Foot shape assessment techniques for orthotic and footwear applications: a methodological literature review.

Introduction: Foot shape assessment is important to characterise the complex shape of a foot, which is in turn essential for accurate design of foot orthoses and footwear, as well as quantification of foot deformities (e.g., hallux valgus). Numerous approaches have been described over the past few decades to evaluate foot shape for orthotic and footwear purposes, as well as for investigating how one's habits and personal characteristics influence the foot shape. This paper presents the developments reported in the literature for foot shape assessment. Method: In particular, we focus on four main dimensions common to any foot assessment: (a) the choice of measurements to collect, (b) how objective these measurement procedures are, (c) how the foot measurements are analyzed, and (d) other common characteristics that can impact foot shape analysis. Results: For each dimension, we summarize the most commonly used techniques and identify additional considerations that need to be made to achieve a reliable foot shape assessment. Discussion: We present how different choices along these two dimensions impact the resulting foot assessment, and discuss possible improvements in the field of foot shape assessment.

Non-Rigid Registration Via Intelligent Adaptive Feedback Control.

Preserving features or local shape characteristics of a mesh using conventional non-rigid registration methods is always difficult, as the preservation and deformation are competing with each other. The challenge is to find a balance between these two terms in the process of the registration, especially in presence of artefacts in the mesh. We present a non-rigid Iterative Closest Points (ICP) algorithm which addresses the challenge as a control problem. An adaptive feedback control scheme with global asymptotic stability is derived to control the stiffness ratio for maximum feature preservation and minimum mesh quality loss during the registration process. A cost function is formulated with the distance term and the stiffness term where the initial stiffness ratio value is defined by an Adaptive Neuro-Fuzzy Inference System (ANFIS)-based predictor regarding the source mesh and the target mesh topology, and the distance between the correspondences. During the registration process, the stiffness ratio of each vertex is continuously adjusted by the intrinsic information, represented by shape descriptors, of the surrounding surface as well as the steps in the registration process. Besides, the estimated process-dependent stiffness ratios are used as dynamic weights for establishing the correspondences in each step of the registration. Experiments on simple geometric shapes as well as 3D scanning datasets indicated that the proposed approach outperforms current methodologies, especially for the regions where features are not eminent and/or there exist interferences between/among features, due to its ability to embed the inherent properties of the surface in the process of the mesh registration.

Pressure sensitivity for head, face and neck in relation to soft tissue.

Pressure sensitivity research on the head, face, and neck is critical to develop ways to reduce discomfort caused by pressure in head-related products. The aim of this paper is to provide information for designers to be able to reduce the pressure discomfort by studying the relation between pressure sensitivity and soft tissue in the head, face and neck. We collected pressure discomfort threshold (PDT) and pressure pain threshold (PPT) from 119 landmarks (unilateral) for 36 Chinese subjects. Moreover, soft tissue thickness data on the head, face and neck regions of 50 Chinese people was obtained through CT scanning while tissue deformation data under the PDT and PPT states was obtained from literature. The results of the three-elements correlation analysis revealed that soft tissue thickness is positively correlated with deformation but not an important factor in pressure sensitivity. Our high-precision pressure sensitivity maps confirm earlier findings of more rough pressure sensitivity studies, while also revealing additional fine scale sensitivity differences. Finally, based on the findings, a high-precision "recommended map" of the optimal stress-bearing area of the head, face and neck was generated.

Reduced Air Leakage During Non-Invasive Ventilation Using a Simple Anesthetic Mask With 3D-Printed Adaptor in an Anthropometric Based Pediatric Head-Lung Model.

