Foot Function in Diabetic Patients after Partial Amputation

1996 ◽  
Vol 17 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Juan Carlos Garbalosa ◽  
Peter R. Cavanagh ◽  
Ge Wu ◽  
Jan S. Ulbrecht ◽  
Mary B. Becker ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Plantar Pressure ◽  
Three Dimensional ◽  
Diabetic Patients ◽  
Plantar Pressures ◽  
Plantar Pressure Distribution ◽  
Patients With Diabetes ◽  
Peak Plantar Pressure ◽  
Partial Amputation ◽  
Foot Function

The function of partially amputated feet in 10 patients with diabetes mellitus was studied. First-step bilateral barefoot plantar pressure distribution and three-dimensional kinematic data were collected using a Novel EMED platform and three video cameras. Analysis of the plantar pressure data revealed a significantly greater mean peak plantar pressure in the feet with transmetatarsal amputation (TMA) than in the intact feet of the same patients. The heels of the amputated feet had significantly lower mean peak plantar pressures than all the forefoot regions. A significantly greater maximum dynamic dorsiflexion range of motion was seen in the intact compared with the TMA feet. However, no difference was noted in the static dorsiflexion range of motion between the two feet and there was, therefore, a trend for the TMA feet to use less of the available range of motion. Given the altered kinematics and elevated plantar pressures noted in this study, careful postsurgical footwear management of feet with TMA would appear to be essential if ulceration is to be prevented.

The Relationship of the Position of the Metatarsal Heads and Peak Plantar Pressure

2003 ◽  
Vol 24 (4) ◽  
pp. 349-353 ◽  
Author(s):  
René E. Weijers ◽  
Geert H.I.M. Walenkamp ◽  
Henk van Mameren ◽  
Alphons G.H. Kessels
Keyword(s):  
Plantar Pressure ◽  
Lateral Side ◽  
Ct Scanner ◽  
Plantar Pressures ◽  
Medial Side ◽  
Plantar Pressure Distribution ◽  
Peak Plantar Pressure ◽  
The Right ◽  
Relationship Of ◽  
The Relationship

We test the premise that peak plantar pressure is located directly under the bony prominences in the forefoot region. The right foot of standing volunteers was examined in three different postures by a CT-scanner. The plantar pressure distribution was simultaneously recorded. The position of the metatarsal heads and the sesamoids could be related to the corresponding local peak plantar pressures. The metatarsal heads 1, 4, and 5 had a significantly different position than the local peak plantar pressures. The average difference in distance between the position of the metatarsal heads and the peak plantar pressure showed a significant correlation: on the medial side the head was located more distally to the local peak plantar pressure, on the lateral side more proximally. The findings suggest that normal plantar soft tissue is able to deflect a load. The observations might improve insight into the function of the normal forefoot and might direct further research on the pathological forefoot and on the design of footwear.

In-shoe Plantar Pressure Distribution in Nonneuropathic Type 2 Diabetic Patients in Singapore

2011 ◽  
Vol 101 (6) ◽  
pp. 509-516 ◽  
Author(s):  
Jasper W. K. Tong ◽  
U. Rajendra Acharya ◽  
Kuang C. Chua ◽  
Peck H. Tan
Keyword(s):  
Diabetes Mellitus ◽  
Control Group ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Maximum Peak ◽  
Plantar Pressures ◽  
Plantar Pressure Distribution ◽  
Pressure Time ◽  
Patients With Diabetes

Background: We sought to establish the in-shoe plantar pressure distribution during normal level walking in type 2 diabetic patients of Chinese, Indian, and Malay descent without clinical evidence of peripheral neuropathy. Methods: Thirty-five patients with type 2 diabetes mellitus without loss of tactile sensation and foot deformities and 38 nondiabetic individuals in a control group had in-shoe plantar pressures collected. Maximum peak pressure and peak pressure-time integral of each foot were analyzed as separate variables and were masked into 13 areas. Differences in pressure variables were assessed by analysis of covariance, adjusting for relevant covariates at the 95% confidence interval. Results: No significant differences were noted in maximum peak pressures after adjusting for sex, race, age, height, and body mass. However, patients with diabetes mellitus had significantly higher mean ± SD pressure-time integrals at the right whole foot (309.50 ± 144.17 kPa versus 224.06 ± 141.70 kPa, P < .05) and first metatarsal (198.65 ± 138.27 kPa versus 121.54 ± 135.91 kPa, P < .05) masked areas than did those in the control group after adjustment. Conclusions: Patients without clinical observable signs of foot deformity (implying absence of motor neuropathy) and sensory neuropathy had similar in-shoe maximum peak pressures as controls. This finding supported the notion that either component of neuropathy needs to be present before plantar pressures are elevated. Patients with diabetes mellitus demonstrated greater pressure-time integrals, implying that this variable might be the first clinical sign observable even before peripheral neuropathy could be tested. (J Am Podiatr Med Assoc 101(6): 509–516, 2011)

