автореферат диссертации по приборостроению, метрологии и информационно-измерительным приборам и системам, 05.11.17, диссертация на тему:Биотехнические методы оценки и коррекции растяжки стопы человека и лечебно-диагностический комплекс на их основе

MEDICAL UNIVERSITY OF KYOTO SAINT-PETERSBURG STATE ELECTROTECHNICAL UNIVERSITY "LET! NAMED AFTER V.I. UL'YANOV (LENIN)

SEIGOIRIE

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BIOTECHNICAL METHODS OF ESTIMATION AND CORRECTION OF FOOT STRETCHING AND MEDICAL - DIAGNOSTIC COMPLEX

ON THEIR BASIS

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Specialty: 05.11.17 - Devices, systems and articles

of medical purpose

Dissertation for scientific degree of Philosophy Doctor in Technical Sciences

Scientific Supervisors: Honored worker of Science of RF, Dr.T.S., Professor Popechitelev E.P. Ph.D. in Medicine, Professor Hirokazu Iida

St.-Petersburg-2003

CONTENTS

INTRODUCTION 4

CHAPTER 1. Review of known methods and means for estimation

and correction of foot functions........................................................................................................14

1.1. Classification of functional foot disoders........................................................................14

1.2. Description of known foot state parameters..................................................................23

1.3. Known Instrumental methods for the foot state............................................................31

1.4. Known Methods of correction of foot disfunctions..................................................42

1.5. Reseach problems formulation................................................................................................52

CHAPTER 2. Biotechnical for foot state estimation and correction......................57

2.1. Medical technology of foot state estimation and correction..............................57

2.2. Biotechnical instrumental system...............................................................................65

2.3. The system of the foot state correction methods........................................................81

2.4. Conclusions............................................................................................................................................93

CHAPTER 3. Biotechnical Technology and research results of foot state.... 97

3.1. Classification of foot state parameters................................................................................97

3.2. The development of mathematical model describing the foot state..............106

3.3. Expert estimation of mathematical model parameters............................................121

3.4. Biotechnical method of foot state estimation................................................................129

3.5. Conclusions..............................................................................................................................................134

CHAPTER 4. Experimental research results............................................................................137

4.1. Research program for foot estimation and correction..............................................137

4.2. Results of experimental research............................................................................................146

4.3. Recommendation for clinical usage......................................................................................152

GENERAL CONCLUSION..................................................................................................................160

ADDRESS OF THANKS........................................................................................................................163

REFERENCES................................................................................................................................................164

APPENDIXES..................................................................................................................................................173

INTRODUCTION

The human feet which support the entire body weight, control vertical balance, provide body's motion in the space, coordination when walking and other complex movements differ by variety of elements with complex structure of their interaction [1]. These interactions are reflected in so much matched physiological processes that even slight restriction of the range of motion (RROM) or myalgia affect the quality of performing of the said functions. It is not easy to maintain all functions of such a delicate part of the body because of the external factors influence (injury, contusion etc.), as well as internal reasons ( worsening of cord (copula, elasticity, salts deposits, age changers etc.) disorders of foot range motion occur and as a consequence, appearance of diseases of support and motion organs of a human being [2, 3, 4, 5]. Special importance myalgia has for professional sportsmen and those who are engaged in sufficient loads on support and motion organs. However for other people any disorders of foot range motion create difficulties for the fulfillment of every day work.

The main method for relieving of RROM syndrome and myalgia is thorough foot stretching. It is thought that many people recognize the benefits of stretching from their own experience, however, their role in provision of normal foot functioning has also been proved scientifically, physiologically, and statistically [6-8]. At the same time when studying possibilities of foot stretching methods surgeons pay attention mainly to mechanical mechanisms of this process not touching the depth aspects

which would allow to reveal the disorders reasons of foot range of motion and offer efficient methods for rehabilitation (recovery). One of the reasons of that may be the fact that complex methods and devices used for the walking analysis of a human being and allowing to perform detailed study of reasons of motion coordination disorders are not applicable in clinics. They require lengthy research and as a rule do not provide fast effect thus significantly increasing the time a patient spends in clinic.

