Integration of Foot Pressure and Foot Kinematics Measurements for Medical Applications

  • Claudia Giacomozzi
  • Paolo Caravaggi
  • Julie A. Stebbins
  • Alberto Leardini
Reference work entry


Plantar pressure measurement quantitatively characterizes the interaction between the foot and the ground. Clinical assessment of foot function often relies on the analysis of pressure and pressure-related parameters under specific regions of the foot. Identification of these foot regions is a crucial and yet highly debated issue. Algorithms to identify these regions are mostly based on generic, geometrical features of the acquired pressure map. But this approach may not be valid in the presence of foot deformity.

Three-dimensional motion tracking can deliver accurate and reliable quantification of full-body motion through all anatomical planes and axes of human movement. When used in conjunction with validated multi-segment foot models, clinicians are able to investigate detailed relative motion of the foot and ankle complex.

The integration of these two measurement techniques offers a new perspective in the study of foot function. First, it allows anatomical, as opposed to purely geometrical, masking of dynamic pressure footprints. This leads to a reliable association of footprint regions with foot anatomy, even in the presence of significant foot deformity and abnormal footprint shapes. Second, but equally important, it allows joint kinematics of foot segments to be correlated with corresponding regional loads. A method for this integration was first proposed in the early 2000s, and since then it has been implemented in numerous studies. State-of-the-art instrumentation and validated foot models are necessary to implement this methodology.

An overview of the integration technique, applicability, validation, and initial clinical applications is hereby reviewed and discussed.


Anatomical masking Pressure-kinematics integration Foot motion Multi-segment model Gait 



The authors would like to thank and acknowledge Gaia Stirpe for supporting the graphical editing.


