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Askø Andersen J, Rasmussen A, Engberg S, Bencke J, Frimodt-Møller M, Kirketerp-Møller K, Rossing P. Effect of flexor tendon tenotomy of the diabetic hammertoe on plantar pressure: a randomized controlled trial. BMJ Open Diabetes Res Care 2024; 12:e004398. [PMID: 39631844 PMCID: PMC11624764 DOI: 10.1136/bmjdrc-2024-004398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 11/06/2024] [Indexed: 12/07/2024] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the effects of flexor tendon tenotomy treatment of the diabetic hammertoe deformity on plantar pressure. RESEARCH DESIGN AND METHODS The study was a substudy including participants from a randomized study on tenotomy treatment of diabetic hammertoes. This study was conducted between December 20, 2019 and June 22, 2021. Participants were randomized to tenotomy and standard non-surgical treatment or standard non-surgical treatment alone. Barefoot plantar pressure measurement was performed pre-intervention and 3 months post-intervention. Primary outcome was change in peak plantar pressure post tenotomy treatment. RESULTS Of the 95 participants screened in the original study, 45 (57.8% male) were included andcompleted this substudy. Of the 45 participants, 22 were randomized to intervention. The average age of participants was 65.6 ((SD±) 9.5) years and 30 (66.7%) had type 2 diabetes.The average peak plantar pressure (PPP) in toe regions of the participants in the intervention group was significantly (p<0.0001) reduced from 205.6 kPa ((Q1-Q3) 152.0-289.1) pre-intervention to 61.3 kPa (39.1-100.5) post-intervention. The average reduction in PPP of toe regions for participants in the intervention group (-145.3 kPa (-225.9 to -56.2)) was significantly (p=0.00017) higher than what was observed for participants in the control group (-1.6 kPa (-30.2 to 27.9)). CONCLUSION This study found that tenotomies of the diabetic hammertoe reduces plantar pressure affecting the treated toes. This likely explains the positive effects of tenotomy treatment on diabetic foot ulcers.
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Affiliation(s)
- Jonas Askø Andersen
- Orthopedic Department, Nordsjaellands Hospital, Hillerød, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Susanne Engberg
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Novo Nordisk A/S, Bagsvaerd, Denmark
| | - Jesper Bencke
- Department of Orthopedic Surgery, Copenhagen University Hospital at Amager-Hvidovre, Copenhagen, Denmark
| | | | - Klaus Kirketerp-Møller
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Copenhagen Wound Healing Center Bispebjerg Hospital, Copenhagen, Denmark
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Kurnianto RR, Hijmans JM, Greve C, Houdijk H. Human-in-the-loop optimization of rocker shoe to reduce plantar pressure and collision work simultaneously. Clin Biomech (Bristol, Avon) 2024; 116:106282. [PMID: 38850883 DOI: 10.1016/j.clinbiomech.2024.106282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/25/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Rocker shoes can be used to reduce foot pressure and adjust lower limb kinetics for various patient population, such as people with diabetic peripheral neuropathy. Selecting adequate properties of the rocker sole is of great importance for its efficacy. This study investigated the capability of human-in-the-loop optimization (HILO) to individually optimize apex position and angle of rocker shoe to reduce peak pressure and collision work simultaneously. METHODS Peak pressure, kinetic, and kinematic data were recorded from 10 healthy participants while walking at preferred speed wearing rocker shoes with adjustable apex position and angle. An evolutionary algorithm was used to find optimal apex parameters to reduce both peak pressure in medial forefoot and collision work. The optimized shoe (HILO shoe) was compared with generic optimal rocker settings (Chapman settings) and normal shoe. FINDINGS Compared to normal shoe, the HILO shoe had lower plantar pressure (pHILO = 0.007; pChapman = 0.044) and Chapman shoe showed higher collision work (pHILO = 0.025; pChapman = 0.014). Both HILO and Chapman shoe had smaller push-off work than normal shoe (pHILO = 0.001; pChapman < 0.001) with the Chapman shoe exhibited earlier push-off onset (pHILO = 0.257; pChapman = 0.016). INTERPRETATION The Human-in-the-loop optimization approach resulted in individualized apex settings which performed on average similar to Chapman settings but, were superior in selected cases. In these cases, medial forefoot could be further offloaded with apex angles larger than generic settings. The larger apex angle might increase the external ankle moment arm and push-off work. However, there is limited room for improvement on collision work compared to generic settings.
