Comparison of Pedobarographic Profile in Young Males with Left
and Right Scoliotic Posture
Igor Gruić, Karlo Cebović and Vladimir Medved
Faculty of Kinesiology, University of Zagreb, Horvaćanski zavoj 15, Zagreb, Croatia
Keywords: Scoliosis, Posture, Gait, Plantar Pressure, Movement Compensation.
Abstract: Background: Scoliosis alters both posture and gait. Pedobarography is a biomechanical method for assessing
gait that has been rarely used in scoliosis-specific gait research. Objective: To determine differences between
left and right scoliotic posture in plantar pressure and force gait profile among young males. Methods:
Twenty-one young, trained males assigned to one of two groups: left scoliotic posture (LSP; N=12) and right
scoliotic posture (RSP; N=9) group. Subjects were assigned to a group based on forward-bending test and
controlled for age, height, weight, body mass index (BMI), right and left leg length. All subjects were blinded
for group they were assigned and study outcomes. Examiners were blinded for study outcomes. Subjects
walked at self-selected speed along the 9,5-meter-long walkway for 2 minutes. Plantar pressures and forces
were measured using pedobarographic device Zebris medical FDM 1.5. Measured outcomes during gait
included: Maximum force right foot (N), Maximum force left foot (N), Maximum force at first contact right
foot (N), Maximum force at first contact left foot (N), Maximum force at take-off right foot (N), Maximum
force at take-off left foot (N), Maximum forefoot force right foot (N), Maximum forefoot force left foot (N),
Maximum midfoot force right foot (N), Maximum midfoot force left foot (N), Maximum heel force right foot
(N), Maximum heel force left foot (N), Maximum forefoot pressure right foot (N/cm
2
), Maximum forefoot
pressure left foot (N/cm
2
), Maximum midfoot pressure right foot (N/cm
2
), Maximum midfoot pressure left
foot (N/cm
2
), Maximum heel pressure right foot (N/cm
2
), Maximum heel pressure left foot (N/cm
2
). Results:
There were no significant differences in any observed foot pressure or force gait parameter between left and
right scoliotic posture group (p<0,05). Conclusion: Plantar pressure and force gait parameters seems to have
no diagnostic value in determining scoliosis-specific gait. Focus should be shifted to other pedobarographic
gait parameters (e.g. center of pressure, time-force parameters, etc.). Future research should investigate
relationships between biomechanical movement compensation and neuromuscular, musculo-skeletal and
genetic factors that may initiate scoliosis.
1 INTRODUCTION
Scoliosis is a deformity of the spine which results in
lateroflexion of spine and vertebral rotations. Because
scoliosis alters posture, it can also alter gait (Schultz,
1984). Gait altered by scoliosis can be objectively
described through biomechanical analysis (Simon et
al., 2015). However, scoliosis-specific gait is still
controversial topic, because of inconclusive research
(Karimi et al., 2015).
Some studies show significantly lower trunk
range of motion (ROM) between scoliotic and healthy
subjects (Engsberg et al., 2001; Mahaudens et al.,
2009; Mahaudens and Mousny, 2010). Other show no
differences in trunk ROM between scoliotic and
healthy subjects (Yang et al., 2013; Park et al., 2016a;
Schmid et al., 2016). Chen et al. (1998) concluded
that scoliotic individuals manifest smaller spinal
ROM in frontal plane, but the same in shoulder
sagittal, frontal plane and spine sagittal plane as their
healthy counterparts. Two studies (Kramers-de
Quervain et al., 2004; Yang et al., 2013) found
asymmetries in trunk ROM in scoliotic patients.
However, it seems that there is no evidence for
relationship between scoliotic severity and trunk
ROM asymmetries (Mahaudens et al., 2009;
Mahaudens and Mousny, 2010).
Pelvic ROM differences between scoliotic and
non-scoliotic groups also show conflicting results
(Chen et al., 1998; Chow et al., 2006; Mahaudens et
al., 2009; Mahaudens and Mousny, 2010; Park et al.,
2016a). Correlations between pelvic motions and
scoliotic severity are non-existing or week (Kramers-
de Quervain et al., 2004; Mahaudens et al., 2009;
Grui
´
c, I., Cebovi
´
c, K. and Medved, V.