  1. Baker R, Robb J (2006) Foot models for clinical gait analysis. Gait Posture 23:399–400CrossRefGoogle Scholar
  2. Caravaggi P, Benedetti MG, Berti L, Leardini A (2011) Repeatability of a multi-segment foot protocol in adult subjects. Gait Posture 33:133–135CrossRefGoogle Scholar
  3. Caravaggi P, Leardini A, Giacomozzi C (2016) Multiple linear regression approach for the analysis of the relationships between joints mobility and regional pressure-based parameters in the normal-arched foot. J Biomech 49: 3485–3491.
  4. Cavanagh PR, Ae M (1980) A technique for the display of pressure distributions beneath the foot. J Biomech 13(2):69–75CrossRefGoogle Scholar
  5. Cavanagh PR, Sanders LJ, Sims DS Jr (1987) The role of pressure distribution measurement in diabetic foot care. J Rehabil Res Dev 25(1):53–54Google Scholar
  6. Cavanagh PR, Ulbrecht JS (1992) Clinical plantar pressure measurement in diabetes: rationale and methodology. Foot 4:123–135CrossRefGoogle Scholar
  7. Cousins SD, Morrison SC, Drechsler WI (2012) The reliability of plantar pressure assessment during barefoot level walking in children aged 7–11 years. J Foot Ankle Res 5(1):8CrossRefGoogle Scholar
  8. Deschamps K, Staes F, Roosen P, Nobels F, Desloovere K, Bruyninckx H, Matricali GA (2011) Body of evidence supporting the clinical use of 3D multisegment foot models: a systematic review. Gait Posture 33(3):338–349CrossRefGoogle Scholar
  9. Deschamps K, Roosen P, Nobels F, Deleu P-A, Birch I, Desloovere K, Bruyninckx H, Matricali G, Staes F (2015) Review of clinical approaches and diagnostic quantities used in pedobarographic measurements. J Sports Med Phys Fitness 55(3):191–204Google Scholar
  10. Ellis SJ, Stoecklein H, Yu JC, Syrkin G, Hillstrom H, Deland JT (2011) The accuracy of an automasking algorithm in plantar pressure measurements. HSS J 7(1):57–63. Scholar
  11. Franco de Moura RC , Almeida CS, Dumont AJ, Lazzari RD, Lopes JB, Duarte NA, Braun LF, Oliveira CS (2016) Kinematic upper limb evaluation of children and adolescents with cerebral palsy: a systematic review of the literature. J Phys Ther Sci 28(2):695–700. Review
  12. Giacomozzi C, Macellari V (1997) Piezo-dynamometric platform for a more complete analysis of foot-to-floor interaction. IEEE Trans Rehabil Eng 5(4):322–330CrossRefGoogle Scholar
  13. Giacomozzi C, Macellari V, Leardini A, Benedetti MG (2000) Integrated pressure-force-kinematics measuring system for the characterisation of plantar foot loading during locomotion. Med Biol Eng Comput 38(2):156–163CrossRefGoogle Scholar
  14. Giacomozzi C, Benedetti MG, Leardini A, Macellari V, Giannini S (2006) Gait analysis with an integrated system for functional assessment of talocalcaneal coalition. J Am Podiatr Med Assoc 96(2):107–115CrossRefGoogle Scholar
  15. Giacomozzi C (2010) Appropriateness of plantar pressure measurement devices: a comparative technical assessment. Gait Posture 32(1):141–144. Scholar
  16. Giacomozzi C (2011) Chapter 11. Potentialities and criticalities of plantar pressure measurements in the study of foot biomechanics: devices, methodologies and applications. In: Vaclav Klika V (ed) Biomechanics in applications, InTech Publication. Croatia – European Union, Rijeka. Available from:
  17. Giacomozzi C, Keijsers N, Pataky T, Rosenbaum D (2012) International scientific consensus on medical plantar pressure measurement devices: technical requirements and performance. Ann Ist Super Sanita 48(3):259–271CrossRefGoogle Scholar
  18. Giacomozzi C, Stebbins JA, Way L (2014a) Validation and clinical relevance of footprint anatomical masking in clubfoot. J Foot Ankle Res 7(S1):A25 (Cited as Giacomozzi et al. 2014a)CrossRefGoogle Scholar
  19. Giacomozzi C, Leardini A, Caravaggi P (2014b) Correlates between kinematics and baropodometric measurements for an integrated in-vivo assessment of the segmental foot function in gait. J Biomech 47(11):2654–2659. (Cited as Giacomozzi et al. 2014b)CrossRefGoogle Scholar
  20. Guiotto A, Sawacha Z, Guarneri G, Cristoferi G, Avogaro A, Cobelli C (2013) The role of foot morphology on foot function in diabetic subjects with or without neuropathy. Gait Posture 37:603–610CrossRefGoogle Scholar
  21. Gurney JK, Kersting UG, Rosenbaum D (2008) Between-day reliability of repeated plantar pressure distribution measurements in a normal population. Gait Posture 27(4):706–709CrossRefGoogle Scholar
  22. Leardini A, Benedetti MG, Catani F, Simoncini L, Giannini S (1999) An anatomically based protocol for the description of foot segment kinematics during gait. Clin Biomech (Bristol Avon) 14:528CrossRefGoogle Scholar
