d-manual static

7/27/2019 D-Manual Static

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The Static Exam


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Table of Contents

1.

How to perform the Static Exam

2.

Analysis

Important Indicators Foot Geometry B.P.I. Static Index Presented I.B.P. Values Compare Data

3.

Static Published Normal Values Static Survey Description of L-C-R

Surface and Pressure Numerical Values Static isopressure analysis


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How to perform the Static Exam


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Explain to the patient what you are investigating and the procedure. The patient shouldbe wearing appropriate attire, as clothes may alter the results of the exam.

While you are inserting the patients information into the computer, let themwalk/stand on the platform to become comfortable and to relax their feet from the shoes

they were wearing.

The patient must stand on the Static place of the platform. Ask them to touch thespecific alignment tool with the heel end of their foot and to assume a comfortable

position. For certain patients you can check if the position is corrected by touching theirleg muscles for contraction.

The static acquisition is acquired with aligned feet from the heel, and it studies thenatural rotation.

Remove the alignment tool and ask the patient to face forwards, arms by their side,breath in and out once, swallow once , and keep their position without moving.Observe the patient and not the monitor.

To start the acquisition simply click on

STATIC ACQUISITION


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The acquisition takes 5 seconds for the software to determine the mean values of the smalloscillations occurred within this time.

While performing a Static Acquisition you can see the patients surface and weight %, which couldbe useful under certain circumstances.

Once the Static exam is completed the software is automatically ready to analyse the data.

Now close this window and perform the Dynamic Exam.


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Analysis

The results of a static analysis acquisition are from a standing

position on the platform. This shows the pressure

points calculated on the average of 5 seconds, in a relaxed position. A wrong position of the patient could easilycompromise the outcome of the examination and reveal unreliable information.

The Static Analysis shows the main parameters

of your patient.

Remember that the basis parameters could completely change when walking. Before giving any diagnosis astudy of the patient in motion should be examined.


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When opening a Static analysis please check the positioning of the X

axis: which should be

placed on the midfoot, just behind the base of the 5th

metatarsal. The Y

axis should be placed in

between the feet. You can also adjust the Axis while performing the acquisition.

Some times the software does not divide the footprint automatically (giving you a whole image): in

this case you must divide those manually (by right clicking on the image) and selecting Split. UseMerge

if rearfoot and forefoot are not recognized automatically by the software. By right clicking

you can Export the footprint as a .txt or .bmp format (this option is available for most of thefootprints you collect in the software and also for all the graphs).


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Important IndicatorsCoF (centre of pressure of each foot L-R) angle. This gives you an idea of the tilt in the structure

(usually hip rotation). This value if negative indicates a clock

wise tilt; positive a counter clockwise

tilt. If it is too high this also shows an important rotation.

Foot Angle Axis calculated as the angle formed by the line that starts on the second/third toe tothe center of the heel and the vertical Y

line. If it is too small (3/4 degrees) it indicates an

excessive medial position if its too high (more than 15 degrees) it indicates an excessive lateralposition.

Total Surface % to observe if there are evident variations. In this case please observe which areahas more visible surface (rearfoot or forefoot).

Total Load % to observe if there are evident variations. In this case please observe which area hasmore visible pressure (rearfoot or forefoot).Other values:Global Surface: sum of the 2 feet

P.Max (g/cm2): corresponding to the maximum point of pressure of all the points of contacts.Showed on the footprint image as an MP.Avg (g/cm2): corresponding to the average pressure detected on

the entire plantar surface

Feet angle: corresponding to the polygon of pressure of the two feetLF/RG rearfoot/midfoot surface and load: corresponding to the distribution of a single area

Weight Ratio R/F: corresponding to the percentage of load distribution between Rearfoot andForefootFoot Angle: corresponding to the angle formed by the external lines of the foot.


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Foot GeometryThis section allows you to add more information to the Static Analysis, such as the Angle

views

(left side of the windows) on which the foot is automatically divided in 6 areas, detecting the

rearfoot (medial and lateral), the midfoot (external/internal) and the forefoot (medial and lateral,including toes, if detected). In each area displayed is the surface and the averaged pressure. Theimage also shows the M, maximum Point of Pressure that usually on a Static Analysis should belocated on the rearfoot (left or right).

Also displayed is the polygon of contacts (right side of the window) which is calculated the CoPPosition (both on mm and %) calculated from the ending line of the rearfoot.


