1. www.footscan.com footscan ® Course 2006 Welcome

2. 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

3. www.footscan.com Goals Optimal measuring Understand and use all features of the footscan ® 7 gait software Get more information out of footscan ®

4. 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)

5. www.footscan.com “What is it about?” footscan ® = a dynamic plantar pressure measuring system with a high frequency Volunteers?

6. 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

7. www.footscan.com “What do we measure?” Highest pressure Lowest pressure

8. 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

9. www.footscan.com “What do we measure?” Force Pressure

10. www.footscan.com “What do we measure?” 100 N 1 cm²4 cm² Pressure 100 N / cm ² 25 N / cm ²

11. www.footscan.com “What do we measure?” “Total contact time off the foot”: = STANCE PHASESWING PHASE

12. www.footscan.com “with a high frequency”: 150 Hz – 300 Hz – 500 Hz “What do we measure?”

13. www.footscan.com Conclusion  Local pressure or total force  During the complete stance phase  With a high frequency  Off the foot Complex structure

14. 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

15. www.footscan.com Basics of the anatomical terminology Bones: femur patella fibula tibia femur Tibia en fibula

16. 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

17. 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

18. 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)

19. 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

20. www.footscan.com Basics of the anatomical terminology Used zone in the footscan® software: HLHM T1 M1 M5 M4 M3 M2 T2 – T5 MF

21. www.footscan.com Basics of the anatomical terminology Ligaments: Knee and ankle joint: medial and lateral ligaments for stability

22. www.footscan.com Basics of the anatomical terminology Ligaments: Plantar aponeuroses From calcaneus till the base of the toes

23. www.footscan.com Basics of the anatomical terminology Muscles:  Initiate motion  Limit extreme motions

24. 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

25. www.footscan.com Basics of the anatomical terminology 4 Muscle groups:

26. 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

27. www.footscan.com Basics of the anatomical terminology

28. www.footscan.com m. extensor digitorum longus Basics of the anatomical terminology

29. www.footscan.com m. peroneus longus and brevis Basics of the anatomical terminology

30. www.footscan.com Joints/Bones and their possible movements: Hip: flexion & extension Femur: interne & extension rotation Basics of the anatomical terminology

31. www.footscan.com Joints/Bones and their possible movements: Knee: flexion & extension Tibia: interne & external rotation Basics of the anatomical terminology

32. www.footscan.com Joints/Bones and their possible movements: Ankle: only plantar & dorsal flexion Subtalar Joint: pronation & supination Basics of the anatomical terminology

33. 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

34. 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

35. www.footscan.com Static measurement 1)Control preferences 2)Recalibrate (1 x per 3 months) 3) Add a patient to the database

36. 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

37. www.footscan.com Static measurement Static measurement = momentary recording Gives: - Static maximal pressures -Deviation of the body weight (in stance!)

38. 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

39. www.footscan.com Static measurement Remark: footscan can only show that there is a difference. Possible causes must be further verified.

40. 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

41. 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

42. www.footscan.com Dynamic measurement Is this a good measurement? Control: Contact time: Slight difference between left - right Normal walking measurement: +/- 800 ms

43. 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.

44. www.footscan.com Dynamic measurement Correct zones: See the footscan software manual for a detailed explanation

45. www.footscan.com Dynamic measurement Control ok?  Save measurement Repeat this procedure several times and then use the best measurement for your analysis.

46. www.footscan.com pause

47. 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

48. www.footscan.com Analyze dynamic measurement Visualizations: Roll off 3DSynchroImpulse 2D

49. www.footscan.com Analyze dynamic measurement Impulse: 0,2 s 6 Ns/cm 2 18 Ns/cm 2 0,6 s

50. www.footscan.com Analyze dynamic measurement

51. www.footscan.com At each frame we see: Center of pressure Analyze dynamic measurement

52. www.footscan.com Analyze dynamic measurement At each frame we see: actual direction of the talus max adduction position max abduction position

53. www.footscan.com Analyze dynamic measurement How does a measurement go? First we repeat the necessary biomechanics.

