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Brady LM, Wukelic C, Ledoux WR. A method for automated masking and plantar pressure analysis using segmented computed tomography scans. Gait Posture 2024; 111:92-98. [PMID: 38657477 PMCID: PMC11127777 DOI: 10.1016/j.gaitpost.2024.04.015] [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: 11/06/2023] [Revised: 03/26/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Plantar pressure, a common gait and foot biomechanics measurement, is typically analyzed using proprietary commercial software packages. Regional plantar pressure analysis is often reported in terms of underlying bony geometry, and recent advances in image processing and accessibility have made computed tomography, radiographs, magnetic resonance imaging, or other imaging methods more popular for incorporating bone analyses in biomechanics. RESEARCH QUESTION Can a computed tomography-based regional mask provide comparable regional analysis to commercial plantar pressure software and can the increased flexibility of an in-house method obtain additional insight from common measurements? METHODS A plantar pressure analysis method was developed based on bony geometry from computed tomography scans to calculate peak pressure, pressure time integral incorporating sub-peak values, force time integral, pressure gradient, and pressure gradient angle. Static and dynamic plantar pressure were acquired for 4 subjects (male, 65 ± 2.4 years). Plantar pressure variables were calculated using commercial and computed tomography-based systems. RESULTS Dynamic peak pressure, pressure time integral, and force-time integral computed using the bone-based software was 5 % (9kPa), 7 % (0.3kPa-s) and 13 % (0.3 N-s) different than the commercial software on average. Region masks of the metatarsals and toes differed between commercial and computed tomography-based software due to subject-specific bone geometry and toe shape. Pressure time integral values incorporating sub-peak pressure were higher and demonstrated higher relative hindfoot values compared to those without. Removing step-on frames to static pressure analysis decreased forefoot pressures. Regional maps of peak pressure and maximum pressure gradient demonstrate different peak locations. SIGNIFICANCE Computed tomography-based regional masks are comparable to commercial masks. Inclusion of static step-on frames and sub-peak pressures may change regional plantar pressure patterns. Differences in location of maximum pressure gradient and peak pressure may be useful for assessing subject specific injury risk.
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Affiliation(s)
- Lynda M Brady
- VA RR& D Center for Limb Loss and MoBility (CLiMB), Seattle, WA 98108, USA; Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
| | - Corey Wukelic
- VA RR& D Center for Limb Loss and MoBility (CLiMB), Seattle, WA 98108, USA
| | - William R Ledoux
- VA RR& D Center for Limb Loss and MoBility (CLiMB), Seattle, WA 98108, USA; Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA; Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA 98195, USA.
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Dai Y, Li J, Cui W, Li J. Coupled effect of load weights and belt use on male shoulder pressure redistribution. ERGONOMICS 2024:1-14. [PMID: 38495011 DOI: 10.1080/00140139.2024.2328357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 03/05/2024] [Indexed: 03/19/2024]
Abstract
Shoulder pressure redistribution is jointly affected by backpack loads and belt support. However, the combined effect of both factors has rarely been fully evaluated. Here, we studied the coupled effect of backpack loads and belt support on shoulder pressure redistribution. All twenty-eight healthy male subjects underwent eight loading conditions with both chest and hip belts fastened (CH) and unfastened (CON) in four conditions where the backpack weighed 7.5, 15, 22.5, and 30% of body weight (BW). Shoulder pressure distribution was quantified through a pressure-sensing vest mat. The results showed that using the hip belt and chest belt was effective in relieving the high pressure in the lateral clavicle and medial trapezius region and strengthening the load-bearing capacity of shoulder. However, the assistance in pressure relief of using belt was weakened when load increased to 30% BW. This study also showed that the belt use can be effective in improving pressure asymmetry on both sides.
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Affiliation(s)
- Yanyang Dai
- College of Fashion and Design, Donghua University, Shanghai, China
| | - Jian Li
- College of Fashion and Design, Donghua University, Shanghai, China
| | - Wen Cui
- College of Fashion and Design, Donghua University, Shanghai, China
| | - Jun Li
- College of Fashion and Design, Donghua University, Shanghai, China
- Key Laboratory of Clothing Design and Technology, Donghua University, Ministry of Education, Shanghai, China
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Haris F, Jan YK, Liau BY, Hsieh CW, Shen WC, Tai CC, Shih YH, Lung CW. Plantar pressure gradient and pressure gradient angle are affected by inner pressure of air insole. Front Bioeng Biotechnol 2024; 12:1353888. [PMID: 38529404 PMCID: PMC10961410 DOI: 10.3389/fbioe.2024.1353888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/21/2024] [Indexed: 03/27/2024] Open
Abstract
Clinically, air insoles may be applied to shoes to decrease plantar pressure gradient (PPG) and increase plantar gradient angle (PGA) to reduce foot ulcers. PPG and PGA may cause skin breakdown. The effects of different inner pressures of inflatable air insoles on dynamic PPG and PGA distributions are largely unknown in non-diabetics and people with diabetes. This study aimed to explore the impact of varying inner air insole pressures on PPG and PGA to establish early mitigation strategies for people at risk of foot ulcers. A repeated measures study design, including three air insoles (80 mmHg, 160 mmHg, and 240 mmHg) and two walking durations (10 and 20 min) for a total of six walking protocols, was tested on 13 healthy participants (height, 165.8 ± 8.4 cm; age, 27.0 ± 7.3 years; and weight, 56.0 ± 7.9 kg, BMI: 20.3 ± 1.7 kg/m^2) over three consecutive weeks. PPG, a measurement of the spatial variation in plantar pressure around the peak plantar pressure (PPP) and PGA, a variation in the gradient direction values at the three plantar regions, big toe (T1), first metatarsal head (M1), and second metatarsal head (M2), were calculated. This study indicated that PPG was lower at 80 mmHg air insoles after 20 min of walking in the M1 region (p = 0.010). The PGA in the M2 increased at an air insole of 80 mmHg compared to 240 mmHg (p = 0.015). Compared to 20 min, the 10 min walking duration at 240 mmHg of air insole had the lowest PPG in the M1 (p = 0.015) and M2 (p = 0.034) regions. The 80 mmHg air insole significantly lowered the PPG compared to a 160 mmHg and 240 mmHg air insole. Moreover, the 80 mmHg air insole significantly decreased PPP and increased PGA compared to the 160 mmHg and 240 mmHg air insole. A shorter walking period (10 min) significantly lowered PPG. The findings of this study suggest that people with a higher risk of foot ulcers should wear softer air insoles to have a lower PPG, as well as an increased PGA.
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Affiliation(s)
- Fahni Haris
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
- School of Nursing, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Yih-Kuen Jan
- Rehabilitation Engineering Lab, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Ben-Yi Liau
- Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan
| | - Chang-Wei Hsieh
- Department of Computer Science and Information Engineering, Asia University, Taichung, Taiwan
| | - Wei-Cheng Shen
- Department of Digital Media Design, Asia University, Taichung, Taiwan
| | - Chien-Cheng Tai
- International Ph.D. Program for Cell Therapy and Regeneration Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yin-Hwa Shih
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Chi-Wen Lung
- Rehabilitation Engineering Lab, University of Illinois at Urbana-Champaign, Champaign, IL, United States
- Department of Creative Product Design, Asia University, Taichung, Taiwan
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Burnie L, Chockalingam N, Holder A, Claypole T, Kilduff L, Bezodis N. Commercially available pressure sensors for sport and health applications: A comparative review. Foot (Edinb) 2023; 56:102046. [PMID: 37597352 DOI: 10.1016/j.foot.2023.102046] [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: 07/14/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023]
Abstract
Pressure measurement systems have numerous applications in healthcare and sport. The purpose of this review is to: (a) describe the brief history of the development of pressure sensors for clinical and sport applications, (b) discuss the design requirements for pressure measurement systems for different applications, (c) critique the suitability, reliability, and validity of commercial pressure measurement systems, and (d) suggest future directions for the development of pressure measurements systems in this area. Commercial pressure measurement systems generally use capacitive or resistive sensors, and typically capacitive sensors have been reported to be more valid and reliable than resistive sensors for prolonged use. It is important to acknowledge, however, that the selection of sensors is contingent upon the specific application requirements. Recent improvements in sensor and wireless technology and computational power have resulted in systems that have higher sensor density and sampling frequency with improved usability - thinner, lighter platforms, some of which are wireless, and reduced the obtrusiveness of in-shoe systems due to wireless data transmission and smaller data-logger and control units. Future developments of pressure sensors should focus on the design of systems that can measure or accurately predict shear stresses in conjunction with pressure, as it is thought the combination of both contributes to the development of pressure ulcers and diabetic plantar ulcers. The focus for the development of in-shoe pressure measurement systems is to minimise any potential interference to the patient or athlete, and to reduce power consumption of the wireless systems to improve the battery life, so these systems can be used to monitor daily activity. A potential solution to reduce the obtrusiveness of in-shoe systems include thin flexible pressure sensors which can be incorporated into socks. Although some experimental systems are available further work is needed to improve their validity and reliability.
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Affiliation(s)
- Louise Burnie
- Department of Sport, Exercise and Rehabilitation, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK; Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK.
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent ST4 2RU, UK
| | | | - Tim Claypole
- Welsh Centre for Printing and Coating (WCPC), Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK
| | - Liam Kilduff
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK
| | - Neil Bezodis
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK
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Chauhan AS, Varre MS, Izuora K, Trabia MB, Dufek JS. Prediction of Diabetes Mellitus Progression Using Supervised Machine Learning. SENSORS (BASEL, SWITZERLAND) 2023; 23:4658. [PMID: 37430572 DOI: 10.3390/s23104658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 07/12/2023]
Abstract
Diabetic peripheral neuropathy (DN) is a serious complication of diabetes mellitus (DM) that can lead to foot ulceration and eventual amputation if not treated properly. Therefore, detecting DN early is important. This study presents an approach for diagnosing various stages of the progression of DM in lower extremities using machine learning to classify individuals with prediabetes (PD; n = 19), diabetes without (D; n = 62), and diabetes with peripheral neuropathy (DN; n = 29) based on dynamic pressure distribution collected using pressure-measuring insoles. Dynamic plantar pressure measurements were recorded bilaterally (60 Hz) for several steps during the support phase of walking while participants walked at self-selected speeds over a straight path. Pressure data were grouped and divided into three plantar regions: rearfoot, midfoot, and forefoot. For each region, peak plantar pressure, peak pressure gradient, and pressure-time integral were calculated. A variety of supervised machine learning algorithms were used to assess the performance of models trained using different combinations of pressure and non-pressure features to predict diagnoses. The effects of choosing various subsets of these features on the model's accuracy were also considered. The best performing models produced accuracies between 94-100%, showing the proposed approach can be used to augment current diagnostic methods.