  23. Leardini A, Benedetti MG, Berti L, Bettinelli D, Nativo R, Giannini S (2007) Rearfoot, midfoot and forefoot motion during the stance phase of gait. Gait Posture 25:453–462CrossRefGoogle Scholar
  24. MacWilliams BA, Cowley M, Nicholson DE (2003) Foot kinematics and kinetics during adolescent gait. Gait Posture 17:214–224CrossRefGoogle Scholar
  25. McGinley JL, Baker R, Wolfe R, Morris ME (2009) The reliability of three-dimensional kinematic gait measurements: a systematic review. Gait Posture 29:360–369CrossRefGoogle Scholar
  26. McPoil TG, Cornwall MW, Dupuis L, Cornwell M (1999) Variability of plantar pressure data: a comparison of the two-step and midgait methods. J Am Podiatr Med Assoc 89:495–501CrossRefGoogle Scholar
  27. Menz HB, Morris ME (2006) Clinical determinants of plantar forces and pressures during walking in older people. Gait Posture 24(2):229–236CrossRefGoogle Scholar
  28. Needham R, Stebbins J, Chockalingam N (2016) Three-dimensional kinematics of the lumbar spine during gait using marker-based systems: a systematic review. J Med Eng Technol 40(4):172–185. Scholar
  29. Phethean J, Pataky TC, Nester CJ, Findlow AH (2014) A cross-sectional study of age-related changes in plantar pressure distribution between 4 and 7 years: a comparison of regional and pixel-level analyses. Gait Posture 39(1):154–160CrossRefGoogle Scholar
  30. Portinaro N, Leardini A, Panou A, Monzani V, Caravaggi P (2014) Modifying the Rizzoli foot model to improve the diagnosis of pes-planus: application to kinematics of feet in teenagers. J Foot Ankle Res 7(1):754CrossRefGoogle Scholar
  31. Sawacha Z, Guarneri G, Cristoferi G, Guiotto A, Avogaro A, Cobelli C (2012) Integrated kinematics–kinetics–plantar pressure data analysis: a useful tool for characterizing diabetic foot biomechanics. Gait Posture 36:20–26CrossRefGoogle Scholar
  32. Scott G, Menz HB, Newcombe L (2007) Age-related differences in foot structure and function. Gait Posture 26(1):68–75CrossRefGoogle Scholar
  33. Stebbins JA, Harrington ME, Giacomozzi C, Thompson N, Zavatsky A, Theologis TN (2005) Assessment of sub-division of plantar pressure measurement in children. Gait Posture 22(4):372–376CrossRefGoogle Scholar
  34. Stebbins J, Harrington M, Theologis T, Thompson N, Giacomozzi C, Macellari V (2006a) Measurement of foot kinematics and plantar pressure in children using the Oxford foot model. In: Harris GF, Smith PA, Marks RM (eds) Foot and ankle motion analysis: clinical treatment and technology. CRS Press/Taylor and Francis Group, Boca Raton. pp 403–424. ISBN-13: 978–0–8493-3971-4 (Cited as Stebbins et al. 2006a)Google Scholar
  35. Stebbins J, Harrington M, Thompson N, Zavatsky A, Theologis T (2006b) Repeatability of a model for measuring multi-segment foot kinematics in children. Gait Posture 23:401–410 (Cited as Stebbins et al. 2006b)CrossRefGoogle Scholar
  36. Stebbins J, Giacomozzi C, Theologis T (2008) Correlation between plantar pressure and Oxford Foot Model kinematics. J Foot Ankle Res 1(S1):O22CrossRefGoogle Scholar
  37. Stebbins J, Giacomozzi C, Tsvetkova T (2010) An automated and anatomically based method for defining plantar pressure masks in foot deformity. In: Proceedings JEGM conference, MiamiGoogle Scholar
  38. van Hoeve S, de Vos J, Weijers PHE, Verbruggen JPAM, Willems P, Poeze M, Meijer K (2015) Repeatability of the oxford foot model for kinematic gait analysis of the foot and ankle. Clin Res Foot Ankle 3:171. Scholar
  39. Wearing SC, Urry S, Smeathers JE, Battistutta D (1999) A comparison of gait initiation and termination methods for obtaining plantar foot pressures. Gait Posture 10(3):255–263CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Claudia Giacomozzi
    • 1
  • Paolo Caravaggi
    • 2
  • Julie A. Stebbins
    • 3
    • 4
  • Alberto Leardini
    • 2
  1. 1.Department of Cardiovascular Diseases, Dysmetabolic Diseases and AgeingItalian National Institute of HealthRomeItaly
  2. 2.Movement Analysis Laboratory and Functional-Clinical Evaluation of ProsthesesIstituto Ortopedico RizzoliBolognaItaly
  3. 3.Oxford Gait LaboratoryOxford University Hospitals NHS Foundation TrustOxfordUK
  4. 4.Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesUniversity of OxfordOxfordUK

Section editors and affiliations

  • Freeman Miller
    • 1
  • Sebastian I. Wolf
    • 2
  1. 1.duPont Hospital for ChildrenWilmingtonUSA
  2. 2.Movement Analysis LaboratoryClinic for Orthopedics and Trauma Surgery; Center for Orthopedics, Trauma Surgery and Spinal Cord Injury;Heidelberg University HospitalHeidelbergGermany

Personalised recommendations