Onur AKBEN, Seval KUTLUTÜRK YIKILMAZ, Esra ATILGAN

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.

Anahtar Kelimeler:

Ayak, Plantar basınç, Ayak ortezi, Postüral denge, Ampute

Immediate effect of use of CAD/CAM Insoles at the healthy side on plantar pressure and postural stability in individuals using transtibial prosthesis

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.

Keywords:

Foot Plantar pressure, Foot orthoses, Analysis, Postural balance, Amputee,

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