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Affiliation(s)
- R R Kurnianto
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, the Netherlands; Institut Teknologi Bandung, Faculty of Industrial Technology, Industrial Engineering Department, Bandung, Indonesia.
| | - J M Hijmans
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - C Greve
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - H Houdijk
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, the Netherlands
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Mesci E. Pedobarographic evaluations in physical medicine and rehabilitation practice. Turk J Phys Med Rehabil 2023; 69:400-409. [PMID: 38766578 PMCID: PMC11099855 DOI: 10.5606/tftrd.2023.13637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 05/22/2024] Open
Abstract
The feet are complex structures that transmit loads transferred by other parts of the body to the ground and are involved in many static and dynamic activities, such as standing and walking. The contact area and pressure changes between the feet and the ground surface can be measured using pedobarographic devices. With pedobarographic examinations, it is possible to obtain a wide range of information needed to support clinical evaluation and diagnostic tests in physical medicine and rehabilitation practice. Foot structure and function, postural stability, lower extremity biomechanics, and gait analysis are among the areas that can be further investigated using pedobarography.
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Affiliation(s)
- Erkan Mesci
- Department of Physical Medicine and Rehabilitation, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Türkiye
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Brisbane JM, McCullough MBA, Baker C, London JS, Queen RM. Impact of Race, gait speed and arch height on plantar loading. J Biomech 2023; 155:111648. [PMID: 37247518 DOI: 10.1016/j.jbiomech.2023.111648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 05/14/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023]
Abstract
Diabetes is a leading cause for death in the United States, with African Americans (AA) being twice as likely to die from diabetes than White Americans (WA). AA are twice as likely to experience diabetes-related foot amputation due to foot ulcers, which are most often caused by high plantar pressure. While it is known that arch height, sex, family history of diabetes, Body Mass Index (BMI), age, and gait speed can impact plantar loading, there is a need to test the hypothesis that race in combination with the previously mentioned variables are significant predictors of plantar loading. To answer this question, plantar loading data was collected from 107 participants using an EMED pressure-measurement system (Novel Electronics, Inc, St Paul, MN, USA). Each participant walked barefoot at a self-selected walking pace ten times. Contact area, maximum force, and were force-time integral collected for each step on the pressure plate. A multiple linear regression was used to test if race, age, Arch Height Index (AHI), gait speed, sex assigned at birth, family history of diabetes, and BMI significantly predicted plantar loading. Race, age, AHI, gait speed, sex, and BMI were considered significant predictor variables for plantar loading. Most importantly, race was a significant predictor of maximum force in the hallux (β = 6.46, p < 0.001), rearfoot (β = -6.36, p < 0.001), and lateral midfoot (β = -2.72, p < 0.001), and the force-time integral in the hallux (β = 2.37, p < 0.001), rearfoot (β = -2.14, p < 0.001), and lateral midfoot (β = -0.65, p < 0.001). These findings could help with understanding why AA are more likely to develop diabetic foot ulcers than WA.
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Affiliation(s)
- Julia M Brisbane
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA; Department of Engineering Education, Virginia Tech, Blacksburg, VA, USA.
| | - Matthew B A McCullough
- Department of Chemical, Biological, and Bioengineering, North Carolina Agricultural and Technical State University, Greensboro, NC, USA
| | - Charlotte Baker
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
| | - Jeremi S London
- Department of Engineering Education, Virginia Tech, Blacksburg, VA, USA
| | - Robin M Queen
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
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Martin JK, Davis BL. Diabetic Foot Considerations Related to Plantar Pressures and Shear. Foot Ankle Clin 2023; 28:13-25. [PMID: 36822683 PMCID: PMC10111339 DOI: 10.1016/j.fcl.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Diabetic foot ulcers are a complex, multifaceted, and widespread complication of diabetes mellitus. Although there are a multitude of risk factors contributing to diabetic foot ulcer development, pressure and (more recently) shear stresses are two biomechanical metrics that are gaining popularity for monitoring risk factors predisposing skin breakdown. Other areas of diabetic foot ulcers under research include plantar temperature measuring, as well as monitoring wear-time compliance and machine learning/AI algorithms. Charcot arthropathy is another diabetes complication that has a relationship with diabetic foot ulcer development, which should be monitored for development alongside ulcer development. The ability to monitor and prevent diabetic foot ulcer development and Charcot neuroarthropathy will lead to increased patient outcomes and patient quality of life.
