scholarly journals Efficacy and Mechanism of Orthotic Devices to Unload Metatarsal Heads in People With Diabetes and a History of Plantar Ulcers

2006 ◽  
Vol 86 (6) ◽  
pp. 833-842 ◽  
Author(s):  
Michael J Mueller ◽  
Donovan J Lott ◽  
Mary K Hastings ◽  
Paul K Commean ◽  
Kirk E Smith ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Contact Area ◽  
Weight Bearing ◽  
Orthotic Devices ◽  
Shoe Condition ◽  
Plantar Pressures ◽  
Skin Breakdown ◽  
Second Metatarsal ◽  
Plantar Ulcers ◽  
History Of

Abstract Background and Purpose. Total-contact inserts (TCIs) and metatarsal pads (MPs) frequently are prescribed to reduce excessive plantar stresses to help prevent skin breakdown in people with diabetes mellitus (DM) and peripheral neuropathy. The first purpose of this study was to determine the effect of a TCI and an MP on metatarsal head peak plantar pressures (PPP) and pressure-time integrals (PTI). The second purpose of this study was to determine a possible mechanism of pressure reduction by measuring contact area and loaded soft-tissue thickness (STT) under the metatarsal heads and second metatarsal shaft. Subjects. Twenty subjects (12 men and 8 women; age [mean±SD]=57±9 years) with DM (duration [mean±SD]=16±11 years), peripheral neuropathy, and a history of plantar ulcers participated. Methods. A repeated-measures research design was used, and outcome measures are reported for 3 footwear conditions: shoe, shoe with TCI, and shoe with TCI and MP. In-shoe plantar pressures were collected during walking and during spiral x-ray computed tomography (SXCT). The STT and identification of the pressure sensor and location of the MP in relationship to the metatarsal heads were determined by use of SXCT. Results. The PPP and the PTI were 16% to 24% lower at the metatarsal heads in the TCI condition than in the shoe condition. The PPP and the PTI decreased an additional 15% to 28% (for a total reduction of 29% to 47%) with the addition of the MP. The contact area increased 27% with the TCI but not with the MP. The STT did not increase under the metatarsal heads in the TCI condition (compared with the shoe condition) but did increase 8% to 22% at metatarsal heads 2 to 5 with the addition of the MP. The PPP increased substantially (308%) and the STT decreased 14% under the shaft of the second metatarsal with the addition of the MP to the TCI-plus-shoe condition. Discussion and Conclusion. The TCI and the MP caused substantial and additive reductions of pressures under the metatarsal heads. The TCI reduces excessive pressures at the metatarsal heads by increasing the contact area of weight-bearing forces. Conversely, the MP acts by compressing the soft tissues proximal to the metatarsal heads and relieving compression at the metatarsal heads. These findings can assist in the design of effective orthotic devices to relieve excessive plantar stresses that contribute to skin breakdown and subsequent amputation in people with DM and peripheral neuropathy. [Mueller MJ, Lott DJ, Hastings MK, et al. Efficacy and mechanism of orthotic devices to unload metatarsal heads in people with diabetes and a history of plantar ulcers. Phys Ther. 2006;86:833–842.]

Plantar Pressures During Shod Gait in Diabetic Neuropathic Patients with and without a History of Plantar Ulceration

2009 ◽  
Vol 99 (4) ◽  
pp. 285-294 ◽  
Author(s):  
Isabel C. N. Sacco ◽  
Tatiana Almeida Bacarin ◽  
Maíra Grizzo Canettieri ◽  
Ewald M. Hennig
Keyword(s):  
Diabetic Neuropathy ◽  
Plantar Pressure ◽  
Clinical History ◽  
Control Group ◽  
Diabetic Patients ◽  
Plantar Pressures ◽  
Time Integral ◽  
Pressure Time ◽  
Plantar Ulcers ◽  
History Of