When you explain this foot stretching by using the mathematics model, depression of the arch of the foot causes increases the tone of soft supportive tissue and the compression forces of various articular surfaces of tarsal bones during weight bearing. On the other hand, its elevation reduces the tone and compression forces and causes diffusion of the body weight applied to the plantar [9]. This is clear also from Hick's formula t = W-l/L-P/Q , in which t is the tone of the soft supportive tissue, W is the body weight, L is the distance from the heel to the thenar eminence, 1 is the distance from the heel to the line of weight-bearing, and P/Q is the inclination of the arch [9]. If tension t does not change constantly here, the height of the arch will be decided at the position of equal the COP to P and 1 ,that is, the position of the load line.

In a word, Hick's formula t = because can rewrite as — = —. Therefore, 1 is

QL PtL

done and when growing and still standing position incline forward, the arch can do elevate [10-12].

About the angle of the joint concerning foot stretching, Okita [13] examine the influence that the movable region limitation of the foot exerts on walking from floor reaction and motion analysis, and are considering the ideal way of the science treatment in thesis "The effect of limited range of motion in the foot on gait". That is, a movable region of the dorsi-flexionl5 degree and the plantar-flexion 15 degree is needed by articulatio talocrualis, and it described that the working rules the movement of a smooth weight core in relation to the movement of knee joint and hip joint and closeness [13]. And, it is described that it is not a little to cause an abnormal walking such as slouch gait of genu recurvatum and trunk in the case who has the movable region limitation in the foot such as after total ankle arthroplasty and ankle fracture after ankle arthrodesis, and to appeal for the pain to the joint and the stripe, etc. secondarily either in a clinical scene [13].

Because the promotion power decreases after heel strike when foot joint is fixed as the conclusion, it is necessary to stop the movable region limitation in the minimum. Moreover, it is described that the muscular power reinforcement of other surroundings muscles of the joint, maintenance, the improvements of the arch function, and consideration to shoes are necessary [13].

Miyahara [14] consider the relations such as the pressure distribution measurement values and arche about pressure distribution on the sole. That is, pressure is high in the heel and the hallucis, and it is reported it was low with the pedobaragram analyses of the distribution of maximum pressure areas of during

walking in midfoot [14]. High pressure's concentrating on calcaneus and caput Os metatarsale primum when walking does not have the objection by other reports either [15-20].

The author started research in order to clarify the mechanical effectiveness of foot stretching methods and revealing of stretching process aspects that were not taken into consideration earlier. In this case preference was given to such methods that can be easily used in clinics and at all that they should shorten the rehabilitation time of patients. The methods should include a set of treatment exercises and diagnostic estimations of their influence on foot range of motion in real time. This can be done only having a special biotechnical complex which should measure a number of biomechanical parameters characterizing the range of each foot motion and present diagnostic information to a doctor who controls the effect of applied exercises.

The objective of the thesis is to create a biotechnical method which allow to estimate as well as correct range of foot motion a human being with the help of a set of treatment exercises, and a diagnostic system for efficiency control of their application that allows to shorten significantly the period of patient rehabilitation in clinics.

In order to achieve these objectives, the following tasks were carried out:

- to perform systematization of known in traumatology ways of disorders correction associated with restrictions of foot range of motion, as well as applied for this purpose exercises and stretching methods;

- to perform experimental research both of forward and backward balance and purposes of RROM and myalgia appearance simultaneously registering pressure distribution on the foot in conditions of norm and pathological states;

- to develop both mechanical and mathematical models based on measurements of ankle joint RROM;

- to develop biotechnical system for diagnostics of foot range of motion (BTS-ROM) and clinical method allowing to control and correct foot range of motion;

- to perform experimental research which would confirm BTS-ROM efficiency in clinical practice and to develop recommendations on application of offered means.

