Purpose: The aim of this study was to investigate to immediate effect of using insoles on the healthy extremities of individuals using transtibial prosthesis on plantar pressure and postural stability.
Methods: The study was performed on 16 unilateral transtibial amputees aged 18-65 years using transtibial prosthesis. Foot posture, Foot Posture Index, and calcaneus angle were evaluated with the CJ Ortho mobile application (Collège des Jeunes Orthopédistes–CJO) and universal goniometric measurement, foot plantar pressure and postural stability Sensor Medica®️ system. The evaluations made before and after the insoles were recorded instantly. Normal distribution was done with the Shapiro Wilk test and it was determined that all data did not show normal distribution. Wilcoxon Signed Ranks Test, one of the non-parametric tests, was used to reveal the difference between the two dependent variables. The statistical analysis of the study was performed using SPSS 21.00 at the significance limit of 0.05.
Results: It was observed that the plantar pressure forces (forefoot loading, total loading, forefoot contact surface, total contact surface) on the intact extremity of the individuals increased and the maximum pressure decreased (p <0.05). It was determined that the subtalar joint angle of the ankle decreased with the insoles, and there was a decrease in the length of postural sway and medio-lateral sway (p <0.05).
Conclusion: It was found that the application of personalized insoles on the healthy extremity of amputees using transtibial prosthesis instantly reduces postural sway and improves the plantar pressure distribution of the foot. We think that the use of personalized insoles on the healthy side should be encouraged for amputees using prosthetics.
Yalçın Pernot HFM, Winnubst GMM, Cluitmans JMM, et al. Amputees in limburg: incidence, morbidity and mortality, prosthetics supply, care utilisation and functional level after one year. Prosthet Orthot Int. 2000;24:90-96.
Samitier C, Luis G, Maria G. The benefits of using a vacuum-assisted socket system to improve balance and gait in elderly transtibial amputees. Prosthet Orthot Int. 2016;40:83-88.
Hafner BJ, Smith DG. Differences in function and safety between medicare functional classification level 2 and 3 transfemoral amputees and influence of prosthetic knee. J Rehabil Res Dev. 2009;46:417-433.
Gailey R, Allen K, Castles J, et al. Review of secondary physical conditions associated with lower-limb amputation and long-term prosthesis use. J Rehabil. 2008;45:15-30.
Martin AE, Schmeideler JP. Gait differences when maximizing efficiency versus symmetry with a transtibial amputee model. World congress of biomechanics. Boston:MA;2014.
Eshraghi A, Osman NAA, Karimi M, et al. Gait biomechanics of individuals with transtibial amputation: effect of suspension system. PLoS One. 2014;9:1-12.
Murley GS, Landorf KB, Menz HB. Do foot orthoses change lower limb muscle activity in flat-arched feet towards a pattern observed in normalarched feet?. Clin Biomech. 2010;25:728-736.
Mündermann A, Nigg BM, Neil Humble R, et al. Foot orthotics affect lower extremity kinematics and kinetics during running. Clin Biomech. 2003;18:254-262.
Ahmad A, Jaafar R, Omar AR, et al. Preliminary investigations on the reduction of foot pressure measurement and muscle activity with different insole materials. Adv Mat Res. 2012;576:695-699.
Rezaeian T. The Effects of Insoles on Biomechanics of Standing Balance and Walking of Trans-Femoral Amputees. PhD thesis, University of Leeds, 2020.
Borrenpohl D, Brian K, Matthew JM. Survey of US practitioners on the validity of the Medicare Functional Classification Level system and utility of clinical outcome measures for aiding K-level assignment. Arch Phys Med Rehabil. 2016;97:1053-1063.
Redmond AC, Crosbie J, Ouvrier RA. Development and validation of a novel rating system for scoring standing foot posture. The foot posture index. Clin Biomech. 2006;21:89-98.
Redmond AC, Crane YZ, Menz HB. Normative values for the Foot Posture Index. J Foot Ankle Res. 2008;1:6.
Reina N, Cognault J, Ollivier M, et al. The Cjortho App: a mobile clinical and educational tool for orthopedics. Orthop Traumatol Surg Res. 2018;104:523-527.
Smith OK, Harris BA. Interrater reliability of subtalar neutral, calcaneal ınversion and eversion. J Orthop Sports Phys Ther. 1990;12:10-15.
