Lower limb biomechanical characteristics in patients with diabetic foot: Analysis and efficacy of modified orthopedic insoles

We studied biochemical characteristics of the lower limbs of patients with diabetic foot (DF) to develop custom orthopedic insoles. In this study of 88 patients with diabetes, 58 had a normal foot appearance, 18 had plantar calluses, and 12 had valgus feet. The maximum pressure applied to the left and right plantar of patients with DF is under the third metatarsal, and the peak areas of the left and right feet are below the first metatarsal. Pain and American Orthopedic Foot and Ankle Society scores were reduced after one year of wearing modified orthopedic insoles versus unmodified insoles. After one year of wearing the insole, the pressure was reduced in the left and right feet of both groups, but the intervention group showed a more significant reduction than the controls. The swing time was shorter in the intervention group and the incidence of DF ulcers was 6.81% higher in the control group. Thus, lower limb biomechanics differ in patients with DF, most of who experience calluses and hallux valgus. Modified orthopedic insoles provide improved sole pain, ankle-foot joint function, and distribution of plantar pressure, and incidence of DF ulcers.

The Design of Individual Orthopedic Insoles for the Patients with Diabetic Foot Using Integral Curves to Describe the Plantar Over-Pressure Areas

Identification of over-pressure areas in the plantar side of the foot in patients with diabetic foot and reduction of plantar pressure play a major role in clinical practice. The use of individual orthopedic insoles is essential to reduce the over-pressure. The aim of the present study is to mark the over-pressure areas of the plantar part of the foot on a pedogram and describe them with high accuracy using a mathematical research method. The locally over-pressured areas with calluses formed due to repeated injuries were identified on the patients’ pedograms. The geometric shapes of the over-pressure areas were described by means of the integral curves of the solutions to Dirichlet singular boundary differential equations. Based on the mathematical algorithm describing those curves, the computer programs were developed. The individual orthopedic insoles were produced on a computer numerical control milling machine considering the locally over-pressured areas. The ethylene vinyl acetate polymers of different degrees of hardness were used to produce the individual orthopedic insoles. For the over-pressure areas, a soft material with a hardness of 20 Shore A was used, which reduces the pressure on the plantar side of the foot and increases the contact area. A relatively hard material with a hardness of 40 Shore A was used as the main frame, which imparts the stability of shape to the insole and increases its wear life. The individual orthopedic insoles produced by means of such technology effectively reduce the pressure on the plantar side of the foot and protect the foot from mechanical damage, which is important for the treatment of the diabetic foot.

The attitude of doctors of various specialties to the problem of flatfoot

Purpose: to assess the subjective perception of flatfoots prevalence in children, its age dynamics and the main approaches to the diagnosis and treatment by doctors of various pediatric specialties with different medical experience and working in medical facilities at various levels by anonymous questionnaire. Materials and methods. Questionnaire data from 80 orthopedists (50 outpatient doctors, 30 doctors from a specialized scientific research institute and orthopedic departments of city hospitals (research institutes / hospitals) and 30 neurologists (polyclinic). Results: our study demonstrated that outpatient orthopedists diagnose the flatfoot on average in half of the cases. The orthopedists diagnose flatfoot only by means of visual examination in 46.1% of cases (neurologists in 85.7% of cases). According to our data, 58.9 % of outpatient doctors recommend wearing special orthopedic shoes (46.1 % only if the foot alone is affected) and 95.1 % of specialists recommend wearing individual orthopedic insoles (53.6 % if there are complaints). While 88.2 % of the orthopedic surgeons from specialized research institutes and hospitals do not recommend wearing orthopedic shoes; 26.7 % of experts recommend wearing individual orthopedic insoles only in the presence of complaints. On the other hand, the neurologists recommend wearing orthopedic shoes 5.3 times more often than the orthopedists do. Conclusion: our study demonstrates that the specialty of the doctor (orthopedist, neurologist) and the type of health care facilities in which the specialist works have the greatest impact on his subjective perception of the prevalence and age dynamics of flatfoot in children, tactics of diagnostics and treatment. The outpatient orthopedists diagnose flatfoot 4.2 times more often than the orthopedic surgeons from the specialized research institute and hospitals. Also, the outpatient orthopedists prescribe wearing orthopedic shoes 4.9 times more often (insoles 3.6 times more often) in comparison with the orthopedic surgeons of the specialized research institute and orthopedic hospitals. Summarizing the above mentioned, we would like to note that due to the fact that the current assessment of the age limits of the arch height feet is ambiguous, there is a need to introduce a unified system for assessing the foots shape and posture with defining the concepts of average height and typically developing foot.

Assistive Technology for Patient with Congenital Foot Deformity

An assistive technology (AT) is any item, equipment or product used to increase, maintain or improve the functional capabilities of people with disabilities. The aim of this study was to design and develop two ATs in order to assist the needs of a male student from Universidad de Monterrey experiencing gait dysfunction and pain due to a congenital foot deformity preventing him from normal performance. These ATs included personalized orthopedic insoles to improve the participant’s posture and stability as well as two ankle-foot orthosis (AFO) to reduce the pain he presented. In order to design the orthopedic insoles, it was necessary to scan the participant’s feet; this was achieved using the photogrammetry technique. For the design of the AFOs, anthropometric measurements of the lower limbs were taken in order to modify a predefined 3D human model and obtain a digital model of the lower limbs. Both devices were manufactured using 3D printing technology. In order to analyze the participant’s progress and validate the effectiveness of the ATs, we developed a methodology for movement analysis based on the marker-less motion capture system Kinect 2. Data obtained was imported into Matlab in order to calculate lower limb joint angles and compare gait before and after using the ATs. Significant improvement was seen in the participant’s gait after two weeks of using the ATs. Moreover, we were able to demonstrate that the use of orthopedic insoles improved participant’s posture based on the correct alignment (180°) of the heel with the ankle. We believe these posture improvements could further impact on participant’s gait performance. Therefore, we expect a significant improvement on participant’s gait after constant use of both ATs developed.