Plantar Pressures During Shod Gait in Diabetic Neuropathic Patients with and without a History of Plantar Ulceration

2009 ◽  
Vol 99 (4) ◽  
pp. 285-294 ◽  
Author(s):  
Isabel C. N. Sacco ◽  
Tatiana Almeida Bacarin ◽  
Maíra Grizzo Canettieri ◽  
Ewald M. Hennig
Keyword(s):  
Diabetic Neuropathy ◽  
Plantar Pressure ◽  
Clinical History ◽  
Control Group ◽  
Diabetic Patients ◽  
Plantar Pressures ◽  
Time Integral ◽  
Pressure Time ◽  
Plantar Ulcers ◽  
History Of

Background: Diabetic neuropathy leads to progressive loss of sensation, lower-limb distal muscle atrophy, autonomic impairment, and gait alterations that overload feet. This overload has been associated with plantar ulcers even with consistent daily use of shoes. We sought to investigate and compare the influence of diabetic neuropathy and plantar ulcers in the clinical history of diabetic neuropathic patients on plantar sensitivity, symptoms, and plantar pressure distribution during gait while patients wore their everyday shoes. Methods: Patients were categorized into three groups: a control group (CG; n = 15), diabetic patients with a history of neuropathic ulceration (DUG; n = 8), and diabetic patients without a history of ulceration (DG; n = 10). Plantar pressure variables were measured by Pedar System shoe insoles in five plantar regions during gait while patients wore their own shoes. Results: No statistical difference between neuropathic patients with and without a history of plantar ulcers was found in relation to symptoms, tactile sensitivity, and duration of diabetes. Diabetic patients without ulceration presented the lowest pressure–time integral under the heel (72.1 ± 16.1 kPa × sec; P = .0456). Diabetic patients with a history of ulceration presented a higher pressure–time integral at the midfoot compared to patients in the control group (59.6 ± 23.6 kPa × sec × 45.8 ± 10.4 kPa × sec; P = .099), and at the lateral forefoot compared to diabetic patients without ulceration (70.9 ± 17.7 kPa sec × 113.2 ± 61.1 kPa × sec, P = .0193). Diabetic patients with ulceration also presented the lowest weight load under the hallux (0.06 ± 0.02%, P = .0042). Conclusions: Although presenting a larger midfoot area, diabetic neuropathic patients presented greater pressure–time integrals and relative loads over this region. Diabetic patients with ulceration presented an altered dynamic plantar pressure pattern characterized by overload even when wearing daily shoes. Overload associated with a clinical history of plantar ulcers indicates future appearance of plantar ulcers. (J Am Podiatr Med Assoc 99(4): 285–294, 2009)

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)

Plantar Pressure Distribution Character of Diabetic Foot in Young Patients during Normal Gait

2011 ◽  
Vol 474-476 ◽  
pp. 1377-1379
Author(s):  
Ming Rong ◽  
Yao Dong Gu ◽  
Jian She Li
Keyword(s):  
Pressure Distribution ◽  
Diabetic Foot ◽  
Plantar Pressure ◽  
Young Patients ◽  
Control Group ◽  
The Novel ◽  
Time Integral ◽  
Normal Gait ◽  
Plantar Pressure Distribution ◽  
Pressure Time

This study aims to investigate and compare the influence of plantar loading variables during gait of patients with diabetic in young ages. Subjects were divided into the following two groups: diabetic foot, 56 subjects; control group, 52 subjects. Plantar pressure distribution was measured during barefoot gait using the Novel emed platform. Both midfoot and lateral forefoot regions’ peak pressure in the diabetic foot was higher than the normal foot. Also, diabetic foot group experienced significantly higher in pressure-time integral and contact time. Those variables provided an indication of plantar loading behavior over time, and other kinesiological factors like joint deformities and mobility can be investigated in further study.

scholarly journals Children with Obesity Experience Different Age-Related Changes in Plantar Pressure Distributions: A Follow-Up Study in China

