Quantitative Prescription of Foot Orthoses: A Dose-Response Study of Kinematics in Patients with Foot and Ankle Pain using Biplane Fluoroscopy

 描述(由申请人提供)： 项目摘要我们提出这项建议的目的是为了更好地了解鞋内足部矫形器如何改善踝关节骨关节炎(OA)患者和/或因胫骨后肌腱功能障碍(PTTD)导致的成人获得性扁平足患者的足部和踝关节功能。我们的目标也是能够预测适合每个患者的最佳、个性化的矫形器是什么。这些都是常见的，疼痛的，通常是非常虚弱的情况，脚踝骨关节炎估计影响到大约6%的成年人口和大约3.3%的女性成年后获得的扁平足。已有研究表明，足部矫形器是治疗这些疾病的一种有效的保守干预措施，有助于推迟或取消手术。然而，对于很大一部分患者来说，足部矫形术是不成功的，有证据表明，这可能是干预后关节运动和负荷反应的个体间显著差异的结果。这可能是由许多因素造成的，包括足部骨骼形状、肌肉力量和/或关节活动范围。此外，供应商之间的足部矫形器设计经常不一致，这主要是因为设计和制造它们所使用的手工方法。一个更复杂的因素是，足部矫形器的处方往往写得含糊不清。如果我们要在个体患者的水平上改善这些设备的功能，那么提高我们对足部和脚踝对足部矫形器设计变化的不同反应的理解是至关重要的。然而，使用传统技术测量单个脚部骨骼是如何移动的是非常困难的。这种方法依赖于在太空中被跟踪的皮肤安装的标记来确定脚和脚踝的运动学。然而，足部和脚踝骨骼的大小和位置意味着不可能单独测量它们。此外，皮肤和底层骨骼之间的运动，即所谓的软组织伪影，会给测量带来重大误差。由于矫形器需要穿鞋才能正常工作，这一点变得更加复杂。我们团队开发了一种双平面透视系统，该系统专为测量足部运动学而量身定做。这个系统还有一个额外的优势，那就是能够测量未经修改的鞋子的足部矫形器的效果。为了达到了解和预测矫形器效果的目的，我们的具体目标是：[1]：通过双平面透视，收集描述在足部矫形器中改变后足后脚放置角度的效果的运动学数据。这些数据来自90名参与者：30名踝关节骨关节炎患者、30名有症状的PTTD患者和30名健康对照。[2]：使用SA1的数据，进行回归分析，以确定从双平面透视和临床检查中获得的显著影响个体对矫形器干预的反应(即后足运动学)的因素。这些因素包括：足部类型骨骼几何形状、静态足部姿势、关节轴位置、活动范围和肌肉力量。[3]： 使用来自SA1的数据，生成脚的肌肉骨骼模型，该模型允许对控制脚踝运动的肌肉和韧带进行详细分析。这将在OpenSim建模平台中开发，并在项目完成后免费提供。[4]：在一组单独的参与者中，比较使用标准方法指定的矫形器和使用SA2和SA3的算法和洞察力指定的矫形器的运动学反应。使用双平面透视技术收集10例踝关节骨关节炎患者和10例PTTD患者的运动学数据，以比较三对矫形器(一对传统矫形器，一对SA2矫形器和一对SA3矫形器)的性能。这些数据还将用于验证SA2和SA3得出的预测。这项拟议的研究项目将提高我们对足部矫形术工作原理的理解，并将帮助我们为患者开出更有效的器械。这将使大量患有脚踝骨关节炎和成人获得性扁平足的人群受益。

 DESCRIPTION (provided by applicant): PROJECT SUMMARY Our aim with this proposal is to better understand how in-shoe foot orthoses achieve improvements in foot and ankle function for people with ankle osteoarthritis (OA) and/or adult acquired flatfoot resulting from posterior tibial tendon dysfunction (PTTD). We also aim to be able to predict what the optimal, personalized orthotic device is for each patient is. These are common, painful, and often highly debilitating conditions, with ankle OA estimated to affect around 6% of the adult population and adult acquired flat foot around 3.3% percent of females. It has been shown that foot orthoses can be an effective conservative intervention for these conditions, and can help to postpone or negate surgery. However, for a significant proportion of patients foot orthoses are unsuccessful, and there is evidence that this may be a result of significant inter-individual variability in joint movement and loading response to the intervention. This may be due to a number of factors, including foot bone shape, muscle strength, and/or joint range of motion. In addition, the design of foot orthoses is often inconsistent between suppliers, largely because of the manual approach that is used to design and manufacture them. A further complicating factor is that prescriptions for foot orthoses are often vaguely written. Improving our understanding of different foot and ankle responses to variation in foot orthotic design is essential if we are to improve how these devices function at the level of the individual patient. To measure how the individual bones of the foot move using traditional techniques is, however, very difficult. Such methods rely on skin-mounted markers that are tracked in space to determine foot and ankle kinematics. However the size and position of the foot and ankle bones means that it is not possible to measure them all of them individually. Moreover, the movement between the skin and the underlying bones, known as soft tissue artifact, introduces significant errors into the measurements. This is further complicated by the need to wear shoes for orthoses to function properly. Our group has developed a biplane fluoroscopy system that is tailored to address the unique issues of measuring foot kinematics. This system has the additional advantage of being able to measure the effects of foot orthotics in unmodified shoes. To achieve our objective of understanding and being able to predict the effects of orthoses, our specific aims are: [1]: To collect, via biplane fluoroscopy, kinematic dat describing the effect of varying the angle of hindfoot posting in foot orthotics. These data will b obtained from 90 participants: 30 with ankle OA; 30 with symptomatic PTTD; and 30 healthy controls. [2]: Using the data from SA1, carry out a regression analysis to identify factors obtained from biplane fluoroscopy and clinical exam that significantly influence an individual's response (i.e., hindfoot kinematics) to the orthotic intervention. These factors include: foot type bone geometry, static foot posture, joint axis location, range of motion, and muscle strength. [3]: Using the data from SA1, generate a musculoskeletal model of the foot that allows detailed analysis of the muscles and ligaments controlling ankle movement. This will be developed in the OpenSim modeling platform and made freely available upon project completion. [4]: To compare the kinematic responses to orthotic devices prescribed using standard methods and those prescribed using algorithms and insight from SA2 and SA3 in a separate group of participants. Biplane fluoroscopy will be used to collect kinematic data from 10 patients with ankle OA and 10 with PTTD to compare the performance of the three pairs (one traditional, one from SA2 and one from SA3) of orthotics. This data will also be used to validate the predictions resulting from SA2 and SA3. This proposed research project will improve our understanding of how foot orthotics work and will help us to prescribe more effective devices to patients. This will benefit the large number of people in the population with ankle osteoarthritis and adult acquired flat foot.