Plantar Pressure Distribution Patterns During Gait in Diabetic Neuropathy Patients with a History of Foot Ulcers

OBJECTIVE: To investigate and compare the influence of a previous history of foot ulcers on plantar pressure variables during gait of patients with diabetic neuropathy. INTRODUCTION: Foot ulcers may be an indicator of worsening diabetic neuropathy. However, the behavior of plantar pressure patterns over time and during the progression of neuropathy, especially in patients who have a clinical history of foot ulcers, is still unclear. METHODS: Subjects were divided into the following groups: control group, 20 subjects; diabetic neuropathy patients without foot ulcers, 17 subjects; and diabetic neuropathy patients with at least one healed foot ulcer within the last year, 10 subjects. Plantar pressure distribution was recorded during barefoot gait using the Pedar-X system. RESULTS: Neuropathic subjects from both the diabetic neuropathy and DNU groups showed higher plantar pressure than control subjects. At midfoot, the peak pressure was significantly different among all groups: control group (139.4±76.4 kPa), diabetic neuropathy (205.3±118.6 kPa) and DNU (290.7±151.5 kPa) (p=0.008). The pressure-time integral was significantly higher in the ulcerated neuropathic groups at midfoot (CG: 37.3±11.4 kPa.s; DN: 43.3±9.1 kPa.s; DNU: 68.7±36.5 kPa.s; p=0.002) and rearfoot (CG: 83.3±21.2 kPa.s; DN: 94.9±29.4 kPa.s; DNU: 102.5±37.9 kPa.s; p=0.048). CONCLUSION: A history of foot ulcers in the clinical history of diabetic neuropathy subjects influenced plantar pressure distribution, resulting in an increased load under the midfoot and rearfoot and an increase in the variability of plantar pressure during barefoot gait. The progression of diabetic neuropathy was not found to influence plantar pressure distribution

Foot posture and classification of the plantar arch among adolescent wearers and non-wearers of high-heeled shoes

OBJETIVOS: Correlacionar a postura dos pés com o arco plantar de adolescentes usuárias e não usuárias de calçados de salto alto. MÉTODOS: Foram selecionadas 36 adolescentes, 16 no grupo de não usuárias e 20 no grupo de usuárias, com idade entre 13 e 20 anos. A postura do pé foi analisada por fotos nas condições descalça e com calçado de salto alto tipo Anabella, previamente padronizado, após terem permanecido com ele por uma hora. Sua análise foi realizada pelo software SAPO. A impressão plantar foi realizada descalça e, a partir dela, calculado o Índice de Chipaux - Smirak para classificação do arco plantar. Para análise estatística, utilizou-se o teste t pareado para verificar igualdade entre lados direito e esquerdo. Foi realizado o teste de aderência Shapiro Wilk e, então, a análise inferencial por meio dos testes não paramétricos de Wilcoxon, o teste de Mann-Whitney e a correlação de Spearman. O nível de significância adotado foi de 0,05. RESULTADOS: Não foi encontrada correlação entre o tipo de arco plantar e a postura do pé das adolescentes estudadas. Porém, o ângulo do retropé se mostrou significativamente diferente, apresentando varo de retropé após a colocação do calçado em ambos os grupos, e o arco plantar do grupo de usuárias apresentou valores menores quanto ao Índice Chipaux - Smirak. CONCLUSÕES: Não existe correlação entre a postura do pé e o tipo de arco plantar, embora essas variáveis tenham sofrido influência do calçado de salto alto. Artigo registrado na Australian New Zealand Clinical Trials Registry (ANZCTR) sob o número ACTRN12608000300370.OBJECTIVES: To investigate the relationship between foot posture and plantar arch among adolescent wearers and non-wearers of high-heeled shoes. METHODS: Thirty-six female adolescents aged 13 to 20 years were selected and grouped as 16 high-heel non-wearers and 20 high-heel wearers. Foot posture was analyzed using photos, firstly barefoot and, secondly, after wearing previously standardized high-heeled platform shoes for an hour. The analysis was performed using the software SAPo. Barefoot impressions were taken, and the Chipaux-Smirak Index was calculated to classify the plantar arch of the foot. For statistical analyses, the paired t test was used to investigate equality between the right and left sides. The Shapiro-Wilk adherence test was performed, followed by inferential analysis using the non-parametric Wilcoxon test, the Mann-Whitney test and Spearman's correlation coefficient. The significance level used was 0.05. RESULTS: There was no correlation between the type of plantar arch and foot posture among the female adolescents studied. However, the rearfoot angle was significantly different, with rearfoot varus after wearing the shoes in both groups. The plantar arch in the wearers group presented smaller values for the Chipaux-Smirak Index. CONCLUSIONS: There is no correlation between foot posture and the type of plantar arch, although these variables are influenced by high-heeled shoes. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under the number ACTRN12608000300370

