Mark .... obviously I know why you are asking as I discussed these at recent seminars. What I have to say won't add anything to what I said then, but for others I will mention it.
The question I always ask, is that if I use any technology to assess a patient, then what is the potential for that investigation to potentially:
1) Alter the treatment that the patient is given
2) Improve the outcome for the patient
If one of those is not met, then its a question of ethics ---- however I do acknowledge the marketing/ patient education side of the technology (but still ask ethical questions here).
IMHO (in my humble opinion) until recently there was nothing I could see in a video gait analysis that I used to influence my orthotic prescription decision making - so am I being ethical by subjecting the patient to this test? (I do acknowledge its easy to convince them they need orthotics after showing them the video
). At the seminar I used two cases to illustrate where the use of digital video gait analysis (we use Silicon Coach for the analysis) did actually influence my decision making (both scenarios are now the genesis of 2 research projects). In one scenario, the position of the first ray during propulsion influences my casting position and in the other scenario, the symmetry/asymmetry of heel lift timing influences the heel post material.
As for pressure mapping, the same applies - does the use of this technology have the potential alter the treatment (and hence the outcome). It does give you very pretty pictures (in 3D if you want), that really impresses the patient -- but what do you actually do with that information? (?ethics). We have used pressure mapping in-shoe (with both the F-scan and Pedar) with and without the use of foot orthoses to look at changes in what parameters are actually predictors of better outcomes (we started this after the research showed that changes in the kinematic pattern of rearfoot motion was not associated with outcomes). The f-scan CoM analysis module has given us some good data that appears to be not only predictive of outcomes, but also predictive of failed orthoses - we have also looked at many other parameters -- some from the TAM analysis module has also given up some good data - especially when it comes to the symmetry of velocity of the CoP (remember that girl I discussed with the SI pain?) and first met head pressures (remember that 13 yr old boy I discussed?).
Where we are at with this is early days - we have not done the detailed analysis; we have not submitted this for publication (and had it subjected to peer review); hopefully we will get to report that hard data at the APodC conference in Hobart next year. This is why I showed that video of the cyclist who celebrated before crossing the finish line....
I genuinely believe that in the future, in order to improve outcomes, all issues of foot orthoses to patients (whether prefabricated or custom) should be accompanied by in-shoe pressure mapping with and with out the use of foot orthoses to make final adjustments (such as, for eg, first ray cut outs and type of rearfoot post). I genuinely believe that this will eventually become the gold standard. I just do not think we are there yet with enough data and we got a long way to go.
The dilemma for clinicians (and I assume the reason you asked this question here) is at what stage should clinicians implement these sorts of technology in the absence of good data??? Logically no clinical practice should change without hard data, but podiatry has a track record of not waiting for the research, so its a judgment call you have to make.
A number of Podiatry Arena members do you pressure mapping.
Bruce Williams uses more of the TAM module and uses it more with diagnosis as well as prescription.
Bob Fleck uses the CoM a lot. Good clinical experience has taught these two that different things are important. I use it differently to them .... there is still a lot of work to be done to determine which parameters are more important.....
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
CP
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