Non-invasive ventilation (NIV) is increasingly used in the support of acute respiratory failure in critically ill children admitted to the pediatric intensive care unit (PICU). One of the major challenges in pediatric NIV is finding an optimal fitting mask that limits air leakage, in particular for young children and those with specific facial features. Here, we describe the development of a pediatric head-lung model, based on 3D anthropometric data, to simulate pediatric NIV in a 1-year-old child, which can serve as a tool to investigate the effectiveness of NIV masks. Using this model, the primary aim of this study was to determine the extent of air leakage during NIV with our recently described simple anesthetic mask with a 3D-printed quick-release adaptor, as compared with a commercially available pediatric NIV mask. The simple anesthetic mask provided a better seal resulting in lower air leakage at various positive pressure levels as compared with the commercial mask. These data further support the use of the simple anesthetic mask as a reasonable alternative during pediatric NIV in the acute setting. Moreover, the pediatric head-lung model provides a promising tool to study the applicability and effectiveness of customized pediatric NIV masks in the future.

Feature Preserving Non-Rigid Iterative Weighted Closest Point and Semi-Curvature Registration.

Preserving features of a surface as characteristic local shape properties captured e.g. by curvature, during non-rigid registration is always difficult where finding meaningful correspondences, assuring the robustness and the convergence of the algorithm while maintaining the quality of mesh are often challenges due to the high degrees of freedom and the sensitivity to features of the source surface. In this paper, we present a non-rigid registration method utilizing a newly defined semi-curvature, which is inspired by the definition of the Gaussian curvature. In the procedure of establishing the correspondences, for each point on the source surface, a corresponding point on the target surface is selected using a dynamic weighted criterion defined on the distance and the semi-curvature. We reformulate the cost function as a combination of the semi-curvature, the stiffness, and the distance terms, and ensure to penalize errors of both the distance and the semi-curvature terms in a guaranteed stable region. For a robust and efficient optimization process, we linearize the semi-curvature term, where the region of attraction is defined and the stability of the approach is proven. Experimental results show that features of the local areas on the original surface with higher curvature values are better preserved in comparison with the conventional methods. In comparison with the other methods, this leads to, on average, 75%, 8% and 82% improvement in terms of quality of correspondences selection, quality of surface after registration, and time spent of the convergence process respectively, mainly due to that the semi-curvature term logically increases the constraints and dependency of each point on the neighboring vertices based on the point's degree of curvature.

Fracture patterns in midshaft clavicle fractures.

Current classifications of midshaft clavicle fractures are based on radiography. The aim of the study was to evaluate the fracture pattern of clavicle fractures using 3-dimensional computed tomography (3D CT). A retrospective analysis was performed on CT scans of 65 acute clavicle fractures. Using quantitative 3D CT reconstruction techniques, the fracture of the clavicle was virtually reduced. Based on these reconstructions, a group-based fracture heat map and small fragment heat map, and the location of the most common fracture line were determined. Also, the direction and amount of displacement were evaluated. Three fracture patterns could be distinguished. The primary fracture line in type 1 is going from posteromedial to anterolateral and located between 50% and 68% of the clavicle's length. In type 2, a transverse fracture line is located around 55%, and in type 3, a superolateral to inferomedial line is located between 47% and 56%. Wedged fracture fragments can be seen in types 1 and 2 and are mainly situated inferiorly. The displacement is similar in all types, but the main direction of displacement is specific for the different types (posterior, anterior, inferior). We can conclude that several fracture patterns can be seen in clavicle fractures. Most fractures are located laterally at the midshaft of the clavicle. Wedged segments are mainly located inferiorly, and at the posterior part of the clavicle, no comminution is ever seen. The direction of displacement depends on the fracture pattern.

EquiSim: An Open-Source Articulatable Statistical Model of the Equine Distal Limb.

Most digital models of the equine distal limb that are available in the community are static and/or subject specific; hence, they have limited applications in veterinary research. In this paper, we present an articulatable model of the entire equine distal limb based on statistical shape modeling. The model describes the inter-subject variability in bone geometry while maintaining proper jointspace distances to support model articulation toward different poses. Shape variation modes are explained in terms of common biometrics in order to ease model interpretation from a veterinary point of view. The model is publicly available through a graphical user interface (https://github.com/jvhoutte/equisim) in order to facilitate future digitalization in veterinary research, such as computer-aided designs, three-dimensional printing of bone implants, bone fracture risk assessment through finite element methods, and data registration and segmentation problems for clinical practices.