Razeghi M, Batt ME. Foot type classification: a critical review of current methods. Gait Posture. 2002;15:282-291.
Berg K, Wood-Dauphine S, Williams JI, et al. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can. 1989;41:304-311.
Şahin F, Büyükavcı B, Sağ S, et al. Berg Denge Ölçeği'nin türkçe versiyonunun inmeli hastalarda geçerlilik ve güvenilirliği. J Phys Med Rehabil. 2013;16:170-175.
Major MJ, Fatone S, Roth EJ. Validity and reliability of the Berg Balance Scale for community-dwelling persons with lower-limb amputation. Arch Phys Med Rehabil. 2013;94:2194-2202.
Wong CK. Interrater reliability of the Berg Balance Scale when used by clinicians of various experience levels to assess people with lower limb amputations. Phys Ther. 2014;94:371-378.
Scoppa F, Capra R, Gallamini M, et al. Clinical stabilometry standardization: basic definitions acquisition interval sampling frequency. Gait Posture. 2013;37:290-292.
Sensormedica.https://www.sensormedica.com/en/pages/hardware-en/cnc-milling-machines, (Erişim Tarihi: 25 Aralık 2020).
Khodaei B, Saeedi H, Jalali M, et al. Comparison of plantar pressure distribution in CAD–CAM and prefabricated foot orthoses in patients with flexible flatfeet. J Foot. 2017;33:76-80.
Jiang Y, Wang D, Ying J, et al. Design and preliminary validation of ındividual customized ınsole for adults with flexible flatfeet based on the plantar pressure redistribution. Sensors. 2021;21:1780.
Borg J, Mizzi S, Formosa C. Peak pressure data and pressure-time integral in the contralateral limb in patients with diabetes and a trans-tibial prosthesis. Gait Posture. 2018;64:55-58.
Jael B, Mizzi S, Formosa C. Peak pressure data and pressure-time integral in the contralateral limb in patients with diabetes and a trans-tibial prosthesis. Gait Posture. 2018;64:55-58.
Reilly K, Barker K, Shamley D, et al. The role of foot and ankle assessment of patients with lower limb osteoarthritis. Physiotherapy. 2009;95:164-169.
Braga UM, Mendonça LD, Masceranhas RO, et al. Effects of medially wedged insoles on the biomechanics of the lower limbs of runners with excessive foot pronation and foot varus alignment. Gait Posture. 2019;74:242-249.
Rodrigues P, Chang R, TenBroek T, et al. Medially posted insoles consistently influence foot pronation in runners with and without anterior knee pain. Gait Posture. 2013;37:526-531.
Bateni H. Postural sway in lower extremity amputees and older adults may suggest increased fall risk in amputees. CPOJ. 2020;3.
Mohieldin A, Chidambaram A, Sabapathivinayagam R, et al. Quantitative assessment of postural stability and balance between persons with lower limb amputation and normal subjects by using dynamic posturography. Macedonian Journal of Medical Sciences. 2010;2:138-143.
Ma CZH, Wong DWC, Wan AHP. Effects of orthopedic insoles on static balance ofolder adults wearing thick socks. Prosthet Orthot Int. 2018;42:357-362.
Karataş L, Vurallı D, Günendi Z. The effect of medial longitudinal arch height and medial longitudinal arch support insoles on postural balance in perimenopausal women. Turk J Med Sci. 2019;49:755-760.
Park JH, Jeon HS, Kim JH, et al. Immediate effect of insoles on balance in older adults. Foot (Edinb). 2021;47:101768.
Luengas LA, Gutierrez MA. Plantar pressure in transtibial amputees. International Journal of Biology and Biomedicine. 2019;4:21-25.
Sarroca N, Luesma MJ, Valero J, et al. Influence of insole material density in the stability of patients with prosthetic unilateral transtibial amputation. Sci Rep. 2022;12(1):7854.
Transtibial protez kullanan bireylerde sağlam tarafta CAD/CAM tabanlık kullanımının plantar basınç ve postüral stabiliteye anlık etkisi
Amaç: Bu çalışmada transtibial protez kullanan bireylerin sağlam ekstremitesinde tabanlık kullanımının plantar basınç ve postüral stabiliteye anlık etkisini incelemek amaçlandı.