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Affiliation(s)
- Apoorva S Chauhan
- Department of Mechanical Engineering, University of Nevada, Las Vegas, NV 89154, USA
| | - Mathew S Varre
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
| | - Kenneth Izuora
- Department of Internal Medicine, University of Nevada, Las Vegas, NV 89154, USA
| | - Mohamed B Trabia
- Department of Mechanical Engineering, University of Nevada, Las Vegas, NV 89154, USA
| | - Janet S Dufek
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV 89154, USA
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Yan Y, Ou J, Shi H, Sun C, Shen L, Song Z, Shu L, Chen Z. Plantar pressure and falling risk in older individuals: a cross-sectional study. J Foot Ankle Res 2023; 16:14. [PMID: 36941642 PMCID: PMC10029259 DOI: 10.1186/s13047-023-00612-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/02/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Falls are commonplace among elderly people. It is urgent to prevent falls. Previous studies have confirmed that there is a difference in plantar pressure between falls and non-falls in elderly people, but the relationship between fall risk and foot pressure has not been studied. In this study, the differences in dynamic plantar pressure between elderly people with high and low fall risk were preliminarily discussed, and the characteristic parameters of plantar pressure were determined. METHODS Twenty four high-fall-risk elderly individuals (HR) and 24 low-fall-risk elderly individuals (LR) were selected using the Berg Balance Scale 40 score. They wore wearable foot pressure devices to walk along a 20-m-long corridor. The peak pressure (PP), pressure time integral (PTI), pressure gradient (maximum pressure gradient (MaxPG), minimum pressure gradient (MinPG), full width at half maximum (FWHM)) and average pressure (AP) of their feet were measured for inter-group and intra-group analysis. RESULTS The foot pressure difference comparing the high fall risk with low fall risk groups was manifested in PP and MaxPG, concentrated in the midfoot and heel (p < 0.05), while the only time parameter, FWHM, was manifested in the whole foot (p < 0.05). The differences between the left and right foot were reflected in all parameters. The differences between the left and right foot in LR were mainly reflected in the heel (p < 0.05), while it in the HR was mainly reflected in the forefoot (p < 0.05). CONCLUSIONS The differences comparing the high fall risk with low fall risk groups were mostly reflected in the midfoot and heel. The HR may have been more cautious when landing. In the intra-group comparison, the difference between the right and left foot of the LR was mainly reflected during heel striking, while it was mainly reflected during pedalling in the HR. The sensitivity of PP, PTI and AP was lower and the newly introduced pressure gradient could better reflect the difference in foot pressure between the two groups. The pressure gradient can be used as a new foot pressure parameter in scientific research.
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Affiliation(s)
- Yifeng Yan
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jianlin Ou
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hanxue Shi
- School of Future Technology, South China University of Technology, Guangzhou, China
| | - Chenming Sun
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Longbin Shen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhen Song
- School of Future Technology, South China University of Technology, Guangzhou, China
- School of Microelectronics, South China University of Technology, Guangzhou, China
| | - Lin Shu
- School of Future Technology, South China University of Technology, Guangzhou, China.
- Institute of Modern Industrial Technology of SCUT in Zhongshan, Zhongshan, China.
- Pazhou Lab, Guangzhou, China.
| | - Zhuoming Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China.
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Nam Y, Yang S, Kim J, Koo B, Song S, Kim Y. Quantification of Comfort for the Development of Binding Parts in a Standing Rehabilitation Robot. SENSORS (BASEL, SWITZERLAND) 2023; 23:2206. [PMID: 36850804 PMCID: PMC9967481 DOI: 10.3390/s23042206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Human-machine interfaces (HMI) refer to the physical interaction between a user and rehabilitation robots. A persisting excessive load leads to soft tissue damage, such as pressure ulcers. Therefore, it is necessary to define a comfortable binding part for a rehabilitation robot with the subject in a standing posture. The purpose of this study was to quantify the comfort at the binding parts of the standing rehabilitation robot. In Experiment 1, cuff pressures of 10-40 kPa were applied to the thigh, shank, and knee of standing subjects, and the interface pressure and pain scale were obtained. In Experiment 2, cuff pressures of 10-20 kPa were applied to the thigh, and the tissue oxygen saturation and the skin temperature were measured. Questionnaire responses regarding comfort during compression were obtained from the subjects using the visual analog scale and the Likert scale. The greatest pain was perceived in the thigh. The musculoskeletal configuration affected the pressure distribution. The interface pressure distribution by the binding part showed higher pressure at the intermuscular septum. Tissue oxygen saturation (StO2) increased to 111.9 ± 6.7% when a cuff pressure of 10 kPa was applied and decreased to 92.2 ± 16.9% for a cuff pressure of 20 kPa. A skin temperature variation greater than 0.2 °C occurred in the compressed leg. These findings would help evaluate and improve the comfort of rehabilitation robots.
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Affiliation(s)
- Yejin Nam
- Department of Biomedical Engineering, Yonsei University, Wonju 26493, Republic of Korea
| | - Sumin Yang
- Department of Biomedical Engineering, Yonsei University, Wonju 26493, Republic of Korea
| | - Jongman Kim
- Department of Biomedical Engineering, Yonsei University, Wonju 26493, Republic of Korea
| | - Bummo Koo
- Department of Biomedical Engineering, Yonsei University, Wonju 26493, Republic of Korea
| | - Sunghyuk Song
- Department of Robotics & Mechatronics, Korea Institute of Machinery & Materials, Daejeon 34103, Republic of Korea
| | - Youngho Kim
- Department of Biomedical Engineering, Yonsei University, Wonju 26493, Republic of Korea
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Martínez-Nova A, Gascó-López de Lacalle J, Morán-Cortés JF, Pedrera-Zamorano JD, Sánchez-Rodríguez R. Plantar pressures values related with appearance of mechanical hyperkeratosis before and after surgery of mild hallux valgus. Front Med (Lausanne) 2023; 10:1141091. [PMID: 37122332 PMCID: PMC10130441 DOI: 10.3389/fmed.2023.1141091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/14/2023] [Indexed: 05/02/2023] Open
Abstract
Background Hyperkeratoses are thickenings of the stratum corneum, provoked by deviation of the ray and excessive plantar pressures. They are very common under the first metatarsal head (MTH) and on the big toe when there exists hallux valgus. The objective of this study was to assess plantar pressures pre- and post-surgery to try to define the threshold values that could determine the appearance of keratopathies. Materials and methods Seventy-nine patients (100 feet) who had undergone percutaneous distal soft-tissue release and the Akin procedure were evaluated prospectively. The BioFoot/IBV® in-shoe system was used for objective baropodometric functional evaluations of the heel, midfoot, first through fifth MTHs, hallux, and lesser toes. The presence or absence of a hyperkeratosis (HK) or plantar callus under the first MTH or hallux was recorded. The average follow-up time at which the measurements were repeated was 28.1 months. Results Pre-surgery, 62 feet presented a painful HK on the big toe, while post-surgery, only 9 of the feet presented the same lesion. Patients who presented a prior HK at the first metatarsophalangeal (MTP) joint had a mean pressure of 417.2 ± 254.5 kPa as against a value of 359.6 ± 185.1 kPa for the rest. Post-surgery, these values dropped to 409.8 and 346.3 kPa, respectively. Conclusion Patients with HK presented an 11% greater mean pressure than those without. The values obtained with the BioFoot/IBV® system in the present study can therefore be considered predictive of the appearance of HK under the first MTH and on the side of the big toe.
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Affiliation(s)
| | - Jaime Gascó-López de Lacalle
- School of Health Sciences, Catholic University of Valencia San Vicente Mártir, Valencia, Spain
- *Correspondence: Jaime Gascó-López de Lacalle,
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Wu FL, Lung CW, Wang WTJ, Elliott J, Jain S, Jan YK. Effects of Walking Speeds and Durations on Peak Plantar Pressures. J Am Podiatr Med Assoc 2022; 112:20-043. [PMID: 36525323 DOI: 10.7547/20-043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Walking at various speeds and durations may result in different peak plantar pressure (PPP). However, there is no study comparing the effect of walking speeds and durations on PPP. The purpose of this study was to explore whether different walking speeds and durations significantly change PPP and establish a normal response in healthy people. METHODS An in-shoe plantar pressure system was used to measure PPP under the first toe, first metatarsal, second metatarsal, and heel regions in 12 healthy, young people. All participants performed six walking trials at three speeds (3, 6, and 9 km/h) and for two durations (10 and 20 min). The 3 × 2 two-way analysis of variance was used to examine the main effects of speeds and durations and their interaction. RESULTS The results showed that walking speeds significantly affected PPP and that walking duration did not. No interaction between the walking speed and duration was observed. Peak plantar pressure values under the first toe and the first metatarsal head were significantly higher (P < .05) at 9 km/h (509.1 ± 314.2 kPa and 591.4 ± 302.4 kPa, respectively) than at 3 km/h (275.4 ± 168.7 kPa and 369.4 ± 205.4 kPa, respectively) after 10-min walking. CONCLUSIONS People at risk for foot ulcers may use slow and brisk walking for exercise to reduce PPP, thus reducing risk for foot ulcers. Our study demonstrated that slow running at 9 km/h significantly increases PPP.