PAPPI: Personalized analysis of plantar pressure images using statistical modelling and parametric mapping.

Quantitative analyses of plantar pressure images typically occur at the group level and under the assumption that individuals within each group display homogeneous pressure patterns. When this assumption does not hold, a personalized analysis technique is required. Yet, existing personalized plantar pressure analysis techniques work at the image level, leading to results that can be unintuitive and difficult to interpret. To address these limitations, we introduce PAPPI: the Personalized Analysis of Plantar Pressure Images. PAPPI is built around the statistical modelling of the relationship between plantar pressures in healthy controls and their demographic characteristics. This statistical model then serves as the healthy baseline to which an individual's real plantar pressures are compared using statistical parametric mapping. As a proof-of-concept, we evaluated PAPPI on a cohort of 50 hallux valgus patients. PAPPI showed that plantar pressures from hallux valgus patients did not have a single, homogeneous pattern, but instead, 5 abnormal pressure patterns were observed in sections of this population. When comparing these patterns to foot pain scores (i.e. Foot Function Index, Manchester-Oxford Foot Questionnaire) and radiographic hallux angle measurements, we observed that patients with increased pressure under metatarsal 1 reported less foot pain than other patients in the cohort, while patients with abnormal pressures in the heel showed more severe hallux valgus angles and more foot pain. Also, incidences of pes planus were higher in our hallux valgus cohort compared to the modelled healthy controls. PAPPI helped to clarify recent discrepancies in group-level plantar pressure studies and showed its unique ability to produce quantitative, interpretable, and personalized analyses for plantar pressure images.

The effect of nasal shape on the thermal conditioning of inhaled air: Using clinical tomographic data to build a large-scale statistical shape model.

In this paper, we investigate the heating function of the nasal cavity qualitatively, using a high-quality, large-scale statistical shape model. This model consists of a symmetrical and an asymmetrical part and provides a new and unique way of examining changes in nasal heating function resulting from natural variations in nasal shape (as obtained from 100 clinical CT scans). Data collected from patients suffering from different nasal or sinus-related complaints are included. Parameterized models allow us to investigate the effect of continuous deviations in shape from the mean nasal cavity. This approach also enables us to avoid many of the compounded effects on flow and heat exchange, which one would encounter when comparing different patient-specific models. The effects of global size, size-related features, and turbinate size are investigated using the symmetrical shape model. The asymmetrical model is used to investigate different types of septal deviation using Mladina's classification. The qualitative results are discussed and compared with findings from the existing literature.

Shoe design for older adults: Evidence from a systematic review on the elements of optimal footwear.

Due to changes in foot morphology and the occurrence of foot deformities and foot pain with ageing, older people frequently wear ill-fitting shoes. This can lead to discomfort and reduced mobility. A review of the literature was performed in Medline, Scopus and Embase with three aims: (a) to evaluate the effects of shoes or shoe elements on the comfort and mobility of older adults, (b) to summarise the evidence-based elements of a safe and comfortable shoe for older adults, and (c) from that, to compile those elements into design recommendations for a safe and comfortable shoe for older adults. Safe elements of footwear include proper anatomical fit, a well-fitting toe box, limited heel height, a broad enough heel, a firm insole and midsole, an outsole with sufficient tread, bevelled heel, firm heel counter with snug fit, and an easy and effective closing mechanism. We conclude that there is a need for shoe design specifically aimed at the foot morphology and demands of older people. The shoe market should increase the availability of well-fitting shoes designed for the older foot and person.

Aortic root sizing for transcatheter aortic valve implantation using a shape model parameterisation.

