RIGA TECHNICAL UNIVERSITY

Tatiana OGURTSOVA

METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

The summary oh PhD thesis

Riga 2006

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T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

Riga Technical University Faculty of Transport and Mechanical Engineering Institute of mechanics Division of “Mechanics of prosthesis with disables persons training centre”

Tatiana OGURTSOVA Doctoral student in doctoral program “Bionics and prosthetics”

METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

The summary oh PhD thesis

Scientific supervisor Dr. hab. eng. Professor E. Dukendjiev

Riga 2006

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T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

UDK ………..

T.OGURCOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES Report of doctorate work RTU, 2006. ..... page.

This work has been partly supported by the European Social fund within the National program „Support of the carrying out doctoral study programs and post-doctoral researches” project „Support for the development of doctoral studies at RTU”

Filed according to the decision of institute of Mechanics from 21.06.2005. Protocol №19

ISBN ...............

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T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

CURRENT EVENTS According to data of Statistics Department of United Nations Organization UNO by the end of XX century more then 80% of population of Earth has anatomical functional deviation of feet and lower extremities with corresponding negative aftereffects on health: v Functional failure of feet involves many chronic diseases of foot, ankle joint, knee, pelvis and

spinal column; v Distortion of sensor information from mechanoreceptors of feet leads to dystonia of body pose

(postural) muscles, formation of incorrect movement stereotypes and, later on, to rise of pain syndromes of overload genesis of musculoskeletal system; v Deformation of foot structures leads to abrasions, blisters, corns, ulcers; v Disorder of step parameters and as result of that – increase of energy consumption and decrease

of comfort during walking. Diagnostic of feet condition and correction of their functions – is most important element of basic therapy of many chronic injuries and diseases of musculoskeletal system. Well known methods of diagnostics and correction of feet condition merged by that, that they consider static and kinetostatic foot deformation, during sitting/standing, stepping from one leg on other leg. In movement the Picture is different – if in statics every foot (during standing on both legs) carries ½ of persons’ weight, then in dynamics this assembly grows up on average 4 times That is why the matter of functional diagnostics of feet injuries and diseases is pending when choosing method and way of treatment, also evaluating efficacy of those. Base of basic therapy of many chronic feet injuries is production of instep-raiser and insoles, but in existing licenses of insoles nowhere is considered dynamic components of feet pathology, condition of ankle joint and leaning angle of leg. The structure of known insoles leads up to gluing of 1-2 layers of lining materials, but in difficult cases are used orthopedic boots of individual sewing.

OBJECT OF WORK

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T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

1. To analyze condition of support-movement apparatus by foot sprints in dynamics process (during walking), including for people with amputation of one of lower extremities. 2. To work out the method for analysis of condition of support-movement apparatus by foot sprints in dynamics process. 3. To reveal correlation between metrics and kinematics of support-movement apparatus structure and planar foot print. 4. To work out construction, method and two technologies of insoles production for basic therapy of foot deformation: classical with production of negative and positive and author’s rights – without production positive model, with complex multilayered structure – bionic model of foot functions. To study and to realize possibilities to put those in Standard footwear for mass cases.

METHOD AND EQUIPMENT OF RESEARCH

Nature of METHOD leads up to analysis of three dimensional complex structure of support-movement apparatus with help of two dimensional (planar) image by area and correlation of areas components, color at human contact with support surface in walking process with following use of registered in dynamics two dimensional results of foot contact with surface for creation of three dimensional construction of insoles – bionic model of foot function. EQUIPMENT of fixed clinical type, realizing method of analysis in general characterized by device ВИДЕОИХНОГРАФ ДЕОТ-1 , consisting of frame with length more then 3 meters with glass platform for walking with safety handle; moving subframe with support and three video cameras; remote control and adapters of final switching off of subframe movement and personal computer registering and processing information. Auxiliary equipment is - double treadmill – flexible confined ribbon, encircling two rollers. Both rollers assembled on moving platform, performing transverse and longitudinal inclination. Upper branch lie on vinyl plane, on which ribbon is sliding. To drive of main roller by double belt is attached main roller, on which is spooled ribbon of leather substitute. Above conducted roller is passive roller, of which ribbon of leather substitute is unreeled. To this ribbon are glued two tensometric films, creating left and right track on which patient is stepping. Ribbon of leather substitute moving simultaneously with treadmill ribbon; - podometric chair with glass platform with system of mirrors below it; - mobile orthopedic cabinet - simplified version of ВИДЕОИХНОГРАФ. SCIENTIFIC NOVELTY AND MAIN RESULTS

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T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

NOVELTY First time in podometrics by plane geometrical parameters – area, correlation of areas components and color intensity of print, is carried out dimensional orthopedic diagnostics of condition of lower extremities and feet in walking process, reveeling anatomical and biomechanical pathologies related to condition of support-movement apparatus.