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Additional calculated values are:-

The BPE length, corresponding to the measured length of the foot, calculated on the numbers of

detected pressure points (its not the morphological length).-

The distance of both CoF (LF/RG) from the ending line of the rearfoot (mm).

- The distance (mm) of the LF/RG CoF from the central axis line- The distance (mm) of both CoF (LF/RG) to the CoP

-

The detected distance between the CoP and the Geometrical Center of the Polygon.

In the B.P.I. Static Index section you will find additionaldata of the Static Analysis values.

In this window there is also a brief description of themain values of the Exam that could be used as a goodbase for the diagnostic report of the Static Analysis.Before printing be sure that all the informationdescribed into the generic report

are correct (watch

the numbers and the footprint image). RR

command

will recalculate the report in case of deleting some partof it while overwriting.

By clicking on Area

you will pass from the pressure

point presentation to the 6 colour presentation. This is avery interesting value to better understand the

lateral/medial displacement of the foot, reading thevalues in percentage (pressure/surface). Usually thetotal should be 50%

50%. We are observing that small

variation shows attitudes in pronation/supination.


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B.P.I. Static Index(Biomechanical Postural Index)

From the same Geometry window you canaccess the Indexed indicators by introducingthe assigned password. If you do not have itthis means that you did not order this

feature. Please ask for more details fromyour local Distributor or directly toDiagnostic Support.

You have the list of several exams of thepatient.

You can open different exams, for examplethe first and the last one, and compare thetwo different values simultaneously.

By passing over on each single value with the mouse, you can see a brief explanation ofthe Indicator.The scale for each indicator used is the following:

0

= normal values. This is not an absolute value and includes a small range of variation.

1

= indicates that the values are still close to the normal range

but lightly increased

2

= indicates that the values are higher respect to the normal values and require to be observed during the

treatment3 = indicates a real discrepancy from the norm and require more attention


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Presented I.B.P. values:

The CoP geometric position is calculated as the distance, expressed in percentage of the length of

the polygon of foot support, of the Centre of Pressure (CoP) from the ending line of the rearfoot.

This index allows to evaluate possible shifting of the CoP, and therefore of the body gravity centre,in anterior or posterior direction.

-

The variation of bipedal load is calculated as the difference of load percentage among right and

left foot, calculated on the average of the oscillations of the subject during 5 seconds of acquisition.

This index allows evaluating possible unbalance toward right or toward left.

-

Variation of load between rear and fore foot is calculated as the difference of load percentage

between the rearfoot and the forefoot (values more than 0 point out a greater percentage of load onrearfoot or forefoot). This index allows evaluating possible unbalance of load in direction anterior-

posterior on each of the two feet. Two indexes one for the left and one for the right.

-

The angle of centres of pressure (CoF) is calculated as the angle, express in degrees, formed by a

straight line from the centres of pressure of each single foot (LR). This index allows evaluating apossible tilt of the hip. The angle is negative if in hourly direction (left behind right) and vice versa.

-

The angle of the foot axis is calculated as the angle, expressed in degrees, formed by the axis (from

the 3rd to the center of the heel) of each foot and the vertical

Y

axis. This index allows evaluating

possible medial or lateral foot attitudes with two indexes, one for the left and one for the right.


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-

The location of the Point of Maximum Pressure (PMP) is the calculated position of the

maximum single peak of pressure "M" on the foot. Generally the PMP is located on therearfoot. If on the forefoot or, less favourably on the midfoot,

it is a symptom of

overload, there are two indexes, one for the left and one for the right.

-

The surface is calculated as the number of points active on the

platform, expressed in

square centimeters. This index allows evaluating morphological foot alterations (forinstance flat foot, cavus foot, etc). There are two indexes, one

for the left and one for the

right.

-

The surface variation is calculated as the difference among right and left foot surface. It

is important to evaluate any foot imbalance.

The values are not yet printable because there is still a scientific evaluation inprogress performed by the Postural Biomedicine Team.

At the moment we suggest you to use the Total as an indicator between i.e. before andafter treatment value.

We hope that your experience should also contribute to increase the validation of thevalues.


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Compare Data

By clicking on you can comparethe acquired exam with an image thatshows you (see to the left) a normalfootprint. You can also compare

different exams (static with static orwith dynamic) of the same patient, orwith a different one. The pictures tothe left shows a comparison of thesame patient in between two

acquisitions, one on spontaneousrotation and one with parallel feet (toavoid pelvic influences).