Background: Diabetic neuropathy leads to progressive loss of sensation, lower-limb distal muscle atrophy, autonomic impairment, and gait alterations that overload feet. This overload has been associated with plantar ulcers even with consistent daily use of shoes. We sought to investigate and compare the influence of diabetic neuropathy and plantar ulcers in the clinical history of diabetic neuropathic patients on plantar sensitivity, symptoms, and plantar pressure distribution during gait while patients wore their everyday shoes. Methods: Patients were categorized into three groups: a control group (CG; n = 15), diabetic patients with a history of neuropathic ulceration (DUG; n = 8), and diabetic patients without a history of ulceration (DG; n = 10). Plantar pressure variables were measured by Pedar System shoe insoles in five plantar regions during gait while patients wore their own shoes. Results: No statistical difference between neuropathic patients with and without a history of plantar ulcers was found in relation to symptoms, tactile sensitivity, and duration of diabetes. Diabetic patients without ulceration presented the lowest pressure–time integral under the heel (72.1 ± 16.1 kPa × sec; P = .0456). Diabetic patients with a history of ulceration presented a higher pressure–time integral at the midfoot compared to patients in the control group (59.6 ± 23.6 kPa × sec × 45.8 ± 10.4 kPa × sec; P = .099), and at the lateral forefoot compared to diabetic patients without ulceration (70.9 ± 17.7 kPa sec × 113.2 ± 61.1 kPa × sec, P = .0193). Diabetic patients with ulceration also presented the lowest weight load under the hallux (0.06 ± 0.02%, P = .0042). Conclusions: Although presenting a larger midfoot area, diabetic neuropathic patients presented greater pressure–time integrals and relative loads over this region. Diabetic patients with ulceration presented an altered dynamic plantar pressure pattern characterized by overload even when wearing daily shoes. Overload associated with a clinical history of plantar ulcers indicates future appearance of plantar ulcers. (J Am Podiatr Med Assoc 99(4): 285–294, 2009)

Diabetic Neuropathy Is Related to Joint Stiffness during Late Stance Phase

2007 ◽  
Vol 23 (4) ◽  
pp. 251-260 ◽  
Author(s):  
D.S. Blaise Williams ◽  
Denis Brunt ◽  
Robert J. Tanenberg
Keyword(s):  
Peripheral Neuropathy ◽  
Knee Joint ◽  
Force Plate ◽  
Three Dimensional ◽  
Joint Stiffness ◽  
Plantar Pressures ◽  
Ankle Stiffness ◽  
Plantar Ulcers ◽  
Diabetic Population

The majority of plantar ulcers in the diabetic population occur in the forefoot. Peripheral neuropathy has been related to the occurrence of ulcers. Long-term diabetes results in the joints becoming passively stiffer. This static stiffness may translate to dynamic joint stiffness in the lower extremities during gait. Therefore, the purpose of this investigation was to demonstrate differences in ankle and knee joint stiffness between diabetic individuals with and without peripheral neuropathy during gait. Diabetic subjects with and without peripheral neuropathy were compared. Subjects were monitored during normal walking with three-dimensional motion analysis and a force plate. Neuropathic subjects had higher ankle stiffness (0.236 N·m/ deg) during 65 to 80% of stance when compared with non-neuropathic subjects (−0.113 N·m/deg). Neuropathic subjects showed a different pattern in ankle stiffness compared with non-neuropathic subjects. Neuropathic subjects demonstrated a consistent level of ankle stiffness, whereas non-neuropathic subjects showed varying levels of stiffness. Neuropathic subjects demonstrated lower knee stiffness (0.015 N·m/deg) compared with non-neuropathic subjects (0.075 N·m/deg) during 50 to 65% of stance. The differences in patterns of ankle and knee joint stiffness between groups appear to be related to changes in timing of peak ankle dorsiflexion during stance, with the neuropathic group reaching peak dorsiflexion later than the non-neuropathic subjects. This may partially relate to the changes in plantar pressures beneath the metatarsal heads present in individuals with neuropathy.