Comparison of Pedobarographic Profile in Young Males with Left and Right Scoliotic Posture.
DOI: 10.5220/0006085400890095
In Proceedings of the 4th International Congress on Sport Sciences Research and Technology Support (icSPORTS 2016), pages 89-95
ISBN: 978-989-758-205-9
Copyright
c
2016 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
89
Mahaudens and Mousny, 2010; Syczewska et al.,
2010; Syczewska et al., 2012; Yang et al., 2013).
In spatio-temporal characteristics of gait (e.g.
walking speed, cadence, step length, stride length,
etc.) scoliotic individuals tend to be slower and have
shorter steps compared to non-scoliotic individuals
(Chern et al., 1998; Engsberg et al., 2001; Mahaudens
et al., 2009; Park et al., 2016a). But more studies
show no differences (Chen, et al., 1998; Kramers-de
Quervain et al., 2004; Chow et al., 2006; Mahaudens
et al., 2009; Yang et al., 2013; Schmid et al., 2016).
This might be because of weak to moderate test–retest
reliability of spatio-temporal gait parameters (Fortin
et al., 2008). Also, spine operation may be a factor
that can explain heterogeneity in results (Lenke et al.,
2001). Step length seem to be positively correlated
with vertebrae rotation and negatively correlated with
Cobb angle (Syczewska et al., 2010; Syczewska et al.,
2012).
EMG activity revealed longer contraction of trunk
and pelvis muscles during stride in scoliotic patients
compared to non-scoliotic individuals (Mahaudens et
al., 2009; Mahaudens and Mousny, 2010).
Interestingly, there were no differences in EMG
activity in left-right asymmetries among scoliotic
patients. Furthermore, no differences were observed
in EMG activity among patients with mild, moderate
and severe scoliosis (Mahaudens et al., 2009;
Mahaudens and Mousny, 2010).
Research based on ground reaction forces (GRF)
appear to have more consistent findings. Most of the
studies suggest that there is association between
scoliosis and GRF parameters, especially in right and
left foot asymmetry (Chockalingam et al., 2004;
Chockalingam et al., 2008; Bruyneel et al., 2009;
Chern et al., 2014; Yang et al., 2014; Park et al.,
2016b). Another interesting finding is that GRF
parameters tend to have larger variability in scoliotic
patients compared to non-scoliotic individuals
(Giakas et al., 1996; Chockalingam et al., 2008).
GRF parameters have higher test-retest reliability
then kinematic parameters among scoliotic patients
(Fortin et al., 2008). However, pedobarographic
measurement devices (PMD) haven`t been used to
describe scoliosis-specific gait. Kinetic platforms
have been used in majority of scoliotic research,
although PMD have shown their clinical usefulness
(Lord et al., 1986; Putti et al., 2008; Giacomozzi, C.,
2010).
The purpose of this study is to determine whether
there are differences between left and right scoliotic
posture in pedobarographic gait profile among young
males.
2 METHODS
2.1 Subjects
Sample consists of 21 young, trained males assigned
to one of two groups: left scoliotic posture and right
scoliotic posture group. Subjects were assigned to
group based on forward-bending test (Horne et al.,
2014) which is explained in section 2.4 Scoliotic
posture assessment. All subjects were blinded for
group they were assigned and study outcomes.
Inclusion criteria:
1) people with scoliosis or scoliotic posture,
2) males,
3) age range between 18 and 25 years,
4) regular participation in any sport or
recreational workout.
Exclusion criteria:
1) lower extremity injuries (e.g. ankle
distortion, knee trauma, etc.),
2) musculo-skeletal diseases (e.g. arthritis,
ankylosing spondylitis, etc.),
3) postoperative procedures within 6 months
(e.g. anterior cruciate ligament surgery, hip surgery,
etc.),
4) neurological diseases (e.g. neuropathy,
cerebral palsy, etc.),
5) vascular diseases (e.g. intermittent
claudication…),
6) metabolic diseases (e.g. diabetic foot,
obesity…).
