Overview of Motor Nerve Damage in People with Diabetes Mellitus

Damage to motor nerves in people with diabetes increases the risk of a foot injury. This occurs because the damage results in changes in foot biomechanics, muscle atrophy, deformity, and increased pressure on the feet. So far, the examination of motor nerve damage in people with diabetes in agricultural areas such as the Jember Regency is still rarely touched by primary health services. The purpose of this study was to identify motor nerve damage in people with diabetes in the agriculture area of ​​the Jember Regency. This type of research is exploratory, descriptive, 102 respondents obtained by purposive sampling technique. Inclusion criteria in this study are age> 18 years; do not have DFU active, and did not experience amputation in both legs. Data collection uses instrument modification from MNSI (Michigan Neuropathy Screening Instrument) and MDNS (Michigan Diabetic Neuropathy Score). MNSI using in inspecting for deformity, while MDNS using for forms of physiological reflex damage and muscle strength. The analysis used in univariate and displayed in the frequency distribution. The results showed that the majority of respondents who suffer from DM are experienced in the middle adulthood category (71.6%), with a length of suffering more than five years (95.1%), and have a history of comorbidities (68.6%). The most common form of motor deformity damage was hallux valgus on the right and left legs (38.2%; 26.4%). Forms of motor damage in the form of muscle strength, severe damage to the abduction of the right and left legs (7.8%), and were found right or left toe extensions (1.9%; 2.9%). Motor damage in the form of no physiological reflexes was found in the right and left Quadriceps femoral (2%; 1%), and right or left leg Achilles (1%). The result of total motor damage assessment is that people with diabetes have decreased muscle strength in the right and left extremities (74.5%; 72.5%). This research shows that the majority of people with diabetes in the agricultur area of ​​the Jember Regency suffer motor nerve damage. Therefore, there is a need for preventive measures to prevent the worsening condition of people with diabetes.

A Novel and Inexpensive Technique for High-tension Tendon Clamping with Expandable Mesh Sleeving for in Vitro Foot Biomechanics Testing

In vitro biomechanical testing is common in the field of orthopedics when novel devices are investigated prior to human trials. It is typically necessary to apply loads through tendons to simulate normal activities, such as walking during a foot and ankle study. However, attachment of tendons to linear actuators has proven challenging because of the tendency of clamps to either slip off or rupture the tendon. Freeze clamping is generally accepted as the gold standard for very high load testing in excess of 3000 N, but is expensive, time-consuming, and requires significant ancillary equipment. Purely mechanical solutions such as metal jaw clamps, wire meshes, and others have been explored, but these techniques are either costly, have low load capacities, or have not proven to be reproducible. We have developed a novel tendon clamping technique that utilizes a slip-resistant polyester mesh sleeving that encases the tendon and is fixated at the bottom of the tendon/sleeve interaction with a giftbox suture. The loose end of the sleeving can then be tied in to the linear actuator or load cell apparatus using a timber hitch knot. The sleeving technique allows for loads of 2000-2500 N on the Achilles tendon, and is inexpensive, reproducible, and can be modified to apply loads to smaller tendons as well, though a length of tendon/sleeve overlap of at least 16 cm is required to reach maximum loads. This technique should assist researchers in integrating muscle forces into future biomechanical study designs.

Clinical foot measurements as a proxy for plantar pressure testing in people with diabetes

Background High plantar pressures are associated with increased foot ulcer risk in people with diabetes. Identification of high plantar pressures in people with diabetes is clinically challenging due to time and cost constraints of plantar pressure testing. Factors affecting foot biomechanics, including reduced joint range of motion and foot deformity, are implicated in the development of high plantar pressures and may provide a method to clinically identify those at risk of pressure related complications. The aim of this study was to investigate the contribution of joint range of motion and foot deformity measures on plantar pressures in a community dwelling group with diabetes. Methods Barefoot (Tekscan HR Mat™) and in-shoe (Novel Pedar-X®) plantar pressure variables, weight bearing ankle dorsiflexion, hallux range of motion, lesser toe deformities and hallux abductus (HAV) scale were assessed in 136 adults with diabetes (52.2% male; mean age 68.4 years). Multivariate multiple linear regression was used to assess the effect of the four biomechanical factors plus neuropathy and body mass index on plantar pressure variables. Non-parametric bootstrapping was employed to determine the difference in plantar pressure variables for participants with two or more foot biomechanical pathologies compared to those with less than two pathologies. Results Almost one third (32%) of the cohort had two or more foot biomechanical pathologies. Participants with two or more foot biomechanical pathologies displayed significant increases in all barefoot plantar pressure regions (except forefoot), compared to those with less than two pathologies. No significant changes were found for the in-shoe plantar pressure variables. The regression model explains between 9.9% (95%CI: 8.4 to 11.4%) and 29.6% (95% CI: 28.2 to 31%), and between 2.5% (1.0 to 4.0%) and 43.8% (95% CI: 42.5–44.9%), of the variance in the barefoot and in-shoe plantar pressure variables respectively. Conclusions Participants presenting with two or more factors affecting foot biomechanics displayed higher peak pressures and pressure time integrals in all foot regions compared to those with less than two factors. The tests used in this study could help clinicians detect elevated plantar pressures in people with diabetes and present an opportunity for early preventative interventions.