2020 ◽  
Vol 17 (18) ◽  
pp. 6602
Author(s):  
Yihong Zhao ◽  
Debin Zheng ◽  
Shiyang Yan ◽  
Mengyuan Liu ◽  
Luming Yang
Keyword(s):  
Plantar Pressure ◽  
Obese Children ◽  
Plantar Pressures ◽  
Pressure Distributions ◽  
Time Integral ◽  
Age Related ◽  
Pressure Time ◽  
Key Factor ◽  
Z Scores

Age is a key factor in plantar pressure distributions during the development of obese children. However, the existing evidence for age-related plantar pressures of obese children is not sufficient to make clear how the plantar pressures would change with the increasing age. This study aimed to evaluate the plantar pressure redistributions of obese children after a three-year follow-up and to further compare these changes with normal-weighted children. Ten obese children and eleven normal-weighted counterparts were involved in this study. Plantar pressure measurements were undertaken using a Footscan® plantar pressure plate on two test sessions three years apart. Peak pressure, pressure-time integral, standard maximum force, and z-scores of these variables were analyzed. Loading transference analyses were applied to detect the different loading transferring mechanisms between obese and normal-weighted children. Significantly increased plantar pressures were observed at the lateral forefoot and midfoot for obese children, which gradually deviated from those of normal-weighted children over the 3 years. With the increasing age, obese children displayed a lateral loading shift at the forefoot in contrast to the normal-weighted. Early interventions are cautiously recommended for obese children before the plantar loading deviation gets worse as they grow older.

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)

The Influence of Running on Foot Posture and In-Shoe Plantar Pressures

2016 ◽  
Vol 106 (2) ◽  
pp. 109-115 ◽  
Author(s):  
María Bravo-Aguilar ◽  
Gabriel Gijón-Noguerón ◽  
Alejandro Luque-Suarez ◽  
Javier Abian-Vicen
Keyword(s):  
Heel Strike ◽  
Neutral Position ◽  
Training Time ◽  
Plantar Pressures ◽  
Time Integral ◽  
Pressure Time ◽  
Limb Injuries ◽  
Before And After ◽  
Foot Posture ◽  
The Mean

Background: Running can be considered a high-impact practice, and most people practicing continuous running experience lower-limb injuries. The aim of this study was to determine the influence of 45 min of running on foot posture and plantar pressures. Methods: The sample comprised 116 healthy adults (92 men and 24 women) with no foot-related injuries. The mean ± SD age of the participants was 28.31 ± 6.01 years; body mass index, 23.45 ± 1.96; and training time, 11.02 ± 4.22 h/wk. Outcome measures were collected before and after 45 min of running at an average speed of 12 km/h, and included the Foot Posture Index (FPI) and a baropodometric analysis. Results: The results show that foot posture can be modified after 45 min of running. The mean ± SD FPI changed from 6.15 ± 2.61 to 4.86 ± 2.65 (P < .001). Significant decreases in mean plantar pressures in the external, internal, rearfoot, and forefoot edges were found after 45 min of running. Peak plantar pressures in the forefoot decreased after running. The pressure-time integral decreased during the heel strike phase in the internal edge of the foot. In addition, a decrease was found in the pressure-time integral during the heel-off phase in the internal and rearfoot edges. Conclusions: The findings suggest that after 45 min of running, a pronated foot tends to change into a more neutral position, and decreased plantar pressures were found after the run.

scholarly journals Risk factors associated with peripheral neuropathy among diabetic individuals: a case control study

2021 ◽  
Vol 8 (2) ◽  
pp. 768
Author(s):  
Christa Kingston ◽  
Aravindan J. ◽  
Srikumar Walsalam
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Diabetic Neuropathy ◽  
Case Control Study ◽  
Case Control ◽  
Diabetic Patients ◽  
Factors Associated ◽  
History Of ◽  
Control Study

