Forefoot Pressure Analysis of Adult & Healthy Population

Names Seat No

Rimsha Najam BM-14044

Hafiza Shanza Mehar BM-14055

Ramsha Siddiqui BM-14077

Project Supervisor Dr Syed Wasim Raza

Thesis submitted in the part fulfilment of the

Bachelors in Biomedical Engineering
Ned University of Engineering and Technology
Batch 2014-15
2018
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TABLE OF CONTENTS

TABLE OF CONTENTS ..................................................................................................ii

LIST OF FIGURES ......................................................................................................... iv

LIST OF TABLES ............................................................................................................ v

DEDICATION ................................................................................................................. vi

ACKNOWLEDGEMENTS ............................................................................................vii

DECLARATION ...........................................................................................................viii

ABSTRACT ..................................................................................................................... ix

CHAPTER 1 ..................................................................................................................... 3

1. INTRODUCTION ................................................................................................. 3

1.1. Foot .................................................................................................................... 3

1.1.1. Structure of Foot ............................................................................................. 3

1.1.2. Functions of Foot ............................................................................................ 8

1.2. Sole..................................................................................................................... 8

1.3. Pedobarography.................................................................................................. 9

1.3.1. Needs for Plantar Pressure Measurements .................................................... 10

1.3.2. Barefoot Plantar pressure Measurement Assessment ................................... 10

1.3.3. In-Shoe Pressure Evaluation ......................................................................... 11

1.4. Foot During Gait .............................................................................................. 11

1.5. Aims and Objectives ........................................................................................ 13

2. LITERATURE REVIEW....................................................................................... 13
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CHAPTER 2 ................................................................................................................... 22

2. MATERIALS AND METHODS ............................................................................ 22

2.1 The subject ........................................................................................................ 22

2.2 DATA COLLECTION...................................................................................... 22

2.2.1 Anthropometric Measurements ...................................................................... 22

2.2.2 Planter Pressure Measurement by Pedograph ................................................ 24

2.3 STATISTICAL ANALYSIS ............................................................................. 27

CHAPTER 3 ................................................................................................................... 28

3. RESULTS ............................................................................................................... 28

3.1 LEVENE’S TEST AND t-TEST ...................................................................... 34

3.2 INTERPRETATION OF LEVENE’S TEST RESULTS .................................. 34

3.3 INTERPRETATION OF t-TEST FOR EQUALITY OF MEANS .................. 35

3.4 PAIRED TEST RESULTS ............................................................................... 37

3.5 ASSUMPTIONS ABOUT THE RESULTS ..................................................... 38

CHAPTER 4 ................................................................................................................... 40

4. DISCUSSION ......................................................................................................... 40

CHAPTER 5 ................................................................................................................... 42

5. CONCLUSION ....................................................................................................... 42

REFERENCES................................................................................................................ 44
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LIST OF FIGURES

Figure 2.1 Scale used for anthropometric measurements ............................................... 23

Figure 2.2 Measurement of ankle width and foot span ................................................... 23

Figure 2.3 Measurement of knee width and foot length. ................................................ 24

Figure 2.4 The main sensor unit...................................................................................... 25

Figure 2.5 User friendly command window (Bi-Beat software)..................................... 25

Figure 2.6 Colour coded image showing 3 selected points of pressure. ......................... 26

Figure 2.7 Colour coded graph of the selected pressure points ...................................... 26

Graph 3.1 Means of Anthropometric data in males and females………………………29

Graph 3.2 Means of pressure values in males and females……………………………. 30

Graph 3.3 Means of Anthropometric data in normal weight subject………………….. 31

Graph 3.4 Means of Anthropometric data in over weight subject…………………….. 32

Graph 3.5 Means of Anthropometric data in underweight subject……………………..32

Graph 3.6 Means of Pressure values in under-weight, normal-weight, over-weight

subjects………………………………………………………………………………… 33
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LIST OF TABLES

Table 3.1 Means of Anthropometric data in males and females ..................................... 29

Table 3.2 Means of pressure values in males and females ............................................. 30

Table 3.3 Means of Anthropometric data in under-weight, normal-weight, over-weight

subject ............................................................................................................................. 31

Table 3.4 Means of Pressure values in under-weight, normal-weight, over-weight

subjects ............................................................................................................................ 33

Table 3.5 Independent sample test .................................................................................. 36

Table 3.6 Paired Sample Test-95% Confidence interval of the difference. .................... 38

Table 3.7 Paired Sample Test.......................................................................................... 38

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DEDICATION

We dedicate our work to our supervisor Dr Syed Wasim Raza, family and our friends.

Special feelings of gratitude to our loving parents who gave us encouragement and

supported us through the thick and thin during this project. We also dedicate this

dissertation to all our teachers who have supported us throughout the process. We will

always appreciate to all they have done for helping us to develop technology skills and

help us to bring out the best in us.

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ACKNOWLEDGEMENTS

By the grace of Almighty Allah it is our pleasure to accept that He has blessed us with

strength and wisdom to work on an assignment which was a challenge for us. It is quite

inevitable that the task could not have been done if we were not interested by Allah to

do it efficiently.

It is our great pleasure to accept the extreme support, constructive criticism, sympathetic

treatment and continuous guidance by Dr Syed Wasim Raza during the course of thesis.

We would also like to thanks Mr Syed Mohammad Kamran for sincerely helping us in

our research work.

We are grateful to the entire team of Biomedical Engineering Department, NED

University of Engineering and Technology for providing an opportunity to utilize our

strength in our research

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DECLARATION

We hereby declare that this dissertation entitled (Plantar Pressure Analysis of Fore foot)

has been prepared by us under the direct guidance of (Dr Syed Wasim Raza) as part of

our study for the award of B.E. Degree at the NED University of Engineering and

Technology, Karachi, Pakistan.

We have not submitted this dissertation previously for the award of any degree or

diploma at any other institution.

Names Seat No Signature

Rimsha Najam BM-14044 ________________

Hafiza Shanza Mehar BM-14055 ________________

Ramsha Siddiqui BM-14077 ________________

Date: _______________________
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ABSTRACT

Plantar pressure measurement is one of the most important parameter to assess the

biomechanics of human. Many researches had been done on plantar pressure

distribution of foot to get early and advantageous information which helps in diagnosis

of foot disorders. In addition, a diagnostic tool pedograph develops preventive measures

and the quality of orthopaedic treatment of diabetic foot.

For this study, subjects both male and female were recruited aged between 17 to 25

years. Measurements included anthropometric measurements and plantar pressure

measurements. For each individual anthropometric measurements comprises of foot

length, foot span, leg length, knee width, ankle width and ASIS. To calculate BMI for

every individual weight and height are also measured. For plantar pressure

measurements floor based pedograph is used. The aim of this research is to find out the

maximum pressure point of fore foot in both males and females of each foot during

mid-stance phase and to compare the plantar pressure of fore foot between males and

females.

