Instrumental evaluation  of the consequences on the pelvis and on the vertebral column caused by the use of various orthotics, performed by means of the posturographic rug 3d vrs formetric.

 by M.A.FUSCO Chairwoman I.S.F.O.M./Ph.D in Posturology  and in  Biomechanics

 Responsible  for the KS ITALIA Studies' and Research's Center

R.FUSCO  First level manager Department of Orthopaedia and Traumatology  Ariano Irpino  Hospital (AV).

M.AMBROSONE Student of the faculty of  Medicine and Surgery Università Federico II Naples.

The authors attempted to evaluate the efficacy of the therapeutical intervention implemented by means of orthotics, to treat different types of pathologies, concerning both the feet and the system, through a instrumental  compared examen performed by means of a pedobarographic rug and a 3D imaging of the torso and the pelvis.

They studied 23 patients aged between 15 and 46, 12 male and 11 female. The patients had already undergone different examinations during their clinical history and had followed several therapeutical suggestions. In particular, different and dissimilar types of orthotics, had been prescribed to them. Some patients had been suggested to use different types of orthotics at each new specialistic examination.

The authors asked their patients to carry to them the different types of orthotics used until that moment and began to perform some instrumental evaluation's tests on their patients

The static podobarographic examination, as the 3D imaging of the torso and of the pelvis of each patient, have been performed barefoot and with each one of the prescribed orthotics and/or rehabilitative tools.

For the static padoborometric examination, the authors used the electronic rug, manufactured by Phisical Support s.r.l. and they evaluated whether the use of orthotics, manufactured specifically, that means on the basis of the characteristics of each patient, could restore a more uniform distribution of the loads and  of the pressures of the body's weight on the ground.

To obtain the 3D imaging of the torso and of the pelvis the authors  used the 3D VRS Formetric machine and evaluated the changes in the spatial arrangement of the pelvis and of the vertebral column caused by the different prescribed orthotics or rehabilitative tools. They evaluated as suitable, the therapeutical intervention capable of normalizing this spatial arrangement.

All the patients exhibited an asymmetry of the pelvis and of the medial melleoli, both in upright and in supine position. Nobody of them was suffering from an anatomic asymmetry of the lower limbs.

In the previous examinations performed, before these patients come to us,  by different specialists, different kinds of orthotics had been prescribed to our patients, but they had been replaced by others afterwards.

These observations made us really corious.We attempted to find out why, orthotics that were different from each others had been prescribed to patients, who were however  suffering from the same painful symptoms. By means of an instrumental examination, we evaluated the effects of these rehabilitative tools.

We asked all patients to bring to us all the orthotics they had been using until that moment and we evaluated their efficacy on the basis of the results of two  very important tests : the static podobarographic test and the 3D imaging of the torso and of the pelvis. The  static podobarographic test, as the3D imaging of the torso and of the pelvis of each patient, have been performed barefoot and with every prescribed orthotic or rehabilitative tool.

The static podobarographic  examination  has been performed by means of the electronic rug of the Phisical Support s.r.l.and the different results have been compared to the normal  standard, elaborated by the machine itself. There is a specific standard for each examination and for each patient.( fig. 1 )

The 3D imaging of the torso and of the pelvis has been performed by means of a 3D VRS FORMETRIC machine, that by projecting a light's beam throughout an horizontal shutter, by means of mathematical elaboration of the gathered data, provides an image of the spatial arrangement of the pelvis' bones and of each vertebra from the C7 to the L5,expressing the spatial arrangement both in a graphic way and in numbers to measure the torsion relative to the normal ideal arrangement of each patient.( fig. 2 ) 

The instrumental evaluations have been  performed according to the chronology of the suggestions given previously to our patients by other specialists and they have been performed at the same time for each rehabilitative tool. ( fig. 3 )

The orthotics prescribed to the patients were very different from each others. Among them, there were pure mechanical orthotics made with stiff and semi-stiff materials, or monolateral wedges, or magnetic orthotics or orthotics supposed to be exteroceptive. Some of these orthotics, in particular the stiff ones, were used in combination with orthopaedic shoes. ( fig. 4 )

In these cases, as the "shoe" was an integrating part of the therapeutical prescription, the instrumental  evaluation has be performed with and  without shoes.

