the anatomical terminology Used zone in the footscan® software: HLHM T1 M1 M5 M4 M3 M2 T2 – T5 MF
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www.footscan.com Basics of the anatomical terminology Ligaments: Knee and ankle joint: medial and lateral ligaments for stability
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www.footscan.com Basics of the anatomical terminology Ligaments: Plantar aponeuroses From calcaneus till the base of the toes
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www.footscan.com Basics of the anatomical terminology Muscles: Initiate motion Limit extreme motions
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www.footscan.com Basics of the anatomical terminology Movements of the right foot: Plantar flexion Dorsal flexion Pronation: Eversion Abduction Dorsal flexion Supination: Inversion Adduction Plantar flexion Valgus position Varus position
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www.footscan.com Basics of the anatomical terminology 4 Muscle groups:
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www.footscan.com Analysis of a dynamic measurement J. Deckers & D. Beckers, Bohn Stafleu Van Loghum Pronators Supinators Dorsal flexors Plantar flexors Decelerate foot Prepare push off Stabilisation calcaneus Heellift Push off
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www.footscan.com Basics of the anatomical terminology
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www.footscan.com m. extensor digitorum longus Basics of the anatomical terminology
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www.footscan.com m. peroneus longus and brevis Basics of the anatomical terminology
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www.footscan.com Joints/Bones and their possible movements: Hip: flexion & extension Femur: interne & extension rotation Basics of the anatomical terminology
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www.footscan.com Joints/Bones and their possible movements: Knee: flexion & extension Tibia: interne & external rotation Basics of the anatomical terminology
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www.footscan.com Joints/Bones and their possible movements: Ankle: only plantar & dorsal flexion Subtalar Joint: pronation & supination Basics of the anatomical terminology
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www.footscan.com Joints/Bones and their possible movements: Line of Chopart: pronation & supination Line of Lisfranc: pronation & supination Metatarsophalangal: plantar & dorsal flexion Basics of the anatomical terminology
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www.footscan.com Static measurement With this information in the back of our heads we can continue with the first part of the measurements: The static measurements
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www.footscan.com Static measurement 1)Control preferences 2)Recalibrate (1 x per 3 months) 3) Add a patient to the database
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www.footscan.com Static measurement Procedures: Patient has to stand barefooted on the platform for a number of seconds Hands hanging next to the body Looking straight ahead
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www.footscan.com Static measurement Static measurement = momentary recording Gives: - Static maximal pressures -Deviation of the body weight (in stance!)
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www.footscan.com Static measurement Normal left-right dividing 50% - 50% Possible causes for differences: - proprioceptical problems - structural problems, like a leg length difference - alignment problems with orthotics – prosthetics Also look for large front-backwards differences -possible static problems Or look for diagonal differences -possible pelvic rotation
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www.footscan.com Static measurement Remark: footscan can only show that there is a difference. Possible causes must be further verified.
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www.footscan.com Static vs Dynamic measurement Procedure: Necessary space: 6 to 10 m total walkway length for walking 12 to 20 m total walkway length for running
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www.footscan.com Dynamic measurement Measuring procedure for a 0.5 m plate When the foot does not land in the centre of the platform, start from the green or yellow line
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www.footscan.com Dynamic measurement Is this a good measurement? Control: Contact time: Slight difference between left - right Normal walking measurement: +/- 800 ms
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www.footscan.com Dynamic measurement Further control: Are the footscan zones and foot axis correct? The zone of T1 is too large This will lead to false conclusions Also does the foot axis not start at the middle of the heel.
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www.footscan.com Dynamic measurement Correct zones: See the footscan software manual for a detailed explanation
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www.footscan.com Dynamic measurement Control ok? Save measurement Repeat this procedure several times and then use the best measurement for your analysis.
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www.footscan.com pause
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www.footscan.com Analyze dynamic measurement What do we see? Unroll left and right foot Here we can use the - button so we can look frame per frame Maximal pressure for the left and right foot
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www.footscan.com Analyze dynamic measurement Visualizations: Roll off 3DSynchroImpulse 2D
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www.footscan.com Analyze dynamic measurement Impulse: 0,2 s 6 Ns/cm 2 18 Ns/cm 2 0,6 s
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www.footscan.com Analyze dynamic measurement
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www.footscan.com At each frame we see: Center of pressure Analyze dynamic measurement
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www.footscan.com Analyze dynamic measurement At each frame we see: actual direction of the talus max adduction position max abduction position
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www.footscan.com Analyze dynamic measurement How does a measurement go? First we repeat the necessary biomechanics.
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www.footscan.com Biomechanics Coupled movements (1): Rotation femur = rotation tibia A stretched knee has no rotation possibility
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www.footscan.com Biomechanics Coupled movements (2): Internal tibia rotation eversion calcaneus pronation subt. joint External tibia rotation inversion calcaneus supination subt. joint Because the ankle joint can only plantar and dorsal flex.