The observation of current study showed that males and females applied maximum

pressure on the right-mid and left-mid region of fore foot while minimum pressure was

on right-lateral and left-lateral region of fore foot. Regarding male and female, male

exerts high pressure on their fore foot during mid stance phase because of the

significant difference of height and weight. The data was consistent with the findings

and consequent calculations for the mean, standard deviation and t-test results.

The data obtained from this research will be helpful in detection of foot disorders in

initial stage whose symptoms usually tend to appear lately with the growing age.

This study will also help in providing preventive measures for the treatment of

particular disorders of foot and will also help in designing of foot wear which helps to
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balance the plantar pressure distribution in foot, posture and walking pattern of the

subjects.
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CHAPTER 1

1. INTRODUCTION

1.1. Foot

Foot is the part of lower limb. The foot is formed by malleable arrangement of bones,

muscles, joints, and soft tissues of body which enable us to stand upright perform

movements such as walking, running, climbing and jumping. In various animals with

feet, the foot is an alternate organ at the terminal bit of the leg contained no less than

one parts or bones, all things considered including paws or nails.

1.1.1. Structure of Foot

The human foot is a strong and complex mechanical structure comprises of 28 bones,

30 joints and more than 100 muscles, tendons and ligaments, all of which work together

to give support, balance and mobility.

Figure 1.1 Structure of foot (https://www.webmd.com/pain-management/picture-of-

the-feet, n.d.)
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Foot is divided into three parts:

 Fore foot

 Mid foot

 Hind foot

The fore foot comprises of five toe bones called phalanges, five proximal bones are

metatarsals and tarsal bones. The fore foot is the anterior region of foot which bears half

of the body weight.

The midfoot form the pyramid structure, there are number of bones present which forms

the arch of the foot.

The hind foot also known as rare foot. The region of ankle and heel are part of hind

foot.

Foot structures further has been divided into different groups. It included:

 Bones and articulation

 Nerves

 Muscles

 Blood vessels

 Ligaments and tendons

Bones of Foot

Tarsal are sets of seven irregular bones proximally situated in the foot and in the ankle

area. Metatarsals are the bones which connect the phalanges to the tarsal. There are

three phalanges in each toe a proximal, intermediate and distal. These are the bones of

fore foot.

Mid foot comprises of five bones known as lesser tarsal bones which are cuboid,

navicular, medial cuneiform, intermediate cuneiform, and lateral cuneiform. Cuboid

which is present on the outer part of the foot forms the connection between ankle and
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foot and provides support for the movement of toes. Navicular present on the inner side

of foot. Medial Cuneiform known as a bone of big toe prior to navicular bone.

Intermediate cuneiform is the smallest cuneiform bone which provides flexibility to

foot. Lateral cuneiform present in center of front tarsal bone.

The largest bone of the foot is the part of hind foot. Talus and calcaneus are the bones

of hind foot. Talus is also considered as ankle bone while the calcaneus bone is also

called heel bone.

Figure 1.2 Bones of the foot (http://heritance.me/, n.d.)

Nerves of Foot

Tibial nerve is the main nerve of the foot. This nerve further split into branches like

Medial calcaneal nerve which innervates plantar medial heel. Lateral plantar nerve that

induce adductor, quadratus plantae, all interossi muscles and lateral two lumbricals. It

provides sensation to the fifth toe, plantar lateral foot and lateral fourth foot. Sural nerve

provides dorsal sensory and it is unsafe during the screw placement for stress and in

lateral approach to calcaneus. Deep peroneal nerve provides the response to the first

dorsal webspace. Superficial Peroneal nerve have medial and lateral cutaneous

branches. Medial branch is at risk during bunion surgery and is at dorsomedial aspect of
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hallux. Whereas lateral cutaneous branch is risky at arthroscopic anterolateral portal and

it rises from deep fascia with 12-15 cm proximal to tip of lateral malleolus.

Saphenous Nerve supplies impulse to medial side of foot.

Muscles of Foot

Just like there are so many bones and ligaments in the sole of the foot, there are as many

muscles too which are divided into four groups:

 The central muscles of the sole of the foot

 The lateral muscles of the sole of the foot

 The medial muscles of the sole of the foot

 The muscles of the dorsum of the foot

On the sole of foot, a large amount of muscles of the foot are arranged in layers. They

give easiness underneath the sole of the foot by moving the toes and bringing it

together.

The main muscles of the foot that help in the movement are tibialis posterior, tibialius

anterior, tibialis peroneal, extensors and flexors.

Blood Vessels

There are three primary sources from where the blood supply of foot comes that are:

 Peroneal (fibular) artery

 Posterior tibial artery

 Anterior tibial artery

Peroneal artery: It arises from the posterior tibial artery nearly 2.5 cm from its

origin. Posterior tibial artery: It is the larger of the two branches of the popliteal

artery.

Anterior tibial artery: It is the smallest terminal branch of popliteal artery.

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Figure 1.3 Blood supply to the foot (https://www.orthobullets.com, n.d.)

Ligaments and Tendons

Ligaments are the soft tissues that connects the bones to bones. Other than the soft

tissue that attaches the muscle to the bones are called tendons. Both the ligaments and

tendons are fundamentally same, just their connecting areas are different. Ligaments

however hold the tendons in place and stabilize the joints. Plantar fascia is the longest

of these and it forms the dome of the sole of the foot. It permits the dome to curve or

get flatten providing stability and giving the foot power to start the act of walking. The

lateral and medial ligaments which are on the outside of the foot provides balance and

make sure that the foot can move up and down. Ligaments support and protect the foot

and also form the connection between the bones and skin and attached the arches of

foot.
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Figure 1.4 Ligament and tendons of foot (https://biology-forums.com, n.d.)

1.1.2. Functions of Foot

The foot is one of the most complex structures of the body. It gives basic support during

standing. It has a spring like qualities, absorb forces. This is achieved by foot arches

that spread the load out so it can be supported with least amount of effort and material.

The mobility of foot is important for gripping the ground reaction force of the body.

Stability of foot is necessary as it provides a stable foundation for the body. Foot needs

the volume to support the body weight and act as a stable.

1.2. Sole

The sole is the material organ which is in contact with the surface of ground while

standing and walking. The sole contains the thickest layers of skin on the body in light

of the weight that is reliably determined to it. Like those of the palm, the sweat pores of

the sole need sebaceous organs.

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The subcutaneous tissue in the sole has changed in accordance with deal with the high

neighbourhood compressive qualities on the foot sole area and area between the toes

and the bend by working up a course of action of weight chamber.

The central piece of tissue extends to the supporting bones and gives two divisions, the

normal section and the side log fragment along these lines they portray the breaking

points of the three muscle compartments of the sole.

The skin of the sole does not have any hair and pigmentation found elsewhere on the

body.

Figure 1.5 Sole (foot) (http://www.personaltreyner.com, n.d.)

1.3. Pedobarography

Pedobarography is used to consider the movements such as walking and stair climbing.