Range of Motion and Plantar Pressure Evaluation for the Effects of Self-Care Foot Exercises on Diabetic Patients with and Without Neuropathy

2016 ◽  
Vol 106 (3) ◽  
pp. 189-200 ◽  
Author(s):  
Lale Cerrahoglu ◽  
Umut Koşan ◽  
Tuba Cerrahoglu Sirin ◽  
Aslihan Ulusoy
Keyword(s):  
Pressure Distribution ◽  
Range Of Motion ◽  
Plantar Pressure ◽  
Exercise Program ◽  
Exercise Group ◽  
Home Exercise ◽  
Control Group ◽  
Diabetic Patients ◽  
Plantar Pressure Distribution ◽  
Before And After

Background: We aimed to investigate whether a home exercise for self-care program that consists of range of motion (ROM), stretching, and strengthening exercises could improve ROM for foot joints and plantar pressure distribution during walking in diabetic patients to prevent diabetic foot complications. Methods: Seventy-six diabetic patients were recruited (38 with neuropathy and 38 without neuropathy). Neuropathy and nonneuropathy groups were randomly divided into a home exercise group (n = 19) and a control group (n = 19). Exercise groups performed their own respective training programs for 4 weeks, whereas no training was done in the control group. Total contact area and plantar pressure under six foot areas before and after the exercise program were measured. Ankle and first metatarsophalangeal joint ROM were measured before and after the exercise program. Results: In the exercise group, there were significant improvements in ROM for the ankle and first metatarsophalangeal joints (P < .001); static pedobarographic values showed significant reduction in right forefoot-medial pressure (P = .010); and significant decreases were seen in dynamic pedobarographic values of peak plantar pressure at the left forefoot medial (P = .007), right forefoot lateral (P = .018), left midfoot (P < .001), and right hindfoot (P = .021) after exercise. No significant positive or negative correlation was found between the neuropathy and nonneuropathy groups (P > .05). Conclusions: A home exercise program could be an effective preventive method for improving ROM for foot joints and plantar pressure distribution in diabetic patients independent of the presence of neuropathy.

Forefoot Plantar Pressures in Rheumatoid Arthritis

2004 ◽  
Vol 94 (3) ◽  
pp. 255-260 ◽  
Author(s):  
Simon J. Otter ◽  
Catherine Jane Bowen ◽  
Adam K. Young
Keyword(s):  
Rheumatoid Arthritis ◽  
Pressure Measurement ◽  
Plantar Pressure ◽  
Rheumatoid Arthritis Group ◽  
Foot Pressure ◽  
Plantar Pressures ◽  
Plantar Pressure Distribution ◽  
Temporal Aspects ◽  
Peak Plantar Pressure ◽  
Force Time

We sought to investigate the magnitude and duration of peak forefoot plantar pressures in rheumatoid arthritis. The spatial and temporal characteristics of forefoot plantar pressures were measured in 25 patients with a positive diagnosis of rheumatoid arthritis of 5 to 10 years’ duration (mean, 8 years) and a comparison group using a platform-based pressure-measurement system. There were no significant differences between groups in the magnitude of peak plantar pressure in the forefoot region. Significant differences were, however, noted for temporal aspects of foot-pressure measurement. The duration of loading over sensors detecting peak plantar pressure was significantly longer in the rheumatoid arthritis group. In addition, the rheumatoid arthritis group demonstrated significantly greater force–time integrals. Significant increases in the temporal parameters of plantar pressure distribution, rather than those of amplitude, may be characteristic of the rheumatoid foot. (J Am Podiatr Med Assoc 94(3): 255–260, 2004)

