233 research outputs found

    Predictors of barefoot plantar pressure during walking in patients with diabetes, peripheral neuropathy and a history of ulceration

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    OBJECTIVE:Elevated dynamic plantar foot pressures significantly increase the risk of foot ulceration in diabetes mellitus. The aim was to determine which factors predict plantar pressures in a population of diabetic patients who are at high-risk of foot ulceration. METHODS:Patients with diabetes, peripheral neuropathy and a history of ulceration were eligible for inclusion in this cross sectional study. Demographic data, foot structure and function, and disease-related factors were recorded and used as potential predictor variables in the analyses. Barefoot peak pressures during walking were calculated for the heel, midfoot, forefoot, lesser toes, and hallux regions. Potential predictors were investigated using multivariate linear regression analyses. 167 participants with mean age of 63 years contributed 329 feet to the analyses. RESULTS:The regression models were able to predict between 6% (heel) and 41% (midfoot) of the variation in peak plantar pressures. The largest contributing factor in the heel model was glycosylated haemoglobin concentration, in the midfoot Charcot deformity, in the forefoot prominent metatarsal heads, in the lesser toes hammer toe deformity and in the hallux previous ulceration. Variables with local effects (e.g. foot deformity) were stronger predictors of plantar pressure than global features (e.g. body mass, age, gender, or diabetes duration). CONCLUSION:The presence of local deformity was the largest contributing factor to barefoot dynamic plantar pressure in high-risk diabetic patients and should therefore be adequately managed to reduce plantar pressure and ulcer risk. However, a significant amount of variance is unexplained by the models, which advocates the quantitative measurement of plantar pressures in the clinical risk assessment of the patient

    Effects of rocker radii with two longitudinal bending stiffnesses on plantar pressure distribution in the forefoot

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    INTRODUCTION: Outsole parameters of the shoe can be adapted to offload regions of pain or region of high pressures. Previous studies already showed reduced plantar pressures in the forefoot due to a proximally placed apex position and higher longitudinal bending stiffness (LBS). The aim of this study was to determine the effect of changes in rocker radii and high LBS on the plantar pressure profile during gait. METHOD: 10 participants walked in seven shoe conditions of which one control shoe and six rocker shoes with small, medium and large rocker radii and low and high longitudinal bending stiffness. Pedar in-shoe plantar pressure measuring system was used to quantify plantar pressures while walking on a treadmill at self-selected walking speed. Peak plantar pressure, maximum mean pressure and force-time integral were analyzed with Generalized Estimated Equation (GEE) and Tukey post hoc correction (α = .05). RESULTS: Significantly lower plantar pressures were found in the first toe, toes 2-5, distal and proximal forefoot in all rocker shoe conditions as compared to the control shoe. Plantar pressures in the first toe and toes 2-5 were significantly lower in the small radius compared to medium and large radii. For the distal forefoot both small and medium radii significantly reduced plantar pressure compared to large radii. Low LBS reduced plantar pressure at the first toe significantly compared to high LBS independent of the rocker radius. Plantar pressures in the distal forefoot and toes 2-5 were lower in high LBS compared to low LBS. CONCLUSION: Manipulation of the rocker radius and LBS can effectively reduce peak plantar pressures in the forefoot region during gait. In line with previous studies, we showed that depending on the exact target location for offloading, different combinations of rocker radius and LBS need to be adopted to maximize treatment effects

    Classification of forefoot plantar pressure distribution in persons with diabetes : a novel perspective for the mechanical management of diabetic foot?

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    Background: The aim of this study was to identify groups of subjects with similar patterns of forefoot loading and verify if specific groups of patients with diabetes could be isolated from non-diabetics. Methodology/Principal Findings: Ninety-seven patients with diabetes and 33 control participants between 45 and 70 years were prospectively recruited in two Belgian Diabetic Foot Clinics. Barefoot plantar pressure measurements were recorded and subsequently analysed using a semi-automatic total mapping technique. Kmeans cluster analysis was applied on relative regional impulses of six forefoot segments in order to pursue a classification for the control group separately, the diabetic group separately and both groups together. Cluster analysis led to identification of three distinct groups when considering only the control group. For the diabetic group, and the computation considering both groups together, four distinct groups were isolated. Compared to the cluster analysis of the control group an additional forefoot loading pattern was identified. This group comprised diabetic feet only. The relevance of the reported clusters was supported by ANOVA statistics indicating significant differences between different regions of interest and different clusters. Conclusion/s Significance: There seems to emerge a new era in diabetic foot medicine which embraces the classification of diabetic patients according to their biomechanical profile. Classification of the plantar pressure distribution has the potential to provide a means to determine mechanical interventions for the prevention and/or treatment of the diabetic foot

