Immediate Effects of Weight-Bearing Calf Stretching on Ankle Dorsiflexion Range of Motion and Plantar Pressure During Gait in Patients with Diabetes Mellitus

2021 ◽  
pp. 153473462110313
Author(s):  
Noriaki Maeshige ◽  
Mikiko Uemura ◽  
Yoshikazu Hirasawa ◽  
Yoshiyuki Yoshikawa ◽  
Maiki Moriguchi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Plantar Pressure ◽  
Peak Pressure ◽  
Weight Bearing ◽  
Ankle Dorsiflexion ◽  
Diabetic Foot Ulcers ◽  
Plantar Surface ◽  
Time Integral ◽  
Pressure Time ◽  
Patients With Diabetes

High plantar pressure is a risk factor for diabetic foot ulcers, and it is known that restriction of ankle dorsiflexion range of motion (ROM) causes high plantar pressure. Stretching is a non-invasive and general means to improve ROM; however, the effect of stretching on the ROM and plantar pressure has not been clarified in patients with diabetes mellitus. We aimed to study the effects of intermittent weight-bearing stretching on ankle dorsiflexion ROM and plantar pressure during gait in patients with diabetes mellitus. Seven patients with diabetes mellitus participated, and their triceps surae was stretched using weight-bearing stretching with a stretch board. Five minutes of stretching was performed 4 times with a rest interval of 30 s. Ankle dorsiflexion ROM was measured with the knee flexed and extended. Peak pressure and pressure-time integral during gait were measured and calculated for the rearfoot, midfoot, forefoot, and total plantar surface before and after stretching. Ankle dorsiflexion ROM with the knee extended or bent increased significantly after stretching ( P < .05). Peak pressure and the pressure-time integral decreased significantly, especially in the forefoot ( P < .01), and these also decreased significantly in the total plantar surface ( P < .05). The duration of foot-flat decreased after stretching ( P < .05). Weight-bearing stretching improved ankle dorsiflexion ROM and reduced plantar pressure during gait. These results suggest that weight-bearing calf stretching may be an effective means to prevent and treat diabetic foot ulcers.

Variability of plantar pressure data. A comparison of the two-step and midgait methods

1999 ◽  
Vol 89 (10) ◽  
pp. 495-501 ◽  
Author(s):  
TG McPoil ◽  
MW Cornwall ◽  
L Dupuis ◽  
M Cornwell
Keyword(s):  
Data Collection ◽  
Plantar Pressure ◽  
Peak Pressure ◽  
Pressure Data ◽  
Step Method ◽  
Plantar Surface ◽  
Time Integral ◽  
Risk Of Injury ◽  
Pressure Time ◽  
Reliable Representation

The number of trials required to obtain a reliable representation of the plantar pressure pattern is an important factor in the assessment of people with insensate feet or the use of plantar pressure data as a basis for fabrication of foot orthoses. Traditionally, the midgait method has been used for the collection of pressure data, but the large number of walking trials required by this method can increase the risk of injury to the plantar surface of the insensate foot. As a result, the two-step method of plantar pressure data collection has been advocated. The purpose of this investigation was to determine the degree of variability in regional plantar pressure measurements using the midgait and two-step methods of data collection. Plantar pressure data were collected from ten volunteers (five men and five women) between the ages of 20 and 35 years in 20 trials using both data-collection protocols. The results of the study indicate that three to five walking trials are needed to obtain reliable regional peak pressure and pressure-time integral values when the two-step data-collection protocol is used. Although either method can be used for pressure data collection, one method should be used consistently when repeated assessments are required.