Foot posture and classification of the plantar arch among adolescent wearers and non-wearers of high-heeled shoes

OBJETIVOS: Correlacionar a postura dos pés com o arco plantar de adolescentes usuárias e não usuárias de calçados de salto alto. MÉTODOS: Foram selecionadas 36 adolescentes, 16 no grupo de não usuárias e 20 no grupo de usuárias, com idade entre 13 e 20 anos. A postura do pé foi analisada por fotos nas condições descalça e com calçado de salto alto tipo Anabella, previamente padronizado, após terem permanecido com ele por uma hora. Sua análise foi realizada pelo software SAPO. A impressão plantar foi realizada descalça e, a partir dela, calculado o Índice de Chipaux - Smirak para classificação do arco plantar. Para análise estatística, utilizou-se o teste t pareado para verificar igualdade entre lados direito e esquerdo. Foi realizado o teste de aderência Shapiro Wilk e, então, a análise inferencial por meio dos testes não paramétricos de Wilcoxon, o teste de Mann-Whitney e a correlação de Spearman. O nível de significância adotado foi de 0,05. RESULTADOS: Não foi encontrada correlação entre o tipo de arco plantar e a postura do pé das adolescentes estudadas. Porém, o ângulo do retropé se mostrou significativamente diferente, apresentando varo de retropé após a colocação do calçado em ambos os grupos, e o arco plantar do grupo de usuárias apresentou valores menores quanto ao Índice Chipaux - Smirak. CONCLUSÕES: Não existe correlação entre a postura do pé e o tipo de arco plantar, embora essas variáveis tenham sofrido influência do calçado de salto alto. Artigo registrado na Australian New Zealand Clinical Trials Registry (ANZCTR) sob o número ACTRN12608000300370.OBJECTIVES: To investigate the relationship between foot posture and plantar arch among adolescent wearers and non-wearers of high-heeled shoes. METHODS: Thirty-six female adolescents aged 13 to 20 years were selected and grouped as 16 high-heel non-wearers and 20 high-heel wearers. Foot posture was analyzed using photos, firstly barefoot and, secondly, after wearing previously standardized high-heeled platform shoes for an hour. The analysis was performed using the software SAPo. Barefoot impressions were taken, and the Chipaux-Smirak Index was calculated to classify the plantar arch of the foot. For statistical analyses, the paired t test was used to investigate equality between the right and left sides. The Shapiro-Wilk adherence test was performed, followed by inferential analysis using the non-parametric Wilcoxon test, the Mann-Whitney test and Spearman's correlation coefficient. The significance level used was 0.05. RESULTS: There was no correlation between the type of plantar arch and foot posture among the female adolescents studied. However, the rearfoot angle was significantly different, with rearfoot varus after wearing the shoes in both groups. The plantar arch in the wearers group presented smaller values for the Chipaux-Smirak Index. CONCLUSIONS: There is no correlation between foot posture and the type of plantar arch, although these variables are influenced by high-heeled shoes. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under the number ACTRN12608000300370

Textured insoles affect the plantar pressure distribution while elite rowers perform on an indoor rowing machine

