How is the solution used in the practitioner’s daily activity?

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The podiatrist uses DigitsolePro.com® for the dynamic analysis (walking or running depending on the patient). He collects data on the patient’s walking or running

activity using the web interface available online at https://app.DigitsolePro.com. The results are then presented to the patient, allowing the patient to integrate them into the treatment process and facilitating acceptance.

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Does the practitioner use other movement analysis systems?

The practitioner uses a camera to analyse the activity of athletes and movement analysis software in 2 dimensions of movement.

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What are the most frequently used parameters?

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The sport podiatrist analyses the gait line, the swing phase, and the ankle roll (absolute)

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• The Gaitline provides a quick overall view of the walk and shows what abnormalities may be detected. The contact times are indicated by step phase, allowing one to visualise a potential difference between the two sides and monitor the evolution.
• The swing phase is used to determine propulsion ratio and the muscles that create  the propulsion. In this way, the symmetry  between the two legs  can be verified. The swing phase is also used to analyse the length of  the stride and the similarity between the two sides. These data help in advising patients regarding daily exercises to avoid asymmetry (strength training, proprioceptivity, etc.).
• The ankle roll allows for the visualisation angles when striking, flat footed, and during propulsion in specify corrections. The illustrative graphic is explained to patients, who can see their deformations and the differences between the two sides.

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What information was collected for this patient?

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The walking profile allows us to see the contact times, airtime, and the length of the stride (distance between two heel contacts on the same side) for the right and left foot.

We observe a slight difference in the contact times as well as the length of the stride. The left foot touches for less time but travels a greater distance. The explanation for these differences can be made by interpreting the propulsion ratio and the gait line.

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The gait line allows us to quickly see how the step rolls and the associated contact times.

The left heel contact time is shorter due to the pain. The roll of the step shows few anomalies.

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The propulsion ratio allows us to see which muscles are the most utilised ones. We note a difference between the left and right sides. Due to the pain, the patient uses the plantar flexors on the left side less, which decreases the contact time and slightly increases the stride length on the left side.

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The ankle roll is used to obtain the precise angles of deformation.

The patient strikes normally in postero-external and then rolls in supination. A reinforcement on the external edge (sub-styloid) will be added to avoid this roll in supination.

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What examinations were carried out to complete the analysis?

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Fabrice Millet carried out his examinations in a conventional manner: questioning and examination while seated on a chair, examination standing and on one foot.

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During the questioning, we learned that the patient walks regularly and starting to be handicapped by the pain, which prevents her from walking. She has been walking daily to the hospital for several months to visit her husband.

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The palpation of the painful area does not bring on pain, nor does the flexing with resistance of the 1st toe flexor. An x-ray was performed, and no anomaly (calcaneal spur) was observed. Tightness of the Achilles tendon was observed.

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In the stationary exam, there were very few deformations, the calcaneus is centred, support is very reduced, and we observe a hollow foot combined with hammer toes (factors promoting the occurrence of this pathology).

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The patient has a hard time standing on one foot with a bent knee, and she is very unstable.

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What diagnosis was given?

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The plantar myoaponeurositis is due to a number of factors, for this patient the hollow foot combined with hammer toes, as well as the rapid increase in walking distances (patient who walked very little before, and now visits her husband in the hospital on foot).

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At the beginning she walked in shoes that are unsuitable and this encouraged the occurrence of this pain. Her roll in supination increases the tension on the Achilles tendon and consequently on the plantar fascia (concerning the suro-achilles-plantar system).

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What treatment or solution was provided to the patient?

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Thermoformed soles were made with compressible materials. The addition of removable bilateral heel pieces in order to relax the tendon and the plantar fascia.

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The supination of both feet was corrected in order to decrease the traction on the tendon and the plantar fascia. Recommendations for shoes, massages and stretching were provided.

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