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Affiliation(s)
- Fu-Lien Wu
- *Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Chi-Wen Lung
- *Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL.,†Department of Creative Product Design, Asia University, Taichung, Taiwan
| | - Wendy Tzyy-Jiuan Wang
- ‡Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Jeannette Elliott
- §Disability Resources and Educational Services, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Sanjiv Jain
- ‖Department Physical Medicine and Rehabilitation, Carle Foundation Hospital, Urbana, IL
| | - Yih-Kuen Jan
- *Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL.,¶Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, People's Republic of China
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Lung CW, Mo PC, Cao C, Zhang K, Wu FL, Liau BY, Jan YK. Effects of walking speeds and durations on the plantar pressure gradient and pressure gradient angle. BMC Musculoskelet Disord 2022; 23:823. [PMID: 36042445 PMCID: PMC9426236 DOI: 10.1186/s12891-022-05771-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/25/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Walking exercise has been demonstrated to improve health in people with diabetes. However, it is largely unknown the influences of various walking intensities such as walking speeds and durations on dynamic plantar pressure distributions in non-diabetics and diabetics. Traditional methods ignoring time-series changes of plantar pressure patterns may not fully capture the effect of walking intensities on plantar tissues. The purpose of this study was to investigate the effect of various walking intensities on the dynamic plantar pressure distributions. In this study, we introduced the peak pressure gradient (PPG) and its dynamic patterns defined as the pressure gradient angle (PGA) to quantify dynamic changes of plantar pressure distributions during walking at various intensities. METHODS Twelve healthy participants (5 males and 7 females) were recruited in this study. The demographic data were: age, 27.1 ± 5.8 years; height, 1.7 ± 0.1 m; and weight, 63.5 ± 13.5 kg (mean ± standard deviation). An insole plantar pressure measurement system was used to measure plantar pressures during walking at three walking speeds (slow walking 1.8 mph, brisk walking 3.6 mph, and slow running 5.4 mph) for two durations (10 and 20 min). The gradient at a location is defined as the unique vector field in the two-dimensional Cartesian coordinate system with a Euclidean metric. PGA was calculated by quantifying the directional variation of the instantaneous peak gradient vector during stance phase of walking. PPG and PGA were calculated in the plantar regions of the first toe, first metatarsal head, second metatarsal head, and heel at higher risk for foot ulcers. Two-way ANOVA with Fisher's post-hoc analysis was used to examine the speed and duration factors on PPG and PGA. RESULTS The results showed that the walking speeds significantly affect PPG (P < 0.05) and PGA (P < 0.05), and the walking durations does not. No interaction between the walking duration and speed was observed. PPG in the first toe region after 5.4 mph for either 10 or 20 min was significantly higher than 1.8 mph. Meanwhile, after 3.6 mph for 20 min, PPG in the heel region was significantly higher than 1.8 mph. Results also indicate that PGA in the forefoot region after 3.6 mph for 20 min was significantly narrower than 1.8 mph. CONCLUSIONS Our findings indicate that people may walk at a slow speed at 1.8 mph for reducing PPG and preventing PGA concentrated over a small area compared to brisk walking at 3.6 mph and slow running at 5.4 mph.
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Affiliation(s)
- Chi-Wen Lung
- grid.35403.310000 0004 1936 9991Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL USA ,grid.252470.60000 0000 9263 9645Department of Creative Product Design, Asia University, Taichung, Taiwan
| | - Pu-Chun Mo
- grid.35403.310000 0004 1936 9991Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL USA
| | - Chunmei Cao
- grid.12527.330000 0001 0662 3178Division of Sports Science and Physical Education, Tsinghua University, Beijing, China
| | - Keying Zhang
- grid.12527.330000 0001 0662 3178Division of Sports Science and Physical Education, Tsinghua University, Beijing, China
| | - Fu-Lien Wu
- grid.35403.310000 0004 1936 9991Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL USA
| | - Ben-Yi Liau
- grid.411432.10000 0004 1770 3722Department of Biomedical Engineering, Hungkuang University, Taichung, Taiwan
| | - Yih-Kuen Jan
- grid.35403.310000 0004 1936 9991Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL USA
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Lepesis V, Marsden J, Paton J, Rickard A, Latour JM. Experiences of foot and ankle mobilisations combined with home stretches in people with diabetes: a qualitative study embedded in a proof-of-concept randomised controlled trial. J Foot Ankle Res 2022; 15:7. [PMID: 35093130 PMCID: PMC8801130 DOI: 10.1186/s13047-022-00512-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/12/2022] [Indexed: 01/18/2023] Open
Abstract
Background The benefits of exercise and staying active are widely reported in the literature, however adherence and engagement with exercise amongst people with long-term illness and diabetes is poor. Physiotherapy aims to promote independence and physical activity using a range of strategies, including manual therapy and education/advice on exercises. However, low adherence impacts negatively on treatment outcomes. In this study, the practicality of physiotherapy interventions in patients who participate in a proof-of-concept (PoC) randomised controlled trial (RCT) will be considered. Aim To explore the experiences of people with diabetes who received an intervention package of foot and ankle mobilisations combined with home stretches for a 6-week period. Design An embedded qualitative study in a proof-of-concept RCT using semi-structured interviews and thematic analysis. Participants Purposive sample of 16 participants (mean age 73 years) with a diagnosis of diabetes (mean duration 13.4 years) were recruited. Results Analysis revealed seven themes informing the adherence and non-adherence to the exercise intervention. Themes describing the positive experiences were: 1) support from others to do the exercises; 2) psychological factors to motivate exercise adherence; 2) physical factors contributing to exercise adherence; 4) acceptability of home exercises during and beyond the study. Other themes described barriers: 5) social factors that contributed to exercise disengagement; 6) emotional limitations that influence exercise avoidance; 7) physical circumstances that made exercise participation burdensome. Themes highlighted positive influences by physiotherapists, the motivation of doing exercises while participating in a study, improving the perceived range of motion in their foot and ankle and reducing discomfort in these joints whilst being more active with daily activities. Conclusion Our findings highlighted that the intervention of foot and ankle mobilisations combined with home stretches is feasible for study participants. Psycho-social support, self-efficacy, and physiotherapy support are motivational to adhere to the study intervention and might contribute to the success of a full-scale RCT. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00512-z.
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12
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Kelly ES, Worsley PR, Bowen CJ, Cherry LS, Keenan BE, Edwards CJ, O'Brien N, King L, Dickinson AS. Predicting Forefoot-Orthosis Interactions in Rheumatoid Arthritis Using Computational Modelling. Front Bioeng Biotechnol 2022; 9:803725. [PMID: 35004656 PMCID: PMC8733946 DOI: 10.3389/fbioe.2021.803725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
Foot orthoses are prescribed to reduce forefoot plantar pressures and pain in people with rheumatoid arthritis. Computational modelling can assess how the orthoses affect internal tissue stresses, but previous studies have focused on a single healthy individual. This study aimed to ascertain whether simplified forefoot models would produce differing biomechanical predictions at the orthotic interface between people with rheumatoid arthritis of varying severity, and in comparison to a healthy control. The forefoot models were developed from magnetic resonance data of 13 participants with rheumatoid arthritis and one healthy individual. Measurements of bony morphology and soft tissue thickness were taken to assess deformity. These were compared to model predictions (99th% shear strain and plantar pressure, max. pressure gradient, volume of soft tissue over 10% shear strain), alongside clinical data including body mass index and Leeds Foot Impact Scale–Impairment/Footwear score (LFIS-IF). The predicted pressure and shear strain for the healthy participant fell at the lower end of the rheumatoid models’ range. Medial first metatarsal head curvature moderately correlated to all model predicted outcomes (0.529 < r < 0.574, 0.040 < p < 0.063). BMI strongly correlated to all model predictions except pressure gradients (0.600 < r < 0.652, p < 0.05). There were no apparent relationships between model predictions and instances of bursae, erosion and synovial hypertrophy or LFIS-IF score. The forefoot models produced differing biomechanical predictions between a healthy individual and participants with rheumatoid arthritis, and between individuals with rheumatoid arthritis. Models capable of predicting subject specific biomechanical orthotic interactions could be used in the future to inform more personalised devices to protect skin and soft tissue health. While the model results did not clearly correlate with all clinical measures, there was a wide range in model predictions and morphological measures across the participants. Thus, the need for assessment of foot orthoses across a population, rather than for one individual, is clear.
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Affiliation(s)
- Emily S Kelly
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Peter R Worsley
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Catherine J Bowen
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Lindsey S Cherry
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Bethany E Keenan
- Cardiff School of Engineering and Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, United Kingdom
| | | | - Neil O'Brien
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Leonard King
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Alex S Dickinson
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, United Kingdom
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13
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Ahmadian M, Beheshti MT, Kalhor A, Shirian A. Unsupervised Generative Adversarial Network for Plantar Pressure Image-to-Image Translation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:2580-2583. [PMID: 34891781 DOI: 10.1109/embc46164.2021.9629684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Analyzing human gait from plantar pressure is critical for human health. The majority of works focus on classifying the healthy plantar pattern from unhealthy ones. Different from previous works, we adopt a generative adversarial network to produce healthy plantar pressure image for individual patients. In this work, we do not have pairs of images for training thus we cast the problem as an unsupervised generative adversarial learning task. Our network benefits from multiple components: an encoder-decoder generator, a convolution-based discriminator, a convolution-based evaluation network, and a new term in the loss function to preserve the person's gait style. Our method achieves high performance (99.8%) on the CAD WALK databases which have patients with hallux valgus disease.
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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: 11] [Impact Index Per Article: 3.7] [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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15
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Emerging technologies for the prevention and management of diabetic foot ulcers. J Tissue Viability 2020; 29:61-68. [DOI: 10.1016/j.jtv.2020.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/27/2019] [Accepted: 03/14/2020] [Indexed: 12/14/2022]
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Boyle CJ, Carpanen D, Pandelani T, Higgins CA, Masen MA, Masouros SD. Lateral pressure equalisation as a principle for designing support surfaces to prevent deep tissue pressure ulcers. PLoS One 2020; 15:e0227064. [PMID: 31899778 PMCID: PMC6941906 DOI: 10.1371/journal.pone.0227064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/10/2019] [Indexed: 11/19/2022] Open
Abstract
When immobile or neuropathic patients are supported by beds or chairs, their soft tissues undergo deformations that can cause pressure ulcers. Current support surfaces that redistribute under-body pressures at vulnerable body sites have not succeeded in reducing pressure ulcer prevalence. Here we show that adding a supporting lateral pressure can counter-act the deformations induced by under-body pressure, and that this 'pressure equalisation' approach is a more effective way to reduce ulcer-inducing deformations than current approaches based on redistributing under-body pressure. A finite element model of the seated pelvis predicts that applying a lateral pressure to the soft tissue reduces peak von Mises stress in the deep tissue by a factor of 2.4 relative to a standard cushion (from 113 kPa to 47 kPa)-a greater effect than that achieved by using a more conformable cushion, which reduced von Mises stress to 75 kPa. Combining both a conformable cushion and lateral pressure reduced peak von Mises stresses to 25 kPa. The ratio of peak lateral pressure to peak under-body pressure was shown to regulate deep tissue stress better than under-body pressure alone. By optimising the magnitude and position of lateral pressure, tissue deformations can be reduced to that induced when suspended in a fluid. Our results explain the lack of efficacy in current support surfaces and suggest a new approach to designing and evaluating support surfaces: ensuring sufficient lateral pressure is applied to counter-act under-body pressure.
