Effect of Weight-bearing Pattern and Calcaneal Taping on Heel Width and Plantar Pressure in Standing

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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Dynamic Pedobarography Shows Pain Avoidance Gait of Symptomatic Severe Flatfoot Patient

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00010 ◽

2018 ◽

Vol 3 (2) ◽

pp. 2473011418S0001

Author(s):

Woo-Chun Lee ◽

Chihoon Ahn ◽

Ji-Beom Kim ◽

Mu Hyun Kim

Keyword(s):

Plantar Pressure ◽

Weight Bearing ◽

Metatarsal Head ◽

Assessment System ◽

Medial Longitudinal Arch ◽

Head Elevation ◽

Radiographic Parameters ◽

Longitudinal Arch ◽

Bearing Load ◽

The Mean

Category: Basic Sciences/Biologics, Midfoot/Forefoot Introduction/Purpose: In the flatfoot patients, collapsed medial longitudinal arch during gait induced pain and it results decreased center of progression excursion index(CPEI) in dynamic pedobarography. Although the CPEI decreased is pathologic gait of flatfoot patients, range of the CPEIs is wide even in similar severity of flatfoot patients. We hypothesized that some flatfoot patients inverted forefoot or elevated first metatarsal head during gait for avoiding the pain from collapsed medial longitudinal arch, which resulted wide range of the CPEIs in flatfoot patients. The purposes of this study were to investigate the incidence of forefoot inversion and 1st metatarsal head elevation during gait in severe symptomatic flatfoot patients, and to confirm whether forefoot inversion and 1st metatarsal head elevation increases the CPEI, by using the dynamic pedobarography. Methods: We retrospectively evaluated patients who underwent surgery for flatfoot in our clinic from January, 2017 to May, 2017. Before surgery, all patients underwent plain weight-bearing radiographs and dynamic pedobarography by using in-shoe plantar pressure assessment system (Tekscan, Inc., South Boston, MA). Radiographic parameters, talonavicular coverage angle, Meary angle and moment arm, and the CPEI in dynamic pedobarogrpahy were measured. The forefoot inversion and the 1st metatarsal head elevation were defined when sum of 3rd-4th and 5th submetatarsal plantar pressure was higher than sum of 1st and 2nd submetatarsal plantar pressure, and when 2nd submetatarsal plantar pressure was higher than 1st submetatarsal plantar pressure, respectively. Correlations between the radiographic parameters and the CPEI were investigated. Incidence of the forefoot inversion and the 1st metatarsal head elevation was investigated. The CPEIs in flatfeet with forefoot inversion or 1st metatarsal head elevation were compared with those in flatfeet without these pain avoidance gait. Results: Twenty-eight flatfeet from 28 patients were included in the present study. The average age of patients was 42.3 years (range: 19-71). Means of the three radiographic parameters and the CPEI of the 28 flatfeet were listed at table.1. There was no significant correlation between the CPEI and the three radiographic parameters.(Table.2) The incidence of forefoot inversion and 1st metatarsal head elevation were 11%(3 feet), 54%(15 feet) respectively. The mean CPEI of the flatfeet with forefoot inversion or 1st metatarsal head elevation was 8(range: -10 – 18), and the mean CPEI of the flatfeet without these two compensations was 5 (range: -3 – 12). The CPEI in the flatfeet with the two compensations was significant larger than that of the flatfeet without the two compensations. (P=0.027) Conclusion: In the present study, forefoot inversion or 1st metatarsal head elevation were happened in 65% of symptomatic flatfoot patients. These two pain avoidance gait shifts weight-bearing load laterally, which decreases collapsing medial longitudinal arch and pain on the flatfoot. Because lateral shifting of weight-bearing load increases the CPEI, flatfoot patients with these two gaits showed high the CPEI. Therefore, the degree of the CPEIs are various even in similar severity of flatfoot and are not correlated with the severity of the flatfoot. Clinicians should consider these pain avoidance gait of flatfoot patients when they interpret a dynamic pedobarography of flatfoot.

