Affiliation:Department of Biomedical Engineering, Faculty of Engineering, University Of

Name:Dr.NasrulAnuarAbdRazak

Affiliation:Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, MALAYSIA

Field of research:Electronic Science

Purpose of research topic:Medicated Orthotic Shoes/Footwear Design: Comparison between Korean and Malaysian Unstable Subtalar Joint Patient

Motivation and need for this project:

Asian consists of a wide range of community. With a different culture, different food,

different daily life activities may resultant to have a different type of foot. The demographic data of Korean and Malaysian community might totally different based on their annual daily life activities. However, even the way of life might be different but the disease still occurs such as the foot problem. Some might have conducted the unstable ankle joint movement while conducting annual daily life activities. The impact might come from different style of walking, type of shoes, motion in conducting daily life activities, or even food, might contribute to this foot problem. With that, this ISEF might be the opportunity to conduct comparison study of foot problem of unstable subtalar joint between patient from Korean and Malaysia. The outcome of the research may lead to a suggestion of improving the way of conducting activities to avoid unstable subtalar joint. The electronic technology known as foot scanner might be the focus point in conducting this conjunction research.

Background:

Foot deformity and pain has gradually become one of the major disability factors to the South East Asian (SEA) community in 20thcentury. This may be due to the culture of the community which the people do not get used to wear shoes as often as the Westerners do. The greatest different inshoe-wearingculture between the two continents could be a major distributor to the foot deformity cases reported in many SEA countries. The actual statistic on the foot deformity and pain could be much higher than that of been reported because people tend to ignore the foot pain or take it as a normal aging disease. In fact, the ignorance of the community in foot deformity and pain slowly affected their activity level and productivity, which directly cause a drop in the quality of life.

Foot orthotic or Orthotic Shoes/Footwear seems to be the most preferablenon-invasivetreatment to foot deformity and pain, as most of the cases are related to foot and ankle misalignment, including the unstable subtalar joint. Foot orthotic is a device where its function to realign the foot, accommodate the foot, and prevent further deformity. Foot and ankle misalignment could be congenital or developmental, in the sense that someone might born with the foot disorder but there is also possibility that someone overuse their foot and ankle till it gets deformed. In the cases of, subtalar instability the causes can be due to the congenital or due to the trauma or injury. Subtalar instability is a condition that is characterized by the looseness and/or giving away of the joint and it is usually associated with ankle instability. The loosening of the joint is caused by the injury of the ligament of the subtalar joint and sometimes due to the previous ankle injury that goes without treatment.

According to the International Classification of Functioning, Disabilities and Health (ICF), established by the World Health Organisation (WHO), health conditions could be determined by several attributes. Foot and ankle misalignment which is the main cause of subtalar instability can cause the impairment of the body structure, which will lead to body functions impairment eventually if it is not treated. The subtalar instability can cause pain which limits the activity of the pain bearer in terms of walking and can restrict their participation within the community. The fore mentioned primary foot diseases are normally caused by abnormal foot alignment, but they could also be due to foot overuse or misuse. Foot overuse in the sense that people perform extreme activities that overwhelm the foot ability, especially athletes and those who have prolonged weight bearing period. Foot misuse, or more appropriately less care on the foot condition, the people are more likely to wear improper but stylish footwear and shoes. These improper shoes are meant to be good looking and trendy, but not functionally health to human foot. There is an obvious trend with the current shoes manufacturer and designers in which they compete with each other to give out the best looking and stylish shoe design, regardless of the function and the effect of the design on foot biomechanics.

When human foot failed to perform well, credit to the improper footwear, but there is always an orthotic treatment to help realign and accommodate the deformity and pain. Foot orthosis or the orthotic shoes had been widely used to treat foot problems and pain worldwide. Due to its effectiveness and convenience, it has gradually gained the interest from the foot pain community. However, the effectiveness of the orthotic treatment is greatly depending on the design, biomechanics and materials of the device itself. In this study, the development of orthotic shoes design for unstable subtalar joint is the main focus to help stabilize the unstable joint.

References:

Dawe, E. J., & Davis, J. (2011). (vi) Anatomy and biomechanics of the foot and ankle. Orthopaedics and trauma, 25(4), 279-286.

F. Hawke, & Burns, J. (2009). Understanding the nature mechanism of foot pain. Journal of foot and ankle research, 2(1).

Gentili, A., Masih, S., Yao, L., & Seeger, L. L. (1996). Foot axes and angles. The British Journal of Radiology, 69(826), 968-974. doi:

doi:10.1259/0007-1285-69-826-968

Henry Gray. (1918). Anatomy of the human body (W. H. Lewis Ed. 20th ed.). Philadelphia: Lea & Febiger.