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Affiliation(s)
- Colin J. Boyle
- Department of Bioengineering, Imperial College London, London, United
Kingdom
- Department of Mechanical Engineering, Imperial College London, London,
United Kingdom
- * E-mail:
| | - Diagarajen Carpanen
- Department of Bioengineering, Imperial College London, London, United
Kingdom
| | - Thanyani Pandelani
- Department of Bioengineering, Imperial College London, London, United
Kingdom
| | - Claire A. Higgins
- Department of Bioengineering, Imperial College London, London, United
Kingdom
| | - Marc A. Masen
- Department of Mechanical Engineering, Imperial College London, London,
United Kingdom
| | - Spyros D. Masouros
- Department of Bioengineering, Imperial College London, London, United
Kingdom
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17
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Exploring the Influence of Wheelchair-User Interface and Personal Characteristics on Ischial Tuberosity Peak Pressure Index and Gradient in Elite Wheelchair Basketball Players. Adapt Phys Activ Q 2020; 37:56-71. [PMID: 31837647 DOI: 10.1123/apaq.2019-0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/21/2019] [Accepted: 06/26/2019] [Indexed: 11/18/2022] Open
Abstract
This pilot study investigated the relationship between personal and wheelchair factors on skin pressures at the ischial tuberosity in wheelchair basketball players. Seventeen wheelchair basketball players (7 male and 10 female) were evaluated during static and dynamic propulsive conditions while peak pressure index and peak pressure gradient were recorded with an interface pressure mat. The results showed that greater seat dump angles and backrest heights were negatively associated with the peak pressure index. Therapeutic cushion use was moderately associated with a reduced peak pressure gradient. Higher-class players used chair configurations associated with augmented pressure; however, classification status alone was not associated with pressure magnitude. Body mass index was negatively correlated with the static peak pressure gradient at levels approaching significance (p < .10). In conclusion, greater seat dump angles and backrest heights may provide pressure relief, whereas greater body mass index and therapeutic cushion use may reduce pressure gradients.
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Lazzarini PA, Crews RT, van Netten JJ, Bus SA, Fernando ME, Chadwick PJ, Najafi B. Measuring Plantar Tissue Stress in People With Diabetic Peripheral Neuropathy: A Critical Concept in Diabetic Foot Management. J Diabetes Sci Technol 2019; 13:869-880. [PMID: 31030546 PMCID: PMC6955461 DOI: 10.1177/1932296819849092] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Excessive stress on plantar tissue over time is one of the leading causes of diabetic foot ulcers among people with diabetic peripheral neuropathy. Plantar tissue stress (PTS) is a concept that attempts to integrate several well-known mechanical factors into one measure, including plantar pressure, shear stress, daily weight-bearing activity, and time spent in prescribed offloading interventions (adherence). Despite international diabetic foot guidelines recommending the measure of each of these individual mechanical factors in people with neuropathy, only recently has technology enabled their combined measurement to determine PTS. In this article we review the concept of PTS, the mechanical factors involved, and the findings of pivotal articles reporting measures of PTS in people with neuropathy. We also discuss key existing gaps in this field, including the lack of standards to measure and report PTS, a lack of practical solutions to measure shear stress, and the lack of PTS thresholds that may indicate benefit or detriment to people with neuropathy. To address some of these gaps, we propose recommended clinical and research standards for measuring and reporting PTS in people with neuropathy. Last, we forecast future clinical, research, and technological advancements that may use PTS to highlight the importance of this critical concept in the prevention and management of diabetic foot ulcers.
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Affiliation(s)
- Peter A. Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia
- Peter A. Lazzarini, PhD, School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, Queensland 4059, Australia.
| | - Ryan T. Crews
- Center for Lower Extremity Ambulatory Research (CLEAR), Dr William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Jaap J. van Netten
- Amsterdam UMC, Department of Rehabilitation, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Ziekenhuisgroep Twente, Department of Surgery, Almelo and Hengelo, the Netherlands
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Sicco A. Bus
- Amsterdam UMC, Department of Rehabilitation, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Malindu E. Fernando
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | | | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Encarnación-Martínez A, Lucas-Cuevas ÁG, Pérez-Soriano P, Menayo R, Gea-García GM. Plantar Pressure Differences between Nordic Walking Techniques. J Hum Kinet 2017; 57:221-231. [PMID: 28713474 PMCID: PMC5504594 DOI: 10.1515/hukin-2017-0063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
High plantar pressure has been associated with increased risk of injury. The characteristics of each physical activity determine the load on the lower limbs. The influence of Nordic Walking (NW) technique on plantar pressure is still unknown. The aim of this study was to analyze the differences between plantar pressure during NW with the Diagonal technique (DT) versus Alpha technique (AT) and compare them with the pressure obtained during normal walking (W). The normality and sphericity of the plantar pressure data were checked before performing a two-way repeated measures ANOVA in order to find differences between speeds (preferred, fast) and the gait (NW, W) as within-subject factors. Then, a t-test for independent measures was used to identify the specific differences between NW techniques. The strength of the differences was calculated by means of the effect size (ES). The results demonstrated that during NW with AT at preferred speed the pressure was lower under the Calcaneus, Lateral Metatarsal and Toes compared to the DT group (p = 0.046, ES = 1.49; p = 0.015, ES = 1.44; p = 0.040, ES = 1.20, respectively). No differences were found at the fast speed (p > 0.05). Besides the increase in walking speed during NW (p < 0.01), both technique groups showed lower pressure during NW compared to W under the Hallux and Central Metatarsal heads (F = 58.321, p = 0.000, ES = 2.449; F = 41.917, p = 0.012, ES = 1.365, respectively). As a practical conclusion, the AT technique may be the most effective of the NW techniques at reducing plantar pressure while allowing NW practitioners to achieve the physiological benefits of NW.
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Affiliation(s)
| | | | - Pedro Pérez-Soriano
- Department of Physical Education and Sport, University of Valencia, Valencia, Spain
| | - Ruperto Menayo
- Department of Sport and Physical Education, Catholic University of Murcia, Murcia, Spain
| | - Gemma María Gea-García
- Department of Sport and Physical Education, Catholic University of Murcia, Murcia, Spain
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20
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Claverie L, Ille A, Moretto P. Discrete sensors distribution for accurate plantar pressure analyses. Med Eng Phys 2016; 38:1489-1494. [PMID: 27745875 DOI: 10.1016/j.medengphy.2016.09.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 06/28/2016] [Accepted: 09/26/2016] [Indexed: 11/26/2022]
Abstract
The aim of this study was to determine the distribution of discrete sensors under the footprint for accurate plantar pressure analyses. For this purpose, two different sensor layouts have been tested and compared, to determine which was the most accurate to monitor plantar pressure with wireless devices in research and/or clinical practice. Ten healthy volunteers participated in the study (age range: 23-58 years). The barycenter of pressures (BoP) determined from the plantar pressure system (W-inshoe®) was compared to the center of pressures (CoP) determined from a force platform (AMTI) in the medial-lateral (ML) and anterior-posterior (AP) directions. Then, the vertical ground reaction force (vGRF) obtained from both W-inshoe® and force platform was compared for both layouts for each subject. The BoP and vGRF determined from the plantar pressure system data showed good correlation (SCC) with those determined from the force platform data, notably for the second sensor organization (ML SCC= 0.95; AP SCC=0.99; vGRF SCC=0.91). The study demonstrates that an adjusted placement of removable sensors is key to accurate plantar pressure analyses. These results are promising for a plantar pressure recording outside clinical or laboratory settings, for long time monitoring, real time feedback or for whatever activity requiring a low-cost system.
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Affiliation(s)
- Laetitia Claverie
- Université de Toulouse III, UPS, PRISSMH, 118 route de Narbonne, F-31062 Toulouse Cedex 9, France
| | - Anne Ille
- Université de Toulouse III, UPS, PRISSMH, 118 route de Narbonne, F-31062 Toulouse Cedex 9, France
| | - Pierre Moretto
- Université de Toulouse III, UPS, Centre de Recherche sur la Cognition animale, Centre de Biologie Intégrative (CBI), 118 route de Narbonne, F-31062 Toulouse Cedex 9, France; CNRS, Centre de Recherche sur la Cognition animale, Centre de Biologie Intégrative (CBI), 118 route de Narbonne, F-31062 Toulouse Cedex 9, France.
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Lung CW, Hsiao-Wecksler ET, Burns S, Lin F, Jan YK. Quantifying Dynamic Changes in Plantar Pressure Gradient in Diabetics with Peripheral Neuropathy. Front Bioeng Biotechnol 2016; 4:54. [PMID: 27486576 PMCID: PMC4949238 DOI: 10.3389/fbioe.2016.00054] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/20/2016] [Indexed: 01/17/2023] Open
Abstract
Diabetic foot ulcers remain one of the most serious complications of diabetes. Peak plantar pressure (PPP) and peak pressure gradient (PPG) during walking have been shown to be associated with the development of diabetic foot ulcers. To gain further insight into the mechanical etiology of diabetic foot ulcers, examination of the pressure gradient angle (PGA) has been recently proposed. The PGA quantifies directional variation or orientation of the pressure gradient during walking and provides a measure of whether pressure gradient patterns are concentrated or dispersed along the plantar surface. We hypothesized that diabetics at risk of foot ulceration would have smaller PGA in key plantar regions, suggesting less movement of the pressure gradient over time. A total of 27 participants were studied, including 19 diabetics with peripheral neuropathy and 8 non-diabetic control subjects. A foot pressure measurement system was used to measure plantar pressures during walking. PPP, PPG, and PGA were calculated for four foot regions – first toe (T1), first metatarsal head (M1), second metatarsal head (M2), and heel (HL). Consistent with prior studies, PPP and PPG were significantly larger in the diabetic group compared with non-diabetic controls in the T1 and M1 regions, but not M2 or HL. For example, PPP was 165% (P = 0.02) and PPG was 214% (P < 0.001) larger in T1. PGA was found to be significantly smaller in the diabetic group in T1 (46%, P = 0.04), suggesting a more concentrated pressure gradient pattern under the toe. The proposed PGA may improve our understanding of the role of pressure gradient on the risk of diabetic foot ulcers.
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Affiliation(s)
- Chi-Wen Lung
- Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA; Department of Creative Product Design, Asia University, Taichung, Taiwan
| | - Elizabeth T Hsiao-Wecksler
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign , Urbana, IL , USA
| | - Stephanie Burns
- Department of Physical Therapy, Langston University , Langston, OK , USA
| | - Fang Lin
- Center for Lower Extremity Ambulatory Research, Rosalind Franklin University , North Chicago, IL , USA
| | - Yih-Kuen Jan
- Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign , Champaign, IL , USA
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Merriwether E, Sinacore D. Impact of foot progression angle modification on plantar loading in individuals with diabetes mellitus and peripheral neuropathy. ACTA ACUST UNITED AC 2016. [DOI: 10.5348/d05-2016-7-oa-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Dzienniak D, Cieślik J. Application of DCT-derived parameters for early detection of polyneuropathy in diabetic patients. BIO-ALGORITHMS AND MED-SYSTEMS 2016. [DOI: 10.1515/bams-2016-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractDiabetic foot is one of the most severe complications of diabetes. Early diagnosis of this syndrome can ensure proper medical care and adequate treatment. Various image analysis methods can be used to speed up the diagnosis process, and automated diagnosis can be applied as a screening technique to reduce its cost. Introducing auxiliary diagnostic parameters may help to detect polyneuropathy or neuropathy, both of which often precede the appearance of diabetic foot syndrome. The present paper describes a study performed on a group of diabetic patients by analyzing plantar pressure distribution images. As part of this study, 2D discrete cosine transform (DCT) is computed for the forefoot and rearfoot regions of each diabetic subject in a group of 37 patients. Three new DCT-based parameters are introduced to help to detect polyneuropathy or at least indicate that the patient may have polyneuropathy without a time-consuming examination. The results indicate a certain relationship between these parameters and the presence of polyneuropathy. This information could be used in further diagnosis to prevent foot ulcers from developing in patients with diabetes.