The Distribution of Plantar Pressures in American Indians with Diabetes Mellitus

2001 ◽  
Vol 91 (6) ◽  
pp. 280-287 ◽  
Author(s):  
Thomas G. McPoil ◽  
Wesley Yamada ◽  
Wayne Smith ◽  
Mark Cornwall
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Neuropathy ◽  
Range Of Motion ◽  
American Indians ◽  
Plantar Pressure ◽  
Metatarsophalangeal Joint ◽  
Control Group ◽  
First Metatarsophalangeal Joint ◽  
Plantar Pressures ◽  
Peak Plantar Pressure

The primary purpose of this study was to determine the magnitude and duration of plantar pressures acting on the feet of American Indians with diabetes mellitus. A secondary purpose was to determine whether differences in the range of motion of the ankle and first metatarsophalangeal joints existed between American Indians with and without diabetes. Three groups of American Indian subjects were tested: a control group (n = 20); a group with diabetes but no peripheral neuropathy (n = 24); and a group with diabetes and peripheral neuropathy (n = 21). A floor-mounted pressure sensor platform was used to collect plantar pressure data while subjects walked barefoot. The results indicated that American Indians with diabetes have 1) a pattern of peak plantar pressure similar to patterns previously reported for non–American Indians with diabetes and 2) a reduction in ankle and first metatarsophalangeal joint range of motion in comparison with nondiabetic American Indians. (J Am Podiatr Med Assoc 91(6): 280-287, 2001)

scholarly journals Foot function and strength of patients with diabetes grouped by ulcer risk classification (IWGDF)

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Jane S. S. P. Ferreira ◽  
João P. Panighel ◽  
Érica Q. Silva ◽  
Renan L. Monteiro ◽  
Ronaldo H. Cruvinel Júnior ◽  
...  
Keyword(s):  
Treatment Strategies ◽  
Foot Deformities ◽  
Diabetic Patients ◽  
Foot Pain ◽  
Foot Health ◽  
Significant Difference ◽  
Patients With Diabetes ◽  
Foot Function ◽  
Group 2 ◽  
Stratification System

Abstract Background The stratification system from the International Working Group on the Diabetic Foot (IWGDF) was used to classify the participants as to the ulcer risk. However, it is not yet known what the classification groups’ individual deficits are regarding sensitivity, function, and musculoskeletal properties and mechanics. This makes it difficult to design proper ulcer prevention strategies for patients. Thus, this study aimed to investigate the foot function, foot strength and health of people with diabetes mellitus (DM)—with or without DPN—while considering the different ulcer risk classifications determined by the IWGDF. Methods The subject pool comprised 72 people with DM, with and without DPN. The patients were divided into three groups: Group 0 (G0), which comprised diabetic patients without DPN; Group 1 (G1), which comprised patients with DPN; and Group 2 (G2), which comprised patients with DPN who had foot deformities. The health and foot function of the subjects’ feet were assessed using a foot health status questionnaire (FHSQ-BR) that investigated four domains: foot pain, foot function, footwear, and general foot health. The patients’ foot strength was evaluated using the maximum force under each subject’s hallux and toes on a pressure platform (emed q-100, Novel, Munich, Germany). Results Moderate differences were found between G0 and G1 and G2 for the foot pain, foot function, general foot health, and footwear. There was also a small but significant difference between G0 and G2 in regards to hallux strength. Conclusion Foot health, foot function and strength levels of people with DM and DPN classified by the ulcer risk are different and this must be taken into account when evaluating and developing treatment strategies for these patients.

scholarly journals Reconstructive foot and ankle surgeries in diabetic patients

2011 ◽  
Vol 44 (03) ◽  
pp. 390-395
Author(s):  
Ajit Kumar Varma
Keyword(s):  
Reconstructive Surgical Procedures ◽  
Primary Objective ◽  
Diabetic Patients ◽  
Outpatient Basis ◽  
Foot And Ankle ◽  
Foot Care ◽  
Plantar Pressures ◽  
Reduction Of Pain ◽  
Significant Disability ◽  
Foot Function

ABSTRACTDiabetic foot and ankle deformities are secondary to long-standing diabetes and neglected foot care. The concept of surgical correction for these deformities is quite recent. The primary objective of reconstructive foot and ankle surgery is the reduction of increased plantar pressures, reduction of pain and the restoration of function, stability and proper appearance. Foot and ankle deformities can result in significant disability, loss of life style, employment and even the loss of the lower limb. Therefore, restoration of normal, problem free foot function and activities will have a significant impact on peoples’ lives. Reconstructive surgical procedures are complex and during reconstruction, internal and external fixation devices, including pins, compression screws, staples, and wires, may be used for repair and stabilization. The surgeries performed depend on the type and severity of the condition. Surgery can involve any part of the foot and ankle, and may involve tendon, bone, joint, tissue or skin repair. Corrective surgeries can at times be performed on an outpatient basis with minimally invasive techniques. Recovery time depends on the type of condition being treated.

