A Longitudinal Investigation into the Functional and Physical Durability of Insoles Used for the Preventive Management of Neuropathic Diabetic Feet

2014 ◽  
Vol 104 (1) ◽  
pp. 50-57 ◽  
Author(s):  
Joanne S. Paton ◽  
Elizabeth Stenhouse ◽  
Graham Bruce ◽  
Ray Jones
Keyword(s):  
Pressure Measurement ◽  
Peak Pressure ◽  
Functional Performance ◽  
Metatarsal Head ◽  
First Metatarsal ◽  
Longitudinal Investigation ◽  
Significant Difference ◽  
Foot Lesions ◽  
Neuropathic Foot ◽  
Pressure Measurement System

Background Insoles are commonly used to assist in the prevention of diabetic neuropathic foot ulceration. Insole replacement is often triggered only when foot lesions deteriorate, an indicator that functional performance is comprised and patients are exposed to unnecessary ulcer risk. We investigated the durability of insoles used for ulcer prevention in neuropathic diabetic feet over 12 months. Methods Sixty neuropathic individuals with diabetes were provided with insoles and footwear. Insole durability over 12 months was evaluated using an in-shoe pressure measurement device and through repeated measurement of material depth at the first metatarsal head and the heel seat. Analysis of variance was performed to assess change across time (at issue, 6 months, and 12 months). Results Analyses were conducted using all available data (n = 43) and compliant data (n = 18). No significant difference was found in the reduction of mean peak pressure tested across time (P < .05). For both sites, significant differences in insole depth were identified between issue and 6 months and between issue and 12 months but not between 6 and 12 months (P < .05). Most insole compression occurred during the initial 6 months. Conclusions Visual material compression does not seem to be a reliable indicator of insole usefulness. Frequency of insole replacement is best informed by a functional review of effect determined using an in-shoe pressure measurement system. These results suggest that insoles for diabetic neuropathic patients can be effective in maintaining peak pressure reduction for 12 months regardless of wear frequency.

The effects of increasing heel height on forefoot peak pressure

1999 ◽  
Vol 89 (2) ◽  
pp. 75-80 ◽  
Author(s):  
MG Mandato ◽  
E Nester
Keyword(s):  
Measurement System ◽  
Pressure Measurement ◽  
Peak Pressure ◽  
First Metatarsal ◽  
Heel Height ◽  
Peak Pressures ◽  
Pressure Measurement System

The purpose of this study was to determine the effect of increasing heel height on peak forefoot pressure. Thirty-five women were examined while wearing sneakers and shoes with 2-inch and 3-inch heels. An in-shoe pressure-measurement system was used to document the magnitude and location of plantar peak pressures. Pressure under the forefoot was found to increase significantly with increasing heel height. As the heel height increased, the peak pressure shifted toward the first metatarsal and the hallux. The reproducibility of data obtained with the in-shoe pressure-measurement system was tested in five subjects; the data were found to be reproducible to within approximately 3% of measured pressures.

Radiographic Measurements of the Affected and Unaffected Feet in Patients with Unilateral Hallux Limitus

2016 ◽  
Vol 106 (3) ◽  
pp. 172-181
Author(s):  
Andrew F. Knox ◽  
Alan R. Bryant
Keyword(s):  
Metatarsal Head ◽  
Radiographic Evaluation ◽  
Head Shape ◽  
Intrinsic Factors ◽  
Hallux Limitus ◽  
First Metatarsal ◽  
Radiographic Measurements ◽  
Angle Data ◽  
Significant Difference ◽  
First Ray

Background: Controversy exists regarding the structural and functional causes of hallux limitus, including metatarsus primus elevatus, a long first metatarsal, first-ray hypermobility, the shape of the first metatarsal head, and the presence of hallux interphalangeus. Some articles have reported on the radiographic evaluation of these measurements in feet affected by hallux limitus, but no study has directly compared the affected and unaffected feet in patients with unilateral hallux limitus. This case-control pilot study aimed to establish whether any such differences exist. Methods: Dorsoplantar and lateral weightbearing radiographs of both feet in 30 patients with unilateral hallux limitus were assessed for grade of disease, lateral intermetatarsal angle, metatarsal protrusion distance, plantar gapping at the first metatarsocuneiform joint, metatarsal head shape, and hallux abductus interphalangeus angle. Data analysis was performed using a statistical software program. Results: Mean radiographic measurements for affected and unaffected feet demonstrated that metatarsus primus elevatus, a short first metatarsal, first-ray hypermobility, a flat metatarsal head shape, and hallux interphalangeus were prevalent in both feet. There was no statistically significant difference between feet for any of the radiographic parameters measured (Mann-Whitney U tests, independent-samples t tests, and Pearson χ2 tests: P > .05). Conclusions: No significant differences exist in the presence of the structural risk factors examined between affected and unaffected feet in patients with unilateral hallux limitus. The influence of other intrinsic factors, including footedness and family history, should be investigated further.