Effect of Orthotic Therapy on Claw Toe Loading

2004 ◽  
Vol 94 (3) ◽  
pp. 246-254 ◽  
Author(s):  
Penny J. Claisse ◽  
Jodi Binning ◽  
Julia Potter
Keyword(s):  
Pressure Measurement ◽  
Plantar Pressure ◽  
Metatarsal Head ◽  
Plantar Surface ◽  
Time Integral ◽  
Pressure Time ◽  
Second Metatarsal ◽  
Plantar Pressure Measurement ◽  
Access To Data ◽  
Toe Deformity

This study demonstrates the effect of orthotic therapy for toe deformity on toe and metatarsal head pressures using a new analysis method facilitated by an in-shoe pressure-measurement system’s ability to export detailed data. Plantar pressure–time integrals in 11 individuals (22 feet) with claw deformity of the lesser toes were measured with and without toe props. Differences in pressure–time integrals at every individual sensor unit were then calculated for the two conditions, and significance was tested using the paired t-test. Plantar surface charts with contours of equal significant pressure–time integral change showed significant reduction under 17 second toes (77%), 22 third toes (100%), 15 fourth toes (68%), 13 second metatarsal heads (59%), 16 third metatarsal heads (73%), and 16 fourth metatarsal heads (73%). All 22 feet showed increases under the prop in the area of the third toe sulcus. This innovative approach to plantar pressure analysis could improve access to data that show significant pressure–time integral changes and, therefore, could advance the clinical application of plantar pressure measurement. (J Am Podiatr Med Assoc 94(3): 246–254, 2004)

Increased In-Shoe Lateral Plantar Pressures with Chronic Ankle Instability

2011 ◽  
Vol 32 (11) ◽  
pp. 1075-1080 ◽  
Author(s):  
Heather Schmidt ◽  
Lindsay D. Sauer ◽  
Sae Yong Lee ◽  
Susan Saliba ◽  
Jay Hertel
Keyword(s):  
Plantar Pressure ◽  
Peak Pressure ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Maximum Force ◽  
Pressure System ◽  
Time To Peak ◽  
Time Integral ◽  
Pressure Time ◽  
Force Time

Background: Previous plantar pressure research found increased loads and slower loading response on the lateral aspect of the foot during gait with chronic ankle instability compared to healthy controls. The studies had subjects walking barefoot over a pressure mat and results have not been confirmed with an in-shoe plantar pressure system. Our purpose was to report in-shoe plantar pressure measures for chronic ankle instability subjects compared to healthy controls. Methods: Forty-nine subjects volunteered (25 healthy controls, 24 chronic ankle instability) for this case-control study. Subjects jogged continuously on a treadmill at 2.68 m/s (6.0 mph) while three trials of ten consecutive steps were recorded. Peak pressure, time-to-peak pressure, pressure-time integral, maximum force, time-to-maximum force, and force-time integral were assessed in nine regions of the foot with the Pedar-x in-shoe plantar pressure system (Novel, Munich, Germany). Results: Chronic ankle instability subjects demonstrated a slower loading response in the lateral rearfoot indicated by a longer time-to-peak pressure (16.5% ± 10.1, p = 0.001) and time-to-maximum force (16.8% ± 11.3, p = 0.001) compared to controls (6.5% ± 3.7 and 6.6% ± 5.5, respectively). In the lateral midfoot, ankle instability subjects demonstrated significantly greater maximum force (318.8 N ± 174.5, p = 0.008) and peak pressure (211.4 kPa ± 57.7, p = 0.008) compared to controls (191.6 N ± 74.5 and 161.3 kPa ± 54.7). Additionally, ankle instability subjects demonstrated significantly higher force-time integral (44.1 N/s ± 27.3, p = 0.005) and pressure-time integral (35.0 kPa/s ± 12.0, p = 0.005) compared to controls (23.3 N/s ± 10.9 and 24.5 kPa/s ± 9.5). In the lateral forefoot, ankle instability subjects demonstrated significantly greater maximum force (239.9N ± 81.2, p = 0.004), force-time integral (37.0 N/s ± 14.9, p = 0.003), and time-to-peak pressure (51.1% ± 10.9, p = 0.007) compared to controls (170.6 N ± 49.3, 24.3 N/s ± 7.2 and 43.8% ± 4.3). Conclusion: Using an in-shoe plantar pressure system, chronic ankle instability subjects had greater plantar pressures and forces in the lateral foot compared to controls during jogging. Clinical Relevance: These findings may have implications in the etiology and treatment of chronic ankle instability. Level of Evidence: III, Retrospective Case Control Study