During a transcatheter aortic valve implantation, an axisymmetric implant is placed in an irregularly shaped aortic root. Implanting an incorrect size can cause complications such as leakage of blood alongside or through the implant. The aim of this study was to construct a method that determines the optimal size of the implant based on the three-dimensional shape of the aortic root. Based on the pre-interventional computed tomography scan of 89 patients, a statistical shape model of their aortic root was constructed. The weights associated with the principal components and the volume of calcification in the aortic valve were used as parameters in a classification algorithm. The classification algorithm was trained using the patients with no or mild leakage after their intervention. Subsequently, the algorithms were applied to the patients with moderate to severe leakage. Cross validation showed that a random forest classifier assigned the same size in 65 ± 7% of the training cases, while 57 ± 8% of the patients with moderate to severe leakage were assigned a different size. This initial study showed that this semi-automatic method has the potential to correctly assign an implant size. Further research is required to assess whether the different size implants would improve the outcome of those patients.

An assessment of the information lost when applying data reduction techniques to dynamic plantar pressure measurements.

Data reduction techniques are commonly applied to dynamic plantar pressure measurements, often prior to the measurement's analysis. In performing these data reductions, information is discarded from the measurement before it can be evaluated, leading to unkonwn consequences. In this study, we aim to provide the first assessment of what impact data reduction techniques have on plantar pressure measurements. Specifically, we quantify the extent to which information of any kind is discarded when performing common data reductions. Plantar pressure measurements were collected from 33 healthy controls, 8 Hallux Valgus patients, and 10 Metatarsalgia patients. Eleven common data reductions were then applied to the measurements, and the resulting datasets were compared to the original measurement in three ways. First, information theory was used to estimate the information content present in the original and reduced datasets. Second, principal component analysis was used to estimate the number of intrinsic dimensions present. Finally, a permutational multivariate ANOVA was performed to evaluate the significance of group differences between the healthy controls, Hallux Valgus, and Metatarsalgia groups. The evaluated data reductions showed a minimum of 99.1% loss in information content and losses of dimensionality between 20.8% and 83.3%. Significant group differences were also lost after each of the 11 data reductions (α=0.05), but these results may differ for other patient groups (especially those with highly-deformed footprints) or other region of interest definitions. Nevertheless, the existence of these results suggest that the diagnostic content of dynamic plantar pressure measurements is yet to be fully exploited.

Posture normalisation of 3D body scans.

For product developers that design near-body products, virtual mannequins that represent realistic body shapes, are valuable tools. With statistical shape modelling, the variability of such body shapes can be described. Shape variation captured by statistical shape models (SSMs) is often polluted by posture variations, leading to less compact models. In this paper, we propose a framework that has low computational complexity to build a posture invariant SSM, by capturing and correcting the posture of an instance. The posture-normalised SSM is shown to be substantially more compact than the non-posture-normalised SSM. Practitioner summary: Statistical shape modelling is a technique to map out the variability of (body) shapes. This variability is often polluted by variations in posture. In this paper, we propose a framework to build a posture invariant statistical shape model. Abbreviations: SSM: statistical shape model; 1D: one-dimensional; 3D: three-dimensional; DHM: digital human model; LBS: linear blend skinning; PCA: princial component analysis; PC: principal component; TTR: thumb tip reach.

Matlab® toolbox for semi-automatic segmentation of the human nasal cavity based on active shape modeling.

The nose is a complex and important organ with a multitude of functions. Computational fluid dynamics (CFD) has been shown to be a valuable tool to obtain a better understanding of the functioning of the nose. CFD simulations require a surface geometry, which is constructed from tomographic data. This can be a very time-consuming task when one chooses to exclude the sinuses from the simulation domain, which in general keeps the size of the CFD model more manageable. In this work, an approach for the semi-automatic construction of the human nasal cavity is presented. In the first part, limited manual interaction is needed to create a coarse surface model. In the next part, this result is further refined based on the combination of active shape modeling with elastic surface deformation. The different steps are bundled in a Matlab toolbox with a graphical interface which guides the user. This interface allows easy manipulation of the data during intermediate steps, and also allows manual adjustments of the reconstructed nasal surface at the end. Two results are shown, and the approach and its precision are discussed. These results demonstrated that the followed approach can be used for the semi-automatic segmentation of a human nasal cavity from tomographic data, substantially reducing the amount of operator time.