It is the investigation of weight fields acting between the plantar surface of the foot and

the ground.

The pressure field that acts between the foot and the support surface during every day

locomotors activities is the plantar pressure of foot. Results and information from such

pressure measures studies are so much important in gait and posture research for

diagnosing lower limb problems, footwear design, sport biomechanics, injury

prevention and other applications.

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To measure planter pressure many devices have been used that are generally classified

into two types includes platform system and in-shoe system. For measuring pressure

during walking and standing, platform system are used and are made up of straight and

solid pressure sensing elements organized in a lattice arrangement and embedded in the

floor. Foot must strike the center of sensing area for accurate measurement of planter

pressure. However in-shoe system, sensor are embedded in the foot wear and are

mouldable which gives the relationship of pressure between foot and the shoe.

1.3.1. Needs for Plantar Pressure Measurements

To diagnose foot problems at an early stage it is important to monitor foot health. One

approach to measuring foot health is examining foot plantar pressure characteristics. So

an accurate and reliable foot measurement system should be developed. (Praet &

Louwerens, 2003) and (Queen, 2010) found that the most effective method for reducing

the pressure beneath a neuropathic forefoot is using rocker bottom shoes and claimed

the rocker would decrease pressure under the first and fifth ray (metatarsal head). Queen

et al. indicated that future shoe design for the prevention of metatarsal stress fractures

should be gender specific due to differences in plantar loading between men and

women. Pressure variation can be associated to gait imbalance in the young population

and many individuals with diminish stability having health related issues. For enhancing

stability in the young population, foot planter pressure information must be utilized.

1.3.2. Barefoot Plantar pressure Measurement Assessment

There are several systems through which plantar pressure variation beneath bare foot

can be determined. For example: Sole printing method, optical framework, pressure

platform and load ells and insoles and pressure cushions are the four main types.

Printing technique is a very simple method to determine load distribution but

unfortunately it can indicate only the maximum pressure that happened under foot. On

the other hand optical framework provides an excellent resolution that the foot printing
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technique. So in static and dynamic plantar pressure studies pedograph systems have

been used widely.

1.3.3. In-Shoe Pressure Evaluation

Planter pressure between foot and foot wear is measured using in-shoe system. For

determining the pressure variation inside the foot wear variety of techniques have been

developed. For measurements of desired foot sole sites, in shoe discrete transducers or

matrix insoles has fixed focusing and barefoot walking issues as the transducer can be

placed at a particular region.

1.4. Foot During Gait

Figure 1. 6 The Gait cycle (http://advancedhealth.ca/services/orthotics, n.d.)

From heel-strike to heel-strike one gait cycle is being measured. It consist of a stance

and a swing phase. Stance phase is the time period in which the foot is on the ground.

60% of one gait cycle is on stance phase. During the stance phase, body weight is being

accepted by the leg and it then gives support to the single limb. Whereas in the swing

phase it is the period of time in which the foot is off the ground and it is moving

forward. 40% of the swing phase is one gait cycle. When the limb advances the stride
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which is the distance or gap between the two initial contacts of the same foot with the

ground, while step is the gap between the initial contacts of the alternating feet.

Stance phase

Initial contact (heel strike) is when the foot touches the ground. Muscular contraction

take place in which the hip extensors contract to maintain the hip. Quadriceps and

tibialis anterior also contract.

Loading response (initial double limb support) marks the starting of the double limb

stance. It basically occurs after the starting contact until the elevation of the next limb.

Ankle dorsiflexors contract to control the plantar flexion moment.

Mid-stance (single limb support) is the initial point of single leg support. It is the height

of the other opposite limb until both the ankles are in the coronal plane.

Terminal stance (single limb support) is the phase in which the heel rises off the ground

and continue until the other heel touches the ground.

Pre-swing phase (second double limb support) is the initiation of the second double

limb stance in the gait cycle. Only the hip flexors muscles contract to propel the

advancing limb.

Swing phase

Initial swing (Toe off) initiate the single limb support for the opposite limb. It is from

the elevation of the limb to the point of maximal knee flexion. Hip flexors muscles

contract in this phase.

Mid-swing (foot clearance) phase is the point in which the knee flexes to the extent

where tibia is vertical. Ankle dorsiflexors are the muscles that contract in the mid swing

phase.

Terminal swing (tibia vertical) is the phase in which the tibia is vertical just to the initial

contact. Hamstring muscles decelerates movement of high thigh in this phase.

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1.5. Aims and Objectives

The main objectives of this research are

 To find out the maximum pressure point of fore foot in males and

females during walking( mid-stance phase)

 To find out the comparison of plantar pressure of fore foot in males and

females during mid-stance phase

2. LITERATURE REVIEW

Foot is the inferior part of the body and considered as complex structure of human

body. It comprises of bones, tendons, ligaments, muscles and joints combine together to

form foot. It provide support to human body and perform countless activities such as

running, walking and jumping. The present study is based on determination of pressure

of forefoot during standing and walking in adult population .Difference of pressure was

observed of both right and left foot of male and female among normal weight, under

weight and overweight.

Previous studies were being done on plantar pressure of foot. Charalambos et.al

(Charalambos et al.2015.Plantar pressure measurement of foot in greek adult colleagues

of a technological institute., Journal of Physical Education and Sport,15(1),pp.20-23.,

n.d.) worked on the weight distribution pattern on fore foot of normal weight people and

identify the possible foot disorders between unlike walking patterns. Further, he

calculated maximum and mean pressure of medial, lateral and mid region and

concluded the highest pressure was observed on the mid region of the fore foot of

normal people.

Keijsers et.al (2014) (keijsers et al., 2009) the main objective of his work is to

determine the effect of certain subjects characteristics as compared to plantar pressure

pattern in an accumulated number of subjects. The independent variables of subject

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characteristics are body weight, age, body length, sex, foot length, foot width. From

result, he found that the body weight and foot size has some positive effects on plantar

pressure whereas the body length showed negative effect. More similarity was showed

in the pressure of heel, distal part of fore foot and mid foot.

Cavanagh et.al (1987) (Cavanagh, 1987) observed the plantar pressure distribution

during bare foot standing under eight regions of plantar surface of foot. Selected regions

of foot included lateral mid foot, lateral heel, medial heel, medial mid foot, first second

and lateral Meta tarsal, callus, second and lateral toes. He concluded that pressure under

heel is higher than the forefoot pressure while on fore foot more pressure is found on

second and third metatarsal. Through calculations he concluded that 60% of the weight

bearing load is carried out by heel and no relationship was found between peak pressure

and weight.

Goffar et.al (2013) (Goffar et al., 2013)the purpose of this study was found the effect of

load on plantar pressure during walking having different kind of arch respectively. The

subjects having low arched, high arched or normal arched of foot. The sensors were

placed in the shoes of an individual subject. Without concerning the load, the greater

force was observed in medial fore foot area of subjects having high arched foot while

those subjects who have low arched or normal arched having great force on toes.