Background: Diabetic neuropathy is one among the most common complication in diabetes mellitus. Diabetic peripheral neuropathy hinders the quality of life causing morbidity and mortality. The purpose of this study was to find the risk factors associated with diabetic neuropathy.Methods: This case control study involved 100 diabetic patients attending the Dohnavur fellowship hospital, Dohnavur from October 2019 to March 2020. Sociodemographic profile and diabetic characteristics of the study group were obtained and analysed. Diagnosis of Diabetic Neuropathy was done by using the diagnostic method proposed by American Diabetic Association.Results: Of the total study population with mean age 59.43 years, 63% had family history of diabetes. Almost 70% had poor diabetic control. Statistically significant relationships were found between neuropathy and duration of diabetes, glycaemic control, history of hypertension, monofilament test and pinprick sensation.Conclusions: In this study, glycemic control, dyslipidemia and hypertension were modifiable risk factors for diabetic neuropathy. Early interventional programs to sensitize diabetics on these factors could improve the quality of life of Diabetic patients. 

Biomechanical Response to External Biofeedback During Functional Tasks in Individuals With Chronic Ankle Instability

2021 ◽  
Author(s):  
Danielle M. Torp ◽  
Abbey C. Thomas ◽  
Tricia Hubbard-Turner ◽  
Luke Donovan
Keyword(s):  
Real Time ◽  
Plantar Pressure ◽  
Ankle Instability ◽  
Static Balance ◽  
Eyes Closed ◽  
Visual Biofeedback ◽  
Time Integral ◽  
Pressure Time ◽  
Eyes Open ◽  
Functional Task

Context Altered biomechanics displayed by individuals with chronic ankle instability (CAI) is a possible cause of recurring injuries and posttraumatic osteoarthritis. Current interventions are unable to modify aberrant biomechanics, leading to research efforts to determine if real-time external biofeedback can result in changes. Objective To determine the real-time effects of visual and auditory biofeedback on functional-task biomechanics in individuals with CAI. Design Crossover study. Setting Laboratory. Patients or Other Participants Nineteen physically active adults with CAI (7 men, 12 women; age = 23.95 ± 5.52 years, height = 168.87 ± 6.94 cm, mass = 74.74 ± 15.41 kg). Intervention(s) Participants randomly performed single-limb static balance, step downs, lateral hops, and forward lunges during a baseline and 2 biofeedback conditions. Visual biofeedback was given through a crossline laser secured to the dorsum of the foot. Auditory biofeedback was given through a pressure sensor placed under the lateral foot and connected to a buzzer that elicited a noise when pressure exceeded the set threshold. Cues provided during the biofeedback conditions were used to promote proper biomechanics during each task. Main Outcome Measure(s) We measured the location of center-of-pressure (COP) data points during balance with eyes open and eyes closed for each condition. Plantar pressure in the lateral column of the foot during functional tasks was extracted. Secondary outcomes of interest were COP area and velocity, time to boundary during static balance, and additional plantar-pressure measures. Results Both biofeedback conditions reduced COP in the anterolateral quadrant while increasing COP in the posteromedial quadrant of the foot during eyes-open balance. Visual biofeedback increased lateral heel pressure and the lateral heel and midfoot pressure-time integral during hops. The auditory condition produced similar changes during the eyes-closed trials. Auditory biofeedback increased heel pressure during step downs and decreased the lateral forefoot pressure-time integral during lunges. Conclusions Real-time improvements in balance strategies were observed during both external biofeedback conditions. Visual and auditory biofeedback appeared to effectively moderate different functional-task biomechanics.

scholarly journals Effectiveness of Deep Dry Needling vs Ischemic Compression in the Latent Myofascial Trigger Points of the Shortened Triceps Surae from Triathletes on Ankle Dorsiflexion, Dynamic, and Static Plantar Pressure Distribution: A Clinical Trial