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Differentiating Sitting, Standing, and Walking Through Regional Plantar Pressure Characteristics

Journal of Biomechanical Engineering ◽

10.1115/1.4045049 ◽

2019 ◽

Vol 142 (4) ◽

Cited By ~ 2

Author(s):

Kohle Merry ◽

Megan MacPherson ◽

Evan Macdonald ◽

Michael Ryan ◽

Edward J. Park ◽

...

Keyword(s):

Plantar Pressure ◽

Repeated Measures ◽

Weight Bearing ◽

Heel Pain ◽

Average Pressure ◽

Sedentary Behaviors ◽

Plantar Heel Pain ◽

Measurement Tools ◽

Pressure Peak ◽

Foot Function

Abstract Prolonged static weight bearing (WBR) is thought to aggravate plantar heel pain and is common in the workplace, which may put employees at greater risk of developing plantar heel pain. However, objective measures of physical activity and sedentary behaviors in the workplace are lacking, making it difficult to establish or refute the connection between work exposure and plantar heel pain. Characterizing loading patterns during common workplace postures will enhance the understanding of foot function and inform the development of new measurement tools. Plantar pressure data during periods of sitting, standing, and walking were measured in ten healthy participants using the F-Scan in-shoe measurement system (Tekscan Inc, Boston, MA). Peak and average pressure, peak and average contact area, and average pressure differential were analyzed in ten different regions of the foot. A two-way repeated measures analysis of variance (ANOVA) assessed the posture by foot region interaction for each measurement parameter; significant effects of posture by foot region were identified for all five measurement parameters. Ten foot region by measurement parameter combinations were found to significantly differentiate all three postures simultaneously; seven used pressure measures to differentiate while three used area measures. The heel, lateral midfoot (LM), and medial and central forefoot (CFF) encompassed nine of ten areas capable of differentiating all postures simultaneously. This work demonstrates that plantar pressure is a viable means to characterize and differentiate three common workplace postures. The results of this study can inform the development of measurement tools for quantifying posture duration at work.

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Effects of weight-bearing exercise on a mini-trampoline on foot mobility, plantar pressure and sensation of diabetic neuropathic feet; a preliminary study

Diabetic Foot & Ankle ◽

10.1080/2000625x.2017.1287239 ◽

2017 ◽

Vol 8 (1) ◽

pp. 1287239 ◽

Cited By ~ 9

Author(s):

Wararom Kanchanasamut ◽

Praneet Pensri

Keyword(s):

Plantar Pressure ◽

Weight Bearing ◽

Preliminary Study ◽

Foot Mobility

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Plantar Pressure Reduction in an Incremental Weight-Bearing System

Physical Therapy ◽

10.1093/ptj/77.4.410 ◽

1997 ◽

Vol 77 (4) ◽

pp. 410-416 ◽

Cited By ~ 19

Author(s):

Timothy W Flynn ◽

Paul K Canavan ◽

Peter R Cavanagh ◽

Jin-Hsien Chiang

Keyword(s):

Plantar Pressure ◽

Weight Bearing ◽

Pressure Reduction ◽

Bearing System

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Use of Plantar Pressure Sensors to Take Weight-Bearing Foot Casts

Sensors ◽

10.3390/s21227476 ◽

2021 ◽

Vol 21 (22) ◽

pp. 7476

Author(s):

Enrique Panera-Rico ◽

José Manuel Castillo-López ◽

Inmaculada Concepción Palomo-Toucedo ◽

Fernando Chacón-Giráldez ◽

Javier Ramos-Ortega ◽

...