Yöntem: Çalışma transtibial protez kullanan 18-65 yaş aralığındaki 16 unilateral transtibial ampute üzerinde yapıldı. Ayak postürü Ayak Postür İndeksi, kalkaneus açısı CJ Ortho mobil uygulaması (Collège des Jeunes Orthopédistes–CJO) ve üniversal gonyometrik ölçüm, ayak plantar basıncı ve postüral stabilite Sensor Medica®️ sistemi, denge Berg Denge Ölçeği ile değerlendirildi. Tabanlık öncesi ve sonrası yapılan değerlendirmeler anlık olarak kaydedildi. Normal dağılım Shapiro Wilk testi ile yapıldı ve tüm verilerin normal dağılım göstermediği belirlendi. İki bağımlı değişken arasındaki farkı ortaya koymak için non-parametrik testlerden Wilcoxon Signed Ranks Testi kullanıldı. Çalışmanın istatistiksel analizi SPSS 21.00 programı kullanılarak 0,05 anlamlılık sınırında yapıldı.
Bulgular: Bireylerin sağlam ekstremitedeki tabanlık ile plantar basınç kuvvetlerinin (ön ayak yüklenme, toplam yüklenme, ön ayak temas yüzeyi, toplam temas yüzeyi) yükseldiği, maksimum basıncın azaldığı gözlemlendi. Tabanlık ile ayak bileğinin subtalar eklem açısının azaldığı ve postüral salınım uzunluğunda ve medio-lateral salınımda azalma meydana geldiği görüldü.
Sonuç: Transtibial protez kullanan amputelerde sağlam ekstremitede kişiye özel tabanlık uygulamasının anlık olarak postüral salınımı azalttığı ve ayağın plantar basınç dağılımını iyileştirdiği bulundu. Sağlam tarafta kişiye özel tabanlık kullanımının protez kullanan ampute bireyler için teşvik edilmesi gerektiğini düşünmekteyiz.
Yalçın Pernot HFM, Winnubst GMM, Cluitmans JMM, et al. Amputees in limburg: incidence, morbidity and mortality, prosthetics supply, care utilisation and functional level after one year. Prosthet Orthot Int. 2000;24:90-96.
Samitier C, Luis G, Maria G. The benefits of using a vacuum-assisted socket system to improve balance and gait in elderly transtibial amputees. Prosthet Orthot Int. 2016;40:83-88.
Hafner BJ, Smith DG. Differences in function and safety between medicare functional classification level 2 and 3 transfemoral amputees and influence of prosthetic knee. J Rehabil Res Dev. 2009;46:417-433.
Gailey R, Allen K, Castles J, et al. Review of secondary physical conditions associated with lower-limb amputation and long-term prosthesis use. J Rehabil. 2008;45:15-30.
Martin AE, Schmeideler JP. Gait differences when maximizing efficiency versus symmetry with a transtibial amputee model. World congress of biomechanics. Boston:MA;2014.
Eshraghi A, Osman NAA, Karimi M, et al. Gait biomechanics of individuals with transtibial amputation: effect of suspension system. PLoS One. 2014;9:1-12.
Murley GS, Landorf KB, Menz HB. Do foot orthoses change lower limb muscle activity in flat-arched feet towards a pattern observed in normalarched feet?. Clin Biomech. 2010;25:728-736.
Mündermann A, Nigg BM, Neil Humble R, et al. Foot orthotics affect lower extremity kinematics and kinetics during running. Clin Biomech. 2003;18:254-262.
Ahmad A, Jaafar R, Omar AR, et al. Preliminary investigations on the reduction of foot pressure measurement and muscle activity with different insole materials. Adv Mat Res. 2012;576:695-699.
Rezaeian T. The Effects of Insoles on Biomechanics of Standing Balance and Walking of Trans-Femoral Amputees. PhD thesis, University of Leeds, 2020.
Borrenpohl D, Brian K, Matthew JM. Survey of US practitioners on the validity of the Medicare Functional Classification Level system and utility of clinical outcome measures for aiding K-level assignment. Arch Phys Med Rehabil. 2016;97:1053-1063.
Redmond AC, Crosbie J, Ouvrier RA. Development and validation of a novel rating system for scoring standing foot posture. The foot posture index. Clin Biomech. 2006;21:89-98.
Redmond AC, Crane YZ, Menz HB. Normative values for the Foot Posture Index. J Foot Ankle Res. 2008;1:6.
Reina N, Cognault J, Ollivier M, et al. The Cjortho App: a mobile clinical and educational tool for orthopedics. Orthop Traumatol Surg Res. 2018;104:523-527.