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Abstract
BACKGROUND Conservative pedorthic management of the diabetic foot has been shown to be an effective method to prevent ulcers, amputations, and re-amputations. This article exhibits why and how pedorthics plays such an important role via modalities such as footwear, shoe modifications, custom foot orthoses, and partial foot prostheses. OBJECTIVE The objective of this article is to demonstrate how pedorthics has been shown to be an integral part of conservative diabetic foot care. The authors' goal was to educate the reader about the different modalities that are available for use. STUDY DESIGN This article is based largely on review of previously published research and scholarly articles, augmented by the more than 60 years of pedorthic and orthotic clinical experience of the authors. METHODS Approximately 60 journal articles and book chapters were reviewed by the authors. Articles were located via online resources such as PubMed as well as the authors' own libraries. RESULTS It was repeatedly noted that pedorthic modalities such as shoes, foot orthoses, and shoe modifications may be utilized in the treatment and prevention of diabetic foot wounds and other complications. CONCLUSION Pedorthic devices may be successfully integrated into a comprehensive treatment plan for patients with diabetes and foot ulcers. CLINICAL RELEVANCE This information is of special interest to those who treat patients with diabetes. The article demonstrates the efficacy of pedorthic intervention through the compilation and review of relevant previously published data.
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Affiliation(s)
- Dennis Janisse
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA National Pedorthic Services, Inc., Milwaukee, WI, USA
| | - Erick Janisse
- Orthotic and Prosthetic Design, Inc., St. Louis, MO, USA
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25
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Fawzy OA, Arafa AI, El Wakeel MA, Abdul Kareem SH. Plantar pressure as a risk assessment tool for diabetic foot ulceration in egyptian patients with diabetes. CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2014; 7:31-9. [PMID: 25520564 PMCID: PMC4257475 DOI: 10.4137/cmed.s17088] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 10/15/2014] [Accepted: 10/17/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Diabetic foot ulceration is a preventable long-term complication of diabetes. In the present study, peak plantar pressures (PPP) and other characteristics were assessed in a group of 100 Egyptian patients with diabetes with or without neuropathy and foot ulcers. The aim was to study the relationship between plantar pressure (PP) and neuropathy with or without ulceration and trying to clarify the utility of pedobarography as an ulceration risk assessment tool in patients with diabetes. SUBJECTS AND METHODS A total of 100 patients having diabetes were selected. All patients had a comprehensive foot evaluation, including assessment for neuropathy using modified neuropathy disability score (MNDS), for peripheral vascular disease using ankle brachial index, and for dynamic foot pressures using the MAT system (Tekscan). The studied patients were grouped into: (1) diabetic control group (DC), which included 37 patients who had diabetes without neuropathy or ulceration and MNDS ≤2; (2) diabetic neuropathy group (DN), which included 33 patients who had diabetes with neuropathy and MNDS >2, without current or a history of ulceration; and (3) diabetic ulcer group (DU), which included 30 patients who had diabetes and current ulceration, seven of those patients also gave a history of ulceration. RESULTS PP parameters were significantly different between the studied groups, namely, forefoot peak plantar pressure (FFPPP), rearfoot peak plantar pressure (RFPPP), forefoot/rearfoot ratio (F/R), forefoot peak pressure gradient (FFPPG) rearfoot peak pressure gradient (RFPPG), and forefoot peak pressure gradient/rearfoot peak pressure gradient (FFPPG/RFPPG) (P < 0.05). FFPPP and F/R were significantly higher in the DU group compared to the DN and DC groups (P < 0.05), with no significant difference between DN and DC. FFPPG was significantly higher in the DU and DN groups compared to the DC group (P < 0.05). RFPPP and FFPPG/RFPPG were significantly higher in the DU and DN groups compared to the DC group (P < 0.05) with no significant difference between the DN and DU groups (P > 0.05). FFPPP, F/R ratio, FFPPG, and FFPPG/RFPPG correlated significantly with the severity of neuropathy according to MNDS (P < 0.05). These same variables as well as MNDS were also significantly higher in patients with foot deformity compared to those without deformity (P < 0.05). Using the receiver operating characteristic analysis, the optimal cut-point of PPP for ulceration risk, as determined by a balance of sensitivity, specificity, and accuracy was 335 kPa and was found at the forefoot. Multivariate logistical regression analysis for ulceration risk was statistically significant for duration of diabetes (odds ratio [OR] = 0.8), smoking (OR = 9.7), foot deformity (OR = 8.7), MNDS (OR = 1.5), 2-h postprandial plasma glucose (2 h-PPG) (OR = 0.9), glycated hemoglobin (HbA1c) (OR = 2.1), FFPPP (OR = 1.0), and FFPPG (OR = 1.0). CONCLUSION In conclusion, persons with diabetes having neuropathy and/or ulcers have elevated PPP. Risk of ulceration was highly associated with duration of diabetes, smoking, severity of neuropathy, glycemic control, and high PP variables especially the FFPPP, F/R, and FFPPG. We suggest a cut-point of 355 kPa for FFPPP to denote high risk for ulceration that would be more valid when used in conjunction with other contributory risk factors, namely, duration of diabetes, smoking, glycemic load, foot deformity, and severity of neuropathy.
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Affiliation(s)
- Olfat A Fawzy
- Department of Endocrinology & Metabolism, AL Azhar Faculty of Medicine for Girls, Cairo, Egypt
| | - Asmaa I Arafa
- Department of Endocrinology & Metabolism, AL Azhar Faculty of Medicine for Girls, Cairo, Egypt
| | - Mervat A El Wakeel
- Department of Endocrinology & Metabolism, AL Azhar Faculty of Medicine for Girls, Cairo, Egypt
| | - Shaimaa H Abdul Kareem
- Department of Endocrinology & Metabolism, AL Azhar Faculty of Medicine for Girls, Cairo, Egypt
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Rajala S, Lekkala J. Plantar shear stress measurements - A review. Clin Biomech (Bristol, Avon) 2014; 29:475-83. [PMID: 24820135 DOI: 10.1016/j.clinbiomech.2014.04.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/15/2014] [Accepted: 04/17/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mechanical stress at the plantar surface has two components, pressure acting normal to the surface and shear stress acting tangential to the surface. Typically only pressure is measured and reported. However, plantar shear stress also plays a major role, especially in diabetic ulceration. METHODS During the last few decades, a variety of methods have been developed for the measurement of plantar shear stress. This paper reviews the technologies used in plantar shear stress measurements. FINDINGS Several technologies have been used, e.g. magneto-resistors, strain gauges, optical methods, piezoelectric materials and capacitive sensors. Examples of plantar shear stress values measured with the developed devices are also collected here and the relationship between sensor characteristics and the measured plantar shear stress distribution is discussed. INTERPRETATION Even with the limitations of current plantar shear stress measurement technologies, they can provide useful information on the plantar stress distribution.
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Affiliation(s)
- Satu Rajala
- Department of Automation Science and Engineering, Tampere University of Technology, Korkeakoulunkatu 3, FI-33101 Tampere, Finland.
| | - Jukka Lekkala
- Department of Automation Science and Engineering, Tampere University of Technology, Korkeakoulunkatu 3, FI-33101 Tampere, Finland
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Patry J, Belley R, Côté M, Chateau-Degat ML. Plantar pressures, plantar forces, and their influence on the pathogenesis of diabetic foot ulcers: a review. J Am Podiatr Med Assoc 2014; 103:322-32. [PMID: 23878385 DOI: 10.7547/1030322] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Clinical recommendations for the prevention and healing of diabetic foot ulcers (DFUs) are somewhat clear. However, assessment and quantification of the mechanical stress responsible for DFU remain complex. Different pressure variables have been described in the literature to better understand plantar tissue stress exposure. This article reviews the role of pressure and shear forces in the pathogenesis of plantar DFU. METHODS We performed systematic searches of the PubMed and Embase databases, completed by a manual search of the selected studies. From 535 potentially relevant references, 70 studies were included in the full-text review. RESULTS Variables of plantar mechanical stress relate to vertical pressure, shear stress, and temporality of loading. At this time, in-shoe peak plantar pressure (PPP) is the only reliable variable that can be used to prevent DFU. Although it is a poor predictor of in-shoe PPP, barefoot PPP seems complementary and may be more suitable when evaluating patients with diabetes mellitus and peripheral neuropathy who seem noncompliant with footwear. An in-shoe PPP threshold value of 200 kPa has been suggested to prevent DFU. Other variables, such as peak pressure gradient and peak maximal subsurface shear stress and its depth, seem to be of additional utility. CONCLUSIONS To better assess the at-risk foot and to prevent ulceration, the practitioner should integrate quantitative models of dynamic foot plantar pressures, such as in-shoe and barefoot PPPs, with the regular clinical screening examination. Prospective studies are needed to evaluate causality between other variables of mechanical stress and DFUs.
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Affiliation(s)
- Jérôme Patry
- Hyperbaric Unit and Complex Wound Unit, CSSS Alphonse Desjardins/Centre Hospitalier Affilié Universitaire de Lévis, Lévis, Québec, Canada
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Fernandez MLG, Lozano RM, Diaz MIGQ, Jurado MAG, Hernandez DM, Montesinos JVB. How effective is orthotic treatment in patients with recurrent diabetic foot ulcers? J Am Podiatr Med Assoc 2014; 103:281-90. [PMID: 23878380 DOI: 10.7547/1030281] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND We assessed the efficacy of customized foot orthotic therapy by comparing reulceration rates, minor amputation rates, and work and daily living activities before and after therapy. Peak plantar pressures and peak plantar impulses were compared with the patients not wearing and wearing their prescribed footwear. METHODS One hundred seventeen patients with diabetes were prescribed therapeutic insoles and footwear based on the results of a detailed biomechanical study and were followed for 2 years. All of the patients had a history of foot ulcers, but none had undergone previous orthotic therapy. RESULTS Before treatment, the reulceration rate was 79% and the amputation rate was 54%. Two years after the start of orthotic therapy, the reulceration rate was 15% and the amputation rate was 6%. Orthotic therapy reduced peak plantar pressures in patients with reulcerations and in those without (P < .05), although a significant decrease in peak plantar impulses was achieved only in patients not experiencing reulceration. Sick leave was reduced from 100% to 26%. CONCLUSIONS Personalized orthotic therapy targeted at reducing plantar pressures by off-loading protects high-risk patients against reulceration. Treatment reduced the reulceration rate and peak plantar pressures, leading to patients' return to work or other activities.
