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

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

Multi-segment foot kinematics during running and its association with striking patterns

There is an ongoing debate regarding the advantages and harms of different running striking patterns. The purpose of this study was to explore the kinematic differences between running with a midfoot- and rearfoot striking (RFS) pattern. Multi-segment foot kinematics of 12 students were assessed while running barefoot at 3.3 m/s (±10%) using a passive optoelectronic motion analysis system. Participants performed multiple running trials while landing on the rearfoot and midfoot. Comparison of the kinematic waveforms was performed using one-dimensional statistical parametric mapping (1DSPM) (paired t-test). The inter-segment angle between the shank and calcaneus was found to be significantly more plantar-flexed, more inverted and more adducted in the midfoot striking (MFS) condition compared to the RFS pattern. The calcaneus-midfoot inter-segment angle was found to be more plantar-flexed in the MFS condition. The downward angulation of the metatarsals and the medial longitudinal arch angle in the late swing phase was found to be more pronounced during MFS. Differences between midfoot and RFS patterns occur in the first sub-phase of stance (0-50% of the stance phase). These findings may be of interest for the kinesiopathological or pathokinesiological reasoning processes when facing foot- and lower limb-related running injuries.status: publishe

3D Multi-segment foot kinematics in children: A developmental study in typically developing boys.

BACKGROUND: The relationship between age and 3D rotations objectivized with multisegment foot models has not been quantified until now. The purpose of this study was therefore to investigate the relationship between age and multi-segment foot kinematics in a cross-sectional database. METHODS: Barefoot multi-segment foot kinematics of thirty two typically developing boys, aged 6-20 years, were captured with the Rizzoli Multi-segment Foot Model. One-dimensional statistical parametric mapping linear regression was used to examine the relationship between age and 3D inter-segment rotations of the dominant leg during the full gait cycle. RESULTS: Age was significantly correlated with sagittal plane kinematics of the midfoot and the calcaneus-metatarsus inter-segment angle (p<0.0125). Age was also correlated with the transverse plane kinematics of the calcaneus-metatarsus angle (p<0.0001). CONCLUSION: Gait labs should consider age related differences and variability if optimal decision making is pursued. It remains unclear if this is of interest for all foot models, however, the current study highlights that this is of particular relevance for foot models which incorporate a separate midfoot segment