Introduction: During rowing, foot positioning on the foot stretcher is critical to optimise muscle force transmission and boat propulsion. Following the beneficial effects of textured insoles on gait and balance, this study aims at investigating whether passive stimulation of foot mechanoreceptors induced by these insoles may contribute to improving foot loading pattern and symmetry during indoor rowing. Methods: Eleven elite rowers were assessed during controlled training on a standard rowing machine while wearing control, low-density or high-density textured insoles. Plantar pressure and knee and trunk kinematics were measured; performance data were recorded from the machine. Insole effect on kinematic parameters, peak and average values of foot force, contact area and position of centre of pressure was assessed with ANOVA and Bonferroni correction for pair-wise comparisons. Results: A main effect was observed for force and contact area, with the high-density insoles providing greatest values (P0.190), even though symmetry was higher with high-density insoles. Kinematics (P = 0.800) and rowing performance were not affected by insole type; a consistent though not statistically significant increase in mean travelled distance was observed for denser insoles (P>0.21). Conclusion: The high-density textured insoles affected foot loading distribution during indoor rowing. Rowers applied greater foot force and over a greater foot stretcher area with the high-density than the low-density and control insoles. These findings and the methodology applied may be relevant for the understanding and monitoring of rowing performance. © 2017 Vieira et al

Classification of the severity of diabetic neuropathy: a new approach taking uncertainties into account using fuzzy logic

OBJECTIVE: This study proposes a new approach that considers uncertainty in predicting and quantifying the presence and severity of diabetic peripheral neuropathy. METHODS: A rule-based fuzzy expert system was designed by four experts in diabetic neuropathy. The model variables were used to classify neuropathy in diabetic patients, defining it as mild, moderate, or severe. System performance was evaluated by means of the Kappa agreement measure, comparing the results of the model with those generated by the experts in an assessment of 50 patients. Accuracy was evaluated by an ROC curve analysis obtained based on 50 other cases; the results of those clinical assessments were considered to be the gold standard. RESULTS: According to the Kappa analysis, the model was in moderate agreement with expert opinions. The ROC analysis (evaluation of accuracy) determined an area under the curve equal to 0.91, demonstrating very good consistency in classifying patients with diabetic neuropathy. CONCLUSION: The model efficiently classified diabetic patients with different degrees of neuropathy severity. In addition, the model provides a way to quantify diabetic neuropathy severity and allows a more accurate patient condition assessment

BIOMECHANICAL APPROACH TO BALLET MOVEMENTS: A STUDY OF THE EFFECTS OF BALLET SHOE AND MUSICAL BEAT ON THE VERTICAL REACTION FORCES

Ballet movements can be the focus of biomechanical studies in order to better understand the characteristic mechanical loads of the locomotor apparatus related to classic dance. "Pointe shoes" have been associated to high incidence of morphological and physiological alterations of ballet dancer's feet, however its contribution to injury mechanisms must still be precisely known. On the other hand, movements like jumps and leaps are frequently repeated in a standard ballet training, where the musical beat also plays a role on the motor behavior and its mechanical aspects. Therefore the purpose of the present study was to describe ground reaction forces during the "saute -1st position" under the influence of footwear (slippers and pointe shoes) and musical beat in order to identify the relative contribution of these factors on the external loads measured. It was observed that the musical beat played a greater role on the ground reaction force magnitudes than the footwear

Repeatability of skin-markers based kinematic measures from a multi-segment foot model in walking and running.

Skin-markers based multi-segment models are growing in popularity to assess foot joint kinematics in different motor tasks. However, scarce is the current knowledge of the effect of high-energy motor tasks, such as running, on the repeatability of these measurements. This study aimed at assessing and comparing the inter-trial, inter-session, and inter-examiner repeatability of skin-markers based foot kinematic measures in walking and running in healthy adults. The repeatability of 24 kinematic measures from an established multi-segment foot model were assessed in two volunteers during multiple barefoot walking and running trials by four examiners in three sessions. Statistical Parametric Mapping (1D-SPM) analysis was performed to assess the degree of shape-similarity between patterns of kinematic measurements. The average inter-trial variability across measurements (deg) was 1.0 ± 0.3 and 0.8 ± 0.3, the inter-session was 3.9 ± 1.4 and 4.4 ± 1.5, and the inter-examiner was 5.4 ± 2.3 and 5.7 ± 2.2, respectively in walking and running. Inter-session variability was generally similar between the two motor tasks, but significantly larger in running for two kinematic measures (p 0.01). Inter-examiner variability was generally larger than inter-trial and inter-session variability. While no significant differences in frame-by-frame offset variability was detected in foot kinematics between walking and running, 1D-SPM revealed that the shape of kinematic measurements was significantly affected by the motor task, with running being less repeatable than walking. Although confirmation on a larger population and with different kinematic protocols should be sought, attention should be paid in the interpretation of skin-markers based kinematics in running across sessions or involving multiple examiners