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Static SurveyingAfter carrying out a static acquisition, it is possible to compare the image with normal values.

The standard image values are comparable only if the exam has been carried out checking the exactpositioning of the patient and their correct foot-resting position.

The static footprint shows a ten plantar pressure scale in colour, to point out the loads intensity onpercentage of the maximum pressure, displayed as M (gr/cm).

The load percentage is explained in the scale below:

Colour P.Max %

Red 100-91

Orange 90-81

Pale green 80-71

Dark green 70-61

Dark blue 60-51

Pale blue 50-41

Azure 40-31

Beige 30-21

Dark brown 20-11

Pale brown 10-0


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Description of L - C R

Subjects centre of pressure projected on the perpendicular to the ground C=CoP.

Each limbs pressure centre (L and R) and the pressure centre (C) must be aligned andequidistant among them. Their location is approximately at the mediotarsal line orChopard

interline (peak of the arch).

The CoP can be localized behind or placed before the mid line: if placed behind, thismeans that the body load is more on the rear foot (i.e. a subject with an increasedlordosis), if placed before it means that the load is more on the forefoot and the body isshifted ahead (usually on dancers or tall subjects or patients with increased kyphosis).

If L -

R centres are not aligned (one ahead and one back) it could mean there is a pelvic

imbalance.


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Surface and pressure

Surface should be uniformly distributed in between the feet; and

the rearfoot and

forefoot should have similar surfaces (number of activated sensors).

Usually toes are not completely visible or are presented with small points (light

pressure), due to missed contraction of the toes flexors in standing position.

The forefoot, shown from 1st

to 5th

metatarsal (in cross-section), usually does not show

evidence of high pressures. There is normally more pressure on 3rd

and 4th

metatarsal.

The midfoot should display an area corresponding approximately in between 1/3 and2/3 of the forefoot surface and a pressure less then rearfoot and forefoot, howeverlocalized mostly on the external edge.

The point of maximum pressure " M " must be centrally located in

the rearfoot (is

displayed on the forefoot or on the middle-foot it is a symptom of hyper loads).

N i l l


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Numerical valuesNumerical values are calculated for each exam,compared against normal values. This can alsobe a useful reference point to help patients

understand this data.

The body weight of the subject should be

balanced between the right and left limb; andload should be well distributed between forefoot

and rearfoot areas (see the chart to the right):

Global Load dis tribution LF Limb RG Limb

Normal Values 50% 50%

Tolerance +/- 3% +/- 3%

Rearfoot/Forefoot Distribution Rearfoot Forefoot

Normal values (without footwear) 55% 45%

Normal values (with footwear) 50% 50%

Tolerance +/- 4% +/- 4%

The global surface of both feet should be equallydistributed in between left and right (with an

allowed maximum difference of + / -

10%).

Generally the foot which presents greatersurface, should also present more load.The areas of load/surface of rearfoot/forefootare not so important while analysing data. Justremember that when a patient overloading anarea of the foot (rearfoot or forefoot), usually,due to gravity compensation, display more loadon the controlateral side (i.e. LF rearfoot/RGforefoot).

A normal subject, proportional to foot length,presents the following global surface values foreach foot (with variations of +/-10% accordingto the following table):

Minimum value (cm) Maximum Value (cm)

100 140

WOMAN 90 120

ADOLESCENT 80 120

CHILD 50 80

St ti I A l i


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Static Isopressure AnalysisIsopressure values display all the points having the same load intensity (percentage) and are

useful to understand load characteristics of that subject, while

observing in 3 colours. The three

pressure levels express in order: higher load, medium load and minimum load, detected on

percentage of the foot surface (see table below):Colour Level Surface %

Red I 10-14

Green II 30-35

Blue III 50-55

The 1st

level

is presented with RED

dots. These should be displayed onlyon the rearfoot centrally

with some

points visible either medially and/orlaterally.

The 2nd level

is presented with

GREEN dots. These should bedisplayed surrounding the rearfootand in particular on the metatarsal

(from 1st

to 5th MPJ).

The 3rd level

is presented with

BLUE dots. These should bedisplayed on the lateral edge of themidfoot. Additional points could be

presented surrounding GREEN and

RED colour points.

Generally toes always show someBLUE (on the hallux) or GREY dots. If the a

reas

(rearfoot/midfoot/forefoot/toes)

show pressure values higher or lowerthan the isopressures level, thisindicates an over loading or under

loading.


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