Keyword(s):

Plantar Pressure ◽

Weight Bearing ◽

Pressure Sensors ◽

P Values ◽

Symmetry Index ◽

The Subject

Techniques of taking casts mainly rely not on the objectivity of the procedure, but on the experience and skill of the technician. The aim of this study was to demonstrate the efficiency of a technique of taking standing foot casts controlled via pressure sensors. In this way, we mean to objectivize the degree of correction. The study was carried out through 150 procedures on 50 feet of 29 patients. The value of the “Heel Symmetry Index” was calculated on three casts in three different situations of the same foot: A first cast in which the subject did not control the position of his/her foot; a second cast where manipulations corrected the foot’s pronator position; and a third cast with pressure sensors placed in the subject’s heel. This enabled the control and quantification of the pressure during the manipulation when taking the cast. The comparison of the “Heel Symmetry Index” in the different groups showed significant p-values of 0.05. Conclusion: The technique of taking casts controlled by pressure sensors achieved more equilibrated casts with a better symmetry index of the heel’s outline.

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Analysis of Clinical Profiles, Deformities, and Plantar Pressure Patterns in Diabetic Foot Syndrome

Applied Sciences ◽

10.3390/app112311464 ◽

2021 ◽

Vol 11 (23) ◽

pp. 11464

Author(s):

Claudia Giacomozzi ◽

Giada Lullini ◽

Alberto Leardini ◽

Paolo Caravaggi ◽

Maurizio Ortolani ◽

...

Keyword(s):

Diabetic Foot ◽

Plantar Pressure ◽

Weight Bearing ◽

Descriptive Analysis ◽

Biomechanical Analysis ◽

Diabetic Foot Syndrome ◽

Foot Bones ◽

Patients With Diabetes ◽

Ct Analysis

Diabetic foot syndrome refers to heterogeneous clinical and biomechanical profiles, which render predictive models unsatisfactory. A valuable contribution may derive from identification and descriptive analysis of well-defined subgroups of patients. Clinics, biology, function, gait analysis, and plantar pressure variables were assessed in 78 patients with diabetes. In 15 of them, the 3D architecture of the foot bones was characterized by using weight-bearing CT. Patients were grouped by diabetes type (T1, T2), presence (DN) or absence (DNN) of neuropathy, and obesity. Glycated hemoglobin (HbA1c) and plantar lesions were monitored during a 48-month follow-up. Statistical analysis showed significant differences between the groups for at least one clinical (combined neuropathy score, disease duration, HbA1c), biological (age, BMI), functional (joint mobility, foot alignment), or biomechanical (regional peak pressure, pressure-time integral, cadence, velocity) variable. Twelve patients ulcerated during follow-up (22 lesions in total), distributed in all groups but not in the DNN T2 non-obese group. These showed biomechanical alterations, not always occurring at the site of lesion, and HbA1c and neuropathy scores higher than the expected range. Three of them, who also had weight-bearing CT analysis, showed >40% of architecture parameters outside the 95%CI. Appropriate grouping and profiling of patients based on multi-instrumental clinical and biomechanical analysis may help improve prediction modelling and management of diabetic foot syndrome.

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The effect of partial weight bearing in a walking boot on plantar pressure distribution and center of pressure

Gait & Posture ◽

10.1016/j.gaitpost.2012.04.015 ◽

2012 ◽

Vol 36 (3) ◽

pp. 646-649 ◽

Cited By ~ 7

Author(s):

Kylee North ◽

Michael Q. Potter ◽

Erik N. Kubiak ◽

Stacy J. Morris Bamberg ◽

Robert W. Hitchcock

Keyword(s):

Pressure Distribution ◽

Plantar Pressure ◽

Center Of Pressure ◽

Weight Bearing ◽

Partial Weight Bearing ◽

Plantar Pressure Distribution ◽

Partial Weight

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The Role of Foot-Loading Factors and Their Associations with Ulcer Development and Ulcer Healing in People with Diabetes: A Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm9113591 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3591

Author(s):

Chantal M. Hulshof ◽

Jaap J. van Netten ◽

Mirjam Pijnappels ◽

Sicco A. Bus

Keyword(s):