 It has been really interesting for us, to evaluate the changes occurring both in the distribution of the weight and the loads on the ground and in the pelvis' and vertebral column's spatial arrangement, when whatever orthotics or any other tharepeutical tool are placed under the patients' feet.

 Unfortunately  none of the used orthotics or rehabilitative tools provided satisfactory therapeutical results. However, the patients, who had been prescribed to use these orthotics, were always suffering from the same painful symptoms. For this reason they had undergone several specialistic examinations and followed different therapeutical attempts.

 All the patients had already undergone a radiography of the entire rachis in orthostatisms in the two standards projections with recording on the millimetred plate; many of them had undergone a TAC and/or RMC tests.

 Among the 23 analyzed patients, 12 male and 11 female, 9 of them (39,13%) , 5 male and 4 female, exhibited a left upwards displaced iliac crest ; 14 of them (60,86%),7 male and  7 female, exhibited , on the contrary, a right upwards displaced iliac crest (tab. A).

The results of the morphological plantar stance were:

• in 6 patients (26,08%), 3 male and 3 female, normal foot,

• in 7  patients (30,43%),5male and 2  female, I degree flat foot,

• in 7  patients (30,43%),4 male and 3  female, III degree flat foot ,

• in 3 patients (13,04%), 3  female, I degree claw foot . (tab. B) 

·        a monolateral wedge to be placed under the heel homolateral to the downwards displaced hemipelvis had been prescribed to all 23 (100%) patients, because of the asymmetry of the iliac crests;

·        a traditional static orthotic with a metatarsal olive and  an up pushing tool corresponding to the medial longitudinal arch, made with soft material had been prescribed to 18 patients  (78,26%) , 10 male and  8 female;

·        a dynamic orthotic had been prescribed to 8 patients(34,78%) , 5 male and 3 female;

·        a static orthotic in stiff material had been prescribed to 10 patients(43,47%) , 4 male and  6 female;

·        an magnetic orthotic had been prescribed to  5 patients  (21,73%) , 3 male and  2 female ;

·        an orthotic defined as extroceptive had been prescribed to 3 patients(13,04%) , 1 male and  2 female;

·        a stiff orthotic combined with orthopaedic shoes had been prescribed to 2 patients  (8,69%) , 1 male and 1 female;

·        a stiff orthotic in addition to a monolateral wedge had been prescribed to 1 male patient (4,34%) ,     (tab. C)

The static podobarographic evaluation highlighted that none of the prescribed corrective tools neither allowed to achieve a more balanced distribution of the pressure points or  to get near to the normal standard specifically elaborated for each patient.

The 3D examination performed by means of the 3D VRS Formetric, showed that none of the implemented  therapies enhanced an improvement in the spatial displacement of the column and of the pelvis.

Here you have some documents of the analyzed cases.

(document A / A1 / A2 / A3 )

(document B / B1 / B2  / B3 )

(document C / C1 / C2 / C3 )

This instrumental evaluation on the efficacy of the classical therapeutical intervention implemented when some osteo-joints pains occur, allows to better understand all the factors that cause derangements from the perfect simmetry.Considering this latter as counterbalancing mechanism based on painful stimuli.

In order to find out if it is possible to treat these pathologies, it will be sure necessary to carry out the same investigation, studying a bigger amount of patients, may-be also comparing further therapeutical methods.

Obviously, it is clear that when a pair of orthotics or a simple monolateral mechanical wedge are prescribed, the implemented therapy will exert its influence not only on the foot or on the pelvis, but on the entire organism.