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Walther M, Haage T. Ein im Vorfuß zu schmaler Arbeitsschuh führt zu einer signifikanten Erhöhung des Drucks unter der Fußsohle. ZENTRALBLATT FÜR ARBEITSMEDIZIN, ARBEITSSCHUTZ UND ERGONOMIE 2014. [DOI: 10.1007/bf03344312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McCartan BL, Rosenblum BI. Offloading of the diabetic foot: orthotic and pedorthic strategies. Clin Podiatr Med Surg 2014; 31:71-88. [PMID: 24296019 DOI: 10.1016/j.cpm.2013.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The diabetic foot is more susceptible than the non-diabetic foot to collapse. This frequently leads to bony prominences followed by ulceration. Offloading of areas of increased pressure is paramount to ulcer prevention and healing. Several devices and accommodations can aid practitioners in saving patients' extremities and allow them to ambulate. A team approach works best, and patient education is a must. Regular assessment and modifications are required for longevity of each device. In this article, different therapeutic options are detailed. A variety of presentations and situations are discussed and the authors' best tips for avoiding complications are offered.
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Affiliation(s)
- Brant L McCartan
- Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Baker Span 3, Boston, MA 02215, USA; Private Practice, Milwaukee Foot Specialists, 3610 Michelle Witmer Memorial Drive, Suite 110, New Berlin, WI 53151, USA.
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Cheuy VA, Hastings MK, Commean PK, Ward SR, Mueller MJ. Intrinsic foot muscle deterioration is associated with metatarsophalangeal joint angle in people with diabetes and neuropathy. Clin Biomech (Bristol, Avon) 2013; 28:1055-60. [PMID: 24176198 PMCID: PMC3893062 DOI: 10.1016/j.clinbiomech.2013.10.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 10/07/2013] [Accepted: 10/08/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Metatarsophalangeal joint deformity is associated with skin breakdown and amputation. The aims of this study were to compare intrinsic foot muscle deterioration ratios (ratio of adipose to muscle volume), and physical performance in subjects with diabetic neuropathy to controls, and determine their associations with 1) metatarsophalangeal joint angle and 2) history of foot ulcer. METHODS 23 diabetic, neuropathic subjects [59 (SD 10) years] and 12 age-matched controls [57 (SD 14) years] were studied. Radiographs and MRI were used to measure metatarsophalangeal joint angle and intrinsic foot muscle deterioration through tissue segmentation by image signal intensity. The Foot and Ankle Ability Measure evaluated physical performance. FINDINGS The diabetic, neuropathic group had a higher muscle deterioration ratio [1.6 (SD 1.2) vs. 0.3 (SD 0.2), P<0.001], and lower Foot and Ankle Ability Measure scores [65.1 (SD 24.4) vs. 98.3 (SD 3.3) %, P<0.01]. The correlation between muscle deterioration ratio and metatarsophalangeal joint angle was r=-0.51 (P=0.01) for all diabetic, neuropathic subjects, but increased to r=-0.81 (P<0.01) when only subjects with muscle deterioration ratios >1.0 were included. Muscle deterioration ratios in individuals with diabetic neuropathy were higher for those with a history of ulcers. INTERPRETATION Individuals with diabetic neuropathy had increased intrinsic foot muscle deterioration, which was associated with second metatarsophalangeal joint angle and history of ulceration. Additional research is required to understand how foot muscle deterioration interacts with other impairments leading to forefoot deformity and skin breakdown.
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Affiliation(s)
- Victor A. Cheuy
- Applied Biomechanics Laboratory, Movement Science Program, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mary K. Hastings
- Human Biodynamics Laboratory, Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Paul K. Commean
- Electronic Radiology Laboratory, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Samuel R. Ward
- Muscle Physiology Laboratory, Department of Orthopaedic Surgery, Department of Radiology, and Department of Bioengineering, University of California San Diego, San Diego, California, USA
| | - Michael J. Mueller
- Applied Biomechanics Laboratory, Movement Science Program, Program in Physical Therapy, and Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
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Jan YK, Lung CW, Cuaderes E, Rong D, Boyce K. Effect of viscoelastic properties of plantar soft tissues on plantar pressures at the first metatarsal head in diabetics with peripheral neuropathy. Physiol Meas 2012; 34:53-66. [PMID: 23248175 DOI: 10.1088/0967-3334/34/1/53] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Diabetic foot ulcers are one of the most serious complications associated with diabetes mellitus. Current research studies have demonstrated that biomechanical alterations of the diabetic foot contribute to the development of foot ulcers. However, the changes of soft tissue biomechanical properties associated with diabetes and its influences on the development of diabetic foot ulcers have not been investigated. The purpose of this study was to investigate the effect of diabetes on the biomechanical properties of plantar soft tissues and the relationship between biomechanical properties and plantar pressure distributions. We used the ultrasound indentation tests to measure force-deformation relationships of plantar soft tissues and calculate the effective Young's modulus and quasi-linear viscoelastic parameters to quantify biomechanical properties of plantar soft tissues. We also measured plantar pressures to calculate peak plantar pressure and plantar pressure gradient. Our results showed that diabetics had a significantly greater effective Young's modulus and initial modulus of quasi-linear viscoelasticity compared to non-diabetics. The plantar pressure gradient and biomechanical properties were significantly correlated. Our findings indicate that diabetes is linked to an increase in viscoelasticity of plantar soft tissues that may contribute to a higher peak plantar pressure and plantar pressure gradient in the diabetic foot.
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Affiliation(s)
- Yih-Kuen Jan
- Rehabilitation Research Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
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Chao CY, Zheng YP, Cheing GL. The association between skin blood flow and edema on epidermal thickness in the diabetic foot. Diabetes Technol Ther 2012; 14:602-9. [PMID: 22512286 PMCID: PMC3389379 DOI: 10.1089/dia.2011.0301] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Skin blood flow plays an important role in maintaining the health of the skin. The development of interstitial edema may impede oxygen diffusion to the skin. The aim of this study was to evaluate the association of skin blood flow and edema and epidermal thickness in the feet of people with and without diabetic neuropathy compared with a healthy control group. SUBJECTS AND METHODS Eighty-seven subjects (19 people with diabetic neuropathy and foot ulceration, 35 people with diabetes but without neuropathy, and 33 healthy controls without diabetes) participated in the study. High-frequency ultrasonography was used to measure the epidermal thickness and edema in papillary skin at the big toe as reflected by the thickness of the subepidermal low echogenic band (SLEB). The capillary nutritive blood flow was measured by the use of video capillaroscopy, and skin blood flux was monitored by laser Doppler flowmetry. RESULTS There was a 7.2% increase in epidermal thickness in those with diabetes but without neuropathy and a 16.5% decrease in people with diabetic neuropathy and foot ulceration compared with the healthy controls (all P<0.05). The SLEB thickness increased in all subjects with diabetes to a greater degree in those with neuropathy and ulceration than in those without (64.7% vs. 11.8%, P<0.001). Skin blood flux was shown to be higher in the diabetes groups than in the controls (all P<0.05), but no significant differences were found in the resting nutritive capillary blood flow (P>0.05). A significant negative correlation (P=0.002, r=-0.366) was demonstrated between the SLEB and epidermal thickness at the pulp of the big toe, whereas no significant correlation was demonstrated between skin blood flow and epidermal thickness (all P>0.05). CONCLUSIONS An increase in subepidermal edema was demonstrated in people with diabetic neuropathy and ulceration, which may partly contribute to reduced epidermal thickness at the pulp of the big toe. This may subsequently lead to the breaking down of skin in the diabetic foot.
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Affiliation(s)
- Clare Y.L. Chao
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Physiotherapy Department, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Yong-Ping Zheng
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Gladys L.Y. Cheing
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Abstract
Biomechanical factors play an important role in diabetic foot disease. Reducing high foot pressures (i.e. offloading) is one of the main goals in healing and preventing foot ulceration. Evidence-based guidelines show the strong association between the efficacy to offload the foot and clinical outcome. However, several aspects related to offloading are underexposed. First, in the management of foot complications, offloading is mostly studied as a single entity, whereas it should be analysed in a broader perspective of contributing factors to better predict clinical outcome. This includes assessment of patient behavioural factors such as type and intensity of daily physical activity and adherence to prescribed treatment. Second, a large gap exists between evidence-based recommendations and clinical practice in the use of offloading for ulcer treatment, and this gap needs to be bridged. Possible ways to achieve this are discussed in this article. Third, our knowledge about the efficacy and role of offloading in treating complicated and non-plantar neuropathic foot ulcers needs to be expanded because these ulcers currently dominate presentation in multidisciplinary foot practice. Finally, foot ulcer prevention is underexposed when compared with ulcer treatment. Prevention requires a larger focus, in particular regarding the efficacy of therapeutic footwear and its relative role in comparison with other preventative strategies. These priorities need the attention of clinicians, scientists and professional societies to improve our understanding of offloading and to improve clinical outcome in the management of the diabetic foot.
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Affiliation(s)
- Sicco A Bus
- Academic Medical Centre, Department of Rehabilitation, University of Amsterdam, Amsterdam, The Netherlands.
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Stucke S, McFarland D, Goss L, Fonov S, McMillan GR, Tucker A, Berme N, Cenk Guler H, Bigelow C, Davis BL. Spatial relationships between shearing stresses and pressure on the plantar skin surface during gait. J Biomech 2011; 45:619-22. [PMID: 22169152 DOI: 10.1016/j.jbiomech.2011.11.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 11/07/2011] [Accepted: 11/09/2011] [Indexed: 11/16/2022]
Abstract
Based on the hypothesis that diabetic foot lesions have a mechanical etiology, extensive efforts have sought to establish a relationship between ulcer occurrence and plantar pressure distribution. However, these factors are still not fully understood. The purpose of this study was to simultaneously record shear and pressure distributions in the heel and forefoot and to answer whether: (i) peak pressure and peak shear for anterior-posterior (AP) and medio-lateral (ML) occur at different locations, and if (ii) peak pressure is always centrally located between sites of maximum AP and ML shear stresses. A custom built system was used to collect shear and pressure data simultaneously on 11 subjects using the 2-step method. The peak pressure was found to be 362 kPa ± 106 in the heel and 527 kPa ± 123 in the forefoot. In addition, the average peak shear values were higher in the forefoot than in the heel. The greatest shear on the plantar surface of the forefoot occurred in the anterior direction (mean and std. dev.: 37.7 ± 7.6 kPa), whereas for the heel, peak shear the foot was in the posterior direction (21.2 ± 5 kPa). The results of this study suggest that the interactions of the shear forces caused greater "spreading" in the forefoot and greater tissue "dragging" in the heel. The results also showed that peak shear stresses do not occur at the same site or time as peak pressure. This may be an important factor in locating where skin breakdown occurs in patients at high-risk for ulceration.