RESULTS 1. For registration of tensometric, temporary, linear and angle walking parameters is improved existing method of receiving tensometric foot prints, with combining it with double treadmill. 2. First time in podometrics is used method of remote sounding for investigation with following production of insoles without positive gyps’ model. 3. Defines and solved: direct assignment – revealed interconnection between three biomechanical axles of lower extremities with plane foot print and reverse assignment – to diagnose condition of support-movement apparatus by plane foot print. 4. For mass usage of method out of stationary clinical conditions was created mobile orthopedic cabinet and worked out system of matrixes which allow revealing pathology quickly. 5. There is worked out digital methodology of processing of sprints. It excludes subjectivism in valuation of feet condition, makes objective diagnostics available without high requests to specific knowledge in foot field (for example, medical examination in school). 6. There is synthesized basic construction of bionic insoles – model of foot functions. 7. There are worked out two technologies of production of bionic insoles: one – without usage of positives, second one with positives. There is worked out method for it “treatment on positive”, which leads to execution of plane print parameters into three dimensional positives. 8. Discovered and described new foot disease – dynamic flatfoot.

RELIABILITY OF RESULTS Received results checked for reliability with well known, modified author, by ichnographic print method on tensometric paper, placed on moving double treadmill. They correspond to results, received by new method.

PUBLICATIONS. Main materials of dissertation are published in 13 local and foreign collections of works of scientific conferences and congresses.

[1] V. Mihnovičs, T. Ogurcova. Kompleksā sistēma cilvēka gaitas pētīšanai. zinātniskā un tehniskā konference, 2000.g. 9.aprili -12. maijā, Riga, Latvija

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41. RTU studentu

T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

[2] Т.Огурцова, Е. Дюкенджиев. Методы и исследовательская аппаратура Лаборатории Атипичного Протезиования с Центром Обучения Инвалидов – Рижского Технического Университета, для анализа контакта стопы с опорной поверхностью. International Conference for Young Scientists on Mechanics and Biomechanics. June 4-6, 2001 Varna, Bulgaria. [3] T.Ogurcova, J.Djukendžijevs. Pēdas un atbalsta virsmas mijiedarbības eksperimentāla pētīšana. RTU 42. starptautiskā zinātniskā konference. 2001.g. 11.-13. oktobrī, Rīga, Latvija. [4] Т.Огурцова, Д.Шишкин. Биомеханические тесты и методы для оценки результатов протезирования голени. International Conference on Bionics, Biomechanics and Mechanics. June 3-5, 2002 Varna, Bulgaria. [5] E.Dukendjiev, T. Ogurtsova. Express method for evaluation of the results of prosthetics and orthotics. 12th Nordic Baltic Conference on Biomedical Engineering and Medical Physics. June 18th-22nd, 2002 in Reykjavík, Iceland. [6] J.Djukendžijevs, T.Ogurcova. Bionisko zolīšu lietošana apakšējo ekstremitāšu garumu starpība līdz 4 centimetriem. RTU 43. starptautiskā zinātniskā konference. 2002.g. 10.-14. oktobrī, Rīga, Latvija. [7] T.Ogurcova, J. Djukendžijevs. Balsta – kustību aparāta stāvokļa analīze pēc pēdas nospieduma dinamikā. RTU 44. starptautiskā zinātniskā konference. 2003.g. 9.-11. oktobrī, Rīga, Latvija. [8] E. Dukendjiev, T. Ogurcova. Examination of Feet During Walking and Synthesis of Bionical Insoles The 11th World Congress of the International Society for Prosthetics & Orthotics August 1-6, 2004, China, Hong Kong [9] Т.Огурцова. Клиническая методика цифровой диагностики патологии стопы по плоскостным отпечаткам в статике и динамике. International Conference

on Bionics

Prosthetics, Biomechanics and Mechanics, mechatronics and robotics. June 14-15, 2004 Varna, Bulgaria. [10] С.Миров, А. Иванов,Т. Огурцова, Е. Дюкенджиев Применение данных дистанционного зондирования в подометрии. Сентябрь 2004, Белорусия, Минск [11] T.Ogurcova. Pacienta pēdas nospieduma izmeklēšana dinamikā un statika. Metodes salīdzinājums. RTU 45. starptautiskā zinātniskā konference.2004.g. 15. oktobrī, Rīga, Latvija. [12] Т.Оgurtsova,

Е. Dukendjiev. PLANAR GEOMETRY OF FEET IMPRINTSAS THE

REFLECTION OF THE STRUCTUREAND CONDITION OF LOCOMOTIVE SYSTEM IFMBE Proceedings NBC 2005 “13th Nordic Baltic Conference on Biomedical Engineering and Medical Physics”, Vol. 9, 2005, Umeå, Sweden

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T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

[13] Т. Огурцова. Начальный статистический анализ состояния опорного аппарата детей и школьников Латвии. International Conference

on Bionics Prosthetics, Biomechanics and

Mechanics, mechatronics and robotics. June 5 -6, 2006 Varna, Bulgaria.

