GLOBAL BODY POSTURE AND PLANTAR PRESSURE

DISTRIBUTION IN INDIVIDUALS WITH AND

WITHOUT TEMPOROMANDIBULAR DISORDER: A
PRELIMINARY STUDY
Juliana A. Souza, MD, a Fernanda Pasinato, MD, a Eliane C.R. Corrêa, PhD, b and Ana Maria T. da Silva, PhD c

ABSTRACT

Objective: The aim of this study was to evaluate body posture and the distribution of plantar pressure at physiologic rest of
the mandible and during maximal intercuspal positions in subjects with and without temporomandibular disorder (TMD).
Methods: Fifty-one subjects were assessed by the Diagnostic Criteria for Research on Temporomandibular Disorders and
divided into a symptomatic group (21) and an asymptomatic group (30). Postural analysis for both groups was conducted
using photogrammetry (SAPo version 0.68; University of São Paulo, São Paulo, Brazil). The distribution of plantar pressures
was evaluated by means of baropodometry (Footwork software), at physiologic rest and maximal intercuspal positions.
Results: Of 18 angular measurements, 3 (17%) were statistically different between the groups in photogrammetric evaluation.
The symptomatic group showed more pronounced cervical distance (P = .0002), valgus of the right calcaneus (P = .0122), and
lower pelvic tilt (P = .0124). The baropodometry results showed the TMD subjects presented significantly higher rearfoot and
lower forefoot distribution than those in the asymptomatic group. No differences were verified in maximal intercuspal position
in the between-group analysis and between the 2 mandibular positions in the within-group analysis.
Conclusions: Subjects with and without TMD presented with global body posture misalignment. Postural changes
were more pronounced in the subjects with TMD. In addition, symptomatic subjects presented with abnormal plantar
pressure distribution, suggesting that TMD may have an influence on the postural system. (J Manipulative Physiol
Ther 2014;37:407-414)
Key Indexing Terms: Temporomandibular Disorder; Posture; Photogrammetry

emporomandibular disorder (TMD) is characterized of adjacent muscles, which cause tension in the muscular

T by functional and structural changes, the most

frequent symptoms being temporomandibular joint
and/or masticatory muscles pain, functional limitations,
deviations, and sounds during mandibular movements. The
etiology of TMD is multifactorial involving a combination
of psychological, structural, and postural aspects. 1 -4
Alterations in the postural alignment are commonly found
in individuals with TMD, mainly related to the head, cervical
column, and shoulder posture. 5 -8 Postural changes in a
muscle segment could lead to the lengthening or shortening
chain. 9 Forward head posture may lead to a sequence of
changes in the cranio-cervico-mandibular system, such as
more posterior mandibular condyle position and compres-
sion of the retrodiscal region; reduction of C0-C1 functional
space; increase of the posterior dental contacts; cervical and
masticatory muscles unbalance; and, consequently, change
of stomatognathic functions. 4,10-12
The neuron-anatomical and biomechanical interaction
among jaw, head, and neck in individuals with TMD has been
demonstrated by some authors. 5 -8 On the other hand, in more

a
MD in Human Communication Disorders, Physiotherapist,
Research Group Orofacial Motricity Laboratory, Department of
Speech Therapy, Postgraduate Program of Human Communica-
tion Disorders of Federal University of Santa Maria, Santa Maria,
RS, Brazil.
b
PhD in Mouth-Dental Biology, Physiotherapist, Research
Group Orofacial Motricity Laboratory, Department of Speech
Therapy, Postgraduate Program of Human Communication Disor-
ders of Federal University of Santa Maria, Santa Maria, RS, Brazil.
c
PhD in Science of the Communication Disorders, Speech
Therapist, Research Group Orofacial Motricity Laboratory,
Department of Speech Therapy, Postgraduate Program of
Human Communication Disorders of Federal University of
Santa Maria, Santa Maria, RS, Brazil.
Submit requests for reprints to: Juliana A. Souza, MD in
Human Communication Disorders, Physiotherapist, João Goulart
St, Number 540, Apt 301, Camobi District, Santa Maria City, Rio
Grande do Sul, Brazil, CEP: 97105-220.
(e-mail: fisioju@yahoo.com.br).
Paper submitted January 17, 2012; in revised form January 27,
2014; accepted April 12, 2014.
0161-4754
Copyright © 2014 by National University of Health Sciences.
http://dx.doi.org/10.1016/j.jmpt.2014.04.003