First Metatarsal Head and Medial Eminence Widths with and Without Hallux Valgus

2016 ◽  
Vol 106 (5) ◽  
pp. 323-327 ◽  
Author(s):  
Robin C. Lenz ◽  
Darshan Nagesh ◽  
Hannah K. Park ◽  
John Grady
Keyword(s):  
Hallux Valgus ◽  
Frontal Plane ◽  
Metatarsal Head ◽  
Head Width ◽  
Plane Rotation ◽  
First Metatarsal ◽  
Significant Difference ◽  
Medial Eminence ◽  
And Control

Background: Resection of the medial eminence in hallux valgus surgery is common. True hypertrophy of the medial eminence in hallux valgus is debated. No studies have compared metatarsal head width in patients with hallux valgus and control patients. Methods: We reviewed 43 radiographs with hallux valgus and 27 without hallux valgus. We measured medial eminence width, first metatarsal head width, and first metatarsal shaft width in patients with and without radiographic hallux valgus. Results: Medial eminence width was 1.12 mm larger in patients with hallux valgus (P < .0001). Metatarsal head width was 2.81 mm larger in patients with hallux valgus (P < .001). Metatarsal shaft width showed no significant difference (P = .63). Conclusions: Metatarsal head width and medial eminence width are significantly larger on anteroposterior weightbearing radiographs in patients with hallux valgus. However, frontal plane rotation of the first metatarsal likely accounts for this difference.

The Plantar Loading Variations to Uphill and Downhill Gradients During Treadmill Walking

2000 ◽  
Vol 21 (3) ◽  
pp. 227-231 ◽  
Author(s):  
John Grampp ◽  
John Willson ◽  
Thomas Kernozek
Keyword(s):  
Measurement System ◽  
Pressure Measurement ◽  
Peak Pressure ◽  
Treadmill Walking ◽  
Peak Force ◽  
Capacitive Sensors ◽  
Gradient Condition ◽  
Pressure Measurement System

The purpose of the study was to examine the plantar loading changes during 5 gradient conditions on a treadmill (−15%, −8.5%, Level, 8.5%, 15%) for 20 participants using the Pedar® in-shoe pressure measurement system. The measurement system uses EMED insoles, each consisting of 99 capacitive sensors, sampled at 50 Hz. Data was collected from the last 20 seconds at each gradient condition while participants walked. As the treadmill gradient increased, loading (peak pressure [PP] and peak force [PF]) increased in the hallux and 1st metatarsal regions and decreased in the heel region. With negative gradients, loading (PP and PF) increased in the heel region and decreased in the 4th and 5th metatarsal regions.

Reliability of an In-Shoe Pressure Measurement System During Treadmill Walking

1996 ◽  
Vol 17 (4) ◽  
pp. 204-209 ◽  
Author(s):  
T. W. Kernozek ◽  
E. E. LaMott ◽  
M. J. Dancisak
Keyword(s):  
Measurement System ◽  
Pressure Measurement ◽  
Peak Pressure ◽  
Measurement Techniques ◽  
Peak Force ◽  
Foot Pressure ◽  
Time Integral ◽  
Pressure Time ◽  
Force Time ◽  
Pressure Measurement System

We examined the reliability of in-shoe foot pressure measurement using the Pedar in-shoe pressure measurement system for 25 participants walking at treadmill speeds of 0.89, 1.12, and 1.34 meters/sec. The measurement system uses EMED insoles, which consist of 99 capacitive sensors, sampled at 50 Hz. Data were collected for 20 seconds at two separate times while participants walked at each gait speed. Differences in some of the loading variables across speed relative to the total foot and across the different anatomical regions were detected. Different anatomical regions of the foot were loaded differently with variations in walking speed. The results indicated the need to control speed when evaluating loading parameters using in-shoe pressure measurement techniques. Coefficients of reliability were calculated. Variables such as peak force for the total foot required two steps to achieve a coefficient of reliability of 0.98. To achieve excellent reliability (>0.90) in the peak force, force time integral, peak pressure, and pressure time integral across the total foot and the seven regions, a maximum of eight steps was needed. In general, timing variables, such as the instant of peak force and the instant of peak pressure, tended to be the least reliable measures.

