scholarly journals Plantar Stresses on the Neuropathic Foot During Barefoot Walking

2008 ◽  
Vol 88 (11) ◽  
pp. 1375-1384 ◽  
Author(s):  
Michael J Mueller ◽  
Dequan Zou ◽  
Kathryn L Bohnert ◽  
Lori J Tuttle ◽  
David R Sinacore
Keyword(s):  
Diabetes Mellitus ◽  
Shear Stress ◽  
Peripheral Neuropathy ◽  
Pressure Gradient ◽  
Plantar Pressure ◽  
Peak Pressure ◽  
Control Group ◽  
Skin Breakdown ◽  
Plantar Ulcer ◽  
Peak Plantar Pressure

Background and PurposePatients 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.SubjectsTwenty-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.MethodsPlantar pressures were measured during barefoot walking using a pressure platform. Stress variables were estimated at the forefoot and the rear foot for all subjects.ResultsAll 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 (X̅±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 ConclusionsThese 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.

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 Plantar Pressure as a Risk Assessment Tool for Diabetic Foot Ulceration in Egyptian Patients with Diabetes

2014 ◽  
Vol 7 ◽  
pp. CMED.S17088 ◽  
Author(s):  
Olfat A. Fawzy ◽  
Asmaa I. Arafa ◽  
Mervat A. El Wakeel ◽  
Shaimaa H. Abdul Kareem
Keyword(s):  
Pressure Gradient ◽  
Plantar Pressure ◽  
Assessment Tool ◽  
Peak Pressure ◽  
Foot Deformity ◽  
Duration Of Diabetes ◽  
Significant Difference ◽  
Patients With Diabetes ◽  
Peak Plantar Pressure ◽  
History Of

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 (HbAz1c) (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, glcemic 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.

Plantar Loading Asymmetry in American Indians with Diabetes and Peripheral Neuropathy, with Diabetes Only, and Without Diabetes

2013 ◽  
Vol 103 (2) ◽  
pp. 106-112 ◽  
Author(s):  
Thomas W. Kernozek ◽  
John F. Greany ◽  
Cassandra Heizler
Keyword(s):  
Peripheral Neuropathy ◽  
American Indians ◽  
Plantar Pressure ◽  
Control Group ◽  
Convenience Sample ◽  
Significant Peak ◽  
The Third ◽  
Time Integral ◽  
Pressure Time ◽  
Peak Plantar Pressure

Background: We investigated plantar loading asymmetry during gait in American Indians with and without diabetes and with diabetes and peripheral neuropathy. Methods: A convenience sample of 96 American Indians with and without diabetes was divided into three groups: 20 with diabetes and peripheral neuropathy, 16 with diabetes without peripheral neuropathy, and 60 with no history of diabetes (control group). Plantar loading was measured during barefoot walking across a pressure platform. Five trials were collected per foot during level walking at a self-selected speed using the two-step method. Asymmetry in peak pressure-time integral and peak plantar pressure were calculated from ten plantar regions and compared among groups. Results: Significant pressure-time integral asymmetry occurred across the forefoot regions in American Indians with diabetes and peripheral neuropathy compared with the other two groups. Significant peak plantar pressure asymmetry occurred in the third metatarsal region in both groups with diabetes (with and without peripheral neuropathy) compared with the control group. Conclusions: Overall, American Indians with diabetes seemed to show greater asymmetry in plantar loading variables across the forefoot region compared with those in the control group. Specifically, individuals with diabetes and peripheral neuropathy had the greatest amount of forefoot pressure-time integral asymmetry. Significant peak plantar pressure asymmetry occurred in the third metatarsal region of the forefoot in those with diabetes with and without peripheral neuropathy. Loading asymmetry may play a role in the development of foot ulcers in the forefoot region of American Indians with peripheral neuropathy and diabetes. (J Am Podiatr Med Assoc 103(2): 106–112, 2013)

Comparison of Peak Plantar Pressure and Peak Pressure Gradient among Patients with Prediabetes and Diabetes

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 40-LB
Author(s):  
KENNETH IZUORA ◽  
MOHAMED TRABIA ◽  
JESSICA DEBERARDINIS ◽  
DANIEL E. LIDSTONE ◽  
MATHEW SUNIL VARRE ◽  
...  
Keyword(s):  
Pressure Gradient ◽  
Plantar Pressure ◽  
Peak Pressure ◽  
Peak Plantar Pressure

scholarly journals The Influence of Diabetic Foot Exercise in Sensory Peripheral Neuropathy with Monofilament Test on Diabetes Mellitus Clients

Jurnal NERS ◽  
2020 ◽  
Vol 14 (3) ◽  
pp. 340
Author(s):  
Tintin Sukartini ◽  
Candra Panji Asmoro ◽  
Nandani Alifah
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Neuropathy ◽  
Treatment Group ◽  
Diabetic Foot ◽  
Rank Test ◽  
Control Group ◽  
Sensory Peripheral Neuropathy ◽  
Signed Rank ◽  
Wilcoxon Signed Rank Test ◽  
Signed Rank Test