Methods of mathematical analysis, probability theory and random processes, measurement theory and biotechnical systems synthesis theory were used when carrying out the work.

Experimental research of the restriction reasons of foot range of motion were based on application of standard methods and technical facilities. They were performed on the bases of the departments of physiotherapy and orthopedic surgery of medical faculties of the universities in Kyoto and Kansai, graduate school of engineering science of Osaka university (Japan);clinical trials of BTS-ROM were performed on the basis of medical faculties Methods of mathematical statistics and standard program packages were used for processing of the obtained data. Theoretical grounding of biotechnical facilities as well as partial data processing

were performed on the basis of the department of BME & EP of Saint Petersburg State Electrotechnical University.

Scientific principles presented for the defense:

1. New data on research of the influence of foot stretching methods were obtained. It was shown on the basis of these results that foot motion disorders are connected with the movement of the center of pressure (COP) when walking and standing both forward and backward; this leads to parameters changes of medial longitudinal foot arch that causes restrictions of its ROM.

2. For the correction of the ROM it is possible to use a set of special exercises that take into consideration degree and direction of pathology, biotechnical complex BTS-ROM should be used for the evaluation of efficiency of their application allowing to evaluate a number of biomechanical foot parameters and forming recommendations for a doctor concerning the selection of specific exercises from the recommended set.

New scientific results confirming these scientific principles:

1. Research method of human foot behavior in different modes of foot operation was developed which includes special research biotechnical system, a set of exercises, system for obtaining and processing of experimental research data.

2. New data on foot behavior were obtained that enlarged the view of the interaction processes of different parts of the body when supporting it at standing; in particular it was found out that the foot arch elevation occurs in case of gravity center

movement forward and backward, as well as inclination forward, and it can be registered with the help of sensors. Besides, the influence of other parts of the body (thigh, leg, trunk and head) on the position of its gravity center was shown.

3. Mechanical and mathematical model of foot operation when supporting the balance were constructed based on new data about the interaction of body elements; a relation was obtained connecting the effect of range motion measurement with its arch elevation.

4. Approaches to formation of a finite set of special exercises were developed allowing to influence on the arch elevation and thus objectively judge about the increase of the range of its motion. It was shown that application of theses exercises leads both to significant and fast relieving of RROM syndrome and myalgia and to significant improvement of ankle function.

5. Two modifications of biotechnical complex for RROM diagnostics were developed, one of which is meant for performing scientific research (it includes a set of sensors for arch elevation control and pressure distribution on the foot), and the other - for clinical practice. The latter variant includes the sensor system for arch elevation control, databases on exercise selection from the worked out set and recommendations on complex application in clinical practice.

Practical significance of the work consists in the following:

- new data on foot behavior under different operating conditions allowing to connect the range of foot motion with arch elevation and to reveal the influence of

other part of a human body on keeping vertical position of the body when walking and standing;

- models of foot operation when keeping the balance state when standing and walking explaining interaction of foot elements;

-a set of specially selected exercises for foot stretching with the aim of improvement of its range of motion that are combined in databases containing all necessary data about their application;

- two modifications of diagnostic complex of biotechnical type for the solution of research tasks and application in clinical conditions;

- recommendations on application of biotechnical complexes and the set of special exercises for correction of foot range motion disorders.

Implementation of results.

The results of the dissertation work were used when carrying out scientific research and practical work at medical universities of Kyoto and Kansai and graduate school of engineering science of Osaka university (Japan). The development of biotechnical systems BTS-ROM has been performed together with the department of Biomedical Electronics and Environment Protection of Saint-Petersburg State Electrotechnical University in 2001-2002, and the data on exercises influence on foot range of motion, modeling of biotechnical foot system and methods of experimental results processing were used in the educational process at the department of BME&EP.

Work approbation.