PATENTS

1.Latvian patent LV 13098 B. Method and equipment for expert valuation of prosthetics and orthotics results by foot print in dynamics. J.Djukendžijevs, T.Ogurcova.

2. Latvian patent LV 13325 B. Method of foot examination during walking and bionic insoles. J.Djukendžijevs, T.Ogurcova.

LITERITURE. Were used 63 literature sources

WORK APPROBATION

Main work results were presented at v seminars in Institute of Mechanics of RTU v seminars of Latvian association of bionics and prosthetics – orthotics. v conferences of RTU with international participation v European conferences v world congresses

RECOGNITION AND IMPLEMENTATION OF DISSERTATION

RECOGNITION v Method and equipment recognized as best work in this field and awarded with diploma of

Latvian Science Academy, product supported by grant of year 2002-2004. v Theme of dissertation is supported by ESF grant of year 2004-2005. v For theme of dissertation received 2 patents LR RTU from department of patents of Latvia

(Latvijas Republikas Patentu valde)

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T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

v State Agency of Medical statistics and technologies of Latvia according to rules of CM about

order of registration, valuation of compliance, distribution, exploitation and technical control of medical devices (Medicīnisko ierīču reģistrācijas, atbilstības novērtēšanas, izplatīšanas, ekspluatācijas un tehniskās uzraudzības kārtība): - recognized authors’ method as medical method and permitted to use it in clinical practice, what confirmed by issue of certificate - recognized bionic insoles as medical product and permitted production of those by issue of certificate th

v On World Congress of prosthetics and orthotics (The 11 World Congress of the International

Society for Prosthetics & Orthotics Hong Kong 05.08.2004) bionic insoles and method have received recognition for originality and clinical implementation and award of congress “Crystal Globe”

IMPLEMENTATION v Method and equipment implemented in Laboratory of Atypical prosthetics, where were

organized examination of patients and production of bionic insoles since year 2004. v Method of examination was implemented with help of Department of well-being of Riga

Council in clinic of infant houses of Riga city since year 2004.

DESCRIPTION OF WORK

Work performed on base of Laboratory of Atypical prosthetics. Consists of introduction, 6 chapters, conclusion. Together 78 pages, 48 pictures, 28 tables, ... appendixes.

CHAPTER ONE. LITERATURE PATENT OVERVIEW.

In chapter one is grounded topicality of choice of this topic for investigation. There are reviewed and analyzed known methods and examination devices and corrections of feet and supportmovement apparatus pathologies. There are defined targets and assignments of dissertation. There is analyzed functional anatomy and biomechanics of feet, phases of gait – foot contact with surface. There are found possibilities of improvement of existing methods. There are set assignments of dissertation, defined technological problems to solve ones. 3] - [11], [13], [15], [23], [25], [26], [28], [29], [33], [36], [37], [39], [41], [46], [54], [56] - [63], [63] Beginning of investigation of support-movement apparatus was established in first half of XIX century. Historically first is methodology of straight measurement of footstep length by Weber

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T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

brothers. Oldest of methods, used for studies of walk parameters, is ichnography – leaving foot prints on surface during standing of walking. Principal of ichnography, using up-to-date information carriers, is applied even now. But these are just planotopographical characteristics. In 1873 Morey invented pneumatic system of support dynamography. Farther were variations on topic – hydraulic (Skoreckij 1966),

mechanical

(Jakobson

1958),

electrotensometric

podography

(Roschin

1953),

electroichnograph ЭКИГ-2 Janson 1973. Up-to-date methods of foot examinations, based on digital computer technologies consider static and kinetostatic (sitting/standing, stepping over from one foot to other) foot deformation. But in dynamics is different picture. In statics each foot carries (standing on both feet) ½ of human weight. In dynamics this assembly grows up on average 4 times. It is established that existing examination methods don’t reveal the problem completely, but among best methods of feet pathology correction considered surgical. Beside examination methods were analyzed plentitude of invention that belong to medical equipment, particularly to orthopedics for correction of feet deformation. Traditionally solution of foot orthopedic problem is given to footwear. No doubt slip sole and footwear as a unit is more preferable than simply standard slip sole put in a boot. That is why in plentitude of patents orthopedic slip sole is integral part of footwear. In majority of cases is offered production of insert elements for certain foot area. By big amount of patients’ references it is not effective. It is typical for suggestions to use different self forming materials under foot, but then these devices can be considered as comfortable which don't do any orthopedic correction, just comfortable insoles. More optimistic is invention with production of individual positive model and forming of warmed up under vacuum slip sole's material to obtain insoles. Unfortunately on personal experience discovered that porous and flavoring orthopedic materials which are main elements of insoles, under influence of temperature and vacuum loose their damping features, but individualism of foot positive model unified by insoles cutting device. Nowhere in those are considered dynamic components of feet pathology, as well as condition of ankle joint and angles of leg inclination, don’t model foot functions, but only support arch and create sensation of comfort. Their correcting features, especially of serial ones, very low.