scholarly journals Sex differences in pedobarographic findings and relationship between radiograph and pedobarograph measurements in young healthy adults

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Kyoung Min Lee ◽  
Seung Yeol Lee ◽  
Moon Seok Park ◽  
Ki Hyuk Sung ◽  
Seungbum Koo ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Peak Pressure ◽  
Metatarsal Head ◽  
Healthy Adults ◽  
Tissue Thickness ◽  
First Metatarsal ◽  
Time Integral ◽  
Soft Tissue Thickness ◽  
Metatarsal Angle ◽  
Pressure Time

Category: Basic Sciences/Biologics Introduction/Purpose: Although pedobarographic measurement is increasingly used for clinical and research purposes, relatively few published studies have investigated normative data. This study examined pedobarographic findings in young healthy adults with regard to sex-related differences and correlations among measurement indices. Methods: Twenty young healthy adults (mean age 22.4 years, SD 1.2 years; 10 males and 10 females) were included. Weightbearing anteroposterior and lateral foot radiographs were taken, and dynamic pedobarographic data during treadmill walking and maximum ankle dorsiflexion were obtained. AP talo-first metatarsal angle, naviculocuboid overlap, lateral talo-first metatarsal angle, and plantar soft tissue thickness were measured on foot radiographs. Pedobarographic data including peak pressure and pressure-time integral were measured on five plantar segments: medial forefoot (MFF), lateral forefoot (LFF), medial midfoot (MMF), lateral midfoot (LMF), and heel. Results: Male and female subjects significantly differed in BMI (p<0.001), AP talo-first metatarsal angle (p=0.018), soft tissue thickness under the metatarsal head (p=0.04) and calcaneal tuberosity (p<0.001), maximum dorsiflexion during stance phase (p=0.041), peak pressure on the MFF (p=0.005) and LFF (p=0.004), and pressure-time integral on the MFF (p=0.018) and heel (p=0.001). Maximum dorsiflexion demonstrated significant negative correlations with pressure-time integral on the MFF (r=-0.595, p=0.007) and total pressure-time integral (r=-0.492, p=0.032). Pressure-time integral varus/valgus index was significantly correlated with pressure-time integral forefoot/heel index (r=0.472, p=0.036). Conclusion: Sex-related differences in pedobarographic examination were observed. Achilles stretching exercise was considered to reduce foot pressures, and subtalar joint was hypothesized to play an important role in pressure distribution.

scholarly journals Vibration Preconditioning as a Method to Reduce Hyperemia Responses to Plantar Pressure-Induced Ischemia

2020 ◽  
Author(s):  
Hongmei Liu ◽  
Weiyan Ren ◽  
Yijie Duan ◽  
Wenqiang Ye ◽  
Yih-Kuen Jan ◽  
...  
Keyword(s):  
Healthy Subjects ◽  
Reactive Hyperemia ◽  
Test Group ◽  
Metatarsal Head ◽  
Constant Load ◽  
Foot Ulcers ◽  
First Metatarsal ◽  
Foot Lesions ◽  
The Right ◽  
Over Time

Abstract Background: One of the main causes for foot ulcers in diabetics is an excessive, constant load on the foot which over time leads to ischemia. The aim of this study is to explore whether vibration preconditioning can alleviate pressure-induced hyperemia responses in foot tissue.Methods: Fifteen healthy subjects were subjected to compression stimulation with or without vibration preconditioning, determined randomly. Skin blood flow and temperature were measured under the first metatarsal head of the right foot for each subject and compared across the test group.Results: The results showed that both test groups displayed a reactive hyperemia response, but the peak hyperemia was significantly decreased when vibration was used in combination with compression. In the group subjected to compression only (no vibration), the plantar skin temperature during the first minute after compression was significantly higher than the basal temperature, but this was not so when vibration was applied.Conclusions: The results of this study suggest that vibration preconditioning before the application of compression can decrease the degree of reactive hyperemia and alleviate pressure-induced ischemic damage. These findings may be used to develop methods to protect against pressure-induced foot lesions in diabetic people.

scholarly journals Influence of Cold Sensation on Plantar Tactile Sensation for Young Females

