Location of plantar ulcerations in diabetic patients referred to a Department of Veterans Affairs podiatry clinic.

This study described the location of foot ulcerations via a retrospective chart review of diabetic patients in a Department of Veterans Affairs podiatry clinic and correlated location of ulceration with specific medical parameters. The heel was a site of ulceration in 11% of the patients. By multiple logistic regression, patients with diminished vascular function were more than five times more likely to have heel ulceration than patients with adequate vascular status. The findings suggest that heel ulcerations are more common than originally thought and are associated with diminished vascular status. Further work is necessary for reducing plantar heel pressure in individuals who are not presently candidates for vascular interventions.

Effects of footwear on medial compartment knee osteoarthritis.

This pilot study investigated whether lateral-wedge insoles inserted into shock-absorbing walking shoes altered joint pain, stiffness, and physical function in patients with symptomatic medial compartment knee osteoarthritis (OA). Twenty-eight subjects wore full-length lateral-wedge insoles with an incline of 4 degrees in their walking shoes for 4 weeks. Pain, stiffness, and functional status were measured with the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index at baseline and 4 weeks postintervention. Significant improvements were observed in all three WOMAC subscales (pain, stiffness, and function). Pain scores were significantly reduced for the most challenging activity-stair climbing. Subjects wore insoles daily and tolerated them well. The results of this study indicated that lateral-wedge insoles inserted into shock-absorbing walking shoes are an effective treatment for medial compartment knee OA.

Outcomes of a consult fall prevention screening clinic.

OBJECTIVE: To report patient satisfaction and quality outcomes from a standardized, multicenter fall prevention screening clinic. DESIGN: Referrals were made to the fall prevention screening clinic, which was staffed by a physician, pharmacist, therapist, nurse, and the site coordinator. The fall prevention screening clinic staff utilized a team-meeting format with clearly delineated management options to determine the appropriate interventions based on various screening examinations. RESULTS: Primary care providers acknowledged pharmacy recommendations and >80% of the recommendations were followed. There was a reduction in reported falls (initial visit = 297 falls, follow-up visit = 141 falls, P = 0.0002) and in the number of recurrent fallers. There was a small (average difference = 1.8 secs) but significant (P = 0.025) decrease in the 8-foot Up-and-Go time, representing a functional improvement in walking speed. There was no significant change in the Fall Efficacy Scale, however. At least 80% of the patients reported that they were completely satisfied with their care. CONCLUSIONS: Patients who attended the fall prevention screening clinic demonstrated improved confidence during activities of daily living and reduced falls. They reported high satisfaction with the clinic format.

Comparison of hip and knee muscle moments in subjects with and without knee pain.

Elderly subjects with and without knee pain walked at a comfortable pace during gait analysis. Comparison of peak hip and knee internal extensor generalized muscle moments (GMMs) during loading response was made between groups. Walking velocity, peak hip internal extensor GMM, and knee range of motion (ROM) were significantly less for the group with knee pain than for the group without pain. Peak hip internal extensor GMM was strongly correlated with velocity, but peak knee internal extensor GMM was not. Knee ROM limitations may account for the increased peak knee internal extensor GMM in the knee pain group.

Comparison of cycling kinetics during recumbent bicycling in subjects with and without diabetes.

We compared recumbent bicycle kinetics in diabetic peripheral neuropathy and nondiabetic men (nine per group). 3D kinematic and force pedal data in a linked-segment model were used. The generalized muscle moment (GMM) patterns were similar between the two groups except for (1) decreased maximum knee flexor moment, (2) increased minimum knee flexor GMM, and (3) maximum hip extensor GMM by the diabetic subjects. Similar to the walking support moment, a summation moment immutable pattern was observed, although the groups accomplished it differently. The diabetic group utilized the hip during the power phase and the knee during the recovery phase. The nondiabetic group utilized both joints together during both phases. Differences in ankle GMM were not observed, suggesting further research using the recumbent bicycle as an exercise modality for diabetic peripheral neuropathy patients to enhance ankle range of motion and strength, commonly observed walking deficits.

Lower extremity general muscle moment patterns in healthy individuals during recumbent cycling.

OBJECTIVE: The purpose of this study was to compare lower extremity generalized muscle moments across two workloads during recumbent bicycling in younger and older healthy adults. DESIGN: The study design was a comparative investigation of cycling patterns. BACKGROUND: Biomechanical data regarding muscle activation, kinematic, and kinetic patterns have been presented for upright cycling, but only a few studies have evaluated biomechanical patterns during the alternative configuration of recumbent cycling. METHODS: Twenty-four healthy adults, classified by age into two different groups, under 35 and over 50 years of age, rode a recumbent bicycle at a constant cadence (60-65 rpm) and at two different resistances (0.5 and 1.0 kg m) while kinematic and kinetic data were recorded. General muscle moments were calculated using joint kinematic and kinetic data via inverse dynamic equations. RESULTS: The ankle general muscle moment remained plantar flexor throughout the pedaling cycle; the knee general muscle moment remained flexor throughout the cycle, except during the power phase of the higher workload where an extensor general muscle moment was observed; and the hip general muscle moment was extensor with a transient flexor general muscle moment period during the recovery phase. Increased workload led to increases in ankle plantar flexor and knee extensor general muscle moment magnitudes, but no changes at the hip. Age had no effect on general muscle moment magnitudes or patterns. CONCLUSIONS: Configurational differences between the upright and recumbent bicycle do not affect patterns, but the total output requirements do affect the magnitudes of the general muscle moments. RELEVANCE: Based on previous studies, the recumbent bicycle appears to be a safe rehabilitation tool for post-cerebrovascular accident and cardiorespiratory patients, but in order to more properly and efficiently use the recumbent bicycle as a rehabilitation tool, normative biomechanical data are necessary. The current study is the first such investigation to report normative data of lower extremity general muscle moment patterns during recumbent cycling. Effects of age and workload were also demonstrated.