Jacob (2001) (Jacob,H.A.C., 2001)estimated the amount of force on tendon and over

joint of first and second metatarsal head of forefoot during walking. His studies

concluded that during walking the higher force is along the flexor tendon of the first

metatarsal head that support the longitudinal dome of the foot and the second metatarsal

is more involved in carrying out bending of the foot.

Se-Won Yoon et.al (2016) (Se-Won yoon et al., 2016) the purpose of this study was to

examine the plantar pressure and balance ability on the basis of BMI. He divided the

subjects in two groups and all were females. The first group comprised of normal
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subjects and the second group comprised of obese subjects and none of the group has

any disorder. The area of measurement was hind foot and fore foot of both right and left

foot. The data was collected on two surfaces one is stable while the other is unstable.

The subjects are required to stand still on force platform without shoes that is on stable

surface and the same condition for unstable surface that is on spring plate. After the

calculation of BMI the result showed that during static condition there is no any

significant differences were observed in both hind foot and fore foot peak pressure

between those two groups on stable surface. While on unstable surface significant

difference was observed among the areas of foot in both groups.

Mch et.al (2010) (Mch et al.., 2010)worked on study to evaluate the foot pressure

difference between males and females subjects using in-shoe foot pressure measurement

system. He did not found any significant differences in peak pressure on basis of gender

differences. However contact area in all regions of foot in males was significantly

greater than that of female.

Sivakumar G & Rajesh Ranganathan (2016) (Sivakumar G& Rajesh Ranganathan.,

2016) worked only on the left foot of the subjects having foot disorders mainly diabetic.

He compared the foot trial of the normal people and people having foot disorder and

concluded that abnormal pressure was found in the mid region, third metatarsal and on

the head region.

Han et.al (2011) (Jin Tae Han et al., 2011) the objective of this study is to analyze the

peak plantar foot pressure and centre of pressure in normal foot and flat foot. Result

showed that in group of flat foot subjects the peak plantar pressure is noticed in toe

region as compared to normal ones. And the pressure on first metatarsal area was found

identical between the flat foot subjects and normal subjects. But in second and third

metatarsal a kind of pressure is increased in flat foot subjects than normal people but

there is no any important difference found between them. In flat foot group the lower
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pressure was on fourth and fifth metatarsal as compared to normal subjects and there is

statistically difference were found. In Mid foot area both the groups have similar plantar

pressure. Plantar pressure under the heel region was observed lower in flat foot subjects

than normal subjects.

Teyhan et al.(2009) (Teyhan,D.S, et al., 2009) investigate the association between

plantar pressre measurements with static arch height and dynamic plantar pressure

distribution. The reason of this study was to traverse which plantar pressure

measurements during gait was related with static dome height and dome height index.

Correlation analysis was being performed to find the relation between the static and

dynamic dome height indices. In the variable model of forefoot it is seen that the

forefoot increases dome height as forefoot width increases.

Having more plantar pressure is related to tissue damage, pain and ulceration. It was

observed that when young adults walking with or without shoes was compared resulted

that plantar presssure was increasing in young adults day by day. Burnfield et al.(2004)

(Burnfield, J.M , 2004)walking speed is connected to peak plantar pressure. As

volunteer walked barefoot and in wearing shoes, disimilarity was observed in force,

contact area and pressure in eight regions of foot. Due to fast walking pressure values

became high in arch and lateral metatarsal. The middle metatarsal represented high

metatarsal force when the subject walked without foot wear high heel pressure was

observed as compared to foot wear.

Pressure distribution during barefoot walking was studied by eils et al.(2002) (Elis, et

al., 2002). Subjects were asked to walk on iced condition so that plantar sensation can

be reduced .analysis of plantar pressure distribution showed roll over process under iced

condition. Peak pressure analysis shows us that there was a very important reduction

beneath the toes and the rarefoot and increament towards the middle and lateral forefoot
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and lateral midfoot. Because of the cold applications it will lead to decreament of nerve

conduction velocity and also promote the skin receptors.

D.V. Rai, L.M. Aggarwalthe (2006) in his worked they figure out the plantar pressure

between normal subjects and pathological subjects. For this they recruited sixty six

subjects in which fifty eight were normal subjects while other eight subjects having a

pathological disorder. The readings were taken barefoot. They concluded that in normal

people the pressure distribution was almost consistent. The body weight initially

appeared on the area of heel than on mid foot than shifted towards fore foot and in the

last was received by toe region. The highest pressured is found on second metatarsal in

normal people. The plantar pressure distribution in normal subjects is from heel strike

region to toe off area. Every individual was found to be different pressure in the centre.

As compared to normal people, the subjects having pathological disorder has low

plantar pressure. The pressure distribution in pathological subject having callus in the

heel area and forefoot area.

Zammit et al.(2008) (Zammit,G.V.et al., 2018) studied the difference in dynamic

plantar pressure disribution between older people with or without first

metatarsophalangeal joint( first MPJ) osteoarthritis (OA) of the foot. Plantar pressure

measurement was being recorded during level barefoot walking using the Mat

scan.system. 40 older subjects were recruited in which 20subjects had OA of the first

MPJ confirmed radiographically. The result showed that the first MPJ having OA is

connected with different variation in load-bearing function of the foot. Therefore no

relationship between knee joint osteoarthritis and pressure at plantar surface of foot has

been studied.

Periyasamy et.al (2011) (Periyasamy,R.et al., 2011) evaluate pattern of foot pressure

distribution while standing between male and female using a Pedo Power Graph plantar

pressure measurement system. He found that the value of power ratio beneath hind foot
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and forefoot was more in men than women because the contact area of the men was

greater than women foot.

Periyasamy et.al (2012) (Periyasamy,R.et al., 2010) then investigated pressure

distribution under foot in obese and non-obese subjects while standing using Pedo

Graph system. Limitation of PedoPowerGraph system such as impulse percentage

,pressure distribution ratio and parameter power ratio (PR) of forefoot till hindfoot was

measured and compared between the groups also the link between BMI value and PR

was observed. He observed visible changes in contact area and PR value of mid foot

regions between groups, but didn’t found any difference in hindfoot and forefoot PR

values.whereas BMI value have positive correlation with both the right and left mid foot

PR value for all the subjects participated in study.

The effect of changes in foot sensation on plantar pressure and muscle activity was

investigated by A.nurse et al.(2001) (Matthew A. Nurse*, Benno M. Nigg., 2001) .He

worked on the functional importance and effects in the plantar surface of the foot during

walking by working on cutaneous receptors and sensory feedback. Before and after ice

exposure plantar pressure and lower extremity muscle pattern were collected during

walking. A.nurse et al(2001) concluded that the peak pressure and pressure-time

integral were higher in the areas of normal sensitivity and was low in the areas that were

insensitive. As sensory feedback was changing the muscle patterns were also changing

repeatedly.