From analysis of existing kind of insoles on up-to-date market, can classify them in following way: - serially produced: therapeutic (preventive), sport, professional -

individually manufactured (therapeutic)

Deformations which can be corrected by orthopedic insoles •

Static feet insufficiency, as well without marked anatomical changes, as with moderately marked not fixed and fixed deformations.

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T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

•

Insufficient endurance of foot muscle-ligament apparatus in prolonged standing and prolonged walking.

•

Valgus of middle part of foot.

•

Plane-valgus feet (flatfeet).

•

Flatness of front part.

•

In heel valgus.

•

Shortness of one extremity 1-2 cm (usually accompanied by scoliosis, transform of pelvis and spine) Foot has difficult bone-joint and ligament apparatus, which fulfills following functions:

- spring – ability of flexible flatness under influence of load; - balancing – participation in regulation of positional activity in standing or walking; - pushing – message about acceleration to common centre of body mass of locomotor act.

Pic.1.1. Scheme of foot balance [54]

Foot structure can be compared to arch, supporting on three points – heel bone, on head of first and fifth metatarsus and tighten by sole fascia and sole muscles Pic.1.1. This flexible arch is a balance and damper for whole extremity.. Any deviation of power outlet place P of norm leads to significant redistribution of load in support points А, Б and В. That is why symmetric distribution of load under foot is important. Disturbance of this balanced interrelation brings to asymmetric load in leg and leads to overload of one or other part of foot. Correctly and good balanced system of heel part of foot and ankle joint is a

Pic.1.2 Heel spring [54]

damper of support reactions and provides symmetric load on leg bones from distal part. By mechanical features this system can be compared with steel spring. American scientists Hirsh

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T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

and White have defined coefficients of ankle joint tenseness and back part of foot. If this area would be replaced with corresponding by tenseness steal spring of 7 threads, with diameter 60 mm Pic1.2. , then wire would need to have average diameter 15,8 mm. So powerful spring can be placed in a car. Asymmetric load decreases bearing ability of spring and leads to that that its' resistance used not effectively. In usual conditions within day feet undergo 3000 ÷ 4000 cycles of load. Support area of sole surface of adult person, calculated by plantogram on average is 130 cm2. In symmetric condition specific load expressed by ordinal value 0,25 kg/cm2. Since form of foot print depends on speed of movement, have to conclude that also foot bones, which form foot print, by form and structure at different speed of persons’ walking differ. By this sign all bones which take part in foot forming can be divided in two groups: * bones that provide support of body; * bones that provide movement of body. First group of bones A (Pic.1.3) placed on outer foot side. Those consist of calcaneal and cuboid bone, IV-V metatarsal bone and phalanges of IV-V finger. This group of bones forms foot support system (FSS), print of which stays on

А

the ground (wet sand), when person is standing or slowly walking. Second group of bones B (Pic.1.3.) placed on inner foot side. Those

В

consist of navicular bone, and all three cuneiform bones, I – II - III metatarsal bone and phalange of I – II - III finger. This group of bones makes foot movement system (FMS), which forms foot print with distal part of I-II-III metatarsal bone and phalange of I-II-III finger. Consisting in FMS navicular and cuneiform bones don’t take part in formation of foot print. Mentioned bones placed above foot support plane.

Pic.1.3 full foot print and position of foot bones in it [10]

Foot print of full value is possible to receive only while body movement – while walking or slow running. In such way foot print received in dynamics, its symmetry, color and size can tell us about condition of whole lower extremity.

Depending on vertical inclination of axel in frontal plane of both lower extremities, in varus “O”, valgus “X” or normal “||" condition foot prints on plane will change (Pic.1.4). Similarly lights up dependence of inclination of biomechanical axel in different pathological cases, for example, in shortening of lower extremities more than by 1 cm, (Pic.1.4.) causes damage of spine – STATIC SCOLIOSIS. Examination is carried out by symmetry of Michaelis rhomb.