407
408 Souza et al
Plantar Pressure and Temporomandibular Disorder
recent studies, this association was not evidenced. 9,13-16 Such
divergence may be attributed to methodological variability of
the studies, thus limiting their comparisons. 17
Functional relation of the masticatory and lower limbs
muscles by means of the muscular chains has been
demonstrated. 18-20 Some authors have verified increase of
the electromyographic activity in the peroneus longus and
gastrocnemius muscles during simulated malocclusion 18 and
decrease of the sternocleidomastoid, erector spinal, and soleus
muscle activity with occlusal splint. 19 Electrical activity
changes of the masticatory muscles at mandibular rest and in
the maximal intercuspal position with the induced plantar arch
modification were also demonstrated. 20
It is theorized that the muscular and articular proprioception
of the cranio-cervico-mandibular complex can interfere in the
postural system. The potential role of the mandibular position
change on the weight distribution in the anterior, posterior, left,
and right quadrants of the foot in normal individuals was
demonstrated by Yoshino et al. 21 Ries and Bérzin 22 have
showed the influence of the TMD in the postural control.
Considering the relation between the postural and the
stomatognathic systems, it is possible that the presence of
TMD may have a relationship with the body posture as a
whole and, consequently, the plantar pressure distribution.
Therefore, the purpose of this study was to evaluate body
posture and plantar pressure distribution in subjects during
physiologic rest of the mandibular position and in the maximal
intercuspal position, in individuals with and without TMD.
METHODS
Asymptomatic subjects were recruited by means of
electronic and printed media, and subjects with symptoms
of TMD were recruited from the Occlusion Clinics of
Federal University of Santa Maria (UFSM), Brazil. Of 208
individuals interviewed, 51 were selected for the study.
Next, they were distributed into 2 groups: symptomatic
(those with TMD) and asymptomatic (those without TMD).
Inclusion criteria for the symptomatic group (SG) were both
sexes, age from 18 to 35 years, presence of signals, and
symptoms of TMD for a period over 6 months. For the
asymptomatic group (AG), they were both sexes, age from
18 to 35 years, and absence of pain in the shoulder and
cervical region, facial pain, and/or headache; bruxism habit;
noises; and limitation in the mandibular function.
To confirm the TMD diagnosis, the volunteers under-
went the clinical examination of Research Diagnostic
Criteria for Temporomandibular Disorder (RDC/TMD),
by a trained examiner. 2
Exclusion criteria for both groups included presence of
neuropsychomotor or systemic or rheumatologic diseases
and to be or have been undergone to physical therapy,
speech therapy, or orthodontics treatment (for less than 6
months); pain complaint in the lower limbs; labyrinth
Journal of Manipulative and Physiological Therapeutics
July/August 2014
Interviewed subjects
(208)
Subject who met the inclusion criteria
(51)
Symptomatic Group Assyntomatic Group
(with TMD by RDC/TMD) (without TMD by RDC/TMD)
(21) (30)
Fig 1. Flow diagram of subjects in this study. RDC/TMD, Research
Diagnostic Criteria for Temporomandibular Disorder; TMD,
temporomandibular disorder.
diseases; squint; trauma or malformation in the cervical and
facial regions; and use of analgesic, anti-inflammatory, or
muscular relaxants or antidepressive medicine.
The SG was composed of 21 individuals (20 women and 1
man, mean age of 25 ± 5 years old) with RDC/TMD combined
diagnoses of myofascial pain and arthralgia. Thirty individuals
(28 women and 2 men with mean age of 22 ± 5 years old)
without TMD, that is, asymptomatic according the RDC
instrument, were included in the AG (Fig 1).
The study was approved by the Ethics on Research
Committee of the UFSM, Brazil, under protocol number
CAAE 0048.0.243.000-08. All subjects were properly
informed and signed the consent term.
Photogrammetric Evaluation
The posture evaluation was conducted by the software
SAPo version 0.68 (University of São Paulo, São Paulo,
Brazil) 23 for the photogrammetric analysis. All subjects
were photographed in swimsuit and barefoot, keeping their
usual body posture with opened eyes glancing to the
horizon line. A digital camera (Sony Cybershot 4.1
megapixels; Sony, Shenzhen, China) was positioned in a
1-m-height tripod (VT 131; Vanguard; Guangzhou, China)
and 3 m from the subject. For the image calibration in the
software, a plumb line was suspended in the roof beside the
volunteer. The photographs were taken in anterior, left
lateral, and posterior views. It was used a demarked base
with 10 × 40 × 20 cm of dimensions with the foot outline
drawn in an eraser rug. It was turned 90°, and the volunteer
returned to position over this to change the image's view.
Anatomical points were marked in the voluntary's skin with
styrofoam balls with double-face tape, according to the SAPo
version 0.68 protocol 23 (Fig 2), by 2 trained examiners.
The quantification of the angles among the anatomical
points was conduct by 2 trained physical therapists, who
were blind regarding the subject's group and followed the
SAPo version 0.68 protocol and its conventions. 23
The head position was also evaluated by the horizontal
distance from the middle cervical region to a vertical line
Journal of Manipulative and Physiological Therapeutics Souza et al 409
Volume 37, Number 6 Plantar Pressure and Temporomandibular Disorder