Every person has different physical appearance. These changes may lead to different

physical feature and different characterstics. In-sole Pedar 1-system was used to

measure the peak pressure , contact area, contact time, pressure time integral, force time

integral, instant of peak pressure, maximum force and mean force of subjects for feet

during walking. Putti et al.(2010) (Putti, A.B., Arnold,G.P. &ABBOUD, R.J., 2010)

investigated in-shoe foot presssure difference in indian ands caucasians males. he

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observed that the peak pressure under heel 1st,2nd, 3rd ,and 5th metatarsals head is

much higher in cancasians than in the indian. He furthur evaluated that the higher

pressure in the cancasians may be due to the foot probems in their race group.

Excessive body weight contribute a negative impact on the structure and function of the

feet . foot plays a very important role in locomotion. Britane and tuna et al. (2004)

(Britane,M & Tuna., 2004)determine the distribution of the pressure under foot in obese

and non-obese during walking and standing. High values were reported in obese

subjects of highest pressure ,total force on plantar surface and total contact area in the

feet. whereas in non obese subjects pressure was higher in only mid-foot.

The distribution and magnitudes of plantar pressure have been measured to identify the

functional manifestation disorders is discussed by D.V. Rai et.al (2006) Pedobarograph

measurements of normal and abnormal foot were monitored during walking using

computer assisted optical pedobarograph. Fifty eight subjects who participated in the

study had normal gait and 8 had pathological gait. It was observed that the plantar

pressure distribution in normal subjects are from heel strike to toe off whereas the heel

pressure in the pathological subject was lower than in normal subjects. Plantar pressure

is an important parameter which provides information about the human gait.

Teh et.al (2006) (Teh,E. et al., 2006) researched the weight under the feet in

underweight,typical weight, over weight and stout subjects are indicated by their BMI

values. He concluded that the values of total plantar force and total contact area are

directly related with BMI. No significant difference was observed in total plantar

pressure between males and females.

Zhu et.al (1995) (Hongshen Zhu, 1995,Walking Cadence Effect on Plantar

Pressures.Arch Phys Med Rehabil; 76:1000-5., n.d.) this study was based on the

estimation of effect of walking cadence on in shoe plantar pressure.He figure out that

change in plantar pressure occurred when there is an increased in cadence.Mean foot to

 20

floor influence time will decrease continuously with the increased in cadence whereas

the peak plantar pressure increases respectively.

Best et.al mentioned that the analysis of foot plantar pressure could be helpful to

improve balance in the adults and highlighted the need of balancing for adults and

infants. The balancing of foot is linked with the plantar pressure loadings under the foot

that further helps to prevent foot disorders and help individual in continuing their daily

life cycle healthy.

Enas et.al (2017) from this study, he observed the difference of plantar pressure

between pregnant females and non-pregnant females. There is no any foot disorder was

present among those females. There is no any significant difference found in regard to

these point of pressure calcaneus, first metatarsal and fifth metatarsal. But major

difference was found in conjunction with month of pregnancy and increased weight

bearing on fifth metatarsal. Final result showed that there is a side effect of pregnancy

on plantar pressure.

AP Hills et.al did research on the planter pressure between Obese and non-obese adults.

Pressures were evaluated for 8 anatomical sites under the feet. And during walking,

higher peak pressures were found in both these males and females. Both the groups

demonstrated difference plantar pressure during both standing and walking protocols. It

provides important objective information regarding functional imitations specific to

divide in obese and non-foot mechanics in both static and dynamic situation.

Dowling et.al (2004) (AM Dowling, 2004) He evaluate the plantar pressure in both

static and dynamic conditions of obese and non-obese children. The readings of height

and weight were taken for the calculation of BMI. Readings of each foot were taken for

observation. No any disorder were present among those children and readings were

taken barefoot. In static condition there is no major difference noticed between right and

left feet. The major effect was noticed of body type on plantar pressure. The high peak
 21

pressure, contact region, peak forced was noticed in obese children in comparison with

non-obese children. In dynamic condition, major difference was noticed increased of

foot contact area in obese children. In obese children mean peak pressure was observed

on mid foot and second to fifth metatarsal heads in comparison with non-obese.

Matsuda et.al (2017) (Matsuda et al., 2017) His research worked was based on the

uncertainty aspects regarding to fifth metatarsal. Large number of male soccer players

were recruited for this purpose. The fracture of fifth metatarsal during soccer is

common and take time for recovery that’s why they focused on risk factors related to

fifth metatarsal. The subjects which were recruited had no pain from last one year. The

result concluded that the players who were on mid field during soccer have high rate of

fracture as compared to the defenders which had low rate of fracture. No major

difference of plantar pressure were found among them. No incidence of fracture of fifth

metatarsal was found between the kicking foot and pivoting foot.
 22

CHAPTER 2

2. MATERIALS AND METHODS

2.1 The subject

Subjects were recruited from biomedical engineering department of NED University. A

brief introduction about study was given to the students and consent was taken from

individual student.

Inclusion criteria: Aged between 17 to 25 years. Before taking any measurements it was

ensure that subjects should not experience any kind of fracture, tumor, soft tissue injury

and other infected disease and should be in normal state of health.

Exclusion criteria:

 Any subject suffering from fractured foot or leg.

 Any trauma.

 Suffering from any tumour related disease.

2.2 DATA COLLECTION

2.2.1 Anthropometric Measurements

For anthropometric measurements we had taken leg length (lateral iliac spine of hip to

the lateral malleolus of the foot), ASIS (anterior superior iliac spine, distance between

right and left iliac spine), foot length (distance from the most posterior point of

calcaneus to the end of longest toe), foot span (distance between first and fifth

metatarsal heads), knee width (distance between medial and lateral condyle) and ankle

width (distance between medial and lateral malleolus. Weight and height are also

measured from weight machine and stadiometer to calculate BMI of each individual.
 23

Specially designed equipment similar to the shape of Vernier caliper is used to measure

anthropometric measurements.

Figure 2.1 Scale used for anthropometric measurements

Figure 2.2 Measurement of ankle width and foot span

 24

Figure 2.3 Measurement of knee width and foot length.

2.2.2 Planter Pressure Measurement by Pedograph

Pedograph

Pedograph is used to measure the planter pressure acting along the interface between

planter region and supporting ground during static and dynamic conditions. It is mainly

consist of

 Logitech webcam for capturing video: The Logitech webcam have full HD

1080p (1920 x 1080 pixels) for video recording and also can be used for motion

detection and photo capture.

 Main sensor unit: The main sensor is made up of glass, having four pressure

sensor enclosed in which create an image of light intensities proportional to

pressure impressed at individual point based on optical method. . This pressure

platform system is embedded inside the floor at the mid of 10ft long walk way.

