Barefoot pressure distribution of diabetic patients and non-diabetic volