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Using these methods it is possible to show the percentage contact of the ball of the foot compared to the heel and their positioning when walking.
Tests can be carried out to assess the positioning of the foot, producing a graphic record of the pressure applied on the ground, both when the patient is in a static position and when walking. Important investigations such as checking the transfer of weight, the positioning and the length and degree of load transmission are extremely useful for understanding any static or dynamic dysfunction of the foot, allowing the analysis of postural and locomotive biomechanics together with the pathological changes connected to them. [6]
During its development, Lymphoedema is affected by the impact of both any defects in posture and changes in the muscle pumps, as well as by the weight of the individual themselves, which, acts on the sole of the foot adversely compressing it. [7-8]
As the fundamental resolution offered by an orthopaedic device is to provide the patient as much relief as possible, its design and manufacture must be seen as an endeavour to alleviate the suffering of whoever is afflicted.
The orthotic device must be made to measure in order to fit comfortably between the foot and the surface the individual is standing on, responding to the force of the weight for every single shape and model.
The purpose of each orthotic therefore is not just limited to reducing some podiatric dysfunctions or deformations but it must also meet other needs: to compensate for mechanical problems making them more tolerable for the patient and thereby improving their quality of life.
Orthotics are designed to maintain the correct articulation of the feet and to respect their positioning which, during the phase of contact and propulsion, can be subjected to movements which are anomalous to the structure of the joints.
The provision of an orthotic is mainly requested in order to relieve symptoms of pain and to compensate for situations largely affecting the lower extremities following systemic diseases, for example, diabetic or rheumatic diseases, or those involving the circulatory, nervous or lymphatic apparatus.
It is possible to produce so-called corrective orthotics on the basis of functional characteristics. These are capable of acting to reduce some problems linked to development age such as in the case of infantile flat foot. An orthotic made for this purpose is aimed at changing the articulatory relationship of the feet to obtain a new morpho-structural equilibrium of the limb during the phase of contact and propulsion, when both static and dynamic.
Antalgic orthotics are, on the other hand, designed mainly to limit or eliminate the pain caused by a disease. As they provide total contact, they allow body weight to be distributed over a larger area. The pressure applied on any specific point is reduced, lowering the strain on the foot and therefore helping its anatomical structure. They are made using materials with different degrees of rigidity. In order to distribute the pressure to predetermined points, pieces with shock absorbing characteristics are selectively applied to the specific zones where there is excess pressure.
They are used for advanced arthritic conditions, deforming arthritis, gout, diabetes and generally in all situations in which the foot causes suffering.
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXIX - Nr. 75 - 2017
The distinguishing characteristic of biomechanical orthotics is their ability to re-establish the correct features of the step. They are made using a more complex process which allows the identification of the characteristics of gait and the calculation of the level of daily stress the foot is placed under.
By absorbing the impact on the heel in the first phase of contact, this type of orthotic, contributes to the normalisation of the contact time of the foot on the ground, respecting the correct pronation and supination and the homogeneous transfer of body weight during the whole movement. The materials used to manufacture them can be grouped into three main categories: rigid, semi-rigid and soft. [9]
MATERIALS AND METHODOLOGY
Starting in May 2015, 33 individuals who had already been diagnosed with lymphatic diseases of the lower limbs were selected at random – 24 female and 9 male, aged between 20 and 85 years old.
Each individual was appropriately informed and in order to take part in our research, agreed to provide both their medical records and any other information deemed necessary for the research.
For each individual and without any differentiation, a medical record (see appendix) was created, made up of both a detailed medical history and the data taken at an objective podiatric examination.
The record, set out in different sections, enabled us to have a detailed understanding of physical and familial factors related to the participants.
In the final section, dedicated specifically to lymphatic disorders, all relevant information was taken from the documentation provided by the patients themselves as well as from observations made by the professionals during the assessment of the individual in question. [10 -19]
During the initial information gathering meeting, two different podiatric foot prints were taken of each individual – one using podiatric paper and another using phenolic foam to make an impression and produce a positive plaster cast.
This impression in phenolic foam was produced in two different ways depending on requirements:
a) weight-bearing, in a free orthostatic position
b) partially weight-bearing, manipulating the subtalar joint to bring it into a neutral position.
Using a baropodometric foot board a static assessment was carried out during which the individuals, temporarily without footwear, compression supports or bandages, were asked to stand for a few minutes in a natural pose on their heels, properly aligned on the footboard.
So as to get information on the dynamics of the joints, the timing of rest phase and of course the pressure value of each foot, the individuals were asked to walk along a corridor with a treadmill with a sensitised surface in the centre to carry out a dynamic analysis. [20]
To optimize the research, the orthotics were intentionally produced in two different ways in order, in addition to the main aim of
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