The Effectiveness of Personalized Custom Insoles on Foot Loading Redistribution during Walking and Running

2020 ◽  
Vol 44 ◽  
pp. 1-8
Author(s):  
Yao Meng ◽  
Li Yang ◽  
Xin Yan Jiang ◽  
Bíró István ◽  
Yao Dong Gu
Keyword(s):  
Plantar Pressure ◽  
Peak Pressure ◽  
Young Males ◽  
Time Integral ◽  
Pressure Time ◽  
Mean Pressure ◽  
Pressure Maximum ◽  
Foot Loading ◽  
And Control ◽  
Better Than

The objective of this study was to investigate the effectiveness of different hardness of personalized custom insoles on plantar pressure redistribution in healthy young males during walking and running. Six males participated in the walking and running test (age: 24±1.6 years, weight: 67.9±3.6 kg, height: 175.5±4.7 cm). All subjects were instructed to walk and run along a 10m pathway wearing two different hardness insoles (i.e., hard custom insoles (CHI) and soft custom insole (CSI)) and control insole (CI) at their preferred speed. Peak pressure, mean pressure, maximum force, pressure-time integral were collected to analyze using SPSS. The plantar pressure of forefoot and medial midfoot were significantly increased and of lateral forefoot and lateral midfoot were decreased by both kinds of custom insoles in running tests. While the CHI significantly increased plantar pressure of the medial forefoot compared with the CSI and CI both in walking and running tests. The custom insoles showed significantly higher plantar pressure on medial midfoot. But CSI seems better than CHI because of redistributing the plantar pressure by increasing the plantar pressure of whole forefoot. Moreover, CSI showed significantly lower plantar pressure than CI and CHI at lateral midfoot during running test. The CHI causes significant high pressure at medial forefoot (MF), which may raise the risk of forefoot pain.

Effect of Static Foot Alignment on Plantar-Pressure Measures During Running

2012 ◽  
Vol 21 (2) ◽  
pp. 137-143 ◽  
Author(s):  
Sae Yong Lee ◽  
Jay Hertel
Keyword(s):  
Outcome Measures ◽  
Plantar Pressure ◽  
Weight Bearing ◽  
Maximum Pressure ◽  
Cross Sectional ◽  
Medial Side ◽  
Time Integral ◽  
Pressure Time ◽  
Significant Difference ◽  
Foot Alignment

Context:Altered foot dynamics due to malalignment of the foot may change plantar-pressure properties, resulting in various kinds of overuse injuries.Objective:To assess the effect of foot characteristics on plantar-pressure-related measures such as maximum pressure, maximum pressure–time, and pressure–time integral underneath the medial aspect of the foot during running.Design:Cross-sectional.Setting:Laboratory. Participants: 8 men and 17 women.Main Outcome Measures:Static non-weight-bearing rear-foot and forefoot alignment and navicular drop were measured. Plantar-pressure data were collected while subjects jogged at 2.6 m/s on a treadmill. Maximum pressure, time to maximum pressure, and pressure–time integral of the medial side of the foot were extracted for data analysis. Multiple-regression analysis was used to examine the effect of arch height and rear-foot and forefoot alignment on maximum pressure and pressure–time integral in the medial side of the foot.Results:In the medial rear-foot and midfoot regions, only rear-foot alignment had a significant effect on the variance of maximum pressure and pressure–time integral. There were no significant difference effects in the medial forefoot region.Conclusion:Rear-foot alignment was found to be a significant predictor of maximum plantar pressure and pressure–time integral in the medial rear-foot and midfoot regions. This indicates that control of rear-foot alignment may help decrease plantar pressure on the medial region of the foot, which may potentially prevent injuries associated with excessive rear-foot eversion.