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T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

Pic.1.4. Types of dimensional interplacement of extremities

Even relatively small changes in foot position in foot subtalar joint (5° pronation/supination) lead to changes of regional tone of postural muscles of torso, affect orientation of spinal column parts, linear and angle body parameters. These changes very good are seen in lumbothoracic area. Foot – beginning section of kinetic chain, and disturbances of foot biomechanics affect all upper support structures of body. In such way, obvious is dependence between metrics and kinematics of structure of supportmovement apparatus and plane foot print.

This is why it was necessary in this work to analyze condition of support-movement apparatus by foot sprints in dynamics process, (while walking), including people with amputation of one of lower extremities; to work out a method for analysis of condition of support-movement apparatus by foot prints in dynamics process; to reveal correlation between metrics and kinematics of structure of support-movement apparatus and plane foot print; also to work out construction, method and two technologies (classical with production of negative and positive and authors’ – without production of positive model) of insoles for basic therapy of feet deformation with complex multilayered structure – bionic model of foot functions, to study and realize possibilities to put those in standard footwear for mass cases.

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T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

CHAPTER TWO. BIOMECHANICAL ASPECTS OF PATHOLOGY OF FOOT AND SUPPORT-MOVEMENT APPARATUS IN WALKING PROCESS ON A PLANE

In this chapter is revealed correlation between metrics (interaxial and other distances) and kinematics (angles and dimensional interplacement) of structure of support-movement apparatus and plane foot print. Bionic conclusions are made to create insoles an analyze condition of support-movement apparatus. Right now there are several methods of diagnostics of flatfoot, from which most comfortable in general practice is plantography. This method consists of analysis of foot print at load by plantogram. Plantogram (from Latin planta sole, foot + Greek gramma record) – is shape of vertical foot projection, combined with print of its sole surface.

Authors’ geometrically - calculating method of plantogram. Plantogram divides foot in four parts: back part, represented on plantogram by heel ellipsoid, centre of which is in one of support points – heel hill; middle part in which are main arch formative foot elements flexibly jointed by lines of Chopart, Jaeger and Lisfranc; front part in which are two remaining main foot support points and fingers part. On plantogram also are viewed so-called power rays (rays of Dukendzhiev) by which in walking power load is directed to each toe. Typical on plantogram also are angles at first and fifth toes and angle at heel part. Authors’ plantogram is original system of coordinates, placing foot print in it is possible to understand how close or far we are from norm.

Structure of system of coordinates т. А.

most inwards projective dimensional foot point Complies with head of 1st metatarsal bone

т. А1 most inwards projective point of foot print т. В

most outwards projective dimensional point Complies with head of 5th metatarsal bone

т. В1 most outwards projective point of foot print т. Z

middle line АВ. It is placed between second and third metatarsal bones.

АВ

line, joining т.А and т.В – line of transverse foot arch

т. С′

most laterally (outwards) projective dimensional foot heel point (outer side of heel)

т. С

most medially (inwards) projective dimensional foot heel point (inner side of heel)

СС′ line, joining dimensional foot heel points.

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T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

ВС line, joining т.В and т.С – border tangent to foot print, defining its lateral dimension (lateral base) АС line, joining т.А and т.С border tangent to foot print, defining its medial dimension (medial base) т. D

outer back dimensional foot heel point

ЕЕ′ dimensional tangent to т.D, defining back dimension of foot т. Е′

cross point of line АС′ with dimensional tangent ЕЕ′

т. Е

cross point of line BC with dimensional tangent ЕЕ′

т. Р1:5 - top points of toes from 1st to 5th т. Р1 - first front dimensional foot point, complying with top of 1st toe т. Р2 - first front dimensional foot point, complying with top of 2nd toe QQ′

dimensional tangent to т. Р1 and т.Р2, defining front dimension of foot

т. Q

cross point of dimensional tangent QQ′ with dimensional tangent ВС

т. Q′

cross point of dimensional tangent QQ′ with dimensional tangent АС′

т. Р*1:5 outer front point of foot print from 1st to 5th toe ⊥ Q1P1/ Q′ 1P1 from т. Q1/Q′ , lying on line АС′, is renewed perpendicular to т. Р1 of 1st toe ⊥ Q2P2 / Q′2P2 from т. Q2/Q′2, ′, is renewed perpendicular to т. Р2 2nd toe ⊥ Q3P3 / Q′3P3 from т. Q3/Q′3, ′, is renewed perpendicular to т. Р3 3rd toe ⊥ Q4P4 / Q′4P4 from т. Q4/Q′4, ′, is renewed perpendicular to т. Р4 4th toe ⊥ Q5P5 / Q′5P4 from т. Q5/Q′5, ′, is renewed perpendicular to т. Р5 5th toe (last two perpendiculars in norm geometrically correspond) СС′