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www.footscan.com Biomechanics Coupled movements (3): Pronation of the subtalar joint = detaching the tarsals through Chopart’s line by this detaching the tarsals do not have to follow the rearfoot pronation and enables a correct positioning of the forefoot, so that the longitudinal arch can absorb the shock Supination of the subtalar joint = lock the tarsals through Chopart’s line by this locking the foot becomes a rigid lever
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www.footscan.com Biomechanics What does Lisfranc's line? Nothing if Chopart's line has it's normal function Else Lisfranc's line will take over Chopart's line function
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www.footscan.com Biomechanics MTP joints : dorsal flexion Tighten the plantar aponeuroses Helps creating a rigid lever
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www.footscan.com Biomechanics What happens during gait? Robert Mack, The C.V. Mosby Company, 1980 Internal rotation External rotation Pelvis Internal rotation External rotation
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www.footscan.com Analysis of a dynamic measurement This rotation movements explain the heel’s movements. Because of the coupled movement at Chopart’s line we must seek another explanation for the COP-line of the rest of the foot
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www.footscan.com Analysis of a dynamic measurement After 15% of the stance phase there is a external rotation of the femur causing the subtalar joint to supinate Foot = a rigid lever which transfers weight and helps with the push off
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www.footscan.com Analysis of a dynamic measurement Williams & Wilkins, second edition Further course of the COP line: -By it’s anatomical positioning M5 comes down first -Because the body’s centre of mass position shift, it has to remain above the supporting leg. Making it move from medial to lateral and eventually back to the other leg medial: unroll from M5 M1
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www.footscan.com Analysis of a dynamic measurement
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www.footscan.com Most used functions Analysis of a dynamic measurement
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www.footscan.com Analysis of a dynamic measurement
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www.footscan.com Analysis of a dynamic measurement
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www.footscan.com Male, 53 y Functional foot type Prof. R Cavanagh Analysis of a dynamic measurement
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www.footscan.com Impulse division over the entire contact area Analysis of a dynamic measurement
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www.footscan.com Analysis of a dynamic measurement
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www.footscan.com Analysis of a dynamic measurement
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www.footscan.com Tine Willems, Gait & Posture Analysis of a dynamic measurement
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www.footscan.com Analysis of a dynamic measurement
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www.footscan.com Lunch
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www.footscan.com footscan ® balance curves
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www.footscan.com footscan ® balance curves Look at the curves the following way: X axis = total foot contact time Y axis = ratio of the movements Look at the structures which are being used in the calculation Look at the colours which match with the left or right foot, which are the loaded measurements Look at the (a) symmetry of both feet
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www.footscan.com footscan ® balance curves
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www.footscan.com footscan ® balance curves
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www.footscan.com footscan ® balance curves Heel rotation
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www.footscan.com footscan ® balance curves Forefoot balance
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www.footscan.com footscan ® balance curves Medial forefoot balance
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www.footscan.com footscan ® balance curves Hallux stifness
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www.footscan.com footscan ® balance curves Meta loading
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www.footscan.com footscan ® balance curves Foot balance
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www.footscan.com footscan ® balance curves
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www.footscan.com Comparing two measurements
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www.footscan.com Comparing two measurements
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www.footscan.com Average over several measurements
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www.footscan.com Case studies –To further explain the possibilities of footscan –Sports, orthopaedics or podiatrists –Practical examples
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www.footscan.com Case studies Knee problems
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www.footscan.com Case studies Sagittal knee movements J. Deckers & D. Beckers, Bohn Stafleu Van Loghum
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www.footscan.com Case studies
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www.footscan.com Leg length discrepancy Case studies
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www.footscan.com Case studies
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www.footscan.com Case studies
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www.footscan.com Shin problems Case studies
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www.footscan.com Case studies
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www.footscan.com Case studies
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www.footscan.com Achilles tendon problems Case studies
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www.footscan.com Case studies Rear foot pronation
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www.footscan.com Case studies Practice examples of pronation
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www.footscan.com Case studies
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www.footscan.com Case studies
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www.footscan.com Hallux Valgus RSscan INTERNATIONAL
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www.footscan.com Case studies
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www.footscan.com Case studies
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www.footscan.com Case studies Overloading M2 & M3 in propulsion and twist RSscan INTERNATIONAL
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www.footscan.com Case studies
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www.footscan.com Case studies
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www.footscan.com Case studies
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www.footscan.com Case studies
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www.footscan.com Case studies
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www.footscan.com Case studies
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www.footscan.com RSscan INTERNATIONAL Sn BL Walking
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www.footscan.com RSscan INTERNATIONAL Sn BL Run
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www.footscan.com RSscan INTERNATIONAL Sn Tr shoeL Run
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www.footscan.com RSscan INTERNATIONAL Sn Tr shoe Run
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www.footscan.com RSscan INTERNATIONAL Sn Comp shoe Run
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www.footscan.com RSscan INTERNATIONAL Sn Comp shoe Run
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www.footscan.com Case studies
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www.footscan.com Case studies
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