The main principles and results of the dissertation were discussed and reported at a number of international scientific and technical conferences in Japan and Russia, at the 9th World Congress of the International Society for Prosthetics and Orthotics "ISPO-98" (Amsterdam, The Netherlands, 1998), 13th International Congress of the World Confederation for Physical Therapy "WCPT-99" (Yokohama, Japan, 1999). The materials of the work were discussed at the workshops and annual conferences at the universities of Kyoto, Kansai, Osaka and ETU of the city of Saint-Petersburg.

Publications.

2 abstracts of the reports at scientific conferences and 5 articles in journals were published on the thesis subject.

Each chapter is described as follows.

In the first chapter of the dissertation, physiological mechanisms of foot functions control and purposes of these functions disorders are considered, a review of methods and instrumental means for estimation of foot functions is given.

In the second chapter a method of performing experimental research of foot behavior under different operating modes was developed as well as the research results of the influence of exercises on the improvement of foot range of motion (EIFRM) were given that allowed to obtain new data on interaction of different parts of the human body affecting the foot behavior.

In the third chapter the results of biomechanical and mathematical models of foot

stretching processes are given, relations for calculations allowing to estimate foot parameters are given.

The fourth chapter contains the description of technical facilities developed in this work including the description of two modifications of biotechnical systems of foot state diagnostics BTS-ROM, exercises set for the improvement of foot range of motion and recommendations on application of the developed methods into clinical practice.

CHAPTER1. REVIEW OF KNOWN METHODS AND MEANS FOR ESTIMATION AND CORRECTION OF FOOT FUNCTIONS

1.1. Classification of functional foot disorders

Human feet support the entire body weight, determining vertical balance, providing body's motion in the space, coordination of walking and other complex movements of the body. Morphologically the foot differs by variety of elements with complex structure of their interaction; it includes joints, articulations, ligaments and muscles. The interactions between them is reflected in so much matched physiological processes that even their insignificant changes can lead to the appearance of RROM and myalgia that influence the performance quality of mentioned functions. Rather often because of the influence of external factors (injury, contusion etc.), as well as internal reasons ( worsening of cord (copula, ligament) elasticity, salts deposits, age changers etc.) disorders of foot range motion occur and as a consequence, appearance of diseases of support and motion organs of a human being. Special importance myalgia has for professional sportsmen and those who are engaged in sufficient loads on support and motion organs. However for other people any disorders of foot range motion create difficulties for the fulfillment of every day work.

Four groups of foot diseases were distinguished: - diseases of foot bones and cartilages;

- diseases of foot muscles, fascia, tendons and ligaments;

- pathologies of foot nervous system;

- skin diseases.

Typical examples of such diseases are given for each group, however further research were focused only on those groups that are connected with the restrictions of the range of foot motion. Estimations of foot functioning quality were given when using known parameters of its state.

1.1-1. Disease of bone and cartilage of foot

1. Transformation of bone

• Talipes equinus...Talipes equines when heel goes up, foot does plantar flexion, and there is dorsi-flexion of zero degrees or more in ankle joint in general [21] (Fig. 1.1). There are traumatic talipes equinus, spastic paralysis talipes equinus, and drop foot in talipes equinus.

Atrophy of M. triceps is caused by injury such as tibial fracture, and the case, which becomes talipes equinus by the atorophy, is called traumatic talipes equinus.

The spastic paralysis talipes equinus appears at the cerebral vascular accident (below: CVA) due to injury of cerebral palsy, the apoplexy, and the head. It finally advances to rigidity of M. triceps, and talipes equinus is fixed though this is shown in spasticity of M. triceps.

Drop foot is flaccid paralysis, which consists of polio, spina bifida, and

Fig. 1.1 Talipes equines

paralysis of the peroneal nerve, and dorsi-flexion cannot be done.

Moreover, non-weight bearing is done as for talipes equinus at standing position and walking. And, it is weighted in Articulationes metatarsophalangeae by hyper dorsi-flexion of thenar and toe. Therefore, heel is small, and forefoot is enlarged to compensation.