2.2 Pedobarographic Measurement
Plantar forces and pressures were measured by
pedobarographic device Zebris medical platform
FDM 1.5 (ZMP).
ZMP dimensions are 158.0 x 60.5 x 2.5 cm
(Length x Wide x Height) with sensor area of 149.0 x
54.2 cm (Length x Wide). There are 11264 capacitive
sensors in sensor area that register changes in force
applied on ZMP per each cm
2
. Sampling rate for this
gait protocol was set on 300 Hz Pressure measuring
range was between 1 and 60 N/cm
2
.
WinFDM software for Windows operating
system was used to gather and analyze raw data
obtained from ZMP. Although, WinFDM generates
reports with both graphical and quantitative data
(figures 1, 2), only quantitative data were used for
analyses.
icSPORTS 2016 - 4th International Congress on Sport Sciences Research and Technology Support
90
Figure 1: Part of generated report from WinFDM software
for pedobarographic analysis.
Figure 2: Part of generated report from WinFDM software
for pedobarographic analysis.
Pedobarographic force parameters were
expressed in newtons (N). Pedobarographic pressure
parameters were expressed in newtons per centimeter
squared (N/cm
2
)
ZMP is shown to be reliable and accurate
diagnostic device (Gruić et al., 2015). Diagnostician
who performed pedobarographic measurement was
blinded for study outcomes.
2.3 Anthropometric Measurement
Five anthropometric characteristics were determined:
height, weight, body mass index (BMI), right and left
leg length. Differences in these anthropometric
characteristics can cause differences in
pedobarographic profile (Dillon et al., 2008; Song et
al., 1997). Therefore, both groups should be similar
in these characteristics. Examiners who performed
anthropometric measurement were blinded for study
outcomes.
Height was measured with anthropometer.
Subject was standing straight barefoot with his heels
connected. Head was looking straight forward. In this
position, anthropometer was parallel with the subject.
The horizontal prong of anthropometer was placed on
vertex (highest point on head). Examiner then read
the value on anthropometer. Height was expressed in
centimeters (cm). Weight was measured with digital
scale. Subject was standing still and barefoot on
digital scale until examiner read value on scale.
Weight was expressed in kilograms (kg).
Leg length was measured with anthropometer.
Subject was standing straight barefoot with his feet
hip-width apart. In this position, anthropometer was
parallel with the subject’s leg. The horizontal prong
of anthropometer was placed on subject`s spina iliaca
anterior superior (SIAS). Leg length was expressed in
centimeters (cm).
BMI was calculated using data from measured
height and weight with formula (1):
𝐵𝑀𝐼 =
Weight (kg)
𝐻𝑒𝑖𝑔ℎ𝑡
2
(𝑚
2
)
(1)
BMI was expressed in kilograms per meter
squared (kg/m
2
).
2.4 Scoliotic Posture Assessment
Adam's forward bend test was used to assesses
weather subject has left or right scoliosis or scoliotic
posture (Horne et al., 2014). Subject bends over with
his head and arms relaxed. The examiner looks
subject from behind horizontally along the contour of
the back.
If the gibbous is on the right side, then the subject
was assigned to the right scoliosis/scoliotic posture.
If the gibbous is on the left side, then the subject was
assigned to the left scoliosis/scoliotic posture.
2.5 Gait Protocol
Protocol was performed in Biomechanics Laboratory
of Faculty of Kinesiology, University of Zagreb every
working day from 07:30 to 16:00 h.
prior to each protocol, subjects were instructed to
develop their usual walking speed and to not look or
aim ZMP.
Immediately before protocol started, subject was
standing directly in line with ZMP and 4 meters away.
When the subject was ready he started walking to the
end of walking track, which is 9,5 meters away. At
the end of walking track, subject turned 180º and
walked back to starting point. Subject walked for 2
minutes with his usual walking speed.
Unsuccessful protocol was considered if the
subject during 2-minute protocol:
1) altered his walk by aiming the ZMP,
2) had less than 3 full feet steps on ZMP,
3) was distracted.
