The Static Exam

Table of Contents
1. How to perform the Static Exam 2. Analysis Important Indicators Foot Geometry B.P.I. Static Index Presented I.B.P. Values Compare Data 3. Static Published Normal Values Static Survey Description of L-C-R Surface and Pressure Numerical Values Static isopressure analysis

How to perform the Static Exam

STATIC ACQUISITION
Explain to the patient what you are investigating and the procedure. The patient should be wearing appropriate attire, as clothes may alter the results of the exam. While you are inserting the patients information into the computer, let them walk/stand on the platform to become comfortable and to relax their feet from the shoes they were wearing. The patient must stand on the Static place of the platform. Ask them to touch the specific alignment tool with the heel end of their foot and to assume a comfortable position. For certain patients you can check if the position is corrected by touching their leg muscles for contraction. The static acquisition is acquired with aligned feet from the heel, and it studies the natural rotation. Remove the alignment tool and ask the patient to face forwards, arms by their side, breath in and out once, swallow once , and keep their position without moving. Observe the patient and not the monitor. To start the acquisition simply click on

The acquisition takes 5 seconds for the software to determine the mean values of the small oscillations occurred within this time. While performing a Static Acquisition you can see the patients surface and weight %, which could be useful under certain circumstances. Once the Static exam is completed the software is automatically ready to analyse the data. Now close this window and perform the Dynamic Exam.

Analysis

The results of a static analysis acquisition are from a standing position on the platform. This shows the pressure points calculated on the average of 5 seconds, in a relaxed position. A wrong position of the patient could easily compromise the outcome of the examination and reveal unreliable information. The Static Analysis shows the main parameters of your patient. Remember that the basis parameters could completely change when walking. Before giving any diagnosis a study of the patient in motion should be examined.

When opening a Static analysis please check the positioning of the X axis: which should be placed on the midfoot, just behind the base of the 5th metatarsal. The Y axis should be placed in between the feet. You can also adjust the Axis while performing the acquisition.

Some times the software does not divide the footprint automatically (giving you a whole image): in this case you must divide those manually (by right clicking on the image) and selecting Split. Use Merge if rearfoot and forefoot are not recognized automatically by the software. By right clicking you can Export the footprint as a .txt or .bmp format (this option is available for most of the footprints you collect in the software and also for all the graphs).

Important Indicators
CoF (centre of pressure of each foot L-R) angle. This gives you an idea of the tilt in the structure (usually hip rotation). This value if negative indicates a clock wise tilt; positive a counter clockwise tilt. If it is too high this also shows an important rotation. Foot Angle Axis calculated as the angle formed by the line that starts on the second/third toe to the center of the heel and the vertical Y line. If it is too small (3/4 degrees) it indicates an excessive medial position if its too high (more than 15 degrees) it indicates an excessive lateral position. Total Surface % to observe if there are evident variations. In this case please observe which area has more visible surface (rearfoot or forefoot). Total Load % to observe if there are evident variations. In this case please observe which area has more visible pressure (rearfoot or forefoot). Other values: Global Surface: sum of the 2 feet P.Max (g/cm2): corresponding to the maximum point of pressure of all the points of contacts. Showed on the footprint image as an M P.Avg (g/cm2): corresponding to the average pressure detected on the entire plantar surface Feet angle: corresponding to the polygon of pressure of the two feet LF/RG rearfoot/midfoot surface and load: corresponding to the distribution of a single area Weight Ratio R/F: corresponding to the percentage of load distribution between Rearfoot and Forefoot Foot Angle: corresponding to the angle formed by the external lines of the foot.

Foot Geometry
This section allows you to add more information to the Static Analysis, such as the Angle views (left side of the windows) on which the foot is automatically divided in 6 areas, detecting the rearfoot (medial and lateral), the midfoot (external/internal) and the forefoot (medial and lateral, including toes, if detected). In each area displayed is the surface and the averaged pressure. The image also shows the M, maximum Point of Pressure that usually on a Static Analysis should be located on the rearfoot (left or right). Also displayed is the polygon of contacts (right side of the window) which is calculated the CoP Position (both on mm and %) calculated from the ending line of the rearfoot.