A three-dimensional digital neurological atlas of the mustached bat (Pteronotus parnellii).

Substantial knowledge of auditory processing within mammalian nervous systems emerged from neurophysiological studies of the mustached bat (Pteronotus parnellii). This highly social and vocal species retrieves precise information about the velocity and range of its targets through echolocation. Such high acoustic processing demands were likely the evolutionary pressures driving the over-development at peripheral (cochlea), metencephalic (cochlear nucleus), mesencephalic (inferior colliculus), diencephalic (medial geniculate body of the thalamus), and telencephalic (auditory cortex) auditory processing levels in this species. Auditory researchers stand to benefit from a three dimensional brain atlas of this species, due to its considerable contribution to auditory neuroscience. Our MRI-based atlas was generated from 2 sets of image data of an ex-vivo male mustached bat's brain: a detailed 3D-T2-weighted-RARE scan [(59 × 63 x 85) µm3] and track density images based on super resolution diffusion tensor images [(78) µm3] reconstructed from a set of low resolution diffusion weighted images using Super-Resolution-Reconstruction (SRR). By surface-rendering these delineations and extrapolating from cortical landmarks and data from previous studies, we generated overlays that estimate the locations of classic functional subregions within mustached bat auditory cortex. This atlas is freely available from our website and can simplify future electrophysiological, microinjection, and neuroimaging studies in this and related species.

STAPP: Spatiotemporal analysis of plantar pressure measurements using statistical parametric mapping.

BACKGROUND: Pedobarography produces large sets of plantar pressure samples that are routinely subsampled (e.g. using regions of interest) or aggregated (e.g. center of pressure trajectories, peak pressure images) in order to simplify statistical analysis and provide intuitive clinical measures. RESEARCH QUESTION: We hypothesize that these data reductions discard gait information that can be used to differentiate between groups or conditions. METHODS: To test the hypothesis of null information loss, we created an implementation of statistical parametric mapping (SPM) for dynamic plantar pressure datasets (i.e. plantar pressure videos). Our SPM software framework brings all plantar pressure videos into anatomical and temporal correspondence, then performs statistical tests at each sampling location in space and time. Novelly, we introduce non-linear temporal registration into the framework in order to normalize for timing differences within the stance phase. We refer to our software framework as STAPP: spatiotemporal analysis of plantar pressure measurements. Using STAPP, we tested our hypothesis on plantar pressure videos from 33 healthy subjects walking at different speeds. RESULTS: As walking speed increased, STAPP was able to identify significant decreases in plantar pressure at mid-stance from the heel through the lateral forefoot. The extent of these plantar pressure decreases has not previously been observed using existing plantar pressure analysis techniques. SIGNIFICANCE: We therefore conclude that the subsampling of plantar pressure videos - a task which led to the discarding of gait information in our study - can be avoided using STAPP.

Three-dimensional quantitative analysis of healthy foot shape: a proof of concept study.