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Affiliation(s)
- Jessi K Martin
- Center for Human Machine Systems, Cleveland State University, WH 305, Cleveland, OH 44115, USA
| | - Brian L Davis
- Center for Human Machine Systems, Cleveland State University, WH 305, Cleveland, OH 44115, USA.
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Jorgetto JV, Oggiam DS, Gamba MA, Kusahara DM. Factors associated with changes in plantar pressure of people with peripheral diabetic neuropathy. J Diabetes Metab Disord 2022; 21:1577-1589. [PMID: 36404815 PMCID: PMC9672143 DOI: 10.1007/s40200-022-01104-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/30/2022] [Indexed: 10/14/2022]
Abstract
Abstract Diabetic neuropathy is one of the main complications of Diabetes Mellitus, which can lead to loss of protective sensation, motor, and plantar pressure alteration, generating deformities, abnormal gait and mechanical trauma to the feet. Objective to evaluate the distribution of plantar pressure, sensorimotor changes, balance and associated factors to plantar pressure changes in people with peripheral diabetic neuropathy. Method Cross-sectional study conducted with individuals registered in the primary public health service of a city in the east of São Paulo - Brazil. The sample was composed by people with Diabetes Mellitus and Peripheral Neuropathy identified by the Michigan Screening Instrument. It were investigated variables such as sensory-motor changes, static and dynamic plantar pressure using baropodometry and balance using the Berg scale. A significance level of 5% was adopted for all tests used. Results Of the 200 individuals evaluated, 52.55% had no plantar protective sensitivity, the static evaluation did not demonstrated changes in the peak of plantar pressure, however in the dynamics the mean in the right foot was 6.0 (±2) kgf/cm2 and 6,7 (±1.62) kgf/cm2 on the left foot, the center of static pressure on the right foot was lower (10.55 ± 3.82) than on the left foot (11.97 ± 3.90), pointing hyper plantar pressure. The risk of falling was high, ranging from 8 to 56 points, with an average of 40.9 (±10.77). Conclusion The absence of protective plantar sensitivity, increased pressure, biomechanical changes lead to loss of balance and are predictive of complications in the feet due to diabetic neuropathy.
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Affiliation(s)
- Juliana Vallim Jorgetto
- Department of Public Health in the Collective Dimension, Federal University of São Paulo – UNIFESP, Octávio Parreira Street, 100, Jardim das Paineiras / São João da Boa Vista-SP, São Paulo, CEP: 13,874-720 Brazil
| | - Daniella Silva Oggiam
- Department of Public Health in the Collective Dimension, Federal University of São Paulo – UNIFESP, Octávio Parreira Street, 100, Jardim das Paineiras / São João da Boa Vista-SP, São Paulo, CEP: 13,874-720 Brazil
| | - Mônica Antar Gamba
- Retired teacher of Administration Applied to Nursing and Collective Health, School of Nursing, Federal University of São Paulo – UNIFESP, São Paulo, Brazil
| | - Denise Miyuki Kusahara
- PhD Nurse, Adjunct Professor from Department of Pediatric Nursing of the Paulista School of Nursing, Federal University of São Paulo - UNIFESP - Brazil, São Paulo, Brazil
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Shi QQ, Li PL, Yick KL, Li NW, Jiao J. Effects of contoured insoles with different materials on plantar pressure offloading in diabetic elderly during gait. Sci Rep 2022; 12:15395. [PMID: 36100637 PMCID: PMC9470545 DOI: 10.1038/s41598-022-19814-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/05/2022] [Indexed: 01/22/2023] Open
Abstract
To investigate the effect of contoured insoles constructed of different insole materials, including Nora Lunalastik EVA, Nora Lunalight A fresh, Pe-Lite, and PORON Medical 4708 with Langer Biomechanics longitudinal PPT arch pads on offloading plantar pressure on the foot of the elderly with Type 1 or 2 diabetes during gait. Twenty-two elderly with Type 1 or 2 diabetes participated in the study. Their plantar pressure was measured by using an insole measurement system, while the participants walked 10 m in their bare feet or used each experimental insole in random order. The plantar surface was divided into four specific regions including the toes, forefoot, midfoot, and rearfoot. The mean