Smith OK, Harris BA. Interrater reliability of subtalar neutral, calcaneal ınversion and eversion. J Orthop Sports Phys Ther. 1990;12:10-15.
Razeghi M, Batt ME. Foot type classification: a critical review of current methods. Gait Posture. 2002;15:282-291.
Berg K, Wood-Dauphine S, Williams JI, et al. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can. 1989;41:304-311.
Şahin F, Büyükavcı B, Sağ S, et al. Berg Denge Ölçeği'nin türkçe versiyonunun inmeli hastalarda geçerlilik ve güvenilirliği. J Phys Med Rehabil. 2013;16:170-175.
Major MJ, Fatone S, Roth EJ. Validity and reliability of the Berg Balance Scale for community-dwelling persons with lower-limb amputation. Arch Phys Med Rehabil. 2013;94:2194-2202.
Wong CK. Interrater reliability of the Berg Balance Scale when used by clinicians of various experience levels to assess people with lower limb amputations. Phys Ther. 2014;94:371-378.
Scoppa F, Capra R, Gallamini M, et al. Clinical stabilometry standardization: basic definitions acquisition interval sampling frequency. Gait Posture. 2013;37:290-292.
Sensormedica.https://www.sensormedica.com/en/pages/hardware-en/cnc-milling-machines, (Erişim Tarihi: 25 Aralık 2020).
Khodaei B, Saeedi H, Jalali M, et al. Comparison of plantar pressure distribution in CAD–CAM and prefabricated foot orthoses in patients with flexible flatfeet. J Foot. 2017;33:76-80.
Jiang Y, Wang D, Ying J, et al. Design and preliminary validation of ındividual customized ınsole for adults with flexible flatfeet based on the plantar pressure redistribution. Sensors. 2021;21:1780.
Borg J, Mizzi S, Formosa C. Peak pressure data and pressure-time integral in the contralateral limb in patients with diabetes and a trans-tibial prosthesis. Gait Posture. 2018;64:55-58.
Jael B, Mizzi S, Formosa C. Peak pressure data and pressure-time integral in the contralateral limb in patients with diabetes and a trans-tibial prosthesis. Gait Posture. 2018;64:55-58.
Reilly K, Barker K, Shamley D, et al. The role of foot and ankle assessment of patients with lower limb osteoarthritis. Physiotherapy. 2009;95:164-169.
Braga UM, Mendonça LD, Masceranhas RO, et al. Effects of medially wedged insoles on the biomechanics of the lower limbs of runners with excessive foot pronation and foot varus alignment. Gait Posture. 2019;74:242-249.
Rodrigues P, Chang R, TenBroek T, et al. Medially posted insoles consistently influence foot pronation in runners with and without anterior knee pain. Gait Posture. 2013;37:526-531.
Bateni H. Postural sway in lower extremity amputees and older adults may suggest increased fall risk in amputees. CPOJ. 2020;3.
Mohieldin A, Chidambaram A, Sabapathivinayagam R, et al. Quantitative assessment of postural stability and balance between persons with lower limb amputation and normal subjects by using dynamic posturography. Macedonian Journal of Medical Sciences. 2010;2:138-143.
Ma CZH, Wong DWC, Wan AHP. Effects of orthopedic insoles on static balance ofolder adults wearing thick socks. Prosthet Orthot Int. 2018;42:357-362.
Karataş L, Vurallı D, Günendi Z. The effect of medial longitudinal arch height and medial longitudinal arch support insoles on postural balance in perimenopausal women. Turk J Med Sci. 2019;49:755-760.
Park JH, Jeon HS, Kim JH, et al. Immediate effect of insoles on balance in older adults. Foot (Edinb). 2021;47:101768.
Luengas LA, Gutierrez MA. Plantar pressure in transtibial amputees. International Journal of Biology and Biomedicine. 2019;4:21-25.
Sarroca N, Luesma MJ, Valero J, et al. Influence of insole material density in the stability of patients with prosthetic unilateral transtibial amputation. Sci Rep. 2022;12(1):7854.
Akben O, Kutlutürk Yıkılmaz S, Atılgan E. Transtibial protez kullanan bireylerde sağlam tarafta CAD/CAM tabanlık kullanımının plantar basınç ve postüral stabiliteye anlık etkisi. JETR. 2023;10(2):92-100.