Hertel, J. (2002). Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability. Journal of Athletic

Training, 37(4), 364-375.

Hintermann, B., & Nigg, B. (1998). Pronation in Runners. Sports Medicine, 26(3), 169-176.doi: 10.2165/00007256-199826030-00003

J. Karlsson, B. I., Eriksson, Per A. Renstrom. (1997). Subtalar ankle instability. Sports Medicine, 24(5), 337-346.

Objectives:

This research and study is intended: -

a) to develop a better and effective orthotic footwear/shoes design for person with unstable subtalar joint to be worn by Asian community

b) to analyse the biomechanics evaluation of the subtalar instability with and without the designated orthotic shoes

Scope, design and methodology:

Study Design

This study is focusing on compare theorthotic footwear for patient or person with unstable subtalar joint. The first part of this study is to recruit a participant or subject that having a foot condition of subtalar joint instability. The participants need to undergo a few test and assessment and need to fulfilled all the requirement before they are chosen to be in the study. The assessments and test to identify the patient are: -

a) Angle of Subtalar Joint (Standing)

As been mention earlier, person with unstable subtalar joint will present a condition of foot of overpronation or oversupination. Therefore, the first crucial step in identify a patient is that to measure the angle of the subtalar joint while there are standing. In a normal person, the line of the leg will be in neutral position when standing in which the angle of subtalar joint will set to 0°. Any excessive angle of the joint towards the outside part or inside part of the foot will be measured to determine the severity and condition of the foot. In overpronation and oversupination the angle that consider to be excessive angle is when it exceeds 5° to the left part or right part of the foot, away from its neutral position. (Figure 2)

Figure 2: Analysis of subtalar joint angle using Kinovea software

Figure 3: Analysis of the pressure distribution and foot arch using GaitView software.

b) Angle of Subtalar Joint (Walking)

The second assessment is that to determine the angle of subtalar joint during walking. This is to see and observe the amount or degree of gait deviation encounter by the subject. The phase or part of the gait cycle that are consider when determine the angle are during heel strike andpush-off.During a normal gait cycle of a normal person, there are pronation range of 10° to 15° occur to stabilize the foot and body, but if the angle is more than 15° to lateral part the foot is in overpronation, while if it exceeds 10° angle from the medial part of the body, the foot is in overpronation condition and there present a gait deviation.The method to measure the angle of the joint is same as the measuring the angle will standing. In which Kinovea software is used to analyse the recorded video when the subject walking on the treadmill.

c) Arches of the Foot

Person with unstable subtalar joint is usually present with a feature of the high arch (oversupination) and low arch (overpronation) condition. In this assessment the person arch is observed on the medial side of the foot to see if there are space between the foot and the ground. In this test, a device calledGaitView/F-Scanis used to determine the abnormality of the foot arches. The subjects are requiring to stand on to the device plateand the software will record the pressure distribution of the foot and will determine whether the arches is normal or not. (Figure 3)

Schedule:

Significance:

My academic field:The study will help enhancing the relationship between the pure engineering science with the clinical prosthetic and orthotic. The field of electronic science in medical are very wide and thus need a lot of research to be done. By doing so, it may lead to another finding as well.

My own professional development:The research finding may help me to establish myself in this area, become the reference research and finding for other researcher. The publication will help to burst up my career as well.

My country: The information of demographic data between Korean and Malaysian might help both countries in find the best solution in counter the foot problem and help theyconducting annual daily life activities.

Dissemination plans:

Publication:Will submit to the well-known high impact journal from web of science.

Commercialization:Collaboration with local industry

Media/Press:Targeting to write up for media and press to spread the news to the community

Seminar/Conference:Organizing a workshop/seminar to distribute the information and finding.

Publications:

1.NasrulAnuarAbdRazak, Noor Azuan Abu Osman, HosseinGholizadeh, and Sadeeq Ali (2016). Patient- specific interface pressure case study at transradial prosthetic socket: comparison trials between ICRC polypropylene socket and air splint socket.European Journal of Physical and Rehabilitation Medicine(ISI-Indexed)

2.Sadeeq Ali, Noor Azuan Abu Osman, ArezooEshraghi, HosseinGholizadeh, NasrulAnuarAbdRazak, Wan Abu Bakar Wan Abas(2013). Interface pressure in transtibial socket during ascent and descent on stairs and its effect on patient satisfaction. Clinical Biomechanics(ISI-Indexed)