peak pressure (MPP) and pressure-time integral (PTI) of ten steps with or without wearing one of the four insoles were analyzed on the dominant foot and the four specific plantar regions. After completion of the activities, the participants scored each insole from 1 (the least comfortable) to 10 (the most comfortable). The analysis of variance (ANOVA) factor of the insoles had significant effects on the MPP (P < 0.001) and PTI (P = 0.004) in the dominant foot during gait. Pairwise comparison results showed that the MPP and PTI in the dominant foot were significantly lower (P < 0.001) with PORON Medical 4708 than barefoot, Nora Lunalight A fresh, and Pe-Lite. Additionally, the insole materials had a significant effect for the forefoot (P < 0.001) and rearfoot (P < 0.001) in terms of the MPP and PTI compared with the barefoot condition during gait. Regardless of the plantar region, the MPP and PTI values were the lowest when PORON Medical 4708 was used as the insole material among four insole materials. Meanwhile, a significantly lower MPP and PTI can be found in the forefoot and rearfoot with the use of the four experimental insoles when compared with barefoot. The soft insole materials (i.e., PORON medical 4708 and Nora Lunalastik EVA) had a better performance than the rigid insole materials (i.e., Nora Lunalight A fresh, and Pe-Lite) on plantar pressure offloading for diabetic elderly.
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Affiliation(s)
- Qiu Qiong Shi
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China
| | - Pui Ling Li
- Laboratory for Artificial Intelligence in Design, Hong Kong, China
| | - Kit-Lun Yick
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China.
- Laboratory for Artificial Intelligence in Design, Hong Kong, China.
| | - Nga-Wun Li
- Laboratory for Artificial Intelligence in Design, Hong Kong, China
| | - Jiao Jiao
- Dr. Stephen Hui Research Centre for Physical Recreation and Wellness, Hong Kong Baptist University, Hong Kong, China
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Identificar el pie de riesgo en pacientes con diabetes. Un espacio de mejora en atención primaria. Semergen 2022; 48:297-307. [DOI: 10.1016/j.semerg.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/19/2022]
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Aalaa M, Sanjari M, Esfahani EN, Atlasi R, Larijani B, Mohajeri-Tehrani MR, Mehrdad N, Amini MR. Diabetic Foot scientific activities in Endocrinology and Metabolism Research Institute. J Diabetes Metab Disord 2021; 20:1767-1772. [PMID: 34900823 DOI: 10.1007/s40200-021-00823-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/23/2021] [Indexed: 02/06/2023]
Abstract
Introduction Diabetic Foot (DF) as a common complication of Diabetes should be intensive intervention for prevention, management and rehabilitation. In this regard, Diabetes Research Center of Endocrinology and Metabolism Research Institute (EMRI) of Tehran University of Medical Sciences (TUMS) considered DF as a priority research area to investigate multidimensional aspects of DF care. We are intended to summarize DF research studies affiliated to the EMRI for over the last two decades. Methods Three Electronic databases including Web of Science, PubMed, and Scopus were searched until January 2020 to find articles about DF published affiliated to EMRI. The main concepts of search strategies were "diabetes", "Foot". 115 documents retrieved from these databases which screened for inclusion and exclusion criteria. The visualization of the network of co-authorship of authors and co-occurrence of keywords was illustrated and documents were analyzed for content according to the Main areas of DF Research studies. Result 64 related documents including original articles, reviews, letters, notes, and book chapter have included to this study. According to the objectives of the retrieved studies, DF documents and research studies categorized in the two main groups including DF prevention, classification and risk stratification in addition management of DF. Conclusion Despite conducted research and educational activities in DF prevention and management, the following topics would be considered as well: effective offloading treatment, correcting the nutritional status for improving wound healing and novel educational strategies for diabetic foot multi-disciplinary team.