In a case of unsuccessful protocol, measurement
was terminated and repeated.
Comparison of Pedobarographic Profile in Young Males with Left and Right Scoliotic Posture
91
2.6 Statistical Analysis
Microsoft Excel 2016 and Statistica 12 for Windows
operating system was used for statistical analysis.
Arithmetic mean (AM) and standard deviation
(SD) was used to describe anthropometric
characteristics and pedobarographic gait profile of
subjects.
Mann-Whitney U Test was used to determine
statistical significance of differences between groups
in anthropometric characteristics and foot pressure
and force gait profile of subjects.
3 RESULTS
Subjects were homogenous in all observed
anthropometric characteristics. No significant
differences in age, BMI, weight, height, right and left
leg length between two groups (table 1).
Table 1: Anthropometric characteristics of subjects.
Variables
Left scoliotic
posture group
N=12
Right scoliotic
posture group
N=9
p
value
Age
(years)
22,00 ± 1,41
21,11 ± 0,93
0.12
BMI
(kg/m2)
25,22 ± 2,57
24,10 ± 1,46
0.11
Weight
(kg)
83,01 ± 11,63
80,46 ± 8,75
0.78
Height
(cm)
181,22 ±7,86
182,48 ± 6,41
0.55
Right leg
length
(cm)
103,51 ± 5,02
102,71 ± 4,63
0.97
Left leg
length
(cm)
103,41 ± 5,34
102,44 ± 4,54
1.00
There were no significant differences in any
observed foot pressure or force gait parameter
between left and right scoliotic posture group in this
sample (table 2).
4 DISCUSSION
There are no differences in any observed foot
pressure or force parameter between left and right
scoliotic posture group in this study, suggesting that
scoliotic posture is not associated with those
parameters. These findings are consistent with studies
from this field that assessed asymmetries in force
components of GRF (Giakas et al., 1996;
Chockalingam et al., 2004; Yang et al., 2013; Park et
al., 2016b).
Possible explanation for absence of any
asymmetries in foot pressure and force gait
parameters for people with scoliotic posture can be
movement compensation. It is speculated that from
primary spine curvature downward a series of
movement compensations occur during gait. These
movement compensations can balance asymmetries
caused by scoliosis. This might be the reason why
differences between scoliotic and non-scoliotic
individuals are seen in EMG (Mahaudens et al., 2009;
Mahaudens and Mousny, 2010), kinematic (Chen et
al., 1998; Engsberg et al., 2001; Kramers-de Quervain
et al., 2004; Mahaudens et al., 2009; Mahaudens and
Mousny, 2010; Syczewska et al., 2010; Syczewska et
al., 2012; Yang et al., 2013; Park et al., 2016a),
spatio-temporal (Chen et al., 1998; Lenke et al., 2001;
Engsberg et al., 2001; Mahaudens et al., 2009;
Syczewska et al., 2010; Park et al., 2016a) and some
components of kinetic parameters (Giakas et al.,
1996; Chockalingam et al., 2004; Chockalingam et
al., 2008; Bruyneel et al., 2009; Chern et al., 2014;
Yang et al., 2014; Park et al., 2016b), but not in force
components of ground reaction forces (Giakas et al.,
1996; Chockalingam et al., 2004; Yang et al., 2013;
Park et al., 2016b).
4.1 Study Limitations
There are several limitations of this study that should
be addressed in future studies. Most of subjects in this
study did have scoliotic posture which is mild form of
scoliosis. Adam's forward bend test is known as
inaccurate screening tool (Deurloo and Verkerk,
2015; Fong et al., 2010). This means that there is
possibility that some subjects who are healthy are
classified into left or right scoliotic posture group.
This problem can be avoided with classification of
scoliotic posture based on Cobb angle method.
