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

足部矫形器的定量处方：使用双平面透视对足部和踝部疼痛患者的运动学进行剂量反应研究

• 批准号: 9198737
• 负责人: William R. Ledoux
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-12-01 至 2019-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9198737
• 关键词: Address; Adult; Affect; Algorithms; American; Ankle; Arthritis; Articular Range of Motion; Automobile Driving; Biomechanics; Clinical; Custom; Data; Degenerative polyarthritis; Devices; Diabetes Mellitus; Disease Progression; Dose; Female; Flatfoot; Fluoroscopy; Foot Deformities; General Population; Guidelines; High Prevalence; Individual; Influentials; Injury; Intervention; Joints; Kinetics; Lead; Ligaments; Location; Lower Extremity; Manuals; Measurement; Measures; Medical pins; Methods; Modeling; Modernization; Morphologic artifacts; Motion; Movement; Muscle; Musculoskeletal; Older Population; Operative Surgical Procedures; Orthotic Devices; Outcome; Pain; Participant; Patients; Performance; Population; Positioning Attribute; Posterior Tibial Tendon Dysfunction; Posture; Prevalence; Process; Randomized Controlled Trials; Recommendation; Regression Analysis; Research; Research Project Grants; Roentgen Rays; Shapes; Shoes; Skin; Structure; Surface; System; Tarsal Bones; Techniques; Tissues; Translations; Variant; Veterans; Work; base; bone; bone geometry; clinical decision-making; clinically relevant; design; experience; foot; foot bone; improved; improved functioning; individual patient; innovation; insight; joint loading; joint mobilization; kinematics; muscle strength; orthotics; patient population; predicting response; prescription procedure; pressure; public health relevance; response; soft tissue; stem; treatment strategy

 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.

 描述（由申请人提供）： 项目总结我们提出这项建议的目的是更好地了解鞋内足部矫形器如何改善踝关节骨关节炎（OA）和/或由胫骨后肌腱功能障碍（PTTD）引起的成人获得性扁平足患者的足部和踝关节功能。我们还希望能够预测每个患者的最佳个性化矫正设备是什么。这些都是常见的，痛苦的，往往是高度衰弱的条件，与踝关节OA估计影响约6%的成年人口和成人获得性扁平足约3.3%的女性。已经表明，足部矫形器可以是这些条件的有效保守干预，并可以帮助推迟或否定手术。然而，对于一个显着比例的患者足部矫形器是不成功的，有证据表明，这可能是由于显着的个体间的差异，关节运动和负载的干预反应。这可能是由于许多因素，包括脚骨形状，肌肉力量和/或关节运动范围。此外，足部矫形器的设计通常在供应商之间不一致，主要是因为用于设计和制造它们的手动方法。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。如果我们要改善这些设备在个体患者水平上的功能，那么提高我们对足部矫形器设计变化的不同足部和踝关节反应的理解是至关重要的。然而，使用传统技术来测量足部的单个骨骼如何移动是非常困难的。这种方法依赖于在空间中跟踪的皮肤安装的标记，以确定脚和踝运动学。然而，足部和踝部骨骼的大小和位置意味着不可能单独测量它们。此外，皮肤和下面的骨骼之间的运动（称为软组织伪影）将显著误差引入到测量中。这是进一步复杂的需要穿鞋矫形器正常运作。我们的团队已经开发了一种双平面透视系统，专门用于解决测量足部运动学的独特问题。该系统具有能够测量未修改鞋中的足部矫形器的效果的额外优点。为了实现我们的理解和能够预测矫形器的效果的目标，我们的具体目标是：[1]：通过双平面透视，收集描述足部矫形器中后足支柱角度变化的效果的运动学数据。这些数据将从90名参与者中获得：30名踝关节OA患者; 30名症状性PTTD患者; 30名健康对照者。[2]：使用来自SA 1的数据，进行回归分析，以识别从双平面荧光透视和临床检查中获得的显著影响个体反应的因素（即，后足运动学）到矫正干预。这些因素包括：足型骨骼几何形状、静态足姿势、关节轴位置、活动范围和肌肉力量。[3]: 使用来自SA 1的数据，生成足部的肌肉骨骼模型，该模型允许对控制踝关节运动的肌肉和韧带进行详细分析。这将在OpenSim建模平台上开发，并在项目完成后免费提供。[4]：在单独的一组参与者中，比较使用标准方法规定的矫正装置与使用算法和来自SA 2和SA 3的见解规定的矫正装置的运动学反应。将使用双平面透视法收集10例踝关节OA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，一对来自SA 2，一对来自SA 3）的性能。这些数据也将用于验证SA 2和SA 3的预测结果。这项拟议的研究项目将提高我们对足部矫形器如何工作的理解，并将帮助我们为患者开出更有效的设备。这将使踝关节骨关节炎和成人获得性扁平足人群中的大量人群受益。