Background: Peripheral neuropathy is a long-term complication that attacks the nerves and loses the sensation of protection which affects about 50% of people with diabetes mellitus (DM). Diabetic foot exercises can help blood circulation, especially in the legs or lower limbs. This researched aimed to analyze the effect of diabetic foot exercise on sensory peripheral neuropathy in DM clients.Method: The study design used quasi-experimental pre-post test with control group. Samples were 28 respondents using purposive sampling and divided into two groups of 14 respondents each. The independent variable is diabetic foot training, and the dependent variable is peripheral sensory neuropathy. Interventions are carried out 3 times a week for 4 weeks. The research instrument was Weinstein Monofilament 10 g Semmes and a diabetic foot training checklist. Data analysis using the Wilcoxon-signed rank test and Mann Whitney test with α≤0.05.Result: The Wilcoxon-signed rank test in the treatment group showed differences in sensory peripheral neuropathy after treatment (p=0,000) and no difference in the control group (p=0.564). The Mann Whitney test results showed differences in sensory peripheral neuropathy between the treatment group and the control group after treatment p=0.039.Conclusion: Diabetic foot exercises can be used as an alternative measure to improve sensory peripheral neuropathy.

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.

Timing of peak plantar pressure during the stance phase of walking. A study of patients with diabetes mellitus and transmetatarsal amputation

2000 ◽  
Vol 90 (1) ◽  
pp. 18-23 ◽  
Author(s):  
VE Kelly ◽  
MJ Mueller ◽  
DR Sinacore
Keyword(s):  
Diabetes Mellitus ◽  
Stance Phase ◽  
Plantar Pressures ◽  
Skin Breakdown ◽  
Patients With Diabetes ◽  
Peak Plantar Pressure ◽  
Transmetatarsal Amputation ◽  
Footwear Design ◽  
Neuropathic Foot ◽  
Improved Methods

High plantar pressures contribute to skin breakdown in patients with diabetes mellitus and peripheral neuropathy. The primary purpose of this study was to determine the point during the stance phase of walking that corresponds with forefoot peak plantar pressures. Results indicate that peak plantar pressures occurred at 80% +/- 5% of the stance phase of gait in subjects with diabetes and transmetatarsal amputation, as well as in control subjects. Improved methods of footwear design or walking strategies proposed to patients should focus on the demands of the foot during the late stance phase of walking in order to increase available weightbearing area or to decrease forces, which will minimize plantar pressures and reduce trauma to the neuropathic foot.

Effect of Metatarsal Pad Placement on Plantar Pressure in People with Diabetes Mellitus and Peripheral Neuropathy

2007 ◽  
Vol 28 (1) ◽  
pp. 84-88 ◽  
Author(s):  
Mary K. Hastings ◽  
Michael J. Mueller ◽  
Thomas K. Pilgram ◽  
Donovan J. Lott ◽  
Paul K. Commean ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Neuropathy ◽  
Plantar Pressure

scholarly journals Do Strike Patterns or Shoe Conditions Have a Predominant Influence on Foot Loading?

2018 ◽  
Vol 64 (1) ◽  
pp. 13-23 ◽  
Author(s):  
Xiaole Sun ◽  
Yang Yang ◽  
Lin Wang ◽  
Xini Zhang ◽  
Weijie Fu
Keyword(s):  
Plantar Pressure ◽  
Loading Rate ◽  
Peak Pressure ◽  
Impact Force ◽  
Pressure System ◽  
Risk Of Injury ◽  
Maximum Loading ◽  
Peak Plantar Pressure ◽  
Foot Loading ◽  
The Impact

Abstract This study aimed to explore the effects of strike patterns and shoe conditions on foot loading during running. Twelve male runners were required to run under shoe (SR) and barefoot conditions (BR) with forefoot (FFS) and rearfoot strike patterns (RFS). Kistler force plates and the Medilogic insole plantar pressure system were used to collect kinetic data. SR with RFS significantly reduced the maximum loading rate, whereas SR with FFS significantly increased the maximum push-off force compared to BR. Plantar pressure variables were more influenced by the strike patterns (15 out of 18 variables) than shoe conditions (7 out of 18 variables). The peak pressure of midfoot and heel regions was significantly increased in RFS, but appeared in a later time compared to FFS. The influence of strike patterns on running, particularly on plantar pressure characteristics, was more significant than that of shoe conditions. Heel-toe running caused a significant impact force on the heel, whereas wearing cushioned shoes significantly reduced the maximum loading rate. FFS running can prevent the impact caused by RFS. However, peak plantar pressure was centered at the forefoot for a long period, thereby inducing a potential risk of injury in the metatarsus/phalanx.

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