Ulcer Healing ◽

Plantar Pressure ◽

Lower Risk ◽

Weight Bearing ◽

The Other ◽

Preventative Treatment ◽

Comprehensive Investigation ◽

Foot Loading ◽

Quality Evidence

We aimed to comprehensively and systematically review studies associating key foot-loading factors (i.e., plantar pressure, weight-bearing activity, adherence or a combination thereof) with ulcer development and ulcer healing in people with diabetes. A systematic literature search was performed in PubMed and EMBASE. We included studies if barefoot or in-shoe plantar pressure, weight-bearing activity or footwear or device adherence was measured and associated with either ulcer development or ulcer healing in people with diabetes. Out of 1954 records, 36 studies were included and qualitatively analyzed. We found low to moderate quality evidence that lower barefoot plantar pressure and higher footwear and device adherence associate with lower risk of ulcer development and shorter healing times. For the other foot-loading factors, we found low quality evidence with limited or contradictory results. For combined measures of foot-loading factors, we found low quality evidence suggesting that lower cumulative plantar tissue stress is associated with lower risk of ulcer development and higher ulcer healing incidence. We conclude that evidence for barefoot plantar pressure and adherence in association with ulcer outcome is present, but is limited for the other foot-loading factors. More comprehensive investigation in particularly the combination of foot-loading factors may improve the evidence and targeting preventative treatment.

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Effects of various walking intensities on leg muscle fatigue and plantar pressure distributions

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04705-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Chi-Wen Lung ◽

Ben-Yi Liau ◽

Joseph A. Peters ◽

Li He ◽

Runnell Townsend ◽

...

Keyword(s):

Muscle Fatigue ◽

Plantar Pressure ◽

Walking Speed ◽

Weight Bearing ◽

Metatarsal Head ◽

Multiscale Entropy ◽

Median Frequency ◽

Brisk Walking ◽

First Metatarsal ◽

Leg Muscle

Abstract Background Physical activity may benefit health and reduce risk for chronic complications in normal and people with diabetes and peripheral vascular diseases. However, it is unclear whether leg muscle fatigue after weight-bearing physical activities, such as brisk walking, may increase risk for plantar tissue injury. In the literature, there is no evidence on the effect of muscle fatigue on plantar pressure after various walking intensities. The objectives of this study were to investigate the effects of various walking intensities on leg muscle fatigue and plantar pressure patterns. Methods A 3 × 2 factorial design, including 3 walking speeds (1.8 (slow and normal walking), 3.6 (brisk walking), and 5.4 (slow running) mph) and 2 walking durations (10 and 20 min) for a total of 6 walking intensities, was tested in 12 healthy participants in 3 consecutive weeks. The median frequency and complexity of electromyographic (EMG) signals of tibialis anterior (TA) and gastrocnemius medialis (GM) were used to quantify muscle fatigue. Fourier transform was used to compute the median frequency and multiscale entropy was used to calculate complexity of EMG signals. Peak plantar pressure (PPP) values at the 4 plantar regions (big toe, first metatarsal head, second metatarsal head, and heel) were calculated. Results Two-way ANOVA showed that the walking speed (at 1.8, 3.6, 5.4 mph) significantly affected leg muscle fatigue, and the duration factor (at 10 and 20 min) did not. The one-way ANOVA showed that there were four significant pairwise differences of the median frequency of TA, including walking speed of 1.8 and 3.6 mph (185.7 ± 6.1 vs. 164.9 ± 3.0 Hz, P = 0.006) and 1.8 and 5.4 mph (185.7 ± 6.1 vs. 164.5 ± 5.5 Hz, P = 0.006) for the 10-min duration; and walking speed of 1.8 and 3.6 mph (180.0 ± 5.9 vs. 163.1 ± 4.4 Hz, P = 0.024) and 1.8 and 5.4 mph (180.0 ± 5.9 vs. 162.8 ± 4.9 Hz, P = 0.023) for the 20-min duration. The complexity of TA showed a similar trend with the median frequency of TA. The median frequency of TA has a significant negative correlation with PPP on the big toe ( r = -0.954, P = 0.003) and the first metatarsal head ( r = -0.896, P = 0.016). Conclusions This study demonstrated that brisk walking and slow running speeds (3.6 and 5.4 mph) cause an increase in muscle fatigue of TA compared to slow walking speed (1.8 mph); and the increased muscle fatigue is significantly related to a higher PPP.

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