Fig 2. Anatomical markers and measures of the photogrammetric evaluation: anterior (A), lateral (B), and posterior (C) views.
%, horizontal asymmetry of scapula in relation to the spinous process of the third thoracic vertebra, A1, horizontal alignment of the
head; A2, acromia alignment; A3, anterosuperior iliac spines alignment; A5, varus/valgus of right lower limb; A6, varus/valgus of left
lower limb; A7, horizontal alignment of the head; A8, vertical alignment of the head; A9, vertical shoulder alignment; A10, vertical
alignment of the body; A11, pelvic horizontal alignment; A12, knee angle; A13, ankle angle; A14, valgus/varus of right calcaneus; A15,
varus/valgus of left calcaneus; CD, cervical distance; LD, lumbar distance.

metric analysis were 0° and asymmetrical starting from

0.1°. For the angle of the knee, from 0° to 3°, was
considered normal. In the lateral view, the reference for the
A7 angle was based on a study with asymptomatic
individuals, with angular values of 50.1° ± 5.5°. 24 The
shoulder, body, and knee position was related to the vertical
line, and it was considered normal when lightly anterior to
the lateral malleolus, 25 that is, next to 0°. In the posterior
view, the calcaneus alignment was classified as normal
from 0° to 5°, 26 and the asymmetry index of the scapula, as
0°. 23 The reliability of the measures of SAPo version 0.68
software has been demonstred. 27

Fig 3. Head posture (CD) and lumbar curve (lumbar distance
[LD]) evaluation.
tangent to the thoracic curve apex, nominated cervical distance
(CD). 12 The lumbar curve was evaluated by the horizontal
distance from a vertical line tangent to the thoracic curve apex
to the point of the lumbar curve apex 15 (Fig 3).
In the anterior view, the segments were considered
symmetrical when the angular values in the photogram-
Baropodometric Evaluation
Baropodometry is a quantitative examination that
assesses the distribution of pressures in different points
in the plantar region; the mean pressures, the peak
pressures, and the contact area of the foot 28,29 (Fig 4).
During the examination, the individuals of the SG and AG
stood barefoot in their usual posture, with the parallel feet,
arms relaxed along the body while glancing an object in
the line of their eyes at 1-m distance. The recordings were
acquired in the following situations: (a) physiologic rest
mandibular position—for 20 seconds; (b) maximal
intercuspal position for 5 seconds, stimulated by the
researcher with the verbal command “clench, clench,
clench…,” with a parafilm paper (Parafilm) between
premolar teeth bilaterally. This experimental condition
410 Souza et al Journal of Manipulative and Physiological Therapeutics
Plantar Pressure and Temporomandibular Disorder July/August 2014