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Affiliation(s)
- Samantha Stucke
- Medical Device Development Center, Austen BioInnovation Institute in Akron, Akron, OH 44308, USA
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Knops SP, Van Lieshout EMM, Spanjersberg WR, Patka P, Schipper IB. Randomised clinical trial comparing pressure characteristics of pelvic circumferential compression devices in healthy volunteers. Injury 2011; 42:1020-6. [PMID: 20934696 DOI: 10.1016/j.injury.2010.09.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 09/06/2010] [Accepted: 09/07/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The role of pelvic circumferential compression devices (PCCDs) is to temporarily stabilise a pelvic fracture, reduce the volume and tamponade the bleeding. Tissue damage may occur when PCCDs are left in place longer than a few hours. The aim of this randomised clinical trial was to quantify the pressure at the region of the greater trochanters (GTs) and the sacrum, induced by PCCDs in healthy volunteers. MATERIALS AND METHODS In a crossover study, the Pelvic Binder(®), SAM-Sling(®) and T-POD(®) were applied successively onto 80 healthy participants in random order. The pressure was measured using a pressure mapping system, with the volunteers in supine position on a spine board and on a hospital bed. Data were analysed using Mixed Linear Modelling. RESULTS On a spine board, the pressure exceeded the tissue damaging threshold at the GTs and the sacrum. Pressure at the GTs was highest with the Pelvic Binder(®), and lowest with the SAM-Sling(®). Pressure at the sacrum was highest with the Pelvic Binder(®). The pressure at the GTs and sacrum was reduced significantly for all three PCCDs upon transfer to a hospital bed. CONCLUSION The results of this randomised clinical trial in healthy volunteers showed that patients with pelvic fractures, temporarily stabilised with a PCCD, are at risk for developing pressure sores. The pressure on the skin exceeded the tissue damaging threshold and is, besides PCCD type, influenced by BMI, waist size and age. Regardless with which PCCD trauma patients are stabilised, early transfer from the spine board is of key importance to reduce the pressure to a level below the tissue damaging threshold. Clinicians should be aware of the potential deleterious effects associated with the application of a PCCD, and every effort must be made to remove the PCCD once haemodynamic resuscitation has been established.
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Affiliation(s)
- Simon P Knops
- Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Changes in the Thickness and Stiffness of Plantar Soft Tissues in People With Diabetic Peripheral Neuropathy. Arch Phys Med Rehabil 2011; 92:1484-9. [DOI: 10.1016/j.apmr.2011.03.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 02/11/2011] [Accepted: 03/16/2011] [Indexed: 12/31/2022]
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Chao CYL, Zheng YP, Cheing GLY. Epidermal thickness and biomechanical properties of plantar tissues in diabetic foot. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:1029-1038. [PMID: 21640473 DOI: 10.1016/j.ultrasmedbio.2011.04.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 03/31/2011] [Accepted: 04/08/2011] [Indexed: 05/30/2023]
Abstract
Diabetic foot is a common complication for people with diabetes but it is unclear whether the change is initiated from the skin surface or underneath plantar tissues. This study compared the thickness of epidermis and the thickness and stiffness of the total plantar soft tissue among people with diabetes with or without complications. Seventy-two people with diabetes, including 22 people with neuropathies, 16 foot ulcerations, 34 pure diabetics without complications and 40 healthy controls participated in the study. The thickness of the epidermal layer of the plantar skin was examined using high-frequency ultrasonography; the thickness and stiffness of the total plantar soft tissue were measured by using tissue ultrasound palpation system at the big toe, the first, third and fifth metatarsal heads; and the heel pad. Compared with the control group, the average epidermal thickness of plantar skin was reduced by 15% in people with diabetic foot ulceration and 9% in people with neuropathy, but was increased by 6% in pure diabetics. There was an 8% increase in total thickness of plantar soft tissue in the 3 diabetic groups at all testing sites (all p < 0.05), except the first metatarsal head. The stiffness of plantar soft tissue was increased in all diabetic groups at all testing sites compared with the control (all p < 0.05). The epidermal plantar skin becomes thinner and plantar soft tissues stiffen in people with diabetes, particularly in persons who have neuropathy or ulceration, which increases the risk of tissue breakdown and ulceration formation.
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Affiliation(s)
- Clare Y L Chao
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Ko M, Hughes L, Lewis H. Walking speed and peak plantar pressure distribution during barefoot walking in persons with diabetes. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2011; 17:29-35. [PMID: 21234990 DOI: 10.1002/pri.509] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 12/10/2010] [Accepted: 12/16/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND The impact of walking speed has not been evaluated as a feasible outcome measure associated with peak plantar pressure (PPP) distribution, which may result in tissue damage in persons with diabetic foot complications. The objective of this pilot study was to determine the walking speed and PPP distribution during barefoot walking in persons with diabetes. METHODS Nine individuals with diabetes and nine age-gender matched individuals without diabetes participated in this study. Each individual was marked at 10 anatomical landmarks for vibration and tactile pressure sensation tests to determine the severity of sensory deficits on the plantar surface of the dominant limb foot. A steady state walking speed, PPP, the fore and rear foot (F/R) PPP ratio and gait variables were measured during barefoot walking. RESULTS Persons with diabetes had a significantly slower walking speed than the age-gender matched group resulting in a significant reduction of PPP at the F/R foot during barefoot walking (p < 0.05). There was no significant difference in F/R foot PPP ratio in the diabetic group compared with the age-gender matched group during barefoot walking (p > 0.05). There was a significant difference between the diabetic and non-diabetic groups for cadence, step time, toe out angle and the anterior-posterior excursion (APE) for centre of force (p < 0.05). CONCLUSION Walking speed may be a potential indicator for persons with diabetes to identify PPP distribution during barefoot walking in a diabetic foot. However, the diabetic group demonstrated a more cautious walking pattern than the age-gender matched group by decreasing cadence, step length and APE, and increasing step time and toe in/out angle. People with diabetes may reduce the risk of foot ulcerations as long as they are able to prevent severe foot deformities such as callus, hammer toe or charcot foot.
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Affiliation(s)
- Mansoo Ko
- Physical Therapy, Angelo State University, San Angelo, TX 76909, USA.
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Scott Causby R, Pod M, Jones S. Dressing plantar wounds with foam dressings, is it too much pressure? Diabet Foot Ankle 2011; 2:DFA-2-8751. [PMID: 22396822 PMCID: PMC3284278 DOI: 10.3402/dfa.v2i0.8751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 09/29/2011] [Accepted: 10/04/2011] [Indexed: 11/14/2022]
Abstract
Diabetes and its associated complications have become a major concern locally, nationally and internationally. One such complication is lower extremity amputation, commonly preceded by chronic ulceration. The cause of this tissue breakdown is multi-faceted, but includes an increase in pressure, particularly plantar pressure. As such, the choice of dressing to be applied to a plantar wound should ideally not increase this pressure further. A commonly used and possibly more bulky dressing is the foam dressing. This pilot study investigates the plantar pressures associated with three common foam dressings (Allevyn(®), Lyofoam(®) and Mepilex(®)) compared with a control dressing (Melolin(®)). Twelve healthy males and 19 females [SD] age 36.6 [10.4] were measured using the F-scan plantar pressure measurement system. Substantial variations in individual pressure changes occurred across the foot. No significant differences were identified, once a Bonferroni correction was applied. In healthy adults, it could be concluded that foam dressings do not have any effect on the plantar pressures of the foot. However, the need remains for a robust trial on a pathological population.
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Affiliation(s)
- Ryan Scott Causby
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Abstract
Amputations in patients with diabetes, while often preventable, are unfortunately a far too common outcome. The roles of the certified or licensed pedorthist, certified orthotist, and the certified prosthetist should not be undervalued in the prevention of diabetic foot complications (eg, amputations, revisions, and foot infections secondary to skin ulcerations) and in returning the patient a normal, active, and productive lifestyle in the event of an amputation. This article highlights the roles these specialists play in treating patients with partial foot amputation.
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Abstract
BACKGROUND Diabetic foot complications represent significant morbidity and precede most of the lower extremity amputations performed. Peripheral neuropathy is a frequent complication of diabetes shown to affect gait. Glycosylation of soft tissues can also affect gait. The purpose of this review article is to highlight the changes in gait for persons with diabetes and highlight the effects of glycosylation on soft tissues at the foot-ground interface. METHODS PubMed, the Cochrane Library, and EBSCOhost on-line databases were searched for articles pertaining to diabetes and gait. Bibliographies from relevant manuscripts were also searched. FINDINGS Patients with diabetes frequently exhibit a conservative gait strategy where there is slower walking speed, wider base of gait, and prolonged double support time. Glycosylation affects are observed in the lower extremities. Initially, skin thickness decreases and skin hardness increases; tendons thicken; muscles atrophy and exhibit activation delays; bones become less dense; joints have limited mobility; and fat pads are less thick, demonstrate fibrotic atrophy, migrate distally, and may be stiffer. INTERPRETATION In conclusion, there do appear to be gait changes in patients with diabetes. These changes, coupled with local soft tissue changes from advanced glycosylated end products, also alter a patient's gait, putting them at risk of foot ulceration. Better elucidation of these changes throughout the entire spectrum of diabetes disease can help design better treatments and potentially reduce the unnecessarily high prevalence of foot ulcers and amputation.
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Affiliation(s)
- James S Wrobel
- Center for Lower Extremity Ambulatory Research at Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois 60064, USA.