Second limitation is that only force and pressure
parameters were used to determine pedobarographic
gait profile. Inclusion of other pedobarographic
parameters (e.g. step length, step width, walking
speed, center of pressure, etc.) is advised
(Giacomozzi, 2011). Third limitation is that subjects
weren`t measured in the same time of the day. Some
were measured in the morning, while others
afternoon, depending on their availability. Another
limitation of this study is small sample size. Also, this
study didn`t include females. Females tend to have
different gait profile from man (Ko et al., 2011).
icSPORTS 2016 - 4th International Congress on Sport Sciences Research and Technology Support
92
Table 2: Pedobarographic gait profile for left scoliotic and right scoliotic posture among young males.
4.2 Scientific Importance
Biomechanical movement compensations might be
reactions to neuromuscular (Veldhuizen et al., 2000;
Burwell, 2003; Cheung eta al., 2008), musculo-
skeletal (Burwell, 2003; Cheung eta al., 2008) and/or
genetic (Cheung eta al., 2008) factors that may cause
scoliosis. Therefore, future research should
investigate relationships between biomechanical
movement compensation and neuromuscular,
musculo-skeletal and genetic factors.
4.3 Practical Importance
As shown in this paper, not all biomechanical gait
parameters can determine asymmetries caused by
scoliosis. Also, some biomechanical gait parameters
are better at detecting scoliosis-specific gait. It
appears that pedobarographic force and pressure
parameters can`t be used in determining scoliosis-
specific gait abnormalities. Therefore, attention
should be focused on other pedobarographic gait
parameters (e.g. center of pressure, time-force
parameters, etc.) as diagnostic tool for scoliosis-
specific gait. Knowing which parameters can reveal
scoliosis gait abnormalities does not have just
Variables
Left scoliotic
posture group
N=12
p
value
Maximum force right foot
(N)
869,30 ± 152,67
0.27
Maximum force left foot
(N)
840,90 ± 163,90
0.92
Maximum force at first contact right foot
(N)
819,43 ± 160,76
0.30
Maximum force at first contact left foot
(N)
848,53 ± 148,56
0.64
Maximum force at take-off right foot
(N)
809,45 ± 166,65
0.97
Maximum force at take-off left foot
(N)
795,53 ± 173,71
0.70
Maximum forefoot force right foot
(N)
831,42 ± 99,31
0.59
Maximum forefoot force left foot
(N)
818,28 ± 111,32
0.97
Maximum midfoot force right foot
(N)
170,14 ± 76,01
0.52
Maximum midfoot force left foot
(N)
154,75 ± 74,44
0.30
Maximum heel force right foot
(N)
588,41 ± 97,53
0.46
Maximum heel force left foot
(N)
603,24 ± 86,26
0.59
Maximum forefoot pressure right foot
(N/cm
2
)
50,77 ± 10,79
0.24
Maximum forefoot pressure left foot
(N/cm
2
)
46,94 ± 9,15
0.64
Maximum midfoot pressure right foot
(N/cm
2
)
12,75 ± 4,00
0.59
Maximum midfoot pressure left foot
(N/cm
2
)
13,28 ± 4,41
0.27
Maximum heel pressure right foot
(N/cm
2
)
37,99 ± 11,02
0.70
Maximum heel pressure left foot
(N/cm
2
)
39,76 ± 10,67
0.67
Comparison of Pedobarographic Profile in Young Males with Left and Right Scoliotic Posture
93
diagnostic value, but it is also important for more
effective scoliosis treatment prescription.
5 CONCLUSION
There are no differences in any observed foot
pressure or force gait parameter between left and right
scoliotic posture group. Plantar pressure and force
gait parameters seems to have no diagnostic value in
determining scoliosis-specific gait. Focus should be
shifted on other pedobarographic gait parameters
(e.g. center of pressure, time-force parameters, etc.)
to determine scoliotic gait abnormalities. Future
research should investigate relationships between
biomechanical movement compensation and
neuromuscular, musculo-skeletal and genetic factors
that may initiate scoliosis.
ACKNOWLEDGEMENTS
Research was conducted by Research Group of
Biomechanics Laboratory, Institute of Kinesiology,
Faculty of Kinesiology, as a closure of UniZg project
“Pedobarographic features of human locomotion in
sports and medicine”. Authors declare that there is no
conflict of interest.
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