scholarly journals Pedographic assessment of the impact of off-the-shelf orthopedic shoes on the load distribution under the feet in patients with a high risk of developing diabetic foot syndrome

2021 ◽  
Vol 23 (5) ◽  
pp. 442-451
Author(s):  
Vadim B. Bregovskiy ◽  
Oleg V. Udovichenko ◽  
Anastasia G. Demina ◽  
Eugenia Aleksandrovna Berseneva ◽  
Irina A. Karpova
Keyword(s):  
High Risk ◽  
Diabetic Foot ◽  
Load Distribution ◽  
Objective Assessment ◽  
Daily Basis ◽  
Diabetic Foot Syndrome ◽  
Lateral Part ◽  
Plantar Surface ◽  
The Impact ◽  
Orthopedic Shoes

BACKGROUND: It is known that the so-called “rocker” outsole helps to reduce the load on the forefoot and toes. Such an outsole is available in ready-made orthopedic shoes of some Russian manufacturers, however, an objective assessment of their impact on the load distribution under the foot during walking has not been carried out.AIMS: To study the pressure distribution inside the off-the-shelf orthopedic shoes“Sursil-Ortho” in comparison with the load inside the shoes used by patients on a daily basis.METHODS: We studied 20 patients (40 feet) with a high risk of diabetic foot syndrome. According to clinical data, a risk regions were determined on the plantar surface of the feet. In-shoe pedography (pedar, novel,Germany) was performed in shoes usually worn by the patients, and in orthopedic shoes“Sursil-Orto”(Moscow). The maximum peak pressure (MPP) was calculated. Criterion of efficiency: MPP in the risk region<200 kPa or reducing it by 25% or more.RESULTS: There was a significant decrease of the median MPP in the forefoot and in the risk region. The percentage of feet with MPP >200 kPa in the risk region decreased from 58% to 30% (p=0,014), in any area of the forefoot — from 63% to 30% (p=0,04). The increase in MPP under the midfoot and hindfoot did not exceed +14% (ns). Tested footwear was effective in 71% of cases. Predictors of the insufficient effect were: higher initial MPP in the risk region, risk region on the hallux or in the lateral part of the forefoot.CONCLUSIONS: Shoes with a rigid rocker outsole significantly reduce the pressure under the forefoot and under the toes during walking. The degree of load reduction varies: the lateral part of the forefoot and 2-5 toes are most unloaded, and the hallux and medial forefoot are slightly less.

scholarly journals Changes in plantar load distribution in legally blind subjects

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249467
Author(s):  
Ketlin Jaquelline Santana Castro ◽  
Railson Cruz Salomão ◽  
Newton Quintino Feitosa ◽  
Leonardo Dutra Henriques ◽  
Ana Francisca Rozin Kleiner ◽  
...  
Keyword(s):  
Visual Impairment ◽  
Load Distribution ◽  
Visual Loss ◽  
Center Of Pressure ◽  
Balance Control ◽  
Anterior Displacement ◽  
Plantar Surface ◽  
Eyes Open ◽  
Impaired Balance ◽  
The Impact

We investigated the impact of visual impairment on balance control. We measured the center of pressure (COP) between the two feet and plantar surface pressures on each foot in 18 normal-sighted participants and compared their data with measures from 18 legally blind participants, either acquired or congenital. Pressures were measured in open- and closed-eye conditions using a baropodometric resistive plate. In the eyes-open condition, there were no differences between the sighted and legally blind groups in COP displacement. However, participants with visual loss had significantly increased pressures in two metatarsal regions (M1 and M2 zones) of the plantar surface in both viewing conditions (p < 0.05). The differences in pressure measures between the normally sighted and legally blind groups could be attributed mainly to the subgroup of subjects with acquired impairment. Our findings suggest that subjects with visual impairment present increased metatarsal pressures (i.e. forefoot), not yet associated to anterior displacement of COP or impaired balance control.

scholarly journals Orthoses in diabetic foot treatment and prevention

2013 ◽  
Vol 94 (4) ◽  
pp. 536-541
Author(s):  
I V Klyushkin ◽  
K A Koreyba
Keyword(s):  
Diabetes Mellitus ◽  
Elastic Material ◽  
Diabetic Foot ◽  
Silver Ions ◽  
Cost Effective ◽  
Diabetic Foot Syndrome ◽  
Treatment And Prevention ◽  
Positive Treatment ◽  
Orthopedic Shoes