• Talipes calcaneus...The talipes calcaneus of dorsi-flexion and heel of the foot has fallen [22]. Talipes calcaneus includes traumatic talipes calcaneus, functional talipes calcaneus, paralytic talipes calcaneus, and congenital talipes calcaneus, etc.

Traumatic talipes calcaneus is absorbed by the fracture of ankle joint or foot, and burn cicatrice of the foot dorsal and in front of the leg. Moreover, there are after the inflammations such as arthritis and osteomyelitis.

Both the transitive and the automatic ROM can be limited as for ankle joint when T. Achillis is damaged, and neither toe standing nor toe gait be done. However, this is consequentially called functional talipes calcaneus by talipes calcaneus and the same thing.

M. tibialis anterior and M. extensor digitorum make to vertical, and become Paralytic talipes calcaneus being pushed the functioning result and calcaneus downward with talipes calcaneus while the function of M. triceps disappears by M. triceps paralysis by polio and spina bifida, etc.

Congenital talipes calcaneus is the one that is seen when giving birth, and the

foot does dorsi-flexion as the foot touches front of leg.

• Talipes varus...The foot does adduction with inversion. In a word, supination, adduction, and plantar flexion of the foot are transformed combining [23]. The one of the nature still succeed a lot of etiologies to congenial dislocation of hip joint in the nature disease though it is clear ahead the orthopedics department area.

• Pes planus.. .The back of the foot become flattening by the weight load. Pes planus is combined a lot of elements, and decreases the arch. A main symptom of pes planus is a pain and fortune-telling tiredness. If, if the pain is a slight injury, it is abundant in surroundings and sole of ankle joint. However, it expand to the whole of foot, leg, outside of thigh, and low-back when progressing [24]. Moreover, the pain in pressure in sole, articulation talcalcaneocularis, and ankle joint is caused, too. These pains are conscious with the passage of the time of standing position and walking. Be to take a rest, and the feature however to disappear by non-weight.

2. Pain disease of bone of foot

• Metatarsal pain...Pathology essence is not clearly defined though it is a disease widely admitted. Basically, it is a syndrome of the pain in the vicinity of metatarsal. As for the cause, mechanical or the nerve etc. of the blood vessel, bloodless, and the limited part are enumerated [25].

• Morton syndrome.. .It is a syndrome that hangs to metatarsal secundum by short metatarsal primum a more excessive weight load, and becomes painful [26]. Moreover, this syndrome is an inheritance.

• March fracture...It is admitted by the stress fracture of metatarsal after walking for a long time. This fracture is incomplete fracture of metatarsal diaphysis secundum & tertium that is not accompanied by the bone move at all [27]. Clinical, there is a pain in pressure in the fracture part, and the patient admits the pain with flexion and extension of toe at full weight bearing.

• Pes cavus.. .It is said claw toe, and keeps an abnormally high arch (Fig. 1.2). This high length arch inclines caput metatarsal when shortening foot is caused, and the floor comes in contact. Therefore, the pain in metatarsal is caused, and caput under callus is formed. In pes cavus, there is traumatic pes cavus by the cicatrice etc. of the injuries such as essential pes cavus of an uncertain cause, foot fracture, and dislocation and the burns [28].

• Hallux valgus...It is a disease with a pain by incomplete dislocation of Articulationes metatarsophalangeae. Basically, it is a move of metatarsal primum to the inside, and incomplete dislocation to the outside of phalanx proximalis of hallux. Moreover, the appearance of disease, by both who which is the nature ahead and acquired, is thought as for the etiology. Generation in lineage is seen, and high-heeled shoes which thinly presses arthritis of feet such as rheumatoid arthritis and gout and the foot ahead is used regularly as acquired in the nature ahead [29].

• Hammer toe.. .The pain is possessed with immobilization flex deformity of articulations interphalangeae [30], and it happens well for second, third and fourth

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phalangeae. Callus is formed to back of articulations interphalangeae that does flexion.