Line, joining т.С and т.С′

UU*

approximating line of Chopart, shown on plantogram as ⊥ to lateral base

SU from т. L (end of line of Chopart) is renewed perpendicular to line ВС т. U

cross point of perpendicular ⊥ UU* from lateral base - tangent ВС

т. U* cross point of perpendicular ⊥ UU* from medial base - tangent АС ⊥ СО – perpendicular, renewed from т. С, lying on lateral base ВС, of foot ⊥ С′О - perpendicular renewed from т. С′, lying on line of medial base of foot т. О

cross point ⊥ОС and ⊥ОС′ (in norm complies with projection of heel hill if heel bone – one of

foot support points) In norm triangle СОС′ - isosceles ∅ D = DS – big diameter of ellipse, inserted in shape of heel print (from end of heel dimension till line of Chopart) includes all heel bone with centre in heel hill – in foot support point

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T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

Рис.2.1.Plantogram that follows bone-joint apparatus of foot т. D′

outer back point of foot heel print

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T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

С* - cross point of perpendicular СО with projection of foot shape ∅ d = CС* – small diameter of ellipse ОР1÷ОР5 power rays of load direction from 1st to 5th toe (rays of Dukendzhiev) ZО – definite foot axel, line joining т. Z (middle АB) and т. О′ (middle СС′). In norm it goes between second and third toe. It splits off lateral part of longitudinal foot arch in zone of which has to be print of middle part of foot. Р1D = L line defining foot length. It is joining dimensional foot points – big finger and heel. О1-О5 centre of ellipses of contact spots from 1st till 5th toe ∅ D1-D5 big diameter of prints of ellipses from 1st till 5th toe. Diameters are placed on power rays. ∅ d1 small diameter of prints of ellipses from 1st till 5th toe. Perpendicular to power rays. VV* approximating line of Lisfranc, going by proximal ends of heads of metatarsal bones. It is shown as perpendicular to lateral base (ВС) of foot. т. V* cross point ⊥ VV* with line АС′ т. V1 cross point of line ⊥VV* with line А1С2 with shape line of foot print from lateral side т. V2 cross point of line ⊥VV* with ray ОР3, also С, with shape line of foot print from medial side т. V3 cross point of line ZO with line VV*. It divides middle part in two. т. V4 cross point of line B1C1 with line VV* т. С1 cross point of line СС* with shape line of foot print from lateral side; most outwards projective point of print of foot back part т. С2 cross point of line СС with shape line of foot print from medial side; most inwards projective point of print of foot back part т. В1 cross point of line АВ with shape line of foot print from outer side; Complies with distal head of 5th metatarsal bone т. А1 cross point of line АВ with shape line of foot print from inner side; Complies with distal head of 1st metatarsal bone т. G cross point of line OZ with shape line of foot print between basis of 2nd and 3rd toe; В1С1 Line, joining most curved points of print of back (С1) and front (В1) part of foot; А1С2 Line, joining most curved medial points of print of back (С2) and front (А1) part of foot; B1R || OZ line, parallel to definite foot axel, coming out of point В1 (most lateral curved point of print of front part of foot); B1R* line, coming out of point В1 and going through most frontal point of print of 5th toe; А1N || OZ line, parallel to definite foot axel, coming out of point А1 (most medial curved point of print of front part of foot); А1N* line, coming out of point А1 and going through most frontal point of print of 1st toe;

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T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

Lines B1R, B1R* и А1N, А1N* characterize flatness or narrowness (Hallux valgus) of front part of foot. т. W2 most proximally projective point of print of front part of foot; ⊥W2W1 perpendicular, renewed from point W2 to line В1С1, line that splits off front part of foot т. W cross point of line W2W1 with line ВС; т. W3 cross point of line W2V1 with line А1 С2; т. W* cross point of line W2W1 with ray АС′; С2 Н perpendicular, renewed from point С2 to line СС2; С2К tangent line to point С2, characterizing varus or valgus of heel bone. To define area and shape of contact spots of foot (print) were used simultaneous and combined usage of colorimetry and optical-digital plantography of foot print in statics and dynamics. Studied parameters: print area (support surface of foot), symmetry of prints of both feet, correlation of separate areas of feet to area of whole foot. Under colorimetry

Foot overload

here is meant color of foot skin as reaction in load on glass. For quantitative biomechanical analysis of foot is

Normal load

used video – complex consisting of: digital photo/video camera НР Photosmart 735, attached to personal

Weak load

computer (PC), functional software (FS), printer. For analysis of prints in statics in plane of

Contact without load

filming object is placed big object of lineal, dividend on centimeter areas; digital photo/video camera is placed

No contact

fixedly, 30 cm away from filming object; optical axel of lens of camera guided perpendicularly to plane of

Pic.2.2. Color scale

filming object. Computerized processing of digital pictures of foot is carried out with help of program Photom131, which allows selecting data necessary for analysis of characteristic of foot, to carry out necessary calculations by operators’ selected areas. Operator selects areas of foot print, guided by color of print (Pic.2.3.). After upload of digital picture of foot operator performs calibration of scale marker, which allows program to calculate real coordinates, it is coordinates corresponding to real foot. Program automatically calculates and presents in report file area of foot and area of support spot of foot.

