Kerstin Bosch

Development of healthy children's feet—Nine-year results of a longitudinal investigation of plantar loading patterns

The purpose of the present study was to provide normative data for foot loading patterns and foot form parameters in order to support decisions about the normal or abnormal development of the growing foot during childhood. In a longitudinal design, 36 healthy German children were followed over the course of nine years. The children had a mean age of 14.6 ± 1.8 months at the first appointment and 122.8 ± 2.0 months at the last appointment. The children participated in 17 measurement appointments every 3, 6 or 12 months. Dynamic foot loading was evaluated with plantar pressure measurements during walking and static footprints were taken to determine changes in foot form. During the investigation period an increase of peak pressures of the total foot by 190%, of the relative maximum force of the total foot by 20% and the foot length by 90% was observed. A decrease for the relative maximum force under the midfoot (63%) and for the arch index (49%) could also be demonstrated. Furthermore, body height showed a significant influence on foot length and midfoot width. Body weight had a significant influence on the static parameter midfoot width. Between genders, boys showed a significant wider midfoot and a smaller forefoot contact area as compared to girls. The established database can be used as comparative values for clinical decisions about the normal foot development.

The influence of external ankle braces on subjective and objective parameters of performance in a sports-related agility course

With lateral ankle sprains being the most frequent sports-related injury, there is an evident demand for the preventive measures in active individuals with chronic ankle instability. Braces are commonly used for prevention and treatment of ankle injuries. Various investigations—mostly performed with healthy subjects—focused on this problem, yet they often compared only a few models or used only limited testing procedures. However, controversy exists whether braces affect sports performance. The purpose of the present study was to compare the effects of ten different ankle braces—one rigid, five semirigid, four soft models—in a comprehensive evaluation with multiple testing procedures in 34 subjects with self-reported chronic ankle instability. The multiple testing procedures evaluated objective performance-related parameters and subjective parameters related to comfort and stability. The subjects performed an agility course with maximal effort. The course included a vertical jump and a cutting maneuver, both on a force platform, a single leg hopping test on level and inclined plates, a combined straight and curve sprint and sidesteps. Three valid trials were measured and averaged for each brace and every subject. Subjective aspects were evaluated with a questionnaire about handling, perceived restrictions, support and comfort; it was completed after each brace was worn and tried. With regard to the objective parameters, no significant differences were found between the braces except for the rigid brace which showed decreased values for the vertical jump and longer times for the other tests compared to all other braces. The subjective evaluation of the braces revealed significant differences with respect to comfort and handling and therefore, permitted a distinction between semirigid and soft braces. Although significant differences between braces were found in subjective performance restriction, no significant differences were revealed in the objective evaluation. From that point of view, patients could choose a brace model according to their individual needs. A comfortable brace might have a positive influence on the athlete’s state of mind although other aspects like the brace’s stabilizing effect play an additional role and should also be taken into account for recommendation of braces.

Gait recognition: highly unique dynamic plantar pressure patterns among 104 individuals

Everyones walking style is unique, and it has been shown that both humans and computers are very good at recognizing known gait patterns. It is therefore unsurprising that dynamic foot pressure patterns, which indirectly reflect the accelerations of all body parts, are also unique, and that previous studies have achieved moderate-to-high classification rates (CRs) using foot pressure variables. However, these studies are limited by small sample sizes (n < 30), moderate CRs (CR ≃ 90%), or both. Here we show, using relatively simple image processing and feature extraction, that dynamic foot pressures can be used to identify n = 104 subjects with a CR of 99.6 per cent. Our key innovation was improved and automated spatial alignment which, by itself, improved CR to over 98 per cent, a finding that pointedly emphasizes inter-subject pressure pattern uniqueness. We also found that automated dimensionality reduction invariably improved CRs. As dynamic pressure data are immediately usable, with little or no pre-processing required, and as they may be collected discreetly during uninterrupted gait using in-floor systems, foot pressure-based identification appears to have wide potential for both the security and health industries.

