Baropodometry or pedobarography is the method used to evaluate body load distribution to the foot during rest and walking, measured by an advanced force platform, the baropodometer. This type of device provides information on foot pressure and, through software process, provides an image similar to a podoscope. Baropodometry has been used in patients with many diseases, such as ocular torticollis, Hansen’s disease, stroke, Parkinsonism, obesity, temporomandibular disorder, osteoporosis, diabetes, hemiparesis, hallux valgus and many others. Its ability to give an image of the foot pressure can help health professional on the diagnosis of many conditions, guiding treatments and the evaluation of outcomes. As research studies on this field keeps growing, research protocols and standardization of parameters will be necessary to allow effective comparison and use of this type of load distribution study. The motivation of this effort will be to apply the most clinically beneficial therapies to each patient and to improve the safety of decision making protocols. This review highlights the most recent and interesting articles regarding baropodometry.

• Gait

• Baropodometry

• Foot

• Plantar pressure

Baumfeld T, Baumfeld D, Prats Dias CG, Nery C (2018) Advances of Baropodometry in Human Health. Ann Musc Disord 2(2): 1011

Load bearing and balance are the primary elements needed to proper function of gait, which is the main purpose of the unique human bipedalism locomotors system [1]. Gait is the action of getting from one point to another by using harmonic cycles of positioning one lower limb in front of the other [2]. Many factors influence its efficacy, like central nervous system function [3,4], muscular strength, particular mobility [5] pain and even more specific mechanical properties like the spring mechanism of the foot’s arch [6]. Also, biometrics shows us that each person has a unique gait, as personal as one’s fingertip, signature or voice [7].

Baropodometry or pedobarography is the method used to study body load distribution to the foot during rest and walking, measured by an advanced force platform: the baropodometer [8]. It is the study of pressure fields acting between the plantar surface of the foot and a supporting surface. Used most often for biomechanical analysis of gait and posture, pedobarography is employed in a wide range of applications including sports biomechanics and gait biometrics. This type of device provides information on foot pressure and, through software process, provides an image similar to a podoscope [8,9] (Figure 1). The main indication for a baropodometry study is to help decision making in the treatment of different postural disorders and in the choice of different shoe insoles or surgeries. Sometimes, the baropodometer features themselves are used as a treatment itself, like in the biofeedback systems.

The literature regarding baropodometric studies is not vast, but some effort has been made trying to correlate baropodometric results in specific health conditions, aiming to discuss the indication of such studies based on its capacity of helping clinical decisions. Kaercher [10], found no correlation between chronic pelvic pain and baropodometric results in a study comparing 32 women suffering from such condition and 30 controls.

On the other hand, some studies have found significant differences in the results of baropodometry performed with patients with ocular torticollis [11], Hansen’s disease [12], stroke [13], Parkinsonism [14], obesity [15,16], temporomandibular disorder [17], osteoporosis [18], diabetes [19-22], hemiparesis [23], and hallux valgus [24]. Whether those differences between the results of these patients and normal controls might influence clinical decisions or not is still a topic to be researched. We believe that the standardization of the indication of baropodometry to everyday clinical issues will probably result in very interesting findings helping health professionals to diagnose and classify many obscure conditions, which might lead to better clinical results.

Some conditions already have its treatment protocols or decision making influenced by baropodometric studies. Some pioneer studies regarding outcome evaluation based on baropodometric parameters have been published showing that the baropodometry could be an excellent noninvasive method for monitoring surgical and rehabilitation outcomes. Grassi [25], found that thrust manipulation (a physical therapy intervention modality for compromised joint motion) of the sacroiliac joint affects peak pressure distribution, making baropodometry a good parameter for patient’s improvement. Notarnicola [26], found correlation between baropodometric results and clinical and function improvements, notably on gait pattern. Bacha [27], showed less ground reaction force and better gait rhythm after bariatric surgery. Some studies showed correlation with aesthetic surgical procedures and baropodometric results improvement, probably by an association between the redistribution of the body mass and psychological factors after breast reduction or augmentation and abdominoplasty procedures [28-30].

