The application of New Technologies in Podiatry. Dr Alfred Gatt PhD FFPM RCPS (Glasg.) Podiatry Department University of Malta

Transcription

1 The application of New Technologies in Podiatry Dr Alfred Gatt PhD FFPM RCPS (Glasg.) Podiatry Department University of Malta

2 Disclosure All apparatus shown in this presentation forms part of the equipment available at our Podiatry Biomechanics Laboratory, at the Faculty of Health Sciences at University of Malta, which equipment is solely used for teaching and research purposes.

3 Podiatry is a very hands on profession In the normal clinical scenario, patients are assessed statically and sometimes dynamically We often assume that what we see statically is related directly to dynamic function However,

4 Foot is both a static and dynamic structure Changes its shape according to need Static examination does not necessarily relate to dynamic action

5 1. Foot pressure mapping

6 Transducer Technology Resistive Technology - FSR e.g Fscan Capacitive Technology - e.g. Emed, Pedar Piezo Electric - Kistler Force Plate

7 Types of Foot Pressure Systems Force Plate Systems Pressure Platforms In-Shoe Systems

8 FScan Manufactured by Tekscan Inc, various models available: Inshoe (Fscan) Platform (MatScan)

9 FScan 165Hz sample rate 960 sensors per foot 5mm spatial resolution Reusable and trimmable sensors FSR Technology-sandwich construction of two screen printed circuits separated by a conductive ink layer. Can be user calibrated

10 FSCAN

11 FScan Output

12 Novel Emed Pedar

13 Effectiveness of offloading Offloading does not only apply to the diabetic foot. Multiple scenarios in Podiatry where offloading is required So how do we know that our treatment is being effective? That it does exactly what we want it to do? Answer: measure

14 2. Gait Analysis Complex process of walking that involves various phases Muscle action at the appropriate time Kinematics Kinetics

15 Combined systems

16 Kinematics: 3d Infra red Systems

17 Kinematic Systems E.g of measurements: ankle angle at push-off ankle angle at contact Knee angle at contact swing and stance phase flexion hip extension in terminal stance trunk angle In the frontal/transverse planes, foot angle (varus/valgus), pelvic obliquity & use of the arms (Trendelenberg).

18 3. Foot segment motion Foot segment motion is extremely complex Cannot be studied or observed with the naked eye No objective data can be acquired with observation alone

19 Foot segment motion Oxford Foot Model Rizzoli Foot Model Ghent Foot Model Glasgow-Maastricht Foot Model Heidelberg Foot Model

20 Oxford Foot Model

21 Rizzoli Root Model

22 Complex camera systems that cost $$$ Appropriate for laboratory and Hospital use Validated mostly for Cerebral Palsy nowdays Diabetes??

23 Our LAB

24 Wearable Technology Accelerometers Gygroscopes Magnetometers Can provide orientation and positioning of the body segment in space

25 4. Electromyography (EMG) What are the muscles doing? Whenever we want to answer this question, the benefits of EMG become apparent. EMG allows us to: look at the electrical activity responsible for muscle contractions measure muscular performance.

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30 SURFACE ELECTROMYOGRAPHY (SEMG) Non-invasive technique for measuring muscle electrical activity resulting from contraction and relaxation exercises.

31 EMG Equipment

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35 EMG Integration with Foot Pressure Measurement

36 Integration with Vicon

37 Footswitches Allow analysis of timing of muscle activity relative to the Gait Cycle

38 Some research papers involving podiatrists.

39 Some research papers.

40 Some research papers.

41 5. Orthoses CAD/CAM Subtractive Milling Additive 3D Printing

42 Scanning Can be performed by a number of methods: Laser Structured White Light Photogrammetry

43 Laser Scanning

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45 This orthotic has been changed by increasing forefoot width and a heel raise

46 Full-length insole with 1 st Met cutout

47 CNC Materials

48 CNC Mills May be 2, 3, 4 or 5 axes 3 axis are commonly used for orthoses manufacture

49 Orthotic Mill example

50 CADCAM systems can easily be implemented in Podiatric Clinical Practice

51 6. 3D Printing The future of orthoses manufacture for the Podiatrist? Still in rapid development phase Can be implemented using open-source software Silent, safe, relatively low-cost Very clean Equipment can be in-clinic

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53 7. Thermography: the infrared imaging of the human body a real-time temperature measurement technique used to produce visualization of thermal energy emitted by the measured site at a temperature above absolute zero [1]. noninvasive and non-contact has the potential to measure physiological changes resulting in alteration of emitted skin temperature [2] and skin temperature distribution [3,4]. Thermography has been employed in a number of medical applications: vascular disease

54 Thermography: the infrared imaging of the human body a real-time temperature measurement technique used to produce visualization of thermal energy emitted by the measured site at a temperature above absolute zero [7]. noninvasive and non-contact has the potential to measure physiological changes resulting in alteration of emitted skin temperature [4] and skin temperature distribution [5,6]. Thermography has been employed in a number of medical applications: vascular disease breast disease [5]

55 Thermography: the infrared imaging of the human body a real-time temperature measurement technique used to produce visualization of thermal energy emitted by the measured site at a temperature above absolute zero [7]. noninvasive and non-contact has the potential to measure physiological changes resulting in alteration of emitted skin temperature [4] and skin temperature distribution [5,6]. Thermography has been employed in a number of medical applications: vascular disease breast disease [5] skin disease [6]

56 Thermography: the infrared imaging of the human body a real-time temperature measurement technique used to produce visualization of thermal energy emitted by the measured site at a temperature above absolute zero [7]. noninvasive and non-contact has the potential to measure physiological changes resulting in alteration of emitted skin temperature [4] and skin temperature distribution [5,6]. Thermography has been employed in a number of medical applications: vascular disease breast disease [5] skin disease [6] Raynaud Phenomenon [7]

57 Temperature measurement in the foot Thermography and thermometry have been employed in the study of foot vascular complications and ulceration in diabetes [3]. Thermal changes in the plantar aspect of the diabetic foot may be the result of ischaemia diabetic neuropathy Infection or a combination of these factors [8]. The neuropathic foot exhibits increased skin temperature indicating increased cutaneous blood flow [9]. Temperature differences between corresponding areas on contralateral feet are clinically significant parameters [10]. It has been suggested that if one foot has a significantly higher temperature than the other, an inflammatory disease process may be suspected. Indeed, a temperature change >2.2 o C in one foot is an indicator of a suspected disease process [11].

58 2016

59 In healthy adults, temperature patterns are symmetrical in both feet. We have reported the thermographic patterns of hands and feet of healthy adults [12] demonstrated symmetry in the healthy adult a lack of studies reporting use of thermography to detect differences between healthy and ischaemic feet. When both feet are ischaemic, the temperature difference between the two limbs may not be present, thus making detection utilizing this asymmetry theory difficult.

60 Thermography in Peripheral Arterial Disease

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62 DM, Neuropathy and PAD

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69 Thank you