    On the design and evaluation of adjustable footwear for the prevention of diabetic foot ulcers

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    Worldwide there are over 422 million people with diabetes. Up to 34% of them will develop a diabetic foot ulcer. These ulcers are extremely dangerous and can result in amputation of the affected leg. Elevated pressures at the plantar surface of the foot are a major cause of diabetic foot ulcerations. Diabetic foot ulcers can be prevented by reducing plantar pressures that are too high. Special footwear such as custom-made insoles and rocker profile shoes are commonly used to reduce plantar pressure. However, the design of this footwear is mainly based on the experience of the prescribing specialist and orthopaedic shoe technician. This leads to a large variety of results and sometimes to insufficient offloading of the foot. Even when the insole or rocker profile shoe initially is effective, over time the location of the pressure spots can shift, resulting in poor offloading and putting the person at risk again of developing an ulcer. The work in this thesis aimed to overcome the problems with the current offloading footwear and includes the design and evaluation of an adjustable rocker profile and a self-adjusting insole

    Body mass index and its effect on plantar pressure in overweight and obese adults

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    The proportion of overweight or obese adults is creating a growing problem throughout the world. Overweight and obesity have a significant influence on gait, and often cause difficulty. There is evidence to suggest that being overweight or obese places adults at a greater risk of developing foot complications such as osteoarthritis, tendonitis, plantar fasciitis, and foot ulcers. Increasingly, pressure ulcers have become a serious health problem. The purpose of this research is to investigate the effect of body weight on the feet, and to investigate the use of simulated body mass to study the effect of variable body mass on the foot plantar in adults aged 24 to 50 years of age while walking at a self-selected pace. A series of studies were undertaken to achieve the above purpose. The research involved: 1) assessing dynamic foot plantar pressure characteristics in adults who are normal weight, overweight or obese; 2) studying the gait impact of increased simulated body weight (SBW); and 3) evaluating the spatial relationship between the trace of the centroid of the area of contact with heel strike, midstance, and toe-off phases for the SBW groups. F-Scan in-shoe systems were utilised to gather the foot pressure data. The first study sought to investigate the effect of different body mass index (BMI) levels on plantar pressure distribution during walking, collection in fifteen voluntary participants were recruited. The BMI participants were divided into three groups (healthy, overweight and obese). The foot was divided into ten regions: heel (H), midfoot (MF), first metatarsal head (1MH), second metatarsal head (2MH), third metatarsal head (3MH), fourth metatarsal head (4MH), fifth metatarsal head (5MH), hallux (1stT), second toe (2ndT), and third to fifth toes (3rd-5thT). For each region, the following parameters were calculated: force (F), contact area (CA), contact pressure (CP), pressure time integral (PTI) and peak pressure (PP). The mean of the three repetitions of each subject was computed, and statistical procedures were performed with these mean ± standard deviation (SD) values. This study showed that the obese group had higher plantar pressure parameter values compared to the other two groups (overweight and healthy) for the ten different foot regions. The study observed significant changes in the parameters in the H and MHs (e.g. 2MH and 3MH) foot regions. The forefoot appears to be more sensitive to weight-related pressure under the foot than the rearfoot. Findings from this study indicate that being overweight or obese increases foot pressure measures, even for individuals with similar body features. Higher BMI values correlate with a higher load on the foot during walking in males. These findings have implications for pain and discomfort in the lower extremity in the obese while participating in activities of daily living such as walking. The second study investigated the effect of the research methodology involving the simulation of body weight (SBW) with additional weight, adding 10, 20, 30 kg to each