 Bi-Beat software: Used for processing of recorded video. At the moment when

subject walk over pressure platform, a video is created at that instant and

delivered to the Bi-Beat software installed in a computer. Bi-Beat software is

used to analyze the video and produce a coloured image of the pressure patterns

of foot.
 25

Figure 2.4 The main sensor unit

Figure 2.5 User friendly command window (Bi-Beat software)

All the subjects were asked to perform a practice walk (bare foot) on pedograph to

make them comfortable with pedograph in their natural walking pattern because

deliberate walking can change the pressure measurement. Many walking trials were

done to achieve the indentation of both the right and left feet. During the measurement

it was taken under consideration by the assessor that the subject place whole foot on the

center of plate and if the subject fails to place the whole foot, the assessor request them

to walk again unless the required indentation of whole foot is achieved. A video is

recorded of few seconds by Logitech software which comes with the device.
 26

Selection of Points

The recorded video is then transferred to Bi-Beat software for further analysis which

investigates the foot indentation and gives the colour coded composite image which

shows different areas of foot having maximum and minimum pressure. We selected

three points on forefoot that is on medial, mid and lateral regions and Bi-Beat software

gives a colour coded graph of pressure for the specific points as shown in Figure 2.7

We select peak pressure of medial, mid and lateral regions of fore foot as shown in

figure 2.6

Figure 2.6 Colour coded image showing 3 selected points of pressure.

Figure 2.7 Colour coded graph of the selected pressure points

 27

2.3 STATISTICAL ANALYSIS

For data analysis, SPSS 10.1 is used. To find out the significant differences in of

planter pressure between males and females, t-test (independent sample t-test and

lavene’s test) was performed. t-test was also performed for the investigation of

highest pressure point on the fore foot. Levene’s test and t-test was also compared.
 28

CHAPTER 3

3. RESULTS

To determine the significant differences between two arrays of data (for men and

women) from each other with N = 23 for Male and N = 47 for Females. Differences

between samples were tested when the variance of two normal distributions were

unknown.

The mean age of overall sample is 20.44 whereas the mean age in males and females

are 20.43 and 20.45 respectively. The mean height difference between males and

females is 16 centimetres but the average height for men is higher. The standard

deviation for both groups is almost the same.

The difference in the mean values of weight for both gender groups (male and female)

is roughly 15. Mean value of weight for male is higher so the deviation for is male is

also higher.

The BMI’s average and deviation for both males and females is almost similar.

The mean value of male and female right foot length shows 3 cm lesser value for

females where the mean male right foot length is 26.48 cm and mean female right foot

length is 233.61 cm. For left foot length, there is an also same result obtained as for

right foot length in both gender groups. As the mean value is higher for male so the

standard deviation is also high for male.

 29

Table 3.1 Means of Anthropometric data in males and females

Male (N=23) Female (N=47) Total (N=70)
Mean SD Range Mean SD Range Mean SD Range
Age 20.43 2.52 13.00 20.45 1.53 9.00 20.44 1.89 15.00
Height 172.52 5.86 21.50 157.09 6.71 33.40 162.16 9.70 48.40
Weight 66.70 14.79 50.20 53.68 11.69 61.00 57.96 14.10 61.00
BMI 21.63 4.49 16.00 21.77 4.09 16.00 21.72 4.19 18.00
R_Foot_L 26.48 1.43 5.50 23.61 1.21 5.00 24.56 1.43 8.00
L_Foot_L 26.49 1.36 5.50 23.54 1.13 5.00 24.51 1.36 8.00
R_Foot_S 10.06 0.53 1.80 9.18 0.50 2.00 9.47 0.53 3.00
L_Foot S 10.06 0.52 1.90 9.16 0.46 1.80 9.46 0.52 2.80
R_Ankle_W 7.39 0.43 1.20 6.40 0.39 1.40 6.73 0.43 2.30
L_Ankle_W 7.39 0.44 1.10 6.42 0.38 1.20 6.74 0.44 2.00
R_Knee_W 10.74 0.83 2.50 10.05 0.96 4.30 10.28 0.83 4.30
L_Knee_W 10.83 0.83 2.50 10.05 0.98 4.30 10.31 0.83 4.30
R_Leg_L 59.30 25.76 66.00 47.55 19.86 57.00 51.41 25.76 72.00
L_Leg_L 59.30 25.76 66.00 47.55 19.86 57.00 51.41 25.76 72.00

Graph 3.1 Means of Anthropometric data in males and females

 30

Table 3.2 Means of pressure values in males and females

Male (N=24) Female (N=47) Total (N=70)

Mean SD Range Mean SD Range Mean SD Range

L_Lat_PP 237.52 86.62 327 217.36 77.38 396 223.99 80.47 408.00

L_Mid_PP 355.7 88.15 336 330.3 94.99 489 338.64 92.94 489.00

L_Med_PP 311.09 92.3 381 293.74 82.45 408 299.44 85.53 408.00

R_Lat_PP 233.87 56.36 210 239.38 74.24 330 237.57 68.51 339.00

R_Mid_PP 336.91 101.71 486 318.45 102.59 435 324.51 101.94 486.00

R_Med_PP 304.83 79.9 330 299.91 99.71 489 301.53 93.10 489.00

Graph 3.2 Means of pressure values in males and females

The results show that the highest pressure applied by both males and females is on the

Left Mid of forefoot. The highest pressure values for both males and females are 355.70

and 330.30 respectively. Also both groups apply high pressure on Right Mid of forefoot

at 336.91 for males and 318.45 for females. The rest of the mean values are far lower
 31

with lowest pressure on Right lateral at 233.87 for males and 239.38 for females and

Left lateral with 237.52 for male and 217.36 for female.

Male and female have little differences between mean value of Right lateral at 233.87

and 239.38 respectively. Mean value of Right medial of male also presented slight

difference for male at 304.83 and female at 299.91. The mean values for Left mid, left

medial and right mid have a difference of 20+ in male and female

Table 3.3 Means of Anthropometric data in under-weight, normal-weight, over-weight subject

Underweight Normal weight Over weight
Mean Min Max SD Mean Min Max SD Mean Min Max SD
Height 160.40 139 180 10.84 163.38 148 184 8.85 162.83 136 180 11.76
Weight 45.20 31 91 13.30 57.03 42 79 8.96 73.78 46 92 12.72
BMI 16.47 14 18 1.19 21.28 18 25 1.83 27.72 25 32 2.32
R_Foot_L 23.93 21 27 1.62 24.77 21 29 1.91 24.89 21 28 2.08
L_Foot_L 23.87 21 27 1.62 24.72 21 29 1.82 24.89 21 28 2.08
R_Foot_S 9.07 8 10 0.59 9.54 8 11 0.72 9.50 8 11 0.86
L_Foot_S 9.13 8 10 0.64 9.54 8 11 0.68 9.61 8 11 0.85
R_Ankle_W 6.33 6 7 0.49 6.77 6 08 0.74 6.78 6 8 0.73
L_Ankle_W 6.33 6 7 0.49 6.77 6 08 0.70 6.89 6 9 0.90
R_Knee_W 9.53 8 12 0.99 10.36 9 12 0.81 11.06 8 13 1.30
L_Knee_W 9.53 8 12 0.99 10.36 9 `12 0.84 11.11 8 13 1.30
R_Leg_L 94.53 79 105 6.60 94.95 82 109 6.28 94.22 74 104 8.46
L_Leg_L 94.53 79 105 6.60 94.95 82 109 6.28 94.22 74 104 8.46