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Affiliation(s)
- Maryam Aalaa
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mahnaz Sanjari
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ensieh Nasli Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rash Atlasi
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Mohajeri-Tehrani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Mehrdad
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Nursing Care Research Center, School of Nursing and Midwifery, University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Amini
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Zhao Y, Cai K, Wang Q, Hu Y, Wei L, Gao H. Effect of tap dance on plantar pressure, postural stability and lower body function in older patients at risk of diabetic foot: a randomized controlled trial. BMJ Open Diabetes Res Care 2021; 9:9/1/e001909. [PMID: 33737414 PMCID: PMC7978263 DOI: 10.1136/bmjdrc-2020-001909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/25/2021] [Accepted: 02/28/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION To examine the effects of tap dance (TD) on dynamic plantar pressure, static postural stability, ankle range of motion (ROM), and lower extremity functional strength in patients at risk of diabetic foot (DF). RESEARCH DESIGN AND METHODS A randomised, single-blinded, two-arm prospective study of 40 patients at risk of DF was conducted. The intervention group (n=20) received 16 weeks of TD training (60 min/session×3 sessions/week). The control group attended four educational workshops (1 hour/session×1 session/month). Plantar pressure, represented by the primary outcomes of peak pressure (PP) and pressure-time integral (PTI) over 10 areas on each foot, was measured using the Footscan platform system. Secondary outcomes comprised static postural stability, ankle ROM and lower extremity functional strength. RESULTS Reductions in intervention group PP (right foot: mean differences=4.50~27.1, decrease%=25.6~72.0; left foot: mean differences=-5.90~6.33, decrease%=-22.6~53.2) and PTI at 10 areas of each foot (right foot: mean differences=1.00~12.5, decrease%=10.4~63.6; left foot: mean differences=0.590~25.3, decrease%=21.9~72.6) were observed. Substantial PP and PTI differences were noted at the second through fourth metatarsals, medial heel and lateral heel in the right foot. Substantial PP and PTI differences were detected at metatarsals 1 and 2 and metatarsal 2 in the left foot, respectively. Moderate training effects were found in plantar flexion ROM of both feet, lower extremity functional strength, and length of center-of-pressure trajectory with eyes closed and open (r=0.321-0.376, p<0.05). CONCLUSIONS A 16-week TD training program can significantly improve ankle ROM, lower extremity functional strength, and static postural stability. To attain greater improvements in plantar pressure, a longer training period is necessary. TRIAL REGISTRATION NUMBER ChiCTR1800014714.
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Affiliation(s)
- Yanan Zhao
- School of Sports Science and Physical Education, Nanjing Normal University, Nanjing, China
| | - Keshu Cai
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qianwen Wang
- School of Sports Science and Physical Education, Nanjing Normal University, Nanjing, China
| | - Yaqing Hu
- School of Sports Science and Physical Education, Nanjing Normal University, Nanjing, China
| | - Lijun Wei
- Maigaoqiao Community Health Service Center, Nanjing, China
| | - Huihua Gao
- Xigang Community Health Service Center, Nanjing, China
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Wang D, Ouyang J, Zhou P, Yan J, Shu L, Xu X. A Novel Low-Cost Wireless Footwear System for Monitoring Diabetic Foot Patients. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2021; 15:43-54. [PMID: 33296308 DOI: 10.1109/tbcas.2020.3043538] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Diabetic foot is one of the main complications of diabetes with the characteristics of high incidence and difficulty in treatment. Diabetic patients with peripheral neuropathy may develop foot ulcers, and in severe cases amputations are required and some may even die. Plantar pressure can be used to assess the risk of developing diabetic foot, but the existing plantar pressure monitoring methods are not suitable for long-term monitoring in daily life. This study presents a novel low-cost shoe system for daily monitoring of plantar pressure in diabetics. It includes an insole with pressure sensor array, which can dynamically monitor the plantar pressure and display the changes of plantar pressure in real time in the mobile phone to provide early warning for patients with high risk of diabetic foot. As for the sensor, copper and carbon black were adopted as the electrode and conductive filler respectively, enabling a mass production with low price. It was soft and bendable, meeting the performance needs of daily plantar pressure monitoring. All devices were encapsulated in shoes, and the data was transmitted wirelessly through Bluetooth, which did not affect the user's walking. After using random forest for feature selection, five classifiers were used to classify the plantar pressure of healthy people, diabetic patients without peripheral neuropathy, and diabetic patients with peripheral neuropathy collected by this system. The experimental results showed that the accuracy of the random forest classifier was the highest, reaching 94.7%, which indicated that the system could be useful for daily plantar pressure monitoring of diabetic patients.
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