Fig 4. Baropodometric recording of the plantar pressure distribution (Footwork software).

was adapted from studies that evaluated the effect of jaw .05) and 1% (P b .01) were adopted. Data were analyzed
position on body posture by stabilometry. 21,22,30,31 were using the SPSS Statistics 17.0 (Chicago, IL) and SAS
The examination was carried out by an expert physical 9.1 software (Cary, NC).
therapist that was blinded to the subject's group. Each
situation was repeated 3 times, with a 1-minute break
among them. Three trials were done to ensure a good level RESULTS
of reliability (N 0.8), once this increases with the number of
In the photogrammetric analysis, 3 (17%) of 18 angular
trials. 28 Before data collection, the subject was oriented
measures were significantly different between SG and AG
about the procedures. Equipment calibration was carried
(Table 1). Statistically higher values in the CD, right calcaneus
out by the weight, height, and shoe size of the participants.
valgism (A14), and lower pelvic tilt (A11) were observed in the
The baropodometry (Footwork; STI-AM3, Goult,
SG subjects. Both groups presented postural misalignments of
France) consists of an active surface of 400/400 mm, 704
the head, shoulders, and anterosuperior iliac spine horizontal
capacitive captors, frequency of 150 Hz, maximal pressure
alignment in the anterior view; head, shoulder, knee, and pelvis
by each captor of 100 N/cm 2, and an analogical converter
vertical alignment in the lateral view and in the scapula
of 16 bits. Plantar pressure distribution in the anterior and
symmetry; and calcaneus position in the posterior view.
posterior direction, that is, forefoot and heel and right
The plantar pressure distributions at mandibular rest and
and left, was evaluated. On the orthostatic position, the
in the maximal intercuspal positions are shown in Table 2.
gravity line is projected in the center of the sustentation
The SG presented significantly higher backfoot and lower
polygon, 25 with 57% to 60% of the load pressure on the
forefoot pressure distribution compared to the AG. No
backfoot and 40% to 43% on the forefoot and 50% on
statistical difference was found in maximal intercuspal
the right leg and 50% on the left one. 32
position in the between-group analysis and, between the 2
mandibular positions, in the within-group analysis.
Data Analysis
Data normality was verified by Shapiro-Wilk test. The
Student t test for independent samples compared the DISCUSSION
photogrammetry's data. Repeated-measures analysis of Previous studies support the theory that changes in
variance and Tukey post hoc tests were used for the the body posture may interfere with jaw position and that
between-group and within-group comparisons of the these changes may be more frequent in individuals with
plantar pressure distribution variations in the different TMD. 5 -8,10 However, most of these studies are limited to
mandibular positions. The significance levels of 5% (P b the superior body quadrant 6,13 or conducted using a
Journal of Manipulative and Physiological Therapeutics Souza et al 411
Volume 37, Number 6 Plantar Pressure and Temporomandibular Disorder