scholarly journals Plantar pressure distribution evaluation in children with down syndrome from 2 to 5 years old

2019 ◽  
Vol 32 ◽  
Author(s):  
Paula Silva de Carvalho Chagas ◽  
Riuraly Caroline Barreiros Fortunato Rangel ◽  
Sulamita Saile de Jesus Oliveira Dornelas ◽  
Anderson Daibert Amaral ◽  
Flávio Augusto Teixeira Ronzani ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Pressure Distribution ◽  
Plantar Pressure ◽  
Cross Sectional Study ◽  
Measurement Instruments ◽  
Standing Posture ◽  
Cross Sectional ◽  
Plantar Pressures ◽  
Pressure Distributions ◽  
Plantar Pressure Distribution

Abstract Introduction: Some peculiar features of Down Syndrome (DS), such as ligament laxity, hypotonia, delay in gait acquisition, among others, may generate alterations in the distribution of plantar pressures, modifying the plantar support. Objective: To verify whether there are differences in the evaluation of plantar pressure distributions in standing posture between the measurement instruments (Baropodometer, SAPO, and Radiography). Method: This was a cross-sectional study, evaluating ten children with SD and ten children with normal development (ND), aged from two to five years old. Bio-photogrammetry, baropodometry, and foot radiography were used to assess the plantar pressure distribution. Kappa analysis was used to evaluate the agreement index between the different instruments. Results: Children with DS and ND had a higher prevalence of pronated feet in all three instruments, with poor to substantial agreement among the instruments. Conclusion: According to this study instruments, there was a greater prevalence of pronated feet in the two groups . Differences in the evaluation of the distribution of plantar pressures in the standing posture between the Baropodometer, SAPO, and radiography were observed. These instruments should be used in a complementary manner, as they propose to evaluate different aspects of the feet alignment.

Analysis of Insole Geometry and Deformity by Using a Three-Dimensional Image Processing Technique: A Preliminary Study

2019 ◽  
Vol 109 (2) ◽  
pp. 98-107
Author(s):  
Kit-lun Yick ◽  
Wai-ting Lo ◽  
Sun-pui Ng ◽  
Joanne Yip ◽  
Hung-hei Kwan ◽  
...  
Keyword(s):  
Image Processing ◽  
Cross Sections ◽  
Plantar Pressure ◽  
Three Dimensional ◽  
Processing Technique ◽  
Image Processing Technique ◽  
Diabetic Patients ◽  
Clinical Practices ◽  
Cross Sectional ◽  
Orthotic Treatment

Background: Accurate representation of the insole geometry is crucial for the development and performance evaluation of foot orthoses designed to redistribute plantar pressure, especially for diabetic patients. Methods: Considering the limitations in the type of equipment and space available in clinical practices, this study adopted a simple portable three-dimensional (3-D) desktop scanner to evaluate the 3-D geometry of an orthotic insole and the corresponding deformities after the insole has been worn. The shape of the insole structure along horizontal cross sections is defined with 3-D scanning and image processing. Accompanied by an in-shoe pressure measurement system, plantar pressure distribution in four foot regions (hallux, metatarsal heads, midfoot, and heel) is analyzed and evaluated for insole deformity. Results: Insole deformities are quantified across the four foot regions. The hallux region tends to show the greatest changes in shape geometry (17%–50%) compared with the other foot regions after 2 months of insole wear. As a result of insole deformities, plantar peak pressures change considerably (–4.3% to +69.5%) during the course of treatment. Conclusions: Changes in shape geometry of the insoles could be objectively quantified with 3-D scanning techniques and image processing. This investigation finds that, in general, the design of orthotic insoles may not be adequate for diabetic individuals with similar foot problems. The drastic changes in the insole shape geometry and cross-sectional areas during orthotic treatment may reduce insole fit and conformity. An inadequate insole design may also affect plantar pressure reduction. The approach proposed herein, therefore, allows for objective quantification of insole shape geometry, which results in effective and optimal orthotic treatment.

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