Single leg balancing in ballet: Effects of shoe conditions and poses

The purpose of this study was to describe the effects of lower limb positioning and shoe conditions on stability levels of selected single leg ballet poses performed in demi-pointe position. Fourteen female non-professional ballet dancers (mean age of 18.4±2.8 years and mean body mass index of 21.5±2.8kg/m(2)) who had practiced ballet for at least seven years, without any musculoskeletal impairment volunteered to participate in this study. A capacitive pressure platform allowed for the assessment of center of pressure variables related to the execution of three single leg ballet poses in demi pointé position: attitude devant, attitude derriére, and attitude a la second. Peak pressures, contact areas, COP oscillation areas, anterior-posterior and medio-lateral COP oscillations and velocities were compared between two shoe conditions (barefoot versus slippers) and among the different poses. Barefoot performances produced more stable poses with significantly higher plantar contact areas, smaller COP oscillation areas and smaller anterior-posterior COP oscillations. COP oscillation areas, anterior-posterior COP oscillations and medio-lateral COP velocities indicated that attitude a la second is the least challenging and attitude derriére the most challenging pose.

An anatomically unbiased foot template for inter-subject plantar pressure evaluation

Pedobarographic images reflect the dynamic interaction between the plantar foot and supporting surfaces during gait and postural activities. Since intra-foot and inter-subject contact geometry are grossly similar, images may be spatially registered and directly compared. Previously arbitrary subjects have been selected as registration templates, but this can conceivably introduce anatomical bias. The purposes of this study were: (i) to compute an unbiased pedobarographic template from a large sample of healthy young adult subjects, and (ii) to demonstrate how the resulting template may be used for practical clinical and scientific analyses. Images were obtained from N=104 subjects and were registered (10,712 pairs) using (i) an optimal linear scaling technique and (ii) a nonlinear, locally affine, globally smooth technique. The nonlinear technique was found to offer biomechanically non-trivial advantages over the linear technique, most likely due to non-proportional inter-subject geometry. Specifically, the nonlinear template was able to detect morphological signals in a hallux valgus sample with greater sensitivity than the linear template. Validity of the approach was confirmed by independently assessing left and right feet, through a statistical comparison of local maximal pressures, and also through examination of random subject subsets. The current template, representative of an average healthy foot, could be a valuable resource for automated clinical and scientific analyses of foot morphology and function.

Effect of gait speed changes on foot loading characteristics in children.

Gait speed has been shown to influence foot loading patterns in adults but the mechanism has not been investigated in children. The present study investigated the effects of changes in gait speed on foot loading characteristics in 20 typically developing children who participated in plantar pressure measurements at normal, slow and fast walking speeds. In spite of shorter contact times in the fast walking speed condition, significantly increased foot loading was seen in the hindfoot, medial and central forefoot and toes while it slightly decreased in the lateral midfoot and forefoot. The results generally confirm the findings in adults that gait speed does not uniformly affect foot loading characteristics and that these effects should be kept in mind when comparing different subject groups or children at repeated measurement occasions.

Walking ability of children with a hexapod external ring fixator (TSF®) and foot plate mounting at the lower leg.

Wearing an external fixator for several months can be expected to profoundly affect the ability to walk, but, in principle, full weight-bearing is possible during corrective procedures with the Taylor Spatial Frame (TSF). The present prospective cohort study was conducted to assess whether patients are able to walk with or without crutches during treatment with a TSF on the lower leg. Twenty-four patients (10 girls, 14 boys; average age 11 years, range 6-17) scheduled for fixator surgery with osteotomies in the lower leg and foot mounting were included. Dynamic foot loading during free walking was measured with plantar pressure measurements. The contact area, contact time and contact pressure on the foot plate were recorded and normalized to body weight. In the first postoperative week, all patients needed crutches and 67% showed partial weight-bearing. At the second measurement, about 6 weeks after surgery, 21% of the patients could walk without crutches and 58% were partially weight-bearing with crutches. On the day before fixator removal, 50% of the patients were fully weight-bearing without crutches and 38% were partially weight-bearing, but 12% could not bear any weight or were unable to walk. When a ring fixator is used to correct lower leg deformity and prevent equinus, there is minimal risk of complete dependence and abasia. This study shows that up to 88% of the pediatric patients are able to walk while wearing the fixator. Already a few days after surgery, two-thirds of the patients were partially weight-bearing with crutches, and only 12% needed a wheelchair and were not able to walk with the fixator.

From "first" to "last" steps in life – pressure patterns of three generations.

The human foot has to bear loads during all kinds of bipedal locomotion throughout the whole life. Rapid developmental changes of foot morphology and foot function occur during the first years of walking [1]. Furthermore, disease dependent modifications can also have an influence on plantar loading [2]. Therefore, it is reasonable to assume that foot function alters in life [3]. However, the main differences between the pressure patterns in young and elder humans have not been well described? The aim of the present study was to evaluate age-dependent pressure patterns and their differences between new-walkers, 7-year olds, adults and seniors.