2021 ◽  
Author(s):  
Tianyi Wang ◽  
Shima Okada ◽  
Masaaki Makikawa ◽  
Masayuki Endo ◽  
Yuko Ohno
Keyword(s):  
Postural Control ◽  
Skin Temperature ◽  
Health Problem ◽  
Healthy Subjects ◽  
Metatarsal Head ◽  
Tactile Sensation ◽  
Cold Sensation ◽  
Young Females ◽  
First Metatarsal ◽  
Significant Difference

Cold sensation (CS) is a cold feeling on people’s hands or feet; this is a well-known health problem for young females. Plantar tactile sensation plays an important role in postural control and is affected by skin temperature. However, there is no research focusing on the relation between CS and plantar tactile sensation. In this study, we address the question of whether the CS influences plantar tactile sensation. 32 non cold sensation (Non-CS) and 31 cold sensation (CS) young females have participated in this research. A tactile sensation test was conducted at five plantar points (first and fifth toes, first and fifth metatarsal heads, and heel). Experimental results showed that although there was no significant difference at the first and fifth toes as well as the first metatarsal head and heel, the sensation threshold at the fifth metatarsal head for CS was lower than the Non-CS (21.61 ± 8.10 μm, 27.42 ± 11.02 μm respectively, p < 0.05).  It was concluded that plantar tactile sensation for young females with cold sensation was more sensitive compared to healthy subjects.

Plantar Pressure and Joint Motion After the Youngswick Procedure for Hallux Limitus

2004 ◽  
Vol 94 (1) ◽  
pp. 22-30 ◽  
Author(s):  
Alan R. Bryant ◽  
Paul Tinley ◽  
Joan H. Cole
Keyword(s):  
Pressure Distribution ◽  
Peak Pressure ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Joint Motion ◽  
First Metatarsophalangeal Joint ◽  
Hallux Limitus ◽  
First Metatarsal ◽  
Second Metatarsal

The effects of the Youngswick osteotomy on plantar peak pressure distribution in the forefoot are presented for 17 patients (23 feet) with mild-to-moderate hallux limitus deformity and 23 control subjects (23 feet). During 2 years of follow-up, the operation produced a significant increase in the range of dorsiflexion of the first metatarsophalangeal joint in these patients, reaching near-normal values. Preoperative and postoperative measurements, using a pressure-distribution measurement system, show that peak pressure beneath the hallux and the first metatarsal head remained unchanged. However, peak pressure was significantly increased beneath the second metatarsal head and decreased beneath the fifth metatarsal head. These findings suggest that the foot functioned in a less inverted manner postoperatively. Compared with normal feet, hallux limitus feet demonstrated significantly higher peak pressure beneath the fourth metatarsal head preoperatively and postoperatively. (J Am Podiatr Med Assoc 94(1): 22-30, 2004)

Length of the Sesamoids and Their Distance From the Metatarsophalangeal Joint Space in Feet With Incipient Hallux Limitus

2008 ◽  
Vol 98 (2) ◽  
pp. 123-129 ◽  
Author(s):  
Pedro V. Munuera ◽  
Gabriel Domínguez ◽  
Guillermo Lafuente
Keyword(s):  
Metatarsophalangeal Joint ◽  
Inverse Correlation ◽  
Metatarsal Head ◽  
Joint Space ◽  
Hallux Limitus ◽  
First Metatarsal ◽  
Significant Difference ◽  
Distal Edge ◽  
The Relationship ◽  
Moderate Inverse Correlation

Background: We designed this study to verify whether the sesamoids of the first metatarsal head are longer than normal in feet with incipient hallux limitus, and whether feet with incipient hallux limitus are in a more proximal than normal sesamoid position. Methods: In a sample of 183 dorsoplantar radiographs under weightbearing conditions (115 of normal feet and 68 of feet with slightly stiff hallux), measurements were made of the length of both the medial and the lateral sesamoids and of the distance between these bones to the distal edge of the first metatarsal head. These variables were compared between the normal and the hallux limitus feet. The relationship between these variables and the hallux dorsiflexion was also studied. Results: We found significant differences between the two types of foot in the medial and lateral sesamoid lengths, but no significant difference in the distance between the sesamoids to the distal edge of the first metatarsal. A poor-to-moderate inverse correlation was found between hallux dorsiflexion and medial sesamoid length and between hallux dorsiflexion and lateral sesamoid length. Conclusions: The length of the sesamoid bones of the first metatarsal head could be implicated in the development of the hallux limitus deformity. (J Am Podiatr Med Assoc 98(2): 123–129, 2008)

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