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 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)

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)

Dynamic plantar pressure analysis. Comparing common insole materials

1992 ◽  
Vol 82 (10) ◽  
pp. 507-513 ◽  
Author(s):  
PB Sanfilippo ◽  
RM Stess ◽  
KM Moss
Keyword(s):  
Plantar Pressure ◽  
Human Subjects ◽  
Force Plate ◽  
Vertical Force ◽  
Time Integral ◽  
Pressure Time ◽  
Peak Plantar Pressure ◽  
Force Time ◽  
Dynamic Measures ◽  
Force Time Integral

A comparison of five commonly used insole materials (Spenco, PPT, Plastazote, Nickelplast, and Pelite) was made to evaluate their effectiveness in reducing plantar vertical pressures on human subjects during walking. With the use of the EMED-SF pedograph force plate system, dynamic measures of vertical force, force-time integral, peak plantar pressure, pressure-time integral, and area of foot-to-ground contact were compared with the force plate covered with each of the insole materials and without any interface material.

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 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.

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 Effect of Mini-invasive Floating Metatarsal Osteotomy on Plantar Pressure in Patients With Diabetic Plantar Metatarsal Head Ulcers

2020 ◽  
pp. 107110072097609
Author(s):  
Eran Tamir ◽  
Michael Tamar ◽  
Moshe Ayalon ◽  
Shlomit Koren ◽  
Noam Shohat ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Plantar Pressure ◽  
Case Series ◽  
Metatarsal Head ◽  
Metatarsal Osteotomy ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Retrospective Case Series ◽  
Pressure Time ◽  
Peak Plantar Pressure

Background: Distal metatarsal osteotomy has been used to alleviate plantar pressure caused by anatomic deformities. This study’s purpose was to examine the effect of minimally invasive floating metatarsal osteotomy on plantar pressure in patients with diabetic metatarsal head ulcers. Methods: We performed a retrospective case series of prospectively collected data on 32 patients with diabetes complicated by plantar metatarsal head ulcers without ischemia. Peak plantar pressure and pressure time integrals were examined using the Tekscan MatScan prior to surgery and 6 months following minimally invasive floating metatarsal osteotomy. Patients were followed for complications for at least 1 year. Results: Peak plantar pressure at the level of the osteotomized metatarsal head decreased from 338.1 to 225.4 kPa ( P < .0001). The pressure time integral decreased from 82.4 to 65.0 kPa·s ( P < .0001). All ulcers healed within a mean of 3.7 ± 4.2 weeks. There was 1 recurrence (under a hypertrophic callus of the osteotomy) during a median follow-up of 18.3 months (range, 12.2-27). Following surgery, adjacent sites showed increased plantar pressure and 4 patients developed transfer lesions (under an adjacent metatarsal head); all were managed successfully. There was 1 serious adverse event related to surgery (operative site infection) that resolved with antibiotics. Conclusion: This study showed that the minimally invasive floating metatarsal osteotomy successfully reduced local plantar pressure and that the method was safe and effective, both in treatment and prevention of recurrence. Level of Evidence: Level III, retrospective case series of prospectively collected data.

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)

scholarly journals Association between the levels of physical activity and plantar pressure in 6-14-year-old children

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e8551 ◽  
Author(s):  
Lovro Štefan ◽  
Mario Kasović ◽  
Martin Zvonar
Keyword(s):  
Physical Activity ◽  
Plantar Pressure ◽  
Contact Time ◽  
Cross Sectional Study ◽  
Linear Regression Models ◽  
Older Children ◽  
Cross Sectional ◽  
Time Integral ◽  
Pressure Time ◽  
The Right

Background The main purpose of the study was to determine whether lower levels of physical activity were associated with higher plantar pressure generated under each foot. Methods In this cross-sectional study, we recruited 641 children aged 6–14 years (agemean ± SD = 9.7  ± 2.4 years; heightmean ± SD = 143.6  ± 15.3 cm, weightmean ± SD = 37.6  ± 13.4 kg; body-mass indexmean ± SD = 17.6  ± 3.2 kg/m2; 44.2% girls). We used EMED –XL pressure platform to measure force time integral, pressure-time integral, contact-time and contact area, peak plantar pressure and mean plantar pressure of the right and the left foot during the gait analysis. The level of physical activity was measured by using The Physical Activity Questionnaire for Older Children (PAQ–C). The associations were calculated by using generalized estimating equations with linear regression models. Results Lower levels of physical activity were associated with higher force- and pressure-time integrals, longer contact time and higher peak and mean plantar pressures in both feet. Conclusion Our study shows that the level of physical activity is strongly and inversely associated with plantar pressure in a sample of 6–14 year olds.

scholarly journals The Difference of In-Shoe Plantar Pressure Between Level Walking and Stair Walking

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0026
Author(s):  
Min Gyu Kyung ◽  
Chungho Lee ◽  
Jae Hee Lee ◽  
Yoon Jae Cho ◽  
Cao Linying ◽  
...  
Keyword(s):  
High Pressure ◽  
Plantar Pressure ◽  
Pressure Load ◽  
Stair Ascent ◽  
Time Integral ◽  
Stair Descent ◽  
Level Walking ◽  
Pressure Time ◽  
Stair Walking ◽  
Peak Pressures

Category: Basic Sciences/Biologics Introduction/Purpose: Stair walking is one of common activities of daily living. It is more demanding than level walking and can aggravate discomfort of the foot, such as Morton’s neuroma, plantar fasciitis, Achilles tendinitis, pressure related-ulcer, and etc. Therefore, analysis of increased pressure in specific plantar area at stair walking can be used as a risk assessment of foot discomfort and basic data in the clinical field. The purpose of this study is to analyze plantar pressure distribution and pressure patterns during gait cycle at stair walking compared to level walking. Methods: Fourty healthy male adults were recruited. Radiologic measurements and gait analysis were performed to check participants’ normality, and 35 healthy males with 20-28 years old were included. They performed level walking (18 meters walkway), stair (26 steps stair, height:16.7 cm, depth:29.8 cm) ascending, and descending in same type of running shoes. Measurements of in-shoe plantar pressure including peak pressure, pressure-time integral (PTI) were done by Pedar-X system. Only measurements of right steps were used to exclude the effect of the dominant foot. The sole was masked in 7 segments (hallux, 2nd-5th toes, medial forefoot, central forefoot, lateral forefoot, midfoot, heel region) to analyze properly. Percentages were assigned in relation to the size for each mask segment. Statistical analysis was performed using repeated measure ANOVA, and Bonferroni post hoc test was done. Results: Mean peak pressures in all regions except for the midfoot were higher during level walking than stair walking. During stair descent, mean peak pressures in all the regions except for the midfoot were generally lower than other types of walking, but it was the highest in the midfoot region. Pressure time integral (PTI) in the medial and central forefoot was higher during stair descent than level walking. PTI in the central and lateral forefoot, and the midfoot was higher when stair ascending than level walking. Pressure time integral (PTI) in the heel region was the highest during level walking, followed by stair ascent, stair descent. Conclusion: The risk of aggravation of discomfort in the midfoot area increases when stair descending. The medial region of forefoot bear high pressure load during stair descent, and the lateral region of forefoot and the midfoot region bear high pressure load during stair ascent. This is the first study to show plantar pressure patterns during level and stair walking in the large healthy gender-controlled population. We recommend that patients with pressure related foot lesions in the forefoot or midfoot avoid stair walking.

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