Table 1. Mean Value and SD of the Photogrammetric Evaluation in the Anterior, Left Lateral, and Posterior Views of the Study and
Control Groups
SG (n = 30) AG (n = 30)
View Measures Mean SD Mean SD P
Anterior A1 1.98° ±1.48° 1.79° ±1.37° .6530
A2 1.45° ±1.27° 1.54° ±1.09° .8012
A3 1.31° ±1.05° 1.63° ±0.76° .2205
A4 2.12° ±1.06° 1.44° ±1.38° .0629
A5 3.48° ±2.36° 3.16° ±2.32° .6349
A6 3.41° ±2.59° 3.29° ±2.21° .8509
Lateral A7 51.07° ±6.15° 49.83° ±4.65° .4155
A8 15.28° ±7.15° 14.13° ±6.85° .5651
A9 3.45° ±1.53° 2.61° ±1.61° .0693
A10 1.01° ±0.79° 1.44° ±0.77° .0584
A11 7.74° ±5.07° 11.18° ±4.35° .0124 ⁎
A12 6.56° ±4.24° 4.80° ±4.07° .1413
A13 89.68° ±2.47° 88.34° ±2.70° .0775
CD 7.29 cm ±1.53 cm 6.04 cm ±1.22 cm .0002 ⁎⁎
LD 4.57 cm ±1.40 cm 4.14 cm ±1.01 cm .2090
Posterior A14 21.45° ±6.76° 16.65° ±6.31° .0122 ⁎
A15 18.78° ±7.75° 16.87° ±6.33° .3364
% 15.19 ±11.60 16.22 ±14.58 .7889
%, horizontal asymmetry of scapula in relation to the spinous process of the third thoracic vertebra; A1, horizontal alignment of the head; A2, acromia
alignment; A3, anterosuperior iliac spines alignment; A4, lateral tilt of the trunk; A5, varus/valgus of right lower limb; A6, varus/valgus of left lower limb;
A7, horizontal alignment of the head; A8, vertical alignment of the head; A9, vertical shoulder alignment; A10, vertical alignment of the body; A11, pelvic
horizontal alignment; A12, knee angle; A13, ankle angle; A14, valgus/varus of right calcaneus; A15, varus/valgus of left calcaneus; CD, horizontal distance
from the thoracic curve apex to middle region of cervical curve; LD, horizontal distance from the thoracic curve apex to middle region of lumbar curve.
⁎ P b .05, Student t test.
⁎⁎ P b .01, Student t test.

subjective evaluation method. 7 -9 Based on the photogram-
metric data obtained in the current study, TMD seems to be
related to the global body posture, once changes were
observed in the horizontal pelvic alignment and calcaneus
as well as in the cervical position. Zonnenberg et al 33
verified postural changes in subjects with TMD compared
to the healthy ones, by means of photographic analysis. The
study of Munhoz et al 15 was the only study found that
evaluated quantitatively the global body posture in subjects
with or without TMD. However, they used different
software and angular measures, and they evaluated subjects
with internal derangement TMD diagnosis. The authors did
not find significant postural difference between the
subjects; nonetheless, this methodological difference
makes it difficult to compare with the present study.
In the present study, postural misalignments were
present in subjects with and without TMD such as head
tilt; shoulder, anterosuperior iliac spine, and scapula
asymmetry in the anterior view; forward head and shoulder
posture in relation to the vertical line; pelvic tilt; knees
hyperextension in lateral view; and calcaneus valgus in the
posterior view. Some degree of postural asymmetry due to
dominance interference, such as lower shoulder, higher hip
and calcaneus in mild varus at the dominant side, is
recognized. 25 The great variability in the body posture in
the general population 15 as well as the higher postural
dysfunction occurrence due to poor postural or professional
habits, congenital or acquired changes, sedentary style, and
emotional factors 34 can explain the presence of postural
changes in both groups. In addition, Ferreira et al 35 related
that postural assessment by photographic and computerized
analysis showed slight variations of postural alignment,
indicating that posture might have ranges of normal values.
The cervical distance, one of the photogrammetric
measures related to head posture, was significantly different
between groups, with greater value for the SG (7.29 ± 1.53
cm). For Rocabado, 12 this measure characterizes the forward
head posture when it is greater than 6 cm. However, Strini
et al 36 considered 6 to 8 cm as a normal value.
The horizontal alignment of the head in the lateral view
(A7) did not differ statistically between groups, with mean
values near those verified in asymptomatic individuals. 13,24
Nevertheless, it is not known if these values correspond to a
neutral position of the head in this plane. It is considered that
the smaller the angle, the more forward is the head position. 13
Some studies did not find difference in the head posture
between subjects with and without TMD in the measure-
ment of the same angle (A7) analyzed in this study. 13 -15
Similarly, Matheus et al, 16 in a cephalometric study of
craniocervical posture comparing 30 subjects with TMD of
discal origin and 30 subjects without dysfunction, did not
find difference between the subjects. Munhoz and Marques 9
found similar results between subjects with and without
TMD, both presenting forward head posture (66.7% vs 75%,
respectively) in a photographic visual analysis. Other
studies 5,8 found more frequent forward head posture in
412 Souza et al Journal of Manipulative and Physiological Therapeutics
Plantar Pressure and Temporomandibular Disorder July/August 2014