Graph 3.3 Means of Anthropometric data in normal weight subject

 32

Graph 3.4 Means of Anthropometric data in over weight subject

Graph 3.5 Means of Anthropometric data in underweight subject

 33

Table 3.4 Means of Pressure values in under-weight, normal-weight, over-weight

subjects
Under weight
Normal Weight Over weight

Standard Standard Standard

Mean Min Max Mean Min Max Mean Min Max
Deviation Deviation Deviation
Left
196 0 321 79.51 225.38 99 396 70.85 244.22 57 408 93.72
Lateral
Left
324 66 501 101.20 332.28 189 507 78.63 362.67 147 55 109.31
Mid
Left
310 147 450 85.95 289.62 78 465 77.53 316.67 57 459 104.32
Medial
Right
218 111 345 64.74 239.56 96 435 71.74 253.83 105 339 60.40
Lateral
Right
317 219 438 74.44 321.69 51 537 108.22 346.17 102 537 111.63
Mid
Right
296 228 384 45.88 289.13 0 489 106.56 334.67 192 474 81.88
Medial

Graph 3.6 Means of Pressure values in under-weight, normal-weight, over-weight

subjects

To investigate the impact of weight on plantar pressure, anthropometric data of the

subjects categorized into under-weight, normal weight and over-weight. The results

showed that the maximum pressure is exerted by overweight subjects while the least

pressure is exerted by underweight subject

 34

3.1 LEVENE’S TEST AND t-TEST

The independent sample-test is used when two separate sets of data that are independent

and identically distributed one from each of the two populations being compared.

The Levene’s test is used to test if k samples have equal variances. Equal variances

across samples, is called homogeneity of variance.

This report is made to check the variances in pressure on 3 points of fore foot in males

and females.

The pressure points are:

 Left medial

 Left mid

 Left lateral

 Right medial

 Right mid

 Right lateral

3.2 INTERPRETATION OF LEVENE’S TEST RESULTS

This test is used to find out the significant differences in the variances of male and

female datasets and to observe their results.

When the Sig. value in the results is greater than 0.05 means it shows that the variability

in two conditions is about the same. So the score for men do not vary too much more

than the values for women.

It is discovered that as per Levene’s test the weight characteristic is significantly

different in the data sets given below. The significant value is above 0.05 for mean age

of male and female is same because the mean values are almost same, but the weights

are differed so the significant value is 0.029 which is below 0.05.

We analyzed the rest of the mean values of pressure also by Levene’s test and found the

following results.
 35

 Sig. value for left lateral is 0.328

 Sig. value for left mid is 0.910

 Sig. value for left medial is 0.551

 Sig. value for right lateral is 0.29

 Sig. value for right mid is 0.379

 Sig. value for right medial is 0.535

The above values are greater than 0.05 which shows that there is not a significant

difference between the variance of the datasets for male and female.

3.3 INTERPRETATION OF t-TEST FOR EQUALITY OF MEANS

When the similarity between means of two datasets is to be obtained, T-test is used. To

draw a conclusion from the results of t-test, we check Sig (2-tailed) and if the value is

more than 0.05 we concluded that there is not much significant difference between

male’s data and female’s data.

It is shown in the table that the Sig. (2-tailed) for height and weight is less than 0.05 so

there is a a significant differences between the means of data sets of male and female.

Moved on to run the t-test for Equality of means for pressure points and found the

following results.

 Sig. (2-tailed) value for right medial is 0.838 that is greater than 0.05

 Sig. (2-tailed) value for right mid is 0.481 that is greater than 0.05

 Sig. (2-tailed) value for right lateral is 0.754 that is greater than 0.05

 Sig. (2-tailed) value for left medial is 0.430 that is greater than 0.05

 Sig. (2-tailed) value for left mid is 0.286 that is greater than 0.05

 Sig. (2-tailed) value for left lateral is 0.328 that is greater than 0.05

These results shown that there is not much significant differences in the means of

pressure values of males and females regarding pressure points.

 36

Table 3.5 Independent sample test

Independent Samples Test

Levene's
Test for
t-test for Equality of Means
Equality of
Variances
Sig. Std. 95% Confidence
Mean
(2- Error Interval of the
F Sig. t df Differe Difference
taile Differen
nce
d) ce Lower Upper
Equal
variances 3.307 .073 -.025 68 .980 -.012 .4853 -.980 .956
assumed
Age Equal
variances
-.021 30.182 .983 -.012 .5708 -1.177 1.153
not
assumed
Equal
variances .016 .899 9.404 68 .000 15.424 1.6402 12.151 18.697
assumed
Height Equal
variances
9.855 49.533 .000 15.424 1.5651 12.279 18.568
not
assumed
Equal
variances 3.300 .074 4.004 68 .000 13.019 3.2512 6.531 19.507
assumed
Weight Equal
variances
3.694 35.890 .001 13.019 3.5247 5.870 20.168
not
assumed
Equal
variances .332 .566 -.132 68 .895 -.142 1.0750 -2.287 2.003
assumed
BMI Equal
variances
-.128 40.287 .899 -.142 1.1107 -2.386 2.102
not
assumed
Equal
variances .973 .328 .984 68 .328 20.160 20.4809 -20.709 61.029
assumed
L_Lat
Equal
_PP
variances
.947 39.648 .350 20.160 21.2977 -22.896 63.216
not
assumed
Equal
L_Mid
variances .013 .910 1.075 68 .286 25.398 23.6235 -21.742 72.538
_PP
assumed
 37

Equal
variances
1.103 46.868 .276 25.398 23.0185 -20.913 71.709
not
assumed
Equal
variances .358 .551 .795 68 .430 17.342 21.8231 -26.205 60.890
assumed
L_Med
Equal
_PP
variances
.764 39.644 .449 17.342 22.6944 -28.538 63.222
not
assumed
Equal
variances 2.359 .129 -.314 68 .754 -5.513 17.5496 -40.533 29.506
assumed
R_Lat
Equal
_PP
variances
-.345 55.935 .731 -5.513 15.9807 -37.527 26.501
not
assumed
Equal
variances .784 .379 .709 68 .481 18.466 26.0339 -33.484 70.416
assumed
R_Mid
Equal
_PP
variances
.711 44.129 .481 18.466 25.9557 -33.840 70.772
not
assumed
Equal
variances .389 .535 .206 68 .838 4.911 23.8580 -42.697 52.519
assumed
R_Med
Equal
_PP
variances
.222 53.461 .825 4.911 22.1145 -39.436 49.258
not
assumed

3.4 PAIRED TEST RESULTS

Samples of matched pairs of similar units are considered in paired t-test that’s why the

data is often similar. This test is use to check the correlation for each “pair of variables”

entered.
 38

Table 3.6 Paired Sample Test-95% Confidence interval of the difference.