Aim. To define the role of orthoses in the treatment and rehabilitation of patients with diabetic foot syndrome. Methods. The review of the literature addressing the use of special orthopedic shoes in the treatment and rehabilitation of patients with complicated diabetes mellitus was performed. Results. The common requirements for orthopedic shoes for patients with complicated diabetes mellitus are the following: (1) rigid sole with an artificial curvature; (2) boot-tree elevated by 8 mm due to arch supporter, adequate volume, wide sole, removable insole; (3) insole without functional memory; (4) thermally variable elastic material, advisably with silver ions, for the lining; (5) minimal number of sutures at the lining; (6) no elastic material at the front of the shoe and at the lining at the toes; (7) increased volume and enough space for the toes; (8) front slant of 15°; (9) potential ability to adjust the inner volume of the shoe; (10) hard counter - stabilizing hard back with additional softening at the lining side; (11) heel with a front slant or a solid sole without a heel; (12) smooth non-traumatic surface suitable for scrubbing including cleansing with antiseptics. The indications for orthopedic relief in patients with diabetic foot syndrome are explained. Economic superiority of organ-preserving approaches in such patients is shown. There is an opposition for conservative methods of treatment of patients with diabetic foot syndrome, nevertheless, an amputation can not be estimated as a positive treatment outcome in such patients. Almost 70-90% of ulcers in this group of patients are healed without amputation. Limb-saving treatment and the use of specially selected shoes are cheaper and more cost-effective compared to the limb loss. Conclusion. The use of orthopedic shoes in patients with diabetic foot syndrome is used both for treatment and rehabilitation. This technique can reduce the risk of ulceration and prevent organ-sparing surgeries.

The impact of Syme amputation in surgical treatment of patients with diabetic foot syndrome and Charcot-neuro-osteoarthropathy

2004 ◽  
Vol 124 (3) ◽  
pp. 145-150 ◽  
Author(s):  
A. Eckardt ◽  
C. Sch�llner ◽  
J. Decking ◽  
S. Ritter ◽  
S. Schadmand-Fischer ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Diabetic Foot ◽  
Diabetic Foot Syndrome ◽  
The Impact ◽  
Syme Amputation

scholarly journals Different Patterns of Bacterial Species and Antibiotic Susceptibility in Diabetic Foot Syndrome with and without Coexistent Ischemia

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Rafał Małecki ◽  
Kamil Klimas ◽  
Aleksandra Kujawa
Keyword(s):  
Diabetic Foot ◽  
Bacterial Species ◽  
Treatment Success ◽  
Hospitalized Patients ◽  
Diabetic Foot Syndrome ◽  
Diabetic Patients ◽  
Beta Lactamase ◽  
Bacterial Strains ◽  
Culture Methods ◽  
The Impact

Aims. Infection in diabetic foot syndrome (DFS) represents serious medical problem, and the annual risk of DFS in diabetic patients is 2.5%. More than half of the patients with DFS have symptoms of extremity ischemia (peripheral arterial disease (PAD)). The aim of the present study was to analyze the frequency of particular bacterial strains in people with DFS, analyze the impact of arterial ischemia on the occurrence of a given pathogen, and evaluate the antibacterial treatment based on the results of bacterial culture. Methods. The analysis included 844 bacterial strains obtained from 291 patients with DFS hospitalized in the Department of Angiology in years 2016–2019. Results. The most common isolates were Staphylococcus aureus, Enterococcus faecalis, Enterobacter cloacae, Pseudomonas aeruginosa, and Acinetobacter baumannii. Nearly 20% of the species were found to have at least one resistance mechanism. In patients with PAD, Gram-negative species were isolated more commonly than in people without PAD. The most useful drugs in DFS in hospitalized patients are penicillins with beta-lactamase inhibitors, 3rd- to 5th-generation cephalosporins (with many exceptions), carbapenems, aminoglycosides, and tigecycline. Conclusions. Bacterial strains isolated from ischemic DFS are more resistant to commonly used antibacterial agents, i.e., penicillins (including penicillins with beta-lactamase inhibitors), cephalosporins (except for the 4th and 5th generations), glycopeptides, and linezolid. When planning treatment of hospitalized patients with DFS, the presence of ischemia in DFS should always be taken into consideration. It determines the occurrence of particular bacterial species and the choice of antibacterial agent and may determine the rate of treatment success.

scholarly journals Interdisciplinary approach to the management of the neuropathic form of diabetic foot syndrome. The role of the orthopedist