BACKGROUND: Foot morphology has received increasing attention from both biomechanics researches and footwear manufacturers. Usually, the morphology of the foot is quantified by 2D footprints. However, footprint quantification ignores the foot's vertical dimension and hence, does not allow accurate quantification of complex 3D foot shape. METHODS: The shape variation of healthy 3D feet in a population of 31 adult women and 31 adult men who live in Belgium was studied using geometric morphometric methods. The effect of different factors such as sex, age, shoe size, frequency of sport activity, Body Mass Index (BMI), foot asymmetry, and foot loading on foot shape was investigated. Correlation between these factors and foot shape was examined using multivariate linear regression. RESULTS: The complex nature of a foot's 3D shape leads to high variability in healthy populations. After normalizing for scale, the major axes of variation in foot morphology are (in order of decreasing variance): arch height, combined ball width and inter-toe distance, global foot width, hallux bone orientation (valgus-varus), foot type (e.g. Egyptian, Greek), and midfoot width. These first six modes of variation capture 92.59% of the total shape variation. Higher BMI results in increased ankle width, Achilles tendon width, heel width and a thicker forefoot along the dorsoplantar axis. Age was found to be associated with heel width, Achilles tendon width, toe height and hallux orientation. A bigger shoe size was found to be associated with a narrow Achilles tendon, a hallux varus, a narrow heel, heel expansion along the posterior direction, and a lower arch compared to smaller shoe size. Sex was found to be associated with differences in ankle width, Achilles tendon width, and heel width. Frequency of sport activity was associated with Achilles tendon width and toe height. CONCLUSION: A detailed analysis of the 3D foot shape, allowed by geometric morphometrics, provides insights in foot variations in three dimensions that can not be obtained from 2D footprints. These insights could be applied in various scientific disciplines, including orthotics and shoe design.

High quality statistical shape modelling of the human nasal cavity and applications.

The human nose is a complex organ that shows large morphological variations and has many important functions. However, the relation between shape and function is not yet fully understood. In this work, we present a high quality statistical shape model of the human nose based on clinical CT data of 46 patients. A technique based on cylindrical parametrization was used to create a correspondence between the nasal shapes of the population. Applying principal component analysis on these corresponded nasal cavities resulted in an average nasal geometry and geometrical variations, known as principal components, present in the population with a high precision. The analysis led to 46 principal components, which account for 95% of the total geometrical variation captured. These variations are first discussed qualitatively, and the effect on the average nasal shape of the first five principal components is visualized. Hereafter, by using this statistical shape model, two application examples that lead to quantitative data are shown: nasal shape in function of age and gender, and a morphometric analysis of different anatomical regions. Shape models, as the one presented here, can help to get a better understanding of nasal shape and variation, and their relationship with demographic data.

Ergonomic design of an EEG headset using 3D anthropometry.

Although EEG experiments over the past decades have shown numerous applications for brain-computer interfacing (BCI), there is a need for user-friendly BCI devices that can be used in real-world situations. 3D anthropometry and statistical shape modeling have been shown to improve the fit of devices such as helmets and respirators, and thus they might also be suitable to design BCI headgear that better fits the size and shape variation of the human head. In this paper, a new design method for BCI devices is proposed and evaluated. A one-size-fits-all BCI headset frame is designed on the basis of three digital mannequins derived from a shape model of the human head. To verify the design, the geometric fit, stability and repeatability of the prototype were compared to an EEG cap and a commercial BCI headset in a preliminary experiment. Most design specifications were met, and all the results were found to be similar to those of the commercial headset. Therefore, the suggested design method is a feasible alternative to traditional anthropometric design for BCI headsets and similar headgear.

3D morphometric analysis of the human incudomallear complex using clinical cone-beam CT.

Human middle ears show large morphological variations. This could affect our perception of hearing and explain large variation in experimentally obtained transfer functions. Most morphological studies focus on capturing variation by using landmarks on cadaveric temporal bones. We present statistical shape analysis based on clinical cone beam CT (CBCT) scans of 100 patients. This allowed us to include surface information on the incudomallear (IM) complex (joint, ligaments and tendon not included) of 123 healthy ears with a scanning resolution of 150 µm and without a priori assumptions. Statistical shape modeling yields an average geometry for the IM complex and the variations present in the population with a high precision. Mean values, variation and correlations among anatomical features (length of manubrium, combined length of malleus head and neck, lengths of incus long and short process, enclosing angles, ossicular lever ratio, incudomallear angle, and principal moments of inertia) are reported and compared to results from the literature. Most variation is found in overall size and the angle between incus and malleus. The compact representation provided by statistical shape modeling is demonstrated and its benefits for surface modeling are discussed.