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.

Foot Function in Diabetic Patients after Partial Amputation

1996 ◽  
Vol 17 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Juan Carlos Garbalosa ◽  
Peter R. Cavanagh ◽  
Ge Wu ◽  
Jan S. Ulbrecht ◽  
Mary B. Becker ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Plantar Pressure ◽  
Three Dimensional ◽  
Diabetic Patients ◽  
Plantar Pressures ◽  
Plantar Pressure Distribution ◽  
Patients With Diabetes ◽  
Peak Plantar Pressure ◽  
Partial Amputation ◽  
Foot Function

The function of partially amputated feet in 10 patients with diabetes mellitus was studied. First-step bilateral barefoot plantar pressure distribution and three-dimensional kinematic data were collected using a Novel EMED platform and three video cameras. Analysis of the plantar pressure data revealed a significantly greater mean peak plantar pressure in the feet with transmetatarsal amputation (TMA) than in the intact feet of the same patients. The heels of the amputated feet had significantly lower mean peak plantar pressures than all the forefoot regions. A significantly greater maximum dynamic dorsiflexion range of motion was seen in the intact compared with the TMA feet. However, no difference was noted in the static dorsiflexion range of motion between the two feet and there was, therefore, a trend for the TMA feet to use less of the available range of motion. Given the altered kinematics and elevated plantar pressures noted in this study, careful postsurgical footwear management of feet with TMA would appear to be essential if ulceration is to be prevented.

Surgical revision of the problematic transmetatarsal amputation

1993 ◽  
Vol 83 (2) ◽  
pp. 91-95 ◽  
Author(s):  
BI Rosenblum ◽  
DV Freeman
Keyword(s):  
Diabetes Mellitus ◽  
Surgical Intervention ◽  
Skin Grafting ◽  
Surgical Revision ◽  
Local Resection ◽  
Conservative Care ◽  
Patients With Diabetes ◽  
Transmetatarsal Amputation

Recurrent ulcerations may develop following transmetatarsal amputation in patients with diabetes mellitus. In many cases, these ulcerations require surgical intervention to achieve healing, especially in situations where conservative care has not been effective. These procedures range from the local resection of bone to skin grafting and flap techniques to successfully heal the wound. The ultimate goal of any surgical intervention is to prevent a more proximal amputation.

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)

The Effects of Range-of-Motion Therapy on the Plantar Pressures of Patients with Diabetes Mellitus

2002 ◽  
Vol 92 (9) ◽  
pp. 483-490 ◽  
Author(s):  
Jon R. Goldsmith ◽  
Roy H. Lidtke ◽  
Susan Shott
Keyword(s):  
Diabetes Mellitus ◽  
Range Of Motion ◽  
Joint Stiffness ◽  
Exercise Program ◽  
Controlled Study ◽  
Home Exercise ◽  
Control Group ◽  
Joint Mobility ◽  
Plantar Pressures ◽  
Patients With Diabetes

A randomized controlled study of 19 patients with diabetes mellitus (10 men, 9 women) was undertaken to determine the effects of home exercise therapy on joint mobility and plantar pressures. Of the 19 subjects, 9 subjects performed unsupervised active and passive range-of-motion exercises of the joints in their feet. Each subject was evaluated for joint stiffness and peak plantar pressures at the beginning and conclusion of the study. After only 1 month of therapy, a statistically significant average decrease of 4.2% in peak plantar pressures was noted in the subjects performing the range-of-motion exercises. In the control group, an average increase of 4.4% in peak plantar pressures was noted. Although the joint mobility data revealed no statistically significant differences between the groups, there was a trend for a decrease in joint stiffness in the treatment group. The results of this study demonstrate that an unsupervised range-of-motion exercise program can reduce peak plantar pressures in the diabetic foot. Given that high plantar pressures have been linked to diabetic neuropathic ulceration, it may be possible to reduce the risk of such ulceration with this therapy. (J Am Podiatr Med Assoc 92(9): 483-490, 2002)

TRANSMETATARSAL AMPUTATION FOR INFECTION OR GANGRENE IN PATIENTS WITH DIABETES MELLITUS

1949 ◽  
Vol 130 (4) ◽  
pp. 826-842 ◽  
Author(s):  
Leland S. McKittrick ◽  
John B. McKittrick ◽  
Thomas S. Risley
Keyword(s):  
Diabetes Mellitus ◽  
Patients With Diabetes ◽  
Transmetatarsal Amputation

Biomechanics of the foot in diabetes mellitus. Some theoretical considerations

1998 ◽  
Vol 88 (6) ◽  
pp. 285-289 ◽  
Author(s):  
CB Payne
Keyword(s):  
Diabetes Mellitus ◽  
Lower Extremity ◽  
Diabetic Foot ◽  
Theoretical Concepts ◽  
Plantar Pressures ◽  
Patients With Diabetes ◽  
Diabetic Foot Disease ◽  
Foot Disease ◽  
Biomechanics Of The Foot ◽  
Theoretical Considerations

Although diabetes mellitus is a biochemical disease, it has biomechanical consequences for the lower extremity. Numerous alterations occur in the function of the foot and lower extremity in people with diabetes. This article evaluates biomechanical alterations of the foot in the presence of neuropathy in patients with diabetes in the context of several theoretical concepts. Further study of these hypotheses will result in a better understanding of how diabetes causes elevated plantar pressures and the potential of strategies to prevent these changes so that the burden of diabetic foot disease can be reduced.

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)

Sign in / Sign up

Export Citation Format

Share Document