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T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

Pic 2.3. Processing of photo print in Looking through whole plantogram in general or separate parts of it concerning other parts conclusion is made about foot condition and its dimensional position with help of area coefficients and angles between power rays PARAMETRICAL VALUATION OF PLANTOGRAM I.

Linear parameters

1. Coefficient К1, defining condition of middle part – longitudinal foot arch 2. Coefficient К2, defining correlation of foot parts К2 = lV1V2/ lV1*V1 = 0,47 ± 0.02 Picture is normal Table.2.1. Value К2 К2 = 0,46 ÷ 0,48 К2 > 0,48 К2 [°]

Hallux valgus flattening Hallux rigidus Hallux rigidus Hallux rigidus

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T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

(2) Valuation of condition of back part of foot ∠ HC2K Table.2.3. Value ∠ HC2U* ∠ HC2K = 5° ∠ HC2K > 5° ∠ HC2K < 5° III.

Diagnosis Normal foot Skew foot Flat foot

Area by E.Dugendzhiev and T.Ogurcova

(1) Toe area in percents to total area of print ƒ1 – area of contact spot of 1st toe Ellipsoid with big (longitudinal) diameter D1 Ellipsoid with small (transversal) diameter d1 ƒ2 – area of contact spot of 2nd toe Ellipsoids with diameter D2 and d2 ƒ3 – area of contact spot of 3rd toe (D3 and d3) ƒ4 – area of contact spot of 4th toe (D4 and d4) ƒ5 – area of contact spot of 5th toe (D5 and d5) i=5

Σƒi = ƒ - total area of contact spots of toes i=1

Value ƒi normal ƒ1= 4.67 % ƒ2= 1.31 % ƒ3= 1.09 % ƒ4= 0.83 % ƒ5= 0.79 % Σƒi= F1=8.69%

Table.3.4. Diagnosis Varus legs

Valgus legs

< ƒ1 < ƒ2 < ƒ3 < ƒ4 < ƒ5

> ƒ1 >ƒ2 >ƒ3 >ƒ4 >ƒ5

Hallux valgus Hallux rigidus >>ƒ1 < ƒ2 < ƒ3 < ƒ4 < ƒ5

(2) Foot area and spatial position of leg

F2– area of front part of foot, which is between line W1 W2 and toes F3 – – area of middle part of foot, which is between line W1 W2 and line of Chopart (UU*) F4 – area of back part of foot – proximal to line of Chopart (UU*) Total area of foot print parts F = F1 + F2 + F3+ F4

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Table.2.6.

T.OGURTSOVA METHOD OF INVESTIGATION OF HUMAN SUPPORT-MOVEMENT APPARATUS BY FOOT PRINTS IN DYNAMICS AND SYNTHESIS OF BIONIC INSOLES

Value Fi normal

Diagnosis Varus legs

F1=8.69 % F2= 37.5 % F3= 23.6 % F4= 31.21 %

Valgus legs

F4

>F1 0.48 and F3 > 50 %

а)

b)

Pic.5.1. foot prints in statics –а) height of longitudinal arch at norm and while walking–b) longitudinal arch completely lowered а)

b)

Pic.5.2. а) Foot prints in statics show anatomical norm, b) Foot prints in dynamics on films Otto Bock. Fixed biomechanical pathology Biomechanical type of flatfoot even of third degree at static inspection can stay not revealed and reveals only using author’s methodologies, in this case – treadmill plus podometric films and glass track.

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Т.ОГУРЦОВА. АНАЛИЗ СОСТОЯНИЯ ОПОРНО-ДВИГАТЕЛЬНОГО АППАРАТА ЧЕЛОВЕКА ПО ОТПЕЧАТКАМ СТОП В ДИНАМИКЕ И СИНТЕЗ БИОНИЧЕСКИХ СТЕЛЕК