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Chao CYL, Zheng YP, Huang YP, Cheing GLY. Biomechanical properties of the forefoot plantar soft tissue as measured by an optical coherence tomography-based air-jet indentation system and tissue ultrasound palpation system. Clin Biomech (Bristol, Avon) 2010; 25:594-600. [PMID: 20388577 DOI: 10.1016/j.clinbiomech.2010.03.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Revised: 03/11/2010] [Accepted: 03/15/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND The forefoot medial plantar area withstand high plantar pressure during locomotion, and is a common site that develops foot lesion problems among elderly people. The aims of the present study were to (1) determine the correlation between the biomechanical properties of forefoot medial plantar soft tissue measured by a newly developed optical coherence tomography-based air-jet indentation system and by tissue ultrasound palpation system, and (2) to compare the biomechanical properties of plantar soft tissues of medial forefoot between a young and old adult group. METHODS Thirty healthy subjects were classified as the young or older group. The biomechanical properties of plantar soft tissues measured at the forefoot by the air-jet indentation system and tissue ultrasound palpation system were performed, and the correlation of the findings obtained in the two systems were compared. FINDINGS A strong positive correlation was obtained from the findings in the two systems (r=0.88, P<0.001). The forefoot plantar soft tissue of the older group was significantly stiffer at the second metatarsal head and thinner at both metatarsal heads than that of the young group (all P<0.05). The stiffness coefficient at the second metatarsal head was 28% greater than that at the first metatarsal head in both study groups. INTERPRETATION Older subjects showed a loss of elasticity and reduced thickness in their forefoot plantar soft tissue, with the second metatarsal head displaying stiffer and thicker plantar tissue than the first metatarsal head. The air-jet indentation system is a useful instrument for characterizing the biomechanical properties of soft tissue.
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Affiliation(s)
- Clare Y L Chao
- Physiotherapy Department, Queen Elizabeth Hospital, Hong Kong SAR, China
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Sacco ICN, Hamamoto AN, Gomes AA, Onodera AN, Hirata RP, Hennig EM. Role of ankle mobility in foot rollover during gait in individuals with diabetic neuropathy. Clin Biomech (Bristol, Avon) 2009; 24:687-92. [PMID: 19497649 DOI: 10.1016/j.clinbiomech.2009.05.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 03/23/2009] [Accepted: 05/07/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the ankle range of motion during neuropathic gait and its influence on plantar pressure distribution in two phases during stance: at heel-strike and at push-off. METHODS Thirty-one adults participated in this study (control group, n=16; diabetic neuropathic group, n=15). Dynamic ankle range of motion (electrogoniometer) and plantar pressures (PEDAR-X system) were acquired synchronously during walking. Plantar pressures were evaluated at rearfoot, midfoot and forefoot during the two phases of stance. General linear model repeated measures analysis of variance was applied to investigate relationships between groups, areas and stance phases. FINDINGS Diabetic neuropathy patients walked using a smaller ankle range of motion in stance phase and smaller ankle flexion at heel-strike (P=0.0005). Peak pressure and pressure-time integral values were higher in the diabetic group in the midfoot at push-off phase when compared to heel-strike phase. On the other hand, the control group showed similar values of peak pressure in midfoot during both stance phases. INTERPRETATION The ankle mobility reduction observed could be associated to altered plantar pressure distribution observed in neuropathic subjects. Results demonstrated that midfoot and forefoot play a different role in subjects with neuropathy by receiving higher loads at push-off phase that are probably due to smaller ankle flexion at stance phase. This may explain the higher loads in anterior areas of the foot observed in diabetic neuropathy subjects and confirm an inadequate foot rollover associated to the smaller ankle range of motion at the heel-strike phase.
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Affiliation(s)
- I C N Sacco
- Laboratory of Biomechanics of Human Movement and Posture, Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of Sao Paulo, Brazil.
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Atlas E, Yizhar Z, Khamis S, Slomka N, Hayek S, Gefen A. Utilization of the foot load monitor for evaluating deep plantar tissue stresses in patients with diabetes: proof-of-concept studies. Gait Posture 2009; 29:377-82. [PMID: 19027302 DOI: 10.1016/j.gaitpost.2008.10.055] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 08/30/2008] [Accepted: 10/08/2008] [Indexed: 02/02/2023]
Abstract
The purposes of the present study were to (1) determine the internal plantar mechanical stresses in diabetic and healthy subjects during everyday activities, and (2) identify stress parameters potentially capable of distinguishing between diabetic and healthy subjects. A self-designed, portable, real-time and subject-specific foot load monitor which employs the Hertz contact theory was utilized to determine the internal dynamic plantar tissue stresses in 10 diabetic patients and 6 healthy subjects during free walking and outdoors stair climbing. Internal stress parameters and average stress-doses were evaluated, and the results obtained from the two groups were compared. Internal plantar stresses and averaged stress-doses during free walking and outdoors stairs climbing in the diabetic group were 2.5-5.5-fold higher than in the healthy group (p<0.001; stair climbing comparisons incorporated data from five diabetic patients). The interfacial pressures measured during free walking were slightly higher ( approximately 1.5-fold) in the diabetic group (p<0.05), but there was no significant difference between the two groups during stairs climbing. We conclude that during walking and stair climbing, internal plantar tissue stresses are considerably higher than foot-shoe interface pressures, and in diabetic patients, internal stresses substantially exceed the levels in healthy. The proposed method can be used for rating performances or design of footwear for protecting sub-dermal plantar tissues in patients who are at risk for developing foot ulcers. It may also be helpful in providing biofeedback to neuropathic diabetic patients.
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Affiliation(s)
- Eran Atlas
- Department of Biomedical Engineering, Tel Aviv University, Ramat Aviv, Israel
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Reliability of in-shoe plantar pressure measurements in rheumatoid arthritis patients. Int J Rehabil Res 2009; 32:36-40. [DOI: 10.1097/mrr.0b013e328307bdc2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND AND PURPOSE Patients with diabetes mellitus and peripheral neuropathy are at high risk for plantar skin breakdown due to unnoticed plantar stresses during walking. The purpose of this study was to determine differences in stress variables (peak plantar pressure, peak pressure gradient, peak maximal subsurface shear stress, and depth of peak maximal subsurface shear stress) between the forefoot (where most ulcers occur) and the rear foot in subjects with and without diabetes mellitus, peripheral neuropathy, and a plantar ulcer measured during barefoot walking. SUBJECTS Twenty-four subjects participated: 12 with diabetes mellitus, peripheral neuropathy, and a plantar ulcer (DM+PN group) and 12 with no history of diabetes mellitus or peripheral neuropathy (control group). The subjects (11 men, 13 women) had a mean age (+/-SD) of 54+/-8 years. METHODS Plantar pressures were measured during barefoot walking using a pressure platform. Stress variables were estimated at the forefoot and the rear foot for all subjects. RESULTS All stress variables were higher (127%-871%) in the forefoot than in the rear foot, and the peak pressure gradient showed the greatest difference (538%-871%). All stress variables were higher in the forefoot in the DM+PN group compared with the control group (34%-85%), and the peak pressure gradient showed the greatest difference (85%). The depth (X+/-SD) of peak maximum subsurface shear stress in the forefoot in the DM+PN group was half that in the control group (3.8+/-2.0 versus 8.0+/-4.3 mm, respectively). DISCUSSION AND CONCLUSION : These results indicate that stresses are relatively higher and located closer to the skin surface in locations where skin breakdown is most likely to occur. These stress variables may have additional value in predicting skin injury over the traditionally measured peak plantar pressure, but prospective studies using these variables to predict ulcer risk are needed to test this hypothesis.
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van Londen A, Herwegh M, van der Zee CH, Daffertshofer A, Smit CA, Niezen A, Janssen TW. The effect of surface electric stimulation of the gluteal muscles on the interface pressure in seated people with spinal cord injury. Arch Phys Med Rehabil 2008; 89:1724-32. [PMID: 18760157 DOI: 10.1016/j.apmr.2008.02.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Revised: 01/31/2008] [Accepted: 02/06/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To study effects of surface electric stimulation of the gluteal muscles on the interface pressure in seated persons with spinal cord injury (SCI). DESIGN One session in which alternating and simultaneous surface electric stimulation protocols were applied in random order. SETTING Research laboratory of a rehabilitation center. PARTICIPANTS Thirteen subjects with SCI. INTERVENTION Surface electric stimulation of the gluteal muscles. MAIN OUTCOME MEASURES Interface pressure, maximum pressure, pressure spread, and pressure gradient for the stimulation measurement. Variables were compared using 2-tailed paired t tests. RESULTS Alternating and simultaneous stimulation protocol caused a significant (P<.01) decrease in interface pressure (-17+/-12 mmHg, -19+/-14 mmHg) and pressure gradient (-12+/-11 mmHg, -14+/-12 mmHg) during stimulation periods compared with rest periods. There was no significant difference in effects between the 2 protocols. CONCLUSIONS Surface electric stimulation of the gluteal muscles in persons with SCI causes a decrease in interface pressure. This might restore blood flow in compressed tissue and help prevent pressure ulcers.
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Affiliation(s)
- Andrea van Londen
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands
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Pressure gradient and subsurface shear stress on the neuropathic forefoot. Clin Biomech (Bristol, Avon) 2008; 23:342-8. [PMID: 18060668 PMCID: PMC2387244 DOI: 10.1016/j.clinbiomech.2007.10.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 09/24/2007] [Accepted: 10/09/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Stresses within the neuropathic foot's tissues can be estimated by pressure distributions and may provide information regarding the potential for skin breakdown. The purposes of this study were to: (1) determine the magnitude of peak plantar pressure, pressure time integral, peak pressure gradient, and peak maximum shear stress; and (2) determine the association of these variables with one another. METHODS Forefoot peak plantar pressure, pressure time integral, peak pressure gradient, peak maximal shear stress, and depth of peak maximal shear stress were calculated for 16 controls, 16 people with diabetic neuropathy, and 22 people with diabetic neuropathy and a history of ulceration from pressure assessments. FINDINGS Peak plantar pressure, pressure gradient, and maximal shear stress were greater in subjects with a history of ulceration relative to control subjects (P<0.03), pressure gradient was greater in subjects with diabetic neuropathy and a history of ulceration compared to subjects with diabetic neuropathy and no history of ulceration (P<0.02), and depth of maximal shear stress was less in both groups of subjects with diabetic neuropathy compared to controls (P<0.03). Strong relationships existed between the variables. INTERPRETATION Although these variables are associated with one another, peak pressure gradient and peak maximal shear stress provide information concerning plantar pressure distribution and the potentially injurious internal stresses within the foot's soft tissues. Peak pressure gradient and peak maximal shear stress may perhaps be more discriminating than peak plantar pressure alone in distinguishing between groups of individuals who are at risk for developing a foot ulcer.
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Finch P, Baskwill A, Marincola F, Becker P. Changes in pedal plantar pressure variability and contact time following massage therapy: A case study of a client with diabetic neuropathy. J Bodyw Mov Ther 2007. [DOI: 10.1016/j.jbmt.2007.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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