2020 ◽  
Vol 5 (4) ◽  
pp. 22-27
Author(s):  
A. K. Volkovoy ◽  
V. N. Obolensky ◽  
V. G. Protsko ◽  
E. Yu. Komelyagina ◽  
S. V. Gorokhov ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Chronic Wound ◽  
Interdisciplinary Approach ◽  
Diabetic Foot Syndrome ◽  
Plantar Surface

The article presents the experience of an interdisciplinary approach to the management of diabetic foot syndrome using the example of treating a patient with a neuropathic form, which manifests itself as a chronic wound of the foot plantar surface.

scholarly journals High Incidence of Adverse Outcomes in Haemodialysis Patients with Diabetes with or without Diabetic Foot Syndrome: A 5-Year Observational Study in Lleida, Spain

2021 ◽  
Vol 10 (7) ◽  
pp. 1368
Author(s):  
Montserrat Dòria ◽  
Àngels Betriu ◽  
Montserrat Belart ◽  
Verónica Rosado ◽  
Marta Hernández ◽  
...  
Keyword(s):  
Observational Study ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Adverse Outcomes ◽  
Diabetic Foot Syndrome ◽  
High Incidence ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Baseline Characteristics ◽  
The Impact

Background: We evaluated whether, in subjects receiving haemodialysis (HD), the presence of diabetic foot syndrome (DFS) was associated with increased mortality compared with subjects with diabetes mellitus (DM) without DFS and with non-diabetic subjects. Methods: Retrospective, observational study in 220 subjects followed for six years. We calculated and compared the frequency and 5-year cumulative incidence of all-cause mortality, cardiovascular (CV) mortality, CV events, major adverse CV events (MACE), and new foot ulcer (FU) or amputation. We also examined prognostic factors of all-cause and CV mortality based on baseline characteristics. Results: DM patients had a 1.98 times higher probability of all-cause mortality than those without DM (p = 0.001) and 2.42 times higher likelihood of CV mortality and new FU or amputation (p = 0.002 and p = 0.008, respectively). In the DM cohort, only the risk of a new FU or amputation was 2.69 times higher among those with previous DFS (p = 0.021). In patients with DM, older age was the only predictor of all-cause and CV mortality (p = 0.001 and p = 0.014, respectively). Conclusions: Although all-cause and CV mortality were increased on HD subjects with DM, the presence of DFS did not modify the excess risk. Additional studies are warranted to further explore the impact of DFS in subjects with DM undergoing HD.

scholarly journals Detection of skin microvascular vasodilation disorders in patients with diabetic foot syndrome during the local heating test

2015 ◽  
Vol 14 (3) ◽  
pp. 27-33 ◽  
Author(s):  
N. A. Zubareva ◽  
S. Y. Podtaev ◽  
A. A. Parshakov
Keyword(s):  
Wavelet Analysis ◽  
Diabetic Foot ◽  
Healthy Subjects ◽  
Local Heating ◽  
Diabetic Polyneuropathy ◽  
Limb Ischemia ◽  
Diabetic Foot Syndrome ◽  
Time Frequency ◽  
Plantar Surface ◽  
Heating Test

Introduction and purpose. The aim of investigation was to evaluate the possibility of using the method of wavelet analysis of skin temperature during the local heating test for the study of the microvascular tone regulation in patients with diabetic foot syndrome (DFS). Materials and methods. The study was performed in 15 healthy subjects and 10 patients with neuro-ischemic form of DFS complicated by trophic ulcers. The temperature of the plantar surface of the hallux was recorded by «Microtest» (Perm, Russia) with temperature resolution 0,002°C. Time-frequency analysis of temperature fluctuations was performed using wavelet analysis. For the reconstruction of the oscillations in endothelial (0.02-0.0095 Hz), neurogenic (0.05-0.02 Hz) and myogenic (0.05-0.14 Hz) frequency ranges we used inverse wavelet transform. Results. In healthy people, indexes of vasodilation (relative changes in the oscillation amplitudes) in the myogenic, neurogenic, and endothelial frequency ranges were 3.04, 4.01 and 2.25 respectively. In patients with DFS the values were significantly lower than in healthy subjects (0.60, 0.67 and 0.51, respectively). Conclusion. In contrast to healthy subjects, the combination of diabetic polyneuropathy with endothelial dysfunction and macroangiopathy in patients with neuro-ischemic form of DFS leads to the progression of mutually aggravating pathological processes and lower limb ischemia. Further implementation of the local heating test at the early stages of diabetic foot is of interest for the prognosis of the disease, evaluating the effectiveness of conservative treatment and endovascular interventions.