Effect of Turf Toe on Foot Contact Pressures in Professional American Football Players

2009 ◽  
Vol 30 (5) ◽  
pp. 405-409 ◽  
Author(s):  
Robert H. Brophy ◽  
Seth C. Gamradt ◽  
Scott J. Ellis ◽  
Ronnie P. Barnes ◽  
Scott A. Rodeo ◽  
...  
Keyword(s):  
Body Mass Index ◽  
National Football League ◽  
Peak Pressure ◽  
American Football ◽  
Football Players ◽  
Plantar Pressures ◽  
History Of ◽  
Turf Toe ◽  
The Relationship ◽  
Contact Pressures

Background: The relationship between turf toe and plantar foot pressures has not been extensively studied. Two hypotheses were tested in a cohort of professional American football players: first, that a history of turf toe is associated with increased peak hallucal and first metatarsophalangeal (MTP) plantar pressures; second, that decreased range of motion (ROM) of the first MTP correlates with increased peak hallucal and first MTP plantar pressures. Materials and Methods: Forty-four athletes from one National Football League (NFL) team were screened for a history of turf toe during preseason training. Dorsal passive MTP ROM and dynamic plantar pressures were measured in both feet of each player. Anatomical masking was used to assess peak pressure at the first MTP and hallux. Results: First MTP dorsiflexion was significantly lower in halluces with a history of turf toe (40.6 ± 15.1 degrees versus 48.4 ± 12.8 degrees, p = 0.04). Peak hallucal pressures were higher in athletes with turf toe (535 ± 288 kPa versus 414 ± 202 kPa, p = 0.05) even after normalizing for athlete body mass index ( p = 0.0003). Peak MTP pressure was not significantly different between the two groups tested. First MTP dorsiflexion did not correlate with peak hallucal or first MTP pressures. Conclusion: This study showed that turf toe is associated with decreased MTP motion. In addition, increased peak hallucal pressures were found. Further study is warranted to determine whether these pressures correlate with the severity of symptoms or progression of turf toe to first MTP arthritis.

Stress Fractures in Royal Marine Recruits

1970 ◽  
Vol 56 (1) ◽  
pp. 78-91
Author(s):  
J. Bertram
Keyword(s):  
Soft Tissue ◽  
Weight Bearing ◽  
Fracture Site ◽  
Stress Fractures ◽  
Vigorous Activity ◽  
Main Symptom ◽  
Soft Tissue Swelling ◽  
History Of ◽  
Radiological Changes

AbstractThe main features of stress fractures in Royal Marine recruits are that they occur in normal bones, most often those that are weight bearing. There is no history of injury, but there is usually a history of unaccustomed or more vigorous activity for some weeks before onset. The main symptom is pain on use of the affected part and this pain is relieved by rest. Localised tenderness and soft tissue swelling are present at the fracture site when the affected bone is readily palpable. Radiological changes are absent in the first seven to ten days, but become visible within two months, unless treatment starts or stress ceases early.

Severe peripheral neuropathy and elevated plantar pressures causing foot ulceration in pituitary gigantism

1993 ◽  
Vol 39 (1) ◽  
pp. 113-118 ◽  
Author(s):  
A. M. Jennings ◽  
A. Robinson ◽  
R. H. Kandler ◽  
R. P. Betts ◽  
R. E. J. Ryder ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Foot Ulceration ◽  
Plantar Pressures

scholarly journals Chronic inflammatory demyelinating polyradiculoneuropathy induced by paclitaxel

2021 ◽  
Author(s):  
Isabella Sabião Borges ◽  
João Victor Aguiar Moreira ◽  
Eustaquio Costa Damasceno Junior ◽  
Alencar Pereira dos Santos ◽  
Gabriela Tomás Alves ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Glial Cells ◽  
Conduction Block ◽  
Chemotherapeutic Agents ◽  
Chronic Inflammatory Demyelinating Polyradiculoneuropathy ◽  
Microtubule Stabilization ◽  
Progressive Muscle Weakness ◽  
History Of ◽  
Secondary Demyelination ◽  
Distal Axonal Degeneration