Daily activities have also been correlated with the results of baropodometric studies and might have an influence in clinical practice recommendations. Rodrigues [31], compared the plantar force distribution between different positioning and weight of backpacks in young students. They found that load distribution was not affected by the backpack position, but the increase of backpack’s weight from 10 to 15% of corporal mass alters the pressure center location and, thus, should be avoided

Figure 1 Example of a baropodometric measurement [8]

Biofeedback training may enhance treatment results by using baropodometry devices. Gomes [32], showed that after ten biofeedback training sessions for children with neurological equinus foot deformity, the pressure on the calcaneus increased and the pressure on the forefoot decreased, reducing the equine foot position in gait. Descatoire [33], developed a biofeedback system to prevent ulcer formation in patients with neurological protective sensory impairment of the foot. They stated that the hardware and its auditory and visual feedback system might help relieving pressure on the foot while maintaining walking speed, but it still lacks portability for out of the laboratory use. With the development of new technologies and downsizing of the hardware equipment, new appliances for the baropodometry features will certainly arise.

Concerns about treatment outcomes correlation with baropodometric evaluation are present in literature. In an early study, Nery [34], demonstrated that after a chevron osteotomy for treating hallux valgus followed by a baropodometric evaluation, the maximum and average pressure and its location on the forefoot were restored to normal.

Baropodometric evaluation has also been used to assess results after modified chevron osteotomy for treatment of hallux valgus [35], and was found to correlate with the outcome score used three months postoperatively. Once again, whether those positive results obtained by the baropodometric studies will influence clinical or surgical decision making is yet to be clarified.

Alkmin [36], Alfieri [37] and Kamonseki [38], also validated the efficacy of physical therapy interventions applied for ankle sprains, elder patients and basketball players, respectively, based on the results of baropodometric studies before and after treatment.

These interesting studies shows us clearly that the ability of measuring foot pressure in a very objective way can open new discussions for common problems or can even validate clinical and surgical interventions.

Neto and colleagues [39], compared if the indication of insoles should be guided by clinical analysis or baropodometric values in 36 volunteers. They found that those two categories of evaluation of a patient’s posture are statistically different. All participants who had the insoles indicated by clinical evaluation had normalization of the clinical parameters, but only 77% of the insoles indicated by the baropodometric evaluation had normalization of such parameters. They observed that this difference might be due to a lack of period of adaptation when insoles were selected by baropodometric guidance, whereas, in clinical examination, the postural response of the body might be due to a proprioceptive process and, thus, immediate [39].

Vianna and Greve [40], in a very interesting study found that the lower the mobility of the ankle measured by goniometry, the higher the floor reaction peak force measured by the baropodometer. This interesting clinical finding is not always searched in clinical practice, probably due to lack of interest or availability of this technology. This might even be a publication bias of good to excellent results favoring baropodometry over clinical evaluation. It is generally accepted that the lack of standardization of the available products, as well as problems associated with patient’s acceptance may be associated with such frustration in literature [41]

Baropodometry is a very interesting tool in orthopedics and physical therapy practice, but still on its early days of use and documentation by evidence-based medicine. Although still uncertain, the use of the baropodometer and its results in everyday clinical practice might eventually become extremely necessary helping health professional to make better clinical decisions and evaluate better their treatment outcomes. Baropodometry availability and the lack of good evidence in literature are clear barriers to maximizing its benefits. Continued investigation can facilitate the development of a very useful diagnostic and followup protocols that will enhance the individualization of patient care, aiming to the best patient centered practice. As this field continues to develop, research protocols and standardization of the parameters will be necessary to allow effective comparisons and use of this technology. The boost of this effort will be to apply the most clinically beneficial therapies to each individual and to improve the safety of decision making protocols.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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