Pain Medicine ◽  
2019 ◽  
Vol 21 (2) ◽  
pp. e172-e181 ◽  
Author(s):  
María Benito-de-Pedro ◽  
Ricardo Becerro-de-Bengoa-Vallejo ◽  
Marta Elena Losa-Iglesias ◽  
David Rodríguez-Sanz ◽  
Daniel López-López ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Plantar Pressure ◽  
Ankle Dorsiflexion ◽  
Triceps Surae ◽  
Control Group ◽  
Single Session ◽  
Dry Needling ◽  
Myofascial Trigger Points ◽  
Plantar Pressures ◽  
Before And After

Abstract Objective To determine the immediate efficacy of a single session of deep dry needling (DDN) vs ischemic compression (ICT) in a latent myofascial trigger point (MTrP) of the shortened triceps surae from triathletes for ankle dorsiflexion and redistribution of plantar pressures and stability. Design A randomized simple blind clinical trial (NCT03273985). Setting An outpatient clinic. Subjects Thirty-four triathletes with a latent MTrP in the shortened gastrocnemius. Methods Triathletes were randomized to receive a single session of DDN (N = 17) or ICT (N = 17) in a latent MTrP of the shortened triceps surae. The primary outcome was ankle dorsiflexion range of motion (ROM) by a universal goniometer. Secondary objectives were distribution of dynamic and static plantar pressures by T-Plate platform pressure, with measurements both before and after five, 10, 15, 20, and 25 minutes of treatment. Results There were no statistically significant differences (P > 0.05) for ankle dorsiflexion ROM or dynamic and static plantar pressures between the experimental group treated with DDN and the control group treated with ICT before and after treatment. Conclusions DDN vs ICT carried out in latent MTrPs of the shortened gastrocnemius of triathletes did not present differences in terms of dorsiflexion ROM of the tibiofibular-talar joint or in static and dynamic plantar pressure changes before and immediately after treatment.

The Mechanism of Plantar Unloading in Total Contact Casts: Implications for Design and Clinical Use

1997 ◽  
Vol 18 (12) ◽  
pp. 809-817 ◽  
Author(s):  
Jonathan E. Shaw ◽  
Wei-Li Hsi ◽  
Jan S. Ulbrecht ◽  
Arleen Norkitis ◽  
Mary B. Becker ◽  
...  
Keyword(s):  
Ground Reaction Force ◽  
Load Distribution ◽  
Reaction Force ◽  
Diabetic Patients ◽  
Clinical Use ◽  
Force Measurements ◽  
Bearing Surface ◽  
Total Contact Cast ◽  
Plantar Pressures ◽  
Plantar Ulcers

Although the total contact cast (TCC) has been shown to be an extremely effective treatment for the healing of plantar ulcers in diabetic patients, little is known about the biomechanics of its action. In this study, plantar pressure and ground reaction force measurements were obtained from over 750 foot contacts as five subjects with known elevated plantar forefoot pressures walked barefoot, in a padded cast shoe, and a TCC. Peak plantar pressures in the forefoot were markedly reduced in the cast compared with both barefoot and shoe walking (reductions of 75% and 86% respectively, P < 0.05). Peak plantar pressures in the heel were not, however, significantly different between the shoe and the TCC, and the longer duration of heel loading resulted in an impulse that was more than twice as great in the cast compared with the shoe ( P < 0.05). An analysis of load distribution indicated that the mechanisms by which the TCC achieves forefoot unloading are (1) transfer of approximately 30% of the load from the leg directly to the cast wall, (2) greater proportionate load sharing by the heel, and (3) removal of a load-bearing surface from the metatarsal heads because of the “cavity” created by the soft foam covering the forefoot. These results point out some of the “essential design features” of the TCC (which are different from what had been previously supposed), support the use of the TCC for healing plantar ulcers in the forefoot, but raise questions about its utility in the healing of plantar ulcers on the heel.

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)

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