Foot and ankle survey in adults with diabetes mellitus.

The purpose of this study was to examine the foot and ankle care patterns and shoe wear habits in patients with clinically proven diabetes mellitus who were attending diabetes education classes for the first time. One hundred subjects were recruited from outpatient adult diabetes education classes. No attempts were made to select patients on the basis of disease duration or severity. Each subject completed a questionnaire assessing life-style, shoe wear habits, health care status and interaction with healthcare providers. Thirty-seven percent of the subjects reported prior foot problems. Twenty percent had their feet examined regularly and 59% had never had their feet examined. Foot problems reported were: corns 11%, calluses 11%, bunions 3%, ulcers 1%, gout 1%. Sensation was tested using the 5.07 Semmes Weinstein monofilament across seven zones of the plantar surface of the foot. Subjects unable to feel this varied from 5% to 20% in each of the zones. Shoe wear was assessed for fit and style. Thirty percent of the patients had shoes that were too narrow and 81% of the patients with poorly fitting shoes were women. Shoe wear history and factors influencing shoe selection were recorded. Diabetes mellitus is a common disease, often affecting the feet. Preventive care can help patients deal with the manifestations of diabetic neuropathy. This study showed that a low percentage of subjects with diabetes regularly have their feet examined and that a relatively high percentage (31%) wear shoes that are too narrow. Identifying these patients early may allow modification of habits that put their feet at risk.

Foot pressures during gait: a comparison of techniques for reducing pressure points.

PURPOSE: Various methods have been used to redistribute plantar surface foot pressure in patients with foot ulcers. This study was conducted to determine the effectiveness of four modalities (fracture walker, fracture walker with insert, and open and closed toe total contact casts) in reducing plantar foot pressure. METHODS: Ten healthy, normal volunteer subjects had an F-scan sensor (ultra thin shoe insert pressure monitor) placed under the right foot. They then ambulated on a flat surface, maintaining their normal gait. Dynamic plantar pressures were averaged over 10 steps at four different sites (plantar surface of great toe, first metatarsal head, base of fifth metatarsal, and plantar heel). All subjects repeated this sequence under five different testing conditions (barefoot, with a fracture walker, fracture walker with arch support insert, open and closed toe total contact cast). Each subject's barefoot pressures were then compared with the pressures during the different modalities. RESULTS: All four treatment modalities significantly reduced (p < 0.05) plantar pressure at the first metatarsal head (no method was superior). The fracture walker, fracture walker with insert, and open toe total contact cast significantly reduced pressure at the heel. Pressures at the base of the fifth metatarsal and great toe were not significantly reduced with any treatment form. CONCLUSION: The fracture walker, with and without arch support, and total contact cast can effectively reduce plantar pressure at the heel and first metatarsal head.