54. www.footscan.com Biomechanics Coupled movements (1): Rotation femur = rotation tibia A stretched knee has no rotation possibility

55. 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.

56. 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

57. 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

58. www.footscan.com Biomechanics MTP joints : dorsal flexion  Tighten the plantar aponeuroses  Helps creating a rigid lever

59. 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

60. 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

61. 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

62. 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

63. www.footscan.com Analysis of a dynamic measurement

64. www.footscan.com Most used functions Analysis of a dynamic measurement

65. www.footscan.com Analysis of a dynamic measurement

66. www.footscan.com Analysis of a dynamic measurement

67. www.footscan.com Male, 53 y Functional foot type Prof. R Cavanagh Analysis of a dynamic measurement

68. www.footscan.com Impulse division over the entire contact area Analysis of a dynamic measurement

69. www.footscan.com Analysis of a dynamic measurement

70. www.footscan.com Analysis of a dynamic measurement

71. www.footscan.com Tine Willems, Gait & Posture Analysis of a dynamic measurement

72. www.footscan.com Analysis of a dynamic measurement

73. www.footscan.com Lunch

74. www.footscan.com footscan ® balance curves

75. 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

76. www.footscan.com footscan ® balance curves

77. www.footscan.com footscan ® balance curves

78. www.footscan.com footscan ® balance curves Heel rotation

79. www.footscan.com footscan ® balance curves Forefoot balance

80. www.footscan.com footscan ® balance curves Medial forefoot balance

81. www.footscan.com footscan ® balance curves Hallux stifness

82. www.footscan.com footscan ® balance curves Meta loading

83. www.footscan.com footscan ® balance curves Foot balance

84. www.footscan.com footscan ® balance curves

85. www.footscan.com Comparing two measurements

86. www.footscan.com Comparing two measurements

87. www.footscan.com Average over several measurements

88. www.footscan.com Case studies –To further explain the possibilities of footscan –Sports, orthopaedics or podiatrists –Practical examples

89. www.footscan.com Case studies Knee problems

90. www.footscan.com Case studies Sagittal knee movements J. Deckers & D. Beckers, Bohn Stafleu Van Loghum

91. www.footscan.com Case studies

92. www.footscan.com Leg length discrepancy Case studies

93. www.footscan.com Case studies

94. www.footscan.com Case studies

95. www.footscan.com Shin problems Case studies

96. www.footscan.com Case studies

97. www.footscan.com Case studies

98. www.footscan.com Achilles tendon problems Case studies

99. www.footscan.com Case studies Rear foot pronation

100. www.footscan.com Case studies Practice examples of pronation

101. www.footscan.com Case studies

102. www.footscan.com Case studies

103. www.footscan.com Hallux Valgus RSscan INTERNATIONAL

104. www.footscan.com Case studies

105. www.footscan.com Case studies

106. www.footscan.com Case studies Overloading M2 & M3 in propulsion and twist RSscan INTERNATIONAL

107. www.footscan.com Case studies

108. www.footscan.com Case studies

109. www.footscan.com Case studies

110. www.footscan.com Case studies

111. www.footscan.com Case studies

112. www.footscan.com Case studies

113. www.footscan.com RSscan INTERNATIONAL Sn BL Walking

114. www.footscan.com RSscan INTERNATIONAL Sn BL Run

115. www.footscan.com RSscan INTERNATIONAL Sn Tr shoeL Run

116. www.footscan.com RSscan INTERNATIONAL Sn Tr shoe Run

117. www.footscan.com RSscan INTERNATIONAL Sn Comp shoe Run

118. www.footscan.com RSscan INTERNATIONAL Sn Comp shoe Run

119. www.footscan.com Case studies

120. www.footscan.com Case studies