participant’s body weight on plantar pressures. The sample comprised 31 adult males; each subject walked four times. The first walk was without any external weight (NBW, 0 kg), the second walk was with a weight of 10 kg, the third walk was with a weight of 20 kg and the last walk with a weight of 30 kg in the vest. The foot was divided into ten regions and for each region, the parameters were calculated the same way as the first study. At the end of this study it should be noted that SBW groups subjected to load have shown changes in foot plantar measure values compared to the NBW group. Most of the differences were found under H, MHs, 1stT and MF regions in the most clinically relevant parameters in SBW groups compared to the control group; the SBW groups showed higher values of plantar pressure. The results of the ICC showed a generally good to an excellent level of reliability, the quality of which was dependent on the regions of the foot and the variables investigated with SBW loads. This experiment pointed out that an insole pressure system is a reliable tool for evaluating foot plantar forces and pressures throughout the walk. The plantar pressure measures can be used in relative assessments, as the measures of repeatability are favourable for the measures and foot zones generally utilised in the study of people with clinical problems like neuropathic diabetics. In the final study, associations were investigated of the centroid (coordinates x-axis and y-axis) of the area of contact captured between normal (NBW) and simulated body weight (SBW) changes. The same 31 adult males who enrolled with the SBW tests were used to collect the centroid of the area of contact with the surface. This was located by calculating the geometric centre of a set of cloud points having the lowest z coordinate value. In this part, a foot pressure sensing insole was used to calculate the moment of heel strike, midstance and toe-off phases. Data were analysed descriptively (mean ± SD only). The outcome of this study, relating to specific individual characteristics of the centroid trace of the plantar contact area was compared with the heel strike, midstance, and toe-off phases for the SBW group with the NSBW group. X-axis and y-axis coordinates in the heel strike, midstance and toe-off phases under SBW with 30, 20, 10 kg had higher mean values compared to NSW. The x-axis and y-axis coordinates had mean values of 11.76, 9.68, and 7.76 mm; while the y-axis coordinates had mean values of 11.96, 9.89, and 8.18 mm. Moreover, x-axis and y-axis coordinates were assessed in the midstance phase under SBW with 30, 20, 10 kg with means of 6.59, 5.48, and 4.50 mm; while the y-axis coordinates had mean values of 6.38, 5.41, and 4.41 mm. In addition, x-axis and y-axis coordinates were assessed in the toe-off phase under SBW (30, 20, 10 kg) with mean values of 11.56, 9.67, and 7.97 mm; while the y-axis coordinates had mean values of 11.51, 9.39, 8.02 mm, respectively. X-axis and y-axis coordinates had mean values in relation to NBW in three phases: heel strike of 5.47 and 6.15; midstance of 2.99 and 3.05; and toe-off of 6.04 and 5.82, respectively. The x-locate and y-locate change can be calculate the change in rotation of the ankle joint. As the data was normalised according to the total time taken for the loading phase of the gait, the y-locational change was due partly to the extra weight, which could increase the time of lifting the foot. Therefore, the results showed that the x-locate and y-locate change can help to calculate the change in the rotation of the ankle joint. The project has shown that it is possible to demonstrate that obese people will, throughout their lives, adopt ways to effectively execute a particular activity. This finding provides a foundation for future clinical trials which could assist in preventing foot complications and could assist in the design of appropriate interventions to promote healthy outcomes for these adults. The simulated body weight resulted in a variation in plantar pressure distribution. Because the human foot adapts itself to any simulated condition, knowledge of the variation of pressure distributions of both feet can provide input for suitable guidelines for biomedical engineers. To promote the prevention of likely injury to the feet of overweight and obese people, the results of this study demonstrate the need to develop strategies which could include the building of an insole (orthosis) that absorbs foot plantar pressure