Paired Differences

95% Confidence Sig. (2-

Std. T df
Std. Interval of the tailed)
Mean Error Difference
Deviation
Mean
Lower Upper
R_Foot_L -
Pair 1 .04429 .27643 .03304 -.02163 .11020 1.340 69 .185
L_Foot_L

R_Foot_Span -
Pair 2 .01143 .27216 .03253 -.05347 .07632 .351 69 .726
L_Foot_Span

R_Ankle_Width
Pair 3 - -.01000 .21206 .02535 -.06056 .04056 -.395 69 .694
L_Ankle_Width

R_Knee_Width
Pair 4 - -.03143 .33168 .03964 -.11052 .04766 -.793 69 .431
L_Knee_Width

Table 3.7 Paired Sample Test

Paired Differences
Sig.
Std. 95% Confidence Interval T df (2-
Std. of the Difference tailed)
Mean Error
Deviation
Mean Lower Upper
L_Lat_PP –
-13.5857 73.45540 8.77960 -31.1005 3.9291 -1.547 69 .126
R_Lat_PP

L_Mid_PP -
14.1285 105.13689 12.56626 -10.9404 39.1975 1.124 69 .265
R_Mid_PP

L_Med_PP -
-2.0857 104.03591 12.43467 -26.8922 22.7207 -.168 69 .867
R_Med_PP

3.5 ASSUMPTIONS ABOUT THE RESULTS

We assumed the 95% confidence interval for the difference in Right Foot length, Left

Foot length, Right Foot span, Left Foot span, Right Ankle width and Left Ankle width.

Data set for male has higher mean, standard deviation and standard mean error.
 39

According to the Levene’s test for equality of variances and t-test for equality of means

there is a little significant variance and we ae 95% sure of the lower and upper limits for

the two population means for men and women and their characteristics.
 40

CHAPTER 4

4. DISCUSSION

During gait, at push-off stage the rear area of foot pressure has ascended off the ground

and the accumulated load is conveyed to the fore foot so it is essential to analyze the

stacking of fore foot during push-off stage. We need to focus on the transference of

power in the region of fore foot and our research shows some degree to which certain

regions of foot are stacked during the period of maximum stacking. The motivation

behind this study is to identify the significant contrast of planter weight between male

and female by using the planter weight measuring instrument that is pedograph.

D.V. Rai, L.M. Aggarwal (2015) concluded that the normal subjects applied greater

pressure on mid region of forefoot that supports our study which also shows the highest

pressure applied on mid region of fore foot.

Gurney et al. (2008) (J.K. Gurney et al., 2008) works on 9 subjects healthy subjects in

which includes 5 males and 4 females. The results of this study locate the higher

pressure region on mid-point of fore foot of both males and females. The current

research also prove that the highest pressure applied on mid region of fore foot.

According to Soames, (1985) (RW. Soames., 1985) Highest mean pressure is found

under the third metatarsal head. In the current research the data set for two populations,

distinguished by their gender male and female, was taken and observed. Observations

shows that males and females both placed more pressure on their right forefoot mid and

left fore foot mid region while the least amount of foot pressure was on right and left

fore foot lateral regions. This data was consistent with findings and consequent

calculations for mean, standard deviation and t-test results.

Hayafune and Jacob, (1999) (N.Hayafune,Y.Hayafune,H.A.C Jacob, 1999)also

reported the pressure distribution during push off phase of gait under First metatarsal
 41

head (MTH1), second metatarsal head (MTH2), third metatarsal head (MTH3), fourth

metatarsal head (MTH4), fifth metatarsal head (MTH5), big toe, 2, 3, 4 and 5 of both

left and right foot during barefoot walking. It was observed that big toe and second

metatarsal head exhibit highest pressure. During push off phase, 64% of the fore foot

load is taken by big toe, first and second metatarsal head. There is no significant

correlation between the force under big toe and under each of second metatarsal head,

second metatarsal head, third metatarsal head and fourth metatarsal head was observed.

According to Hennig, Rosenbaum and Staats,(1994) there is no significant difference in

planter pressure of males and females which is supporting my research.

We conclude that regardless of the weight or height of a male, males are more likely to

experience pressures on the mid parts of his foot and lesser on his laterals. Similarly

women regardless of their heights and weights, they are more likely to put pressure on

the mid parts of their foot and less pressure on the lateral parts.

While other variables do not affect the data or results as far as the t-test is concerned

and there is equal variance between two datasets.

Foot pressure indicates that there is not any significant difference in the variance or

mean of the two data sets as shown by Sig. and Sig. (2-tailed) values. The distribution

of foot pressure for males and females are almost same, which supports the initial

hypothesis and observation.

In addition, the t-test for paired samples of variables did not show any definitive

correlation for variance but for the difference of means, it was obtained that there is no

significant differences of means between pressure points.

 42

CHAPTER 5

5. CONCLUSION

This study shows that there is very low significant difference of fore foot pressure in

males and females. From the result of this study we concluded that the greater pressure

applied on mid region of forefoot by both males and females. While males exert high

pressure on their fore foot during push off phase because of difference of height and

weight as compared to females.

All the measurements are carried out from healthy and adult subjects for observation of

normal pressure values. A subject who is suffering from any foot related disorder would

have different pressure readings. This study helps to detect any foot, knee and hip

disorders in early stage which usually tends to appear lately with the growing age. The

data obtained by plantar pressure can also be helpful for the interpretation and

management of patients for foot impairments related to foot disorders

Assessment of planter pressure also helps to treat these disorders by providing

preventive measures.

In future this study will help in designing of foot wear which helps to balance the

plantar pressure distribution in foot and helps to give preventive measures from foot

disorder.

Although research has reached its aims but there were some inescapable limitations.

First, this research was conducted only on a limited size of subjects who were currently

studying in NED University, because of time limit. Therefore, before reporting any

generalized results for larger group , the study should have involved more participants

at different levels. Secondly, this study includes only healthy subjects that limits this

study to control group, in future we can also investigate the plantar pressure of subjects
 43

who suffered any kind of foot disorders and contrast with present study to find out the

relationship between them.

 44

REFERENCES

 AM Dowling, 2004. What are the effects of obesity in children in plantar

pressure distributions?. In: ,International journal of obesity. s.l.:s.n., pp. 1514-

1519.

 Britane,M & Tuna., 2004. The evaluation of plantar pressure distribution in

obese and non-obese adult.Clinical Biomechanics,19(10),pp,1055-1059. Clinical

Biomechanics, Volume 19(10).

 Burnfield, J.M , 2004. The influence of walking speen and footwear on planter

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