scholarly journals Clinical Efficacy and Safety of a New Method for Pressure Off-load for Patients with Diabetic Foot Syndrome: Ankle-foot Pneumoorthosis with TM Orlett

2014 ◽  
Vol 17 (4) ◽  
pp. 66-71 ◽  
Author(s):  
Galina Yur'evna Strakhova ◽  
Sergey Valentinovich Gorokhov ◽  
Irina Nikolaevna Ul'yanova ◽  
Gagik Radikovich Galstyan
Keyword(s):  
Clinical Efficacy ◽  
Diabetic Foot ◽  
Test Group ◽  
Complete Healing ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Maximum Pressure ◽  
Plantar Surface ◽  
Time Integral ◽  
Pressure Time

Aim. The purpose of this study was to assess the clinical efficacy, safety and consumer properties of ankle-foot pneumoorthosis with a HAS-337 TM Orlett compared with non-removable total contact cast (TCC) immobilization. Materials and methods. Our study included 40 patients with diabetes mellitus type 1 (DM1) and type 2 (DM2) with neuropathic diabetic foot syndrome and chronic uninfected wounds of the plantar surface of the forefoot, with wound duration of at least 3 weeks, wound areas not less than 1 cm2 and wound depths not more than stage II based on Wagner?s classification. We excluded patients with infected wounds, osteomyelitis, Charcot osteoarthropathy or peripheral vascular disease. Our test group included 20 patients who received pressure off-load using ankle-foot pneumoorthosis with a HAS-337 TM Orlett. For a control group (n = 20), pressure off-load was achieved using TCC immobilization. Both groups were comparable with regard to age, gender, duration and degree of diabetes compensation and by original wound defect sizes (p >0.05). The study duration was 6 months. Plantar pressure was measured inside the orthosis or TCC and was compared with test shoe measurements. Our major criteria for pressure relief were reduced pressures in the wound area and the whole foot and the rate of wound healing. Results. At the end of the 6-month period, complete healing of all ulcers was achieved. The average healing time was 46.1?19.0 days for the test group and was 48.3?20.5 days for the control group (p >0.05). Two patients who wore pneumoorthosis with HAS-337 were discontinued upon patient request. With pneumoorthosis, the maximum peak pressure on the foot and wound defect areas was reduced by 26% and 57%, respectively. The pressure/time integral decreased on average by 41% (p >0.05). Furthermore, in the midfoot area with pneumoorthosis, the maximum pressure increased by 48% and the pressure/time integral increased by 47%. Conclusions. Using pneumoorthosis with HAS-337 was an effective and safe method for pressure off-load, resulting in 100% healing of uninfected neuropathic ulcers of the plantar surface of the forefoot. However, pneumoorthosis with HAS-337 is not recommended for those patients with wound defects in the midfoot and heel areas.

scholarly journals Photobiomodulation With Customized Insoles on Maximum Plantar Pressure in Diabetic Foot Syndrome by the Biomechanical Model: A Case Report

2021 ◽  
Vol 19 (1) ◽  
pp. 111-116
Author(s):  
Hrishikesh Yadav Korada ◽  
Keyword(s):  
Diabetic Foot ◽  
Plantar Pressure ◽  
Postural Sway ◽  
Dynamic Pressure ◽  
Biomechanical Model ◽  
Photobiomodulation Therapy ◽  
Diabetic Foot Syndrome ◽  
Low Level Laser Therapy ◽  
Plantar Surface ◽  
Plantar Pressures

A 49-year-old male patient with type 2 diabetes mellitus and Diabetic Foot Syndrome (DFS) was evaluated by comprehensive diabetic foot assessment. A 10-session photobiomodulation therapy (low-level laser therapy) was prescribed for neuropathic pain and symptoms applying the scanning and probe method. Customized insoles were recommended for redistributing the plantar pressures and reducing stress on the diabetic foot’s plantar surface for 4 weeks. Dynamic plantar pressure distribution, lower limb kinematics, and postural sway were evaluated using WinTrack dynamic pressure platform. Photobiomodulation therapy with customized insoles is useful in the redistribution and treatment of plantar pressure and gait kinematics. This approach should be extensively used in DFS as preventive and treatment measures.

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