Additional calculated values are: - The BPE length, corresponding to the measured length of the foot, calculated on the numbers of detected pressure points (its not the morphological length). - The distance of both CoF (LF/RG) from the ending line of the rearfoot (mm). - The distance (mm) of the LF/RG CoF from the central axis line - The distance (mm) of both CoF (LF/RG) to the CoP - The detected distance between the CoP and the Geometrical Center of the Polygon.

In the B.P.I. Static Index section you will find additional data of the Static Analysis values. In this window there is also a brief description of the main values of the Exam that could be used as a good base for the diagnostic report of the Static Analysis. Before printing be sure that all the information described into the generic report are correct (watch the numbers and the footprint image). RR command will recalculate the report in case of deleting some part of it while overwriting. By clicking on Area you will pass from the pressure point presentation to the 6 colour presentation. This is a very interesting value to better understand the lateral/medial displacement of the foot, reading the values in percentage (pressure/surface). Usually the total should be 50% 50%. We are observing that small variation shows attitudes in pronation/supination.

B.P.I. Static Index (Biomechanical Postural Index)

From the same Geometry window you can access the Indexed indicators by introducing the assigned password. If you do not have it this means that you did not order this feature. Please ask for more details from your local Distributor or directly to Diagnostic Support. You have the list of several exams of the patient. You can open different exams, for example the first and the last one, and compare the two different values simultaneously. By passing over on each single value with the mouse, you can see a brief explanation of the Indicator.
The scale for each indicator used is the following: 0 = normal values. This is not an absolute value and includes a small range of variation. 1 = indicates that the values are still close to the normal range but lightly increased 2 = indicates that the values are higher respect to the normal values and require to be observed during the treatment 3 = indicates a real discrepancy from the norm and require more attention

Presented I.B.P. values:

The CoP geometric position is calculated as the distance, expressed in percentage of the length of the polygon of foot support, of the Centre of Pressure (CoP) from the ending line of the rearfoot. This index allows to evaluate possible shifting of the CoP, and therefore of the body gravity centre, in anterior or posterior direction. - The variation of bipedal load is calculated as the difference of load percentage among right and left foot, calculated on the average of the oscillations of the subject during 5 seconds of acquisition. This index allows evaluating possible unbalance toward right or toward left. - Variation of load between rear and fore foot is calculated as the difference of load percentage between the rearfoot and the forefoot (values more than 0 point out a greater percentage of load on rearfoot or forefoot). This index allows evaluating possible unbalance of load in direction anteriorposterior on each of the two feet. Two indexes one for the left and one for the right. - The angle of centres of pressure (CoF) is calculated as the angle, express in degrees, formed by a straight line from the centres of pressure of each single foot (LR). This index allows evaluating a possible tilt of the hip. The angle is negative if in hourly direction (left behind right) and vice versa. - The angle of the foot axis is calculated as the angle, expressed in degrees, formed by the axis (from the 3rd to the center of the heel) of each foot and the vertical Y axis. This index allows evaluating possible medial or lateral foot attitudes with two indexes, one for the left and one for the right.

- The location of the Point of Maximum Pressure (PMP) is the calculated position of the maximum single peak of pressure "M" on the foot. Generally the PMP is located on the rearfoot. If on the forefoot or, less favourably on the midfoot, it is a symptom of overload, there are two indexes, one for the left and one for the right. - The surface is calculated as the number of points active on the platform, expressed in square centimeters. This index allows evaluating morphological foot alterations (for instance flat foot, cavus foot, etc). There are two indexes, one for the left and one for the right. - The surface variation is calculated as the difference among right and left foot surface. It is important to evaluate any foot imbalance. The values are not yet printable because there is still a scientific evaluation in progress performed by the Postural Biomedicine Team. At the moment we suggest you to use the Total as an indicator between i.e. before and after treatment value. We hope that your experience should also contribute to increase the validation of the values.

Compare Data
By clicking on you can compare the acquired exam with an image that shows you (see to the left) a normal footprint. You can also compare different exams (static with static or with dynamic) of the same patient, or with a different one. The pictures to the left shows a comparison of the same patient in between two acquisitions, one on spontaneous rotation and one with parallel feet (to avoid pelvic influences).