Use of author's methodology for detection of quality of production of prosthesis of lower extremity. Also were examined handicapped people with amputation of one extremity on different levels to divide results of measurements of defect signs of prosthetics on conditional defects of scheme of building, modeling of detecting cavity of hull, distribution of mass in prostheses and insufficient training of walking with prosthesis. How handicapped person is loading prosthetic extremity can tell by character of changes of vertical component of support reaction, that is why control of corresponding tests is performed with help of auxiliary device – podometer. Patients were examined by seven known tests, offered by Farber, but after that described in work with methods. Systemic approach used in development of new prosthetic-orthopedic products, in addition to Farber’s methodology [1], inquires analysis of functions in conditions of movement activity, which is not deplete by walking, but also turns on non-locomotor movements, locomotion in special conditions, going up and down stairs, inclined plane. Patient goes up and down stairs, walking on glass track stepping with healthy (prosthetic) leg on podometric platform, and then turns around and on the way back stepping on platform with prosthetic (healthy) leg and again walking up and down stairs. He is constantly followed by three video cameras on carriage, forth – below glass stairs and recording whole process in sagittal, frontal and horizontal plane. On basis of eksperiments, carried out by complex methodology of authors, can make some beginning conclusions: * Prosthetic foot rotates, it means that is set to big turn of foot outwards, not enough contact between hull and culta; * Length of step l1 on prosthetic side is shorter than on healthy one l2, it means that patient doesn’t feel balance because of insufficient bending stability it is knee axel of articulation is not enough shifted backwards; * Length of step on prosthetic side is longer than on healthy one – it means that bending contracture of culta in not considered and hull of hip is built in not enough bent position. In all cases at walking patient wont feel roll over prosthesis foot, what fill be fixed on video camera as incomplete foot print. The offered complex of biomechanical tests and methods proved perspectivnes of detection of results of prosthetics by foot sprints. With glass track and podometer it is effective and economical time wise.

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Т.ОГУРЦОВА. АНАЛИЗ СОСТОЯНИЯ ОПОРНО-ДВИГАТЕЛЬНОГО АППАРАТА ЧЕЛОВЕКА ПО ОТПЕЧАТКАМ СТОП В ДИНАМИКЕ И СИНТЕЗ БИОНИЧЕСКИХ СТЕЛЕК

Application of results of research and production of bionic insoles

After results of research were received and were found particular pathology were produced 103 pairs of bionic insoles by author's methodology with production of positive foot model. Below is mentioned typical case. After production of bionic insoles, results were checked on podometer. Patient: man 45 years old, weight 80 kg, height 183 cm. Turned for help with complaints about fast exhaust and painful feet with severe pain in spine. Patient has gone through many surgeries on right hip bone, as result of which shortening of right extremity was formed on hip cost by 4 cm. Analysis of examination data have shown severe overload of heel part of healthy extremity with combined flatfoot, at the same time toes didn’t take part in load, strong, but not fixed transfer of pelvis (Pic…).

а)

b)

c)

Pic.5.3. а) detection of shortening of extremity and scoliotic deviations of spine; b) device for accurate detection of length difference of extremities and straightening of semi-finished insoles; c) control of results For similar cases with shortening the special device has been developed for exact determination of the difference of length of extremities and equalizing of semi-finished insoles (Pic....). Fastening of each foot positive has four degrees of mobility which can be fixed together or following each other that allows achieving extremely accurate installation of positives. For similar complex cases are recommended instead of foot prints in foam mass to make foots gyps negative with capture of an ankle join and lower third of leg. Results of orthotics with insoles, which compensates 4 cm difference in extremities, was checked up by means of two – coordinate laser which has allowed valuating symmetry of patients rhomb of Michaelis, a curvature of spine and whole general symmetry of support – movement apparatus. And also control measurements on podometer without insoles and with insoles are made. With insoles it was practically completely compensated scoliotic curvature of spine and transform of pelvis. Toes started to take part in support and pressure under foot was distributed more close to normal. Prolonged walking, according to patient, has ceased to cause it sufferings.

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Т.ОГУРЦОВА. АНАЛИЗ СОСТОЯНИЯ ОПОРНО-ДВИГАТЕЛЬНОГО АППАРАТА ЧЕЛОВЕКА ПО ОТПЕЧАТКАМ СТОП В ДИНАМИКЕ И СИНТЕЗ БИОНИЧЕСКИХ СТЕЛЕК

In the CONCLUSION it is marked, that the aims laid down in work are reached completely.

1.

The condition of support – movement apparatus is analyzed by foot prints in dynamic process (during walking).

2.

The method is developed for the analysis of condition of the support – movement apparatus by foot prints in dynamic process.

3.

The correlation between the metrics and kinematics of structure of support – movement apparatus and plane prints of foot is revealed.

4.

The construction, method and two technologies (classical, with manufacturing a negative and a positive and author's - without manufacturing of a positive model) of insoles is developed for the basic treatment of foot deformation with complex multilayered structure – the bionic model of foots functions. The opportunity to put them in standard footwear for mass cases is studied and realized.

5.

Making of foot prints in dynamic has allowed revealing new disease - dynamic flatfoot, which is not registered at inspection in a statics.

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