Table 2. Mean Values and SD of the Plantar Pressure Distribution in the Mandibular Rest and Maximal Intercuspal Position Between
and Within Study and Control Groups
Pressure Plantar Distribution (%)
Anterior Posterior Right Left
Tests Rest MI Rest MI Rest MI Rest MI
Between groups Mean ± SD Mean ±SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD
SG 36.86 ± 8.19 38.09 ± 8.91 63.14 ± 8.20 61.90 ± 8.92 48.78 ± 5.67 49.35 ± 5.96 51.25 ± 5.64 50.65 ± 5.98
AG 39.87 ± 8.76 39.80 ± 8.53 60.13 ± 8.76 60.20 ± 8.53 49.67 ± 3.96 49.76 ± 4.59 50.31 ± 4.00 50.24 ± 4.59
F value 4.49 1.37 4.49 1.37 1.26 0.21 1.26 0.21
P level .0357 ⁎ .2430 .0357 ⁎ .2430 .2640 .6457 .2640 .6457

Within groups
SG F value 1.94 1.94 2.61 2.61
P level .1672 .1672 .1094 .1094
AG F value 0.02 0.02 0.09 0.09
P level .8865 .8865 .7623 .7623
AG, asymptomatic group; MI, maximal intercuspal position; SG, symptomatic group.
⁎ P b .05, analysis of variance and Tukey post test.