Static Surveying
After carrying out a static acquisition, it is possible to compare the image with normal values. The standard image values are comparable only if the exam has been carried out checking the exact positioning of the patient and their correct foot-resting position. The static footprint shows a ten plantar pressure scale in colour, to point out the loads intensity on percentage of the maximum pressure, displayed as M (gr/cm). The load percentage is explained in the scale below:

Colour Red Orange Pale green Dark green Dark blue Pale blue Azure Beige Dark brown Pale brown

P.Max % 100-91 90-81 80-71 70-61 60-51 50-41 40-31 30-21 20-11 10-0

Description of L - C R
Subjects centre of pressure projected on the perpendicular to the ground C=CoP. Each limbs pressure centre (L and R) and the pressure centre (C) must be aligned and equidistant among them. Their location is approximately at the mediotarsal line or Chopard interline (peak of the arch). The CoP can be localized behind or placed before the mid line: if placed behind, this means that the body load is more on the rear foot (i.e. a subject with an increased lordosis), if placed before it means that the load is more on the forefoot and the body is shifted ahead (usually on dancers or tall subjects or patients with increased kyphosis). If L - R centres are not aligned (one ahead and one back) it could mean there is a pelvic imbalance.

Surface and pressure

Surface should be uniformly distributed in between the feet; and the rearfoot and forefoot should have similar surfaces (number of activated sensors). Usually toes are not completely visible or are presented with small points (light pressure), due to missed contraction of the toes flexors in standing position. The forefoot, shown from 1st to 5th metatarsal (in cross-section), usually does not show evidence of high pressures. There is normally more pressure on 3rd and 4th metatarsal. The midfoot should display an area corresponding approximately in between 1/3 and 2/3 of the forefoot surface and a pressure less then rearfoot and forefoot, however localized mostly on the external edge. The point of maximum pressure " M " must be centrally located in the rearfoot (is displayed on the forefoot or on the middle-foot it is a symptom of hyper loads).

Numerical values
Numerical values are calculated for each exam, compared against normal values. This can also be a useful reference point to help patients understand this data. The body weight of the subject should be balanced between the right and left limb; and load should be well distributed between forefoot and rearfoot areas (see the chart to the right):

Rearfoot/Forefoot Distribution

Rearfoot

Forefoot

Normal values (without footwear)

55%

45%

Normal values (with footwear)

50%

50%

Tolerance

+/- 4%

+/- 4%

Global Load distribution

LF Limb

RG Limb

Normal Values

50%

50%

The global surface of both feet should be equally distributed in between left and right (with an allowed maximum difference of + / - 10%). Generally the foot which presents greater surface, should also present more load. The areas of load/surface of rearfoot/forefoot are not so important while analysing data. Just remember that when a patient overloading an area of the foot (rearfoot or forefoot), usually, due to gravity compensation, display more load on the controlateral side (i.e. LF rearfoot/RG forefoot).

Tolerance

+/- 3%

+/- 3%

A normal subject, proportional to foot length, presents the following global surface values for each foot (with variations of +/-10% according to the following table):
Minimum value (cm) 100 WOMAN ADOLESCENT CHILD 90 80 50 Maximum Value (cm) 140 120 120 80

Static Isopressure Analysis

Isopressure values display all the points having the same load intensity (percentage) and are useful to understand load characteristics of that subject, while observing in 3 colours. The three pressure levels express in order: higher load, medium load and minimum load, detected on percentage of the foot surface (see table below):
Colour Level I II III Surface % 10-14 30-35 50-55

The 1st level is presented with RED dots. These should be displayed only on the rearfoot centrally with some points visible either medially and/or laterally. The 2nd level is presented with GREEN dots. These should be displayed surrounding the rearfoot and in particular on the metatarsal (from 1st to 5th MPJ). The 3rd level is presented with BLUE dots. These should be displayed on the lateral edge of the midfoot. Additional points could be presented surrounding GREEN and RED colour points. Generally toes always show some BLUE (on the hallux) or GREY dots. If the areas (rearfoot/midfoot/forefoot/toes) show pressure values higher or lower than the isopressures level, this indicates an over loading or under loading.

Red Green Blue

THE END