A novel instrumented outsole for real-time foot kinematics measurement: validation across different speeds and simulated foot landing in Cerebral Palsy gait

<pre>Neuromuscular disorders in Cerebral Palsy (CP) patients lead to foot deformities and affect foot biomechanics leading to compromised gait. Thus, measurement of the foot kinematic measurement is of particular interest to understand and characterize the walking pattern among CP patients. The objective of the present work is to develop a wearable instrument to measure foot kinematics such as foot-to-ground angle in three-dimensional planes and to measure the foot clearance i.e., toe and heel clearances. A template-based outsole was developed that incorporated an optical distance sensor located anatomically on the outsole and the magnetometer to measure the foot kinematics. The developed system was validated against the reference marker-based motion capture system (from Noraxon). The data from eight able-bodied participants were acquired simultaneously from both the systems (developed and the reference system) at three different walking speeds. A CoP based feedback was presented to the participants to shift the sagittal CoP anteriorly, posteriorly and normal to simulate the walking pattern of CP patients with three different foot landing strategies. Pearson's correlation coefficient of more than or equal to 0.62, root mean square error of less than or equal to 7.81 degrees and limit of agreement of more than or equal to 95% is found. Furthermore, a wireless wristband is developed and validated for real-time vibrotactile feedback. The measurement accuracy reported with outsole while participants simulated CP gait shows the potential of present work in real-time foot kinematics detection in CP patients. The instrumentation is wearable, low-cost, easy to use and implement.</pre>

A novel instrumented outsole for real-time foot kinematics measurement: validation across different speeds and simulated foot landing in Cerebral Palsy gait

<pre>Neuromuscular disorders in Cerebral Palsy (CP) patients lead to foot deformities and affect foot biomechanics leading to compromised gait. Thus, measurement of the foot kinematic measurement is of particular interest to understand and characterize the walking pattern among CP patients. The objective of the present work is to develop a wearable instrument to measure foot kinematics such as foot-to-ground angle in three-dimensional planes and to measure the foot clearance i.e., toe and heel clearances. A template-based outsole was developed that incorporated an optical distance sensor located anatomically on the outsole and the magnetometer to measure the foot kinematics. The developed system was validated against the reference marker-based motion capture system (from Noraxon). The data from eight able-bodied participants were acquired simultaneously from both the systems (developed and the reference system) at three different walking speeds. A CoP based feedback was presented to the participants to shift the sagittal CoP anteriorly, posteriorly and normal to simulate the walking pattern of CP patients with three different foot landing strategies. Pearson's correlation coefficient of more than or equal to 0.62, root mean square error of less than or equal to 7.81 degrees and limit of agreement of more than or equal to 95% is found. Furthermore, a wireless wristband is developed and validated for real-time vibrotactile feedback. The measurement accuracy reported with outsole while participants simulated CP gait shows the potential of present work in real-time foot kinematics detection in CP patients. The instrumentation is wearable, low-cost, easy to use and implement.</pre>

A novel instrumented outsole for real-time foot kinematics measurement: validation across different speeds and simulated foot landing in Cerebral Palsy gait

Neuromuscular disorders in Cerebral Palsy (CP) patients lead to foot deformities and affect foot biomechanics leading to compromised gait. The objective of the present work is to develop a wearable instrumentation to measure foot kinematics such as foot-to-ground angle in three-dimensional planes and to measure the foot clearance i.e., toe and heel clearances. A template-based outsole was developed that incorporated an optical distance sensor located anatomically on the outsole and the magnetometer to measure the foot kinematics. The developed system was validated against the reference marker-based motion capture system. The data from eight able-bodied participants were acquired simultaneously from both the systems at three different walking speeds. A CoP based feedback was presented to the participants to shift the sagittal CoP anteriorly, posteriorly and normal to simulate the walking pattern of CP patients with three different foot landing strategies. Pearson’s correlation coefficient of more than or equal to 0.62, root mean square error of less than or equal to 7.81 degrees and limit of agreement of more than or equal to 95% is found. The measurement accuracy reported with outsole while participants simulated CP gait shows the potential of present work in real-time foot kinematics detection in CP patients.