The Effect of Toe Flexion Exercises on Grip

2018 ◽  
Vol 108 (5) ◽  
pp. 355-361 ◽  
Author(s):  
Helen Branthwaite ◽  
Gemma Grabtree ◽  
Nachiappan Chockalingam ◽  
Andrew Greenhalgh
Keyword(s):  
Contact Area ◽  
Plantar Pressure ◽  
Contact Time ◽  
Peak Pressure ◽  
Peak Force ◽  
Time Integral ◽  
Pressure Time ◽  
Flexor Muscles ◽  
Before And After ◽  
Force Contact

Background: Weakness of the toe flexor muscles has been attributed to the development of toe pathologies, and it responds well in the clinic to toe grip exercises. However, it is unknown whether exercising the toe flexor muscles improves the ability to grip and alter function. The aim of this study was to assess the effect of toe flexor exercises on apical plantar pressure, as a measure of grip, while seated and during gait. Methods: Twenty-three individuals with no known toe pathologies were recruited. Static peak pressure, time spent at peak pressure, and pressure-time integral while seated, as well as dynamic forefoot maximal force, contact area, and percentage contact time, were recorded before and after exercise. Toe grip exercises with a therapy ball were completed daily for 6 weeks. Results: Static peak pressure significantly increased after exercise on the apex of the second and third digits, as did the pressure-time integral. Dynamic peak force and contact area did not alter after exercise around the metatarsals and toes, yet percentage contact time significantly increased for each metatarsal after completing daily toe grip exercises. Conclusions: Exercises to improve the grip ability of the toes increased the static peak pressure on the apex of the second and third digits as well as the percentage contact time of the metatarsals during gait. The ability to increase apical peak pressure and contact time after exercises could assist in improving forefoot stability and gait efficiency and in reducing toe pathology progression.

Plantar Shear Stress Distribution in Patients with Rheumatoid Arthritis

2010 ◽  
Vol 100 (4) ◽  
pp. 265-269 ◽  
Author(s):  
Metin Yavuz ◽  
Elaine Husni ◽  
Georgeanne Botek ◽  
Brian L. Davis
Keyword(s):  
Rheumatoid Arthritis ◽  
Shear Stress ◽  
Plantar Pressure ◽  
Peak Pressure ◽  
Joint Inflammation ◽  
Shear Stresses ◽  
Vertical Loading ◽  
Time Integral ◽  
Pressure Profiles ◽  
Pressure Time

Background: Rheumatoid arthritis is an autoimmune disease that causes chronic, progressive joint inflammation; it commonly affects the joints of the feet. Biomechanical alterations and daily pain in the foot are the common outcomes of the disease. Earlier studies focusing on plantar pressure in such patients reported increased vertical loading along with peak pressure-pain associations. However, footwear designed according to the pressure profiles did not relieve symptoms effectively. We examined plantar shear and pressure distribution in patients with rheumatoid arthritis and compared the findings with those of controls, and we investigated a potential relationship between foot pain and local shear stresses. Methods: A custom-built platform was used to collect plantar pressure and shear stress data from nine patients with rheumatoid arthritis and 14 control participants. Seven patients reported the presence of pain under their feet. Pressure-time and shear-time integral values were also calculated. Results: Peak pressure, pressure-time integral, resultant shear-time integral, and mediolateral shear stress magnitudes were higher in the complication group (P &lt; .05). An association between peak shear-time integral and maximum pain locations was observed. Conclusions: Increased mediolateral shear stresses under the rheumatoid foot might be attributable to gait instability in such patients. A correlation between the locations of maximum shear-time integral and pain indicate the clinical significance of plantar shear in patients with rheumatoid arthritis. (J Am Podiatr Med Assoc 100(4): 265–269, 2010)

scholarly journals The Reduction of 1st Metatarsal Plantar Pressures With a Novel Offloading Device (the Mandakini) in a Singaporean Population