Background: Peripheral neuropathies in cancer are most often due to neurotoxic chemotherapeutic agents. Approximately 30% of patients receiving neurotoxic chemotherapy (CTX) will suffer from chemotherapy-induced peripheral neuropathy (CIPN). Paclitaxel is an extremely effective chemotherapeutic agent for the treatment of breast, ovarian, and lung cancer. However, paclitaxel-induced peripheral neuropathy occurs in 59-87% of patients who receive this drug. Paclitaxel is an anti-tubulin drug that causes microtubule stabilization, resulting in distal axonal degeneration, secondary demyelination and nerve fiber loss. Case: We present a case of a 68-year-old female patient with history of breast cancer who presented sensorial ataxia and progressive muscle weakness two months after starting CTX with paclitaxel. The physical examination showed tetraparesis with proximal predominance, areflexia, severe hypopalesthesia and postural instability. Electroneuromyography showed the existence of asymmetric demyelinating polyradiculoneuropathy, with conduction block and temporal dispersion in practically all evaluated nerves. The cerebrospinal fluid confirmed the albumin-cytological dissociation. Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) was confirmed and patient underwent monthly treatment with methylprednisolone with good response. Discussion: Evidences has implicated neuroinflammation in the development of PIPN. While most CTX drugs do not cross the blood-brain-barrier, they readily penetrate the blood-nerve-barrier and bind to and accumulate in dorsal root ganglia and peripheral axons. CTX can induce neuroinflammation through activation of immune and immune- like glial cells. In fact, immune cells (e.g., macrophages, lymphocytes) and glial cells (e.g., Schwann cells) in the peripheral nervous system play important role in the induction and maintenance of neuropathy. Conclusion: CIDP should be included in the spectrum of CIPN.

scholarly journals Successful utilization of triphasic silica containing ceramic coated hydroxyapatite (HASi) for the treatment of comminuted tibial fracture in a goat: a case report

2021 ◽  
Vol 52 (2) ◽  
Author(s):  
Rahul Rao ◽  
P. T. Dinesh ◽  
S. Sooryadas ◽  
George Chandy ◽  
Manju Mathew
Keyword(s):  
Hind Limb ◽  
Tibial Fracture ◽  
Dynamic Compression ◽  
Weight Bearing ◽  
Segmental Defect ◽  
Dynamic Compression Plate ◽  
Comminuted Fracture ◽  
Compression Plate ◽  
History Of ◽  
One Year

A one year old female Sirohi crossbred goat was presented with a history of non weight bearing lameness on right hind limb. Radiography revealed comminuted fracture of tibial mid diaphysis. The comminuted fracture fragments and bone devoid of any soft tissue were surgically removed and the resultant segmental defect was reinstated with triphasic silica containing ceramic coated hydroxyapatite (HASi) after stabilising the fracture fragments with 2.7mm dynamic compression plate and screws. The animal recovered with normal limb ambulation after the eighth post-operative week.

scholarly journals Relationship Between Changes in Activity and Plantar Ulcer Recurrence in a Patient With Diabetes Mellitus

2005 ◽  
Vol 85 (6) ◽  
pp. 579-588 ◽  
Author(s):  
Donovan J Lott ◽  
Katrina S Maluf ◽  
David R Sinacore ◽  
Michael J Mueller
Keyword(s):  
Diabetes Mellitus ◽  
Plantar Pressure ◽  
Weight Bearing ◽  
Rapid Change ◽  
Activity Level ◽  
Ulcer Recurrence ◽  
Sudden Increase ◽  
Average Value ◽  
Plantar Ulcer ◽  
History Of

Abstract Background and Purpose. Although pressure-reducing interventions have been effective in the healing of neuropathic foot ulcers, these ulcers frequently recur in people with diabetes mellitus (DM). This case report illustrates how sudden changes in weight-bearing activity may have affected ulcer recurrence in a patient with DM and how the physical stress theory (PST) relates to ulcer recurrence for this patient. Case Description. The patient was a 66-year-old man with a history of DM, peripheral neuropathy, and recurrent plantar ulcers. His plantar ulcer healed after total contact casting. Outcome. Despite relatively low peak plantar pressure (9.3 N/cm2), the patient's ulcer recurred within 4 weeks of healing. Plantar pressure assessment and activity monitoring suggested that a rapid and sudden increase in weight-bearing activity (steps per day) contributed to cumulative plantar tissue stress that was 3.3 times higher on the day of ulcer recurrence than his average value. Although his cumulative plantar stress was high compared with his usual value, the cumulative value was similar to the amount of daily stress of individuals without a history of recurrent ulcers. Discussion. Within the context of the PST, rapid change in activity level may have an effect on cumulative stress and the risk of ulcer recurrence.

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