Development of a Geometric Forefoot Model: A tool for Clinical Decision Making

描述(申请人提供)：这个研究团队的最终目标是开发一种对异常功能敏感的足部结构的数学模型，并可用于计划更有效的保守和手术治疗。NICHD的使命是通过最佳康复确保所有人的健康、生产力、独立性和福祉。建议的前足模型将有助于指导足科医生、骨科医生、理疗师和理疗师优化治疗策略，以便更好地恢复患者的健康。该项目将专注于三个具体目标：(A)根据X线片和基于3D数字指针的输入数据建立前脚的结构模型，并展示其同步有效性；(B)为无症状的健康人建立一个标准的步态参数和相关足部功能数据库，并对不同的足型(即扁平足、直肌和足腔)进行分层；以及(C)区分一组糖尿病和拇外展外翻(HAV)患者的模型参数和足功能。提高了对扁平苔藓(如甲型肝炎、霍尔克斯氏症、骨关节炎、肌腱炎、足底筋膜炎、神经瘤、胫骨后功能障碍、慢性角化瘤、外翻塌陷等)和PE腔(如锤趾、裁剪拇趾肿、踝关节痛、糖尿病神经病变等)的病理机制的了解。需要双脚。所提出的前足几何模型有望对不同的足部结构(和相关的病理)敏感，因此可以预测相称的足部功能。根据这项调查的积极发现，后续研究将使用该模型作为临床决策的工具。患有糖尿病和缺乏知觉的人可能会在脚下形成威胁肢体的伤口。如果溃疡形成，不能迅速愈合，感染可能随之而来。如果治疗不成功，这种感染可能会导致坏疽，并需要截肢。提出的模型的一个目标是预测这些患者脚下的异常高压，以便提醒临床医生并提出行动方案。

DESCRIPTION (provided by applicant): It is the ultimate objective of this research team to develop a mathematical model of the foot structure that is sensitive to aberrant function and can be used to plan more effective conservative and surgical treatments. The mission of the NICHD is to ensure the health, productivity, independence, and well-being of all people through optimal rehabilitation. The proposed forefoot model would be useful as a guide to Podiatric physicians, Orthopedic surgeons, Physiatrists, and Physical Therapists to optimize treatment strategies in order to better rehabilitate patients. This project will focus upon three specific aims: (A) to develop a structural model of the forefoot from radiographic and 3D digital pointer based input data and demonstrate concurrent validity, (B) to develop a normative database of model parameters and associated foot function during gait for asymptomatic healthy individuals and stratify across foot type (i.e. pes planus, rectus, and pes cavus), and (C) to distinguish the model parameters and foot function for a group of patients with diabetes and hallux abducto valgus (HAV) from that of healthy. Improved understanding of the pathomechanics that afflict pes planus (e.g. HAV, Hallux limitus, osteoarthritis, tendonitis, plantar fasciitis, neuroma, posterior tibial dysfunction, chronic keratomata, collapsing pes valgus.etc) and pes cavus (e.g. hammertoes, tailor bunion, metatarsalgia, diabetic neuropathy, etc.) feet is needed. The proposed model of forefoot geometry is expected to be sensitive to different foot structures (and associated pathologies) and hence be predictive of commensurate foot function. Based upon positive findings from this investigation subsequent studies will be conducted to use the model as a tool for clinical decision making. Individuals with diabetes and lack of sensation may develop limb threatening wounds beneath their feet. If an ulcer forms and does not heel quickly an infection may ensue. If not successfully treated this infection could result in gangrene and the necessity for amputation. One goal of the proposed model is to predict the abnormally high pressures beneath these patients' feet so as to alert clinicians and suggest a course of action.