Shear and pressure under the first ray in neuropathic diabetic patients: Implications for support of the longitudinal arch.

OBJECTIVE: To assess dynamic arch support in diabetic patients at risk for Charcot neuroarthopathy whose arch index has not yet shown overt signs of foot collapse. METHODS: Two indirect measures of toe flexor activation (ratios: peak hallux pressure to peak metatarsal pressure - Ph/Pm; peak posterior hallux shear to peak posterior metatarsal shear - Sh/Sm) were obtained with a custom built system for measuring shear and pressure on the plantar surface of the foot during gait. In addition, the tendency of the longitudinal arch to flatten was measured by quantifying the difference in shear between the 1st metatarsal head and the heel (Sflatten) during the first half of the stance phase. Four stance phases from the same foot for 29 participants (16 control and 13 neuropathic diabetic) were assessed. RESULTS: The peak load ratio under the hallux (Ph/Pm) was significantly higher in the control group (2.10±1.08 versus 1.13±0.74, p=0.033). Similarly, Sh/Sm was significantly higher in the control group (1.87±0.88 versus 0.88±0.45, p=0.004). The difference in anterior shear under the first metatarsal head and posterior shear under the lateral heel (Sflatten) was significantly higher in the diabetic group (p<0.01). Together these findings demonstrate reduced plantar flexor activity in the musculature responsible for maintaining the longitudinal arch. CONCLUSIONS: With no significant difference in arch index between the two groups, but significant differences in Ph/Pm, Sh/Sm and Sflatten the collective results suggest there are changes in muscle activity that precede arch collapse.

Spatial frequency content of plantar pressure and shear profiles for diabetic and non-diabetic subjects.

How high does pressure and shear stress sensor resolution need to be in order to reliably measure the plantar pressure and shear profiles (PPSPs) under normal and diabetic feet? In this study, pressure and shear stress data were collected from 26 total diabetic and control subjects using new instrumentation that measures vertical and horizontal force vectors of the plantar contact surface during multiple instances in the gait cycle. The custom built shear-and-pressure-evaluating-camera-system (SPECS) performs simultaneous recordings of pressure and both components of the horizontal force vector (medio-lateral and antero-posterior) at distinctive regions under one׳s foot, at a spatial resolution for each sensor equal to 1.6mm by 1.6mm. A linear interpolation method was used to simulate the effect of increasing sensor size on PPSPs. Ten square-shaped sensors were included in the analysis, having edge lengths of: (1.6mm, 3.2mm, 4.8mm, 6.4mm, 8mm, 9.6mm, 11.2mm, 12.8mm, 14.4mm, and 16mm). A two-dimensional Discrete Fourier Transform was performed on each data set, for each of the ten sensor sizes. To quantify the difference between sensor sizes, a comparison was made using the maximum pressure and shear stress data over the entire plantar contact surface, equivalent to the peak of the spatial frequency spectrum. A reduction of 5% of any component of the stress vector (i.e., pressure, or medio-lateral shear stress, or anter-posterior shear stress) due to an increase in sensor size was deemed significant. The results showed that a sensor measuring 9.6mm by 9.6mm caused meaningful reductions in all three stress components (p<0.001), whereas sensors measuring 1.6mm by 1.6mm, up to 4.8mm by 4.8mm, can capture the full range of spatial frequencies in both pressure and shear stress data.

Expanded butterfly plots: A new method to analyze simultaneous pressure and shear on the plantar skin surface during gait.

The current method of visualizing pressure and shear data under a subject's foot during gait is the Pedotti, or "butterfly" diagram. This method of force platform data visualization was introduced in the 1970s to display the projection of the ground reaction force vector in the sagittal plane. The purpose of the current study was to examine individual sub-components of the vectors displayed in Pedotti diagrams, in order to better understand the relationship between one foot region and another. For this, new instrumentation was used that allows multiple Pedotti diagrams to be constructed at any instant during the gait cycle. The custom built shear-and-pressure-evaluating camera system (SPECS) allows for simultaneous recordings of pressure and both components of the horizontal force vector (medio-lateral and antero-posterior) at distinctive regions under one's foot during gait. Data analysis of such recordings affirms three conclusions: (i) pressure and shear values on individual sites on the plantar surface of the foot are not associated in a linear manner, (ii) force vectors in the heel and forefoot regions exhibit horizontal force components that oppose one another, and similarly, (iii) force vectors in the frontal plane transecting the forefoot region also exhibit medial-lateral shear components that counteract one another. This approach sheds light on individual vectors that collectively sum to each vector displayed in a Pedotti diagram. The results indicate that shearing between the foot and the ground is not simply a passive event. The structures of the arches and/or muscular activities are major contributors to the observed interfacial stresses.