TMD subjects; however, these studies used different
evaluation methods compared to the current study.
In addition, in the lateral view, there were differences in
the pelvic position between groups with significant lower
tilt in the SG. As a normal value has not been established for
this measure, it is not possible to identify the postural
deviation. A comparative study with 10 women with
temporomandibular joint disk displacement and healthy
women observed pelvic retroversion in the first ones. 7 In
the posterior view, both groups presented angular values
correspondent to calcaneus valgus, with significant differ-
ence in the right side in the SG. There are no studies in the
literature with which these findings can be compared.
In the baropodometric evaluation, differences were found
in the plantar pressure distribution between the groups at the
rest position. The weight distribution in the anterior and
posterior directions was significantly different between
groups. The individuals with TMD had higher backfoot and
lower forefoot pressure compared to the AG. In the AG, the
plantar pressure distribution achieved normal limits. 32 It is
possible that the postural imbalance observed in the TMD
patients, by means of the photogrammetry (such as the pelvic
alignment), was reflected in the more posterior distribution of
plantar pressures in these subjects. Therefore, the presence of
TMD may interfere in the distribution of plantar pressures.
To help explain the mechanisms, Cuccia and Caradonna 37
stated that tensions in the stomatognathic system can
contribute for deficiencies in the alignment and the neural
control of the posture, once there are connections among the
trigeminal system, neural structures involved in the posture
control, and the myofascial chains. As in the current study,
Chessa et al 38 described the relation between craniomandib-
ular disorders and postural alterations using baropodometric
examination. In their study, there was an improvement of
plantar pressure distribution in 80% of the individuals with
TMD who undergone 7 months of occlusal treatment using
acrylic resin plate. Similarly, Cuccia 39 analyzed the interre-
lationship between dental occlusal and plantar arch during
gait in control and TMD subjects. The author concluded that a
pathologic condition of the stomatognathic system such as
the presence of TMD interferes in the baropodometric
dynamic parameters.
Conversely, Ferrario et al 40 in a study with force
platform demonstrated that the modifications of the plantar
pressure center were not influenced by the TMD. For the
authors, the mechanism of the neuromuscular complex,
which should respond to adjustments of body posture, was
not detected in the foot level.
In the within-group analysis for the present study, there
were no significant differences in the pressure plantar
distribution between the rest and the maximal intercuspal
situation in both groups. Such findings are in agreement
with Sakaguchi et al 31 who did not find significant
difference in the anteroposterior and laterolateral distribu-
tion of plantar pressure (MatScan System, Boston, MA) in
healthy subjects, during mandibular position changes.
However, Bracco et al 41 verified improvement in the
symmetry of the plantar pressure distribution on the frontal
plane (right and left) in healthy subjects at the maximal
intercuspal compared to the mandibular rest position.
Yoshino et al 21 also verified an influence of the loss of
occlusal support unilaterally and bilaterally on the weight
distribution in the anterior, posterior, left, and right of the
foot during maximal intercuspal in healthy subjects.
Ries and Bérzin 22 observed, by the stabilometric evalua-
tion, improvement in the postural stability in subjects with
TMD at maximal intercuspal position, compared to control
subjects. For these authors, this finding can be attributed to a
preparatory activity for the occlusal work. However, this was
not demonstrated in others studies that used this same
evaluation method 30,40 and by the baropodometric analysis
during the maximal intercuspidal position in the current study.
Journal of Manipulative and Physiological Therapeutics
Volume 37, Number 6
In a systematic review, Perinetti and Contardo 42 recommended
more investigations with improved levels of scientific evidence
for monitoring the body posture responses to changes in the
stomatognathic system.
The photogrammetric analysis evidenced some significant
differences on the global body posture between subjects with
and without TMD. The first ones presented more postural
misalignment, with increase in the cervical distance, right
calcaneus valgism, and lower pelvic tilt. Temporomandibular
disorder subjects showed abnormal plantar pressures distri-
bution in anterior and posterior direction at rest mandibular
position. These results suggest the need of a global posture
treatment in individuals with myogenic TMD 42,43 and indicate
the baropodometry as a one more resource to evaluate the
interaction between the stomatognathic and postural systems.
Limitations
Limitations should be recognized in this investigation,
including the small sample size with different TMD diagnoses,
that is, combined myofascial pain and arthralgia. Thus, the
results of this study cannot be extended to other TMD
diagnoses. Further studies are necessary to investigate the
relation between TMD and the global posture, considering the
different RDC/TMD diagnostic criteria subgroups. In addition,
the scarcity of studies using baropodometry and the angles
analyzed in this study for the assessment of myogenic TMD
patients limited the discussions.
CONCLUSION
Subjects with and without TMD presented with global
body posture misalignment. Some postural changes were
more pronounced in the subjects with TMD. Subjects with
TMD presented abnormal plantar pressure distribution.
This study suggests that there may be a relationship
between TMD and the postural system.
Practical Applications
• The findings of this study suggest that body
posture including alignment and postural
control should be evaluated in the presence
of TMD.
• Our findings indicate that TMD patients may
show changes in the distribution of plantar
pressures.
• Baropodometry may be a potential resource
to evaluate the interaction between the
stomatognathic and postural systems.
• The need of a global posture treatment in
individuals with myogenic and arthralgy TMD.
Souza et al 413
Plantar Pressure and Temporomandibular Disorder
ACKNOWLEDGMENTS
The authors thank the Postgraduate Program of Human
Communication Disorders of UFSM, Brazil, and Claudio
Figueiró, professor of the Occlusion Clinics of UFSM, and
Janete Amador, professor of the Statistic Department of UFSM.
FUNDING SOURCES AND POTENTIAL CONFLICTS OF INTEREST
No funding sources or conflicts of interest were reported
for this study.
CONTRIBUTORSHIP INFORMATION
Concept development (provided idea for the research):
J.A.S.
Design (planned the methods to generate the results):
J.A.S.,F.P.
Supervision (provided oversight and responsible for
organization and implementation and writing of the
manuscript): J.A.S., F.P., E.C.R.C., A.M.T.daS.
Data collection/processing (responsible for experiments,
patient management, organization, or reporting data):
J.A.S., F.P.
Analysis/interpretation (responsible for statistical analysis,
evaluation, and presentation of the results): J.A.S., F.P.
Literature search (performed the literature search):
J.A.S., F.P.
Writing (responsible for writing a substantive part of the
manuscript): J.A.S.
Critical review (revised manuscript for intellectual
content, this does not relate to spelling and grammar
checking): E.C.C., A.M.T.daS.
Other (list other specific novel contributions): contribu-
tions: Janete Amador (new statistical analysis); Claudio
Figueiró (critical review).
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