This case study shows how the F-Scan helped optimise orthotics and educate the patient on plantar pressure distribution.
Symptoms
A nineteen-year-old female patient was referred with bilateral metatarsalgia for a joint podiatry and orthopaedic opinion. The young patient presented with chronic plantar forefoot pain, lasting over 4 years described as “like walking on hot stones.” The pain was aggravated by standing and walking; it was limiting her activities of daily life. The patient had no medical conditions other than obesity, a body weight of 136 kg (BMI 58.8). Her pain severity was measured on a Visual Analog Scale for Pain (VAS) to be 8/10 standing and 10/10 when trying to walk, causing a limp (antalgic gait).
Diagnosis and Imaging Investigations
The symptoms were attributed to overload metatarsalgia due to congenitally short first metatarsal bones in both feet. MRI and X-ray investigations can be seen at the right. The report verified there was no bone or joint signal typical of bone stress (or synovitis). Signal consistent with intermetatarsal bursitis between the 2nd to 3rd intermetatarsal space (indicated by yellow arrows). X-rays show very slight clawed second toes.
Pressure Measurement Evaluation
A plantar pressure assessment using the F-Scan™ System was performed for a better understanding of the foot function and pressures. The purpose of the gait assessment using F-Scan System was to test and optimise the benefits of the orthotic device; and if this failed, determine if forefoot surgery was necessary and what effect this may have on forefoot pressures.
Previous devices included a casted ¾ Functional Foot Orthotic (FFO) and variations of a pre-fabricated orthoses with metatarsal bar were not as successful. As a result of the plantar pressure measurements, the orthotic devices utilised were modified to optimise pressure redistribution at the forefoot. This was achieved by adding a forefoot rocker to the orthoses.
The patient showed an immediate increase in comfort and improved gait symmetry; as well as at the initial follow-up visit. At pre-surgical follow-up after 3 months, pain scores reduced to 4/10, so the patient opted not to have the surgery; therefore saving the trust a substantial cost. Follow-up plantar pressure scans were not needed due to good clinical response. In addition, the patient has taken the public health message on-board to reduce her foot pressure by losing body weight, which we think the visual feedback of the pressure assessment aided in.
Walking Plantar Pressure Measurement
Screenshot above shows peak pressure at the site of pain and pathology: Left 2nd metatarsal (met) head 815 KPa, Right 2nd met head 930 KPa, additionally there was little to no toe contact.
Peak Pressure Comparison
The screenshot above displays pressure distribution in a trainer type shoe only “before” and with the orthotic device “after.”
Notice how the pressure has been re-distributed in the “after” image, where there is reduced heel pressure, increased midfoot pressure, reduced forefoot pressure and increased toe pressure.
Peak pressure, located at the forefoot, under the 2nd metatarsal head at the site of pain, is lower in the left foot by 24% and on the right foot by 30% when wearing the optimised foot orthoses.
Newest F-Scan GO with FootVIEW Software
F-Scan GO is the next generation of the award winning F-Scan in-shoe gait analysis system. It is a compact, new generation technology for clinicians and researchers that provides dynamic pressure, force and timing information for foot function and gait analysis.
Perfect for both the gait lab and in the field, the versatility of F-Scan GO makes it the preferred choice for use in applications that are central to Biomechanics research. It is highly portable and can be used in almost any environment, its data can be easily exported, and it synchronises with external devices; such as EMG and Motion Capture, through external trigger input controls.
F-Scan GO comes with Tekscan’s next generation of research software – improved interface, more intuitive, and enhanced for use with a tablet. FootVIEW simplifies data collection and analysis and provides a user-friendly layout using docking regions that allows the user to easily organise information in dashboards.
To learn more about F-Scan GO, visit our page at https://bmec.asia/my/tekscan
More Information
Tekscan, Inc. ; Dr. Jill Halstead-Rastrick (PhD), Principal Podiatrist in Biomechanics, Orthotics & Footwear at Salford Royal Hospital (NHS) Foundation Trust