2021 ◽  
Author(s):  
Melissa Yan Ting Lee ◽  
Pui Wah Kong ◽  
Thanaporn Tunprasert
Keyword(s):  
Peak Pressure ◽  
Cost Effective ◽  
Target Population ◽  
Local Hospital ◽  
Plantar Pressures ◽  
Time Integral ◽  
Comfort Levels ◽  
Pressure Time ◽  
Significant Difference ◽  
Patients With Diabetes

Abstract AimsThere is an overall lack of affordable and accessible offloading modalities for diabetic foot ulceration. The Mandakini is a cheap offloading device made-up of gloves. This study aims to investigate its effectiveness in reducing plantar pressures compared to 7mm semi-compressed felt (SCF) and barefoot walking. Materials and methodsPlantar pressures of 30 healthy staff from a local hospital in Singapore were captured under three offloading conditions – the Mandakini, SCF and barefoot walking (control). Peak pressure (PP), pressure-time integral (PTI) and contact time (CT) at the 1st metatarsal and its surrounding regions were analysed. Participants rated their comfort levels in each condition on a visual analogue scale from 1 to 10.Results Statistically significant reductions in PP and PTI of 43 ± 12 kPa (14%) and 14 ± 4 kPa.s (16%) respectively were observed at the 1st metatarsal with the Mandakini compared to control (p=0.001, p=0.002). Reductions were however significantly lower than SCF which reduced PP and PTI by 83 ± 11 kPa (28%) and 28 ± 3 kPa.s (33%) respectively compared to control (p<0.001, p<0.001). No statistically significant difference in CT was observed with the Mandakini compared to control (p=0.499). Comfort levels were not significantly different between the Mandakini and SCF with means 5.7 ± 1.8 and 6.2 ± 2.1 respectively (p=0.257). Conclusion This study highlights the Mandakini’s potential in providing cost-effective offloading through pressure redistribution. Nonetheless, in barefoot conditions, SCF should remain the preferred modality. Future pressure studies on patients with diabetes will provide better representations of the Mandakini’s effectiveness on the target population.

scholarly journals The effects of different accumulated pressure-time integral stimuli on plantar blood flow in people with diabetes mellitus

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yijie Duan ◽  
Weiyan Ren ◽  
Liqiang Xu ◽  
Wenqiang Ye ◽  
Yih-Kuen Jan ◽  
...  
Keyword(s):  
Physical Activity ◽  
Diabetes Mellitus ◽  
Blood Flow ◽  
Repeated Measures ◽  
Weight Bearing ◽  
Similar Response ◽  
Doppler Flowmetry ◽  
Repeated Measures Design ◽  
Time Integral ◽  
Pressure Time

Abstract Background Exercise, especially weight-bearing exercise (e.g. walking), may affect plantar tissue viability due to prolonged repetitive high vertical and high shear pressure stimulus on the plantar tissue, and further induce development of diabetic foot ulcers (DFUs). This study aimed to investigate the effects of different accumulated pressure-time integral (APTI) stimuli induced by walking on plantar skin blood flow (SBF) responses in people with diabetes mellitus (DM). Methods A repeated measures design was used in this study. Two walking protocols (low APTI (73,000 kPa·s) and high APTI (73,000 × 1.5 kPa·s)) were randomly assigned to ten people with DM and twenty people without DM. The ratio of SBF measured by laser Doppler flowmetry after walking to that before (normalized SBF) was used to express the SBF responses. Results After low APTI, plantar SBF of people with DM showed a similar response to people without DM (P = 0.91). However, after high APTI, people with DM had a significantly lower plantar SBF compared to people without DM (P < 0.05). In people with DM, plantar SBF in the first 2 min after both APTI stimuli significantly decreased compared to plantar SBF before walking (P < 0.05). Conclusions People with DM had a normal SBF response after low APTI walking but had an impaired SBF response after high APTI walking, which suggests that they should avoid weight-bearing physical activity with intensity more than 73,000 kPa·s and should rest for more than 2 min after weight-bearing physical activity to allow a full vasodilatory response to reduce risk of DFUs.

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