    The effect of aging, obesity and diabetes on foot health and its association with current and future footwear technologies

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    Changes in foot health trends are beginning to demand significant changes to foot health provision globally, for which appropriate provision to retail and health services is key. With the right input to innovation and design, footwear can help keep us fit and active and contribute to our overall wellbeing, creating exciting opportunities for the footwear market. Likewise, the development of orthotic materials, designs and manufacturing processes is enabling more complex solutions to equally complex developing foot conditions. There are three key issues driving the demand for specific footcare; the global increase in the number of people with diabetes, those who are obese and the fact we are all living longer. The populations of diabetic, elderly and obese adults require specific footcare solutions to meet the specific characteristics of their foot health issues such as wider-fit footwear and pressure relieving orthotic materials. Characteristics of these populations' feet relating to their morphology, tissue characteristics, vascular supply and sensation impact on their requirements from footwear. Additional characteristics relating to their overall health such as excess mass and instability additionally impact on the wear on the loading of the footwear and design features which may be beneficial

    Diseño de estudio de las características de la marcha en personas con diabetes en presencia o no de neuropatía periférica

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    [Resumen] La Diabetes Mellitus es una patología que está en aumento en los últimos años y afecta aproximadamente a 60 millones de personas en Europa. En este proyecto de estudio tiene como objetivo principal diseñar un estudio que permita observar las características de la marcha en personas con diabetes en presencia o no de neuropatía periférica. Con los resultados se pretende demostrar que existen diferencias significativas entre estos grupos de personas además de analizar cada fase de la marcha, así como también las presiones plantares ya que la diabetes mellitus puede causar cambios a nivel fisiopatológico, de tipo neuropático o vascular, a nivel del pie y extremidad inferior y puede llegar a causar cambios patológicos en el patrón de la marcha en este tipo de personas. Para esto se seleccionará una muestra recogida en la Asociación de Diabéticos de Ferrolterra y se crearán 3 grupos de participantes, personas sanas, personas con diabetes mellitus y personas con diabetes en presencia de neuropatía periférica a las que se les realizará una exploración neurológica, una valoración del rango articular y un análisis de la marcha y de las presiones plantares con unos sensores colocados en diferentes segmentos de la planta del pie necesitando para la realización de este estudio un período aproximado de tres meses.[Resumo] A Diabetes Mellitus é unha enfermidade que está a aumentar nos últimos anos e afecta aproximadamente 60 millóns de persoas en Europa. O principal obxectivo deste proxecto de investigación é desenvolver un estudo para observar as características da marcha en persoas con diabetes na presenza ou ausencia de neuropatía periférica. Cos resultados o que se pretende e demostrar que existen diferenzas significativas entre estes grupos de persoas, así como analizar cada fase da marcha e tamén a presión plantar xa que a diabetes mellitus pode causar cambios a nivel fisiopatolóxico, de tipo neurolóxico ou vascular a nivel do pé e dos membros inferiores e pode, Diseño de estudio de las características de la marcha en personas con diabetes en presencia o no de neuropatía periférica 5 eventualmente, causar alteracións patolóxicas no patrón da marcha de este tipo de persoas. Para isto seleccionaráse unha mostra tomada na Asociación de Diabéticos de Ferrolterra, e crearanse 3 grupos de participantes, persoas sas, persoas con diabetes mellitus e persoas con diabetes en presenza de neuropatía periférica as que se lles realizará un exame neurolóxico, unha avaliación do rango articular e unha análise da marcha e presións plantares con sensores colocados nunha plantilla en diferentes segmentos da planta do pé necesitando para a súa realización este estudo dun período de aproximadamente tres meses.[Abstract] Diabetes Mellitus is a pathology that has been increasing in recent years and affects approximately 60 million people in the European region. In this study project has as main objective to design a study that allows to observe the gait characteristics in people with diabetes in the presence or not of peripheral neuropathy. The results are intended to demonstrate that there are significant differences between these groups of people in addition to analyzing each stage of gait, as well as plantar pressures since diabetes mellitus can cause changes at pathophysiological level, neuropathic or vascular type, at the level of the foot and lower limb and may cause pathological changes in the gait pattern in people. For this, a sample collected at the Diabetes Association of Ferrolterra will be selected and 3 groups of participants, healthy people, people with diabetes mellitus, and people with diabetes will be created in the presence of peripheral neuropathy who will do a neurological examination, an assessment of the articular range and an analysis of the gait and the plantar pressures with sensors placed in different segments of the plant the foot needing for the accomplishment of this study a period of approximately three months.Traballo fin de grao (UDC.FEP). Podoloxía. Curso 2016/201

    Measuring and managing foot muscle weakness

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    Foot muscle weakness is caused by disease, injury, inactivity and ageing, with disabling consequences. Exercise improves muscle weakness however, adherence to correct technique is challenging. Biofeedback may improve performance. Chapter One reviews the literature on small foot muscles, muscle function, measurement, causes and consequences of foot muscle weakness, and the role of exercise. Chapter Two is a systematic review on the relationship between foot pain, muscle strength and size. Eight studies were identified evaluating the relationship between foot pain and foot muscle strength or size, with a significant association between foot pain and muscle weakness when pain is of high intensity and weakness measured by toe flexion force. Chapter Three is a reliability study assessing size of abductor hallucis and medial belly flexor hallucis brevis muscles by ultrasound in 21 adults and identify their relationship with toe strength, foot morphology, balance. Intra-rater reliability was excellent. Significant associations were found between cross-sectional area of abductor hallucis with great toe flexion force, arch height sit and stand, truncated and full foot length, balance. Significant associations found between cross-sectional area of medial belly flexor hallucis brevis with Foot Posture Index, truncated and full foot length. After controlling for body size, cross-sectional area of abductor hallucis remained a significant correlate of great toe flexor strength. Chapter Four describes the development of the Archie biofeedback device. Device feasibility is evaluated in Chapter Five by repeat testing of 30 adults performing four foot exercises using Archie, with 89% of exercise and foot location variables collected consistently. Biofeedback significantly improved foot location for all exercises and 97% of participants reported biofeedback helped exercise performance. Archie appears to be a safe and feasible biofeedback device to assist participants perform exercise

    Foot pressures in leprosy

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