• Calcaneus apophysitis...It is calcaneus apophysitis, and infant's pain disease before epiphysis shuts [31]. This disease most often happens to an adolescent man that it is active between 8 years old and 13 years old. It happens due to injury to T. Achillis of the jump etc. like an excessive stress.

1.1-2. Disease of muscle, fascia, tendon, and ligament of the foot

1. Disease of the muscle

• Rupture of M. triceps.. .It is rupture which happen by an inside head of M. triceps. The majority often happens by the age group from 30 to 50 years old because of a rapid movement.

2. Disease of the fascia

• Fascitis of sole.. .The pain in pressure in the pain and the limited part is admitted forward of the heel, and there is a pain in pressure in the area in front of calcaneus when deeply pushing [32]. This disease happen when the person who did not exercise a lot till then stand in the man for a rapid long time or walking.

• Duuytren's contracture...It is a disease by which hard tuberous which divides into the leaflet is shown in aponeurosis of sole [33]. In the etiology, the possibility caused by repeating injury is low, and the inheritance is a factor. Moreover, a lot, and it is abundant in alcoholism, epilepsy, and the diabetic patient at 40-years old level.

3. Disease of the tendon and ligament

• Rupture of T. Achillis.. .It happens because of a blow to a rapid, excessive shrinkage of Mustles of gastrocnemius and soleus or combination of tendons of gastrocnemius and soleus [34]. It is rupture of so-called T. Achillis.

• Sprain of ankle joint...It is sprain most often thought to be an occurrence due to the damage of Lig. Ankle joint lateralis.

1.1-3. Disease of nerve system of foot

• Spinal paralysis...Damage or the pressure that happens at the level of L4-L5, L5-S1 or S1-S2 is a cause. The paralysis occurs to the foot and ankle joint.

• Sciatic paralysis.. .They derives from L4, 5, S1, and two-nerve root, and the paralysis of the movement nerve and the perception nerve to a lot of leg muscles and all stripes of the foot occurs.

• Flaccid paralysis...Abnormality of the perception and the defect of the movement is shown due to disease of leg of the nerve by which foot is violated.

The cause contains a lot of whole body nerve diseases who's the polio, the guillain-barre syndrome, inflammation of sciatic nerve, and the hernia of thelumbar vertebra and diabetics are factors [35].

• Spastic paralysis.. .The function trouble is spastic and talipes equinus. The foot becomes talipes equinus, and dorsi-flexion is disturbed in standing position and walking in a line spastic is accompanied movement neuron disease [36].

1.1-4. Disease of skin of foot

• Callus...Callus is a thickness of manure of the skin that happens as a reaction to obstinate friction stimulation with a pressure tendency. In addition, callus is proliferation of a mere skin at the level of the skin there is neither a complete organization of the skin nor the participation of the blood vessel if I say in detail [37]. The mechanism of an abnormal foot often takes part in the cause. Caput metatarsal primum in hallux valgus etc. are the representative.

1. 2. Description of known foot state parameters Foot existing parameter is described in the following.

1. 2-1. Floor reaction force Floor reaction force is measured by force plate [38]. Force plate is the device that measures the power caused in sole at the walking time, and a basic principle is the same as the platform scale. Therefore, to separate floor reaction force of a right and left leg, and to measure floor reaction force, two-force plate is needed.

In force plate, the foot is first put and a floor thing that walking can do, in a word, the plate is necessary. Moreover, the device, which can perceive power, that is, the sensor, is necessary. As a general sensor, the board is supported in the pillar, and the function of the sensor has been provided for it. The part, which corresponds to this pillar, is a part same as the platform scale.

In the point where force plate is different from a mere platform scale, each one of the pillar is an independent platform scale. Therefore, when the weight is supported in the plate, the size of the power, which support the power, and point of application

can be calculated because the distribution of the power applied to each pillar is understood. In addition, horizontal force can be measured by the pillar's bending in force plate though only the power of direction of vertical can be measured