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| FOOTPRINT: MORPHOLOGIC
EVALUATION AND FUNCTIONAL EVALUATION. COMPARISON BETWEEN TWO
METHODS. |
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| M.
A. FUSCO: Ph. D in Posturology
and Biomechanics - Pres. of I.S.F.O.M. - Responsible for the
studies' and research center of KS ITALIA. |
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The
study of the plantar stance usually consists of the morphologic
evaluation of the footprint.
This evaluation is performed on a podoscope, on podograph's
paper or on a stabilometric rug. A
PODOSCOPE consists of a wooden or metallic box, with a glass
top. The glass top is illuminated on each side by fluorescent
lights. A angled mirror is positioned below the glass to
provide a view of the plantar surface of the foot.
The patient gets
on the glass barefoot standing on one foot or on both feet (Pic. 1). |
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(Pic. 1) |
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The podoscope allows to evaluate the pressure distribution over
the different areas of the plantar stance. These areas are
presented with images of different luminous intensity. The image
as viewed through the mirror can be photographed or videotaped.
The evaluation of the images is based on the observation of the silhouette
of the footprint and of the distribution of the pressures. |
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(Pic. 2) |
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The PODOGRAPH is used to get footprint.
It consists of a a carbon paper positioned on an adhesive thin
card. The resulting image allows to analyze the shape of the
footprint and the distribution of the pressures thanks to
different shaded areas printed on the card. The darker zones
indicate a hyper pressure, whereas the clearer zones indicate a
normal or a hypo pressure. As the footprint is imprinted on a
paper (the so called podogram) and the paper is covered with a
transparent cellophane paper, the image stays indelible. There
are also other devices using ink instead of carbon paper, but they function in the
same way. (Pic. 2)
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The STABILOMETRIC
RUG OR BOARD is a computerized device with
a software set up to record the pressure distribution and equipped with a
peripheral system consisting of sensors and of linking system
between the sensors and the computer. The patient can stand on
one foot or on both feet; with closed or with open eyes according
to the evaluations to be performed. This device allows to analyze
the shape of the footprint, the pressures exerted by the weight
of the body, an the distribution of this weight over the different
segments of the plantar stance. |
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Pressures are expressed in Kg. and the distribution
is expressed in percentage. The values provided with this device
are certainly more precise than the ones provided with the two previous
methods (Pic.3)
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(Pic.3) |
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(Pic.
4) |
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| The evaluation of such a footprint
focuses above all on morphological aspects. A footprint
can be defined as normal, when the print of the foot's
isthmus, that is the middle part of the foot touching
the ground along its lateral edge, is 1/3 of the
forefoot's print. (Pic. 4) |
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| In a footprint of a flatfoot the
isthmus is more than 1/3 of the forefoot's print, you
have also to pay attention to the three degrees
expressing the seriousness of the pathology, that is
slight, middle, serious or 1rst degree, 2nd degree, 3rd
degree evaluated according to the surface covered by the
isthmus' print.
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| In a footprint of a claw foot the
isthmus is smaller than 1/3 of the forefoot's print, you
have also to pay attention to the three degrees
expressing the seriousness of the pathology, that is
slight, middle, serious or 1rst degree, 2nd degree, 3rd
degree evaluated according to the surface covered by the
isthmus' print. |
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There are then a lot of sub classifications
such as: pronated foot or supinated foot, valgus or varus back foot
etc.
This method of evaluation and
classification is universally recognized and shared. Till
nowadays, on the basis of these paramters, it was possible to
distinguish a altered foot from a perfectly normal foot.
On the contrary, my evaluation method is an
evaluation method of functional kind.
Starting from the concept that in statics
the anti gravitational spatial arrangement of the foot's arches
is maintained by the active force developed by muscles and
fasciae, I focused my evaluation on the function of these
muscles and of these fasciae. I singled out the so called
"static muscular chain of the plantar stance"
consisting of : |
- flexor hallucis brevis
- adductor hallucis
- flexor digiti minimi brevis pedis, these muscles are
responsible for maintaining the anterior transversal arch;
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- flexor hallucis brevis
- abductor hallucis
- pronator wedge's zone, these muscles are responsible for maintaining
the medial longitudinal arch;
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- flexor digiti minimi brevis pedis
- abductor digiti minimi pedis
- supinator wedge's zone, these muscles are responsible for
maintaining the lateral longitudinal arch. (Pic.5)
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 (Pic.5)
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Therefore, I consider as normal, a foot
presenting a normal function of all components of the static
muscular chain of the plantar stance. Normal function means that
these components ensure a normal spatial arrangement, a normal
elasticity and a normal shape of the plantar arches. In a normal
foot the afferences of the autonomous nerve endings belonging to
the musculo-legamentous and articular tissue should be normal,
too.
I often noticed that a footprint appearing
as normal from a morphological point of view doesn't correspond
to a normal foot from a functional point of view.
Therefore, I needed a new kind of
classification, not just to elaborate something new, but in
order to express through common words a different concept.
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| Functional classification of the plantar stance (Pic.6-7):
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(Pic.6)
functional flat foot :
loose
musculo-ligamentous tissue concerning the medial foot's sole
area.
1rst, 2nd and 3rd
degree according to the how many muscles are in hypo tone. |
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| (Pic.7)
Functional claw foot: |
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loose
musculo-ligamentous tissue concerning the lateral area of the
foot's sole and never concerning the higher part of the medial
arch.
1rst, 2nd and 3rd
degree according to the how many muscles are in hypo tone. |
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I compared the two different methods by examining 525
patients. The outcomes are showed by the following tables. As
you can see there is a great difference between the two methods.
All tested patient had postural alteration, so they presented
symptoms and signs of this pathology.
If I had performed only a morphologic evaluation of the plantar
stance, I would have never discovered that 14 patients showing a
normal morphologic footprint, presented, in the reality,
postural ascending syndromes. In this case the incidence of the
diagnostic error is 100%. 374 patients presented a morphologic
claw footprint, the merely morphologic evaluation had caused an
incorrect treatment, because 159 patients presented at a
functional evaluation, a flat foot. In this case the incidence
of the diagnostic error is 42,51%.
Only in patients presenting a morphologic flat foot I also
observed a functional flat foot.
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