A Retrospective Study of Foot Biomechanics and Injury History in Varsity Football Athletes at the U.S. Naval Academy

ABSTRACT Introduction The six-item Foot Posture Index (FPI-6) was previously developed as an assessment tool to measure the posture of the foot across multiple segments and planes. It was derived from a criterion-based observational assessment of six components of each foot during static standing. The association between abnormal foot posture and musculoskeletal injuries remains unclear and is in of need further exploration. Hypothesis/Purpose The purpose of this study was to assess the association between foot biomechanics and self-reported history of musculoskeletal pain or injury. Study Design Retrospective, cross-sectional study of collegiate football players at the U.S. Naval Academy. Materials and Methods For each athlete, data were recorded on height, weight, self-reported history of pain or injury, and foot posture, which was measured using a FPI-6 with each item measuring the degree of pronation/supination. The primary outcome was each athlete’s maximum deviation from neutral posture across the six-item index (FPImax). The prespecified primary analysis used generalized linear models to measure the association between FPImax and self-report history of pain or injury. Exploratory analyses measured the association using penalized regression (L1-norm) and a type of tree-based ensemble known as extreme gradient boosting (XGBoost). Results Data were collected on 101 athletes, 99 of whom had sufficient body mass index (BMI) data to be included for analysis. Among the 99 athletes, higher FPImax was associated with a prior history of musculoskeletal pain (odds ratio [OR] 1.15, 95% confidence interval [CI] 0.97 to 1.35), although the sample size was too small for the association to be significant with 95% CI (P = .107). FPImax was not associated with a history of knee injury/pain (OR 0.98, 95% CI 0.83 to 1.15, P = .792), nor with a history of ankle/foot injury or pain (OR 1.04, 95% CI 0.90 to 1.21, P = .599). From the L1-penalized model, the FPI components with the strongest linear associations were the L6, R2, R1-squared, and FPImax. From the XGBoost model, the most important variables were FPItotal, BMI, R1, and R2. Conclusions The U.S. Naval Academy football players whose foot postures deviated from neutral were more likely to have reported a previous history of musculoskeletal pain. However, this deviation from normal was not strongly associated with a specific history of pain or injury to the knee, ankle, or foot. Clinical Relevance The information ascertained from this study could be used to better inform clinicians about the value of the FPI in predicting or mitigating injuries for varsity football athletes.

The co-occurrence of calcaneal spur and hallux valgus: A radiological evaluation

BACKGROUND: Calcaneal spur and hallux valgus are common foot deformities and both conditions have been shown to disrupt foot biomechanics. OBJECTIVES: This study aimed to investigate the association between calcaneal spur and hallux valgus using radiographic and demographic data. METHODS: A total of 1375 patients (1083 women; mean age: 45.5 years) with standard ankle lateral and foot conventional anteroposterior radiographs were evaluated. The following data were obtained: age, gender, laterality, hallux valgus angle (HVA), intermetatarsal angle (IMA), and calcaneal spur. Patients with a HVA of 15∘ and above were considered to have hallux valgus. Patients with hallux valgus were classified into three different groups according to the HVA. RESULTS: The prevalence of calcaneal spur was higher in older age and women (45.8%, 30.2%; p< 0.01, p< 0.01, respectively). Subjects with and without calcaneal spurs had similarities in terms of their laterality, having a HVA of ⩾ 15∘ and an IMA of ⩾ 11∘ (p> 0.05). Hallux valgus severity was not associated with calcaneal spur (p> 0.05). In addition, the hallux valgus prevalence was higher in patients who were over 50 years old (58.2%, p= 0.046). CONCLUSIONS: The presence of calcaneal spurs does not affect the prevalence of hallux valgus. The severity of hallux valgus determined according to the HVA was similar in patients with and without calcaneal spurs. In addition, female gender and older age were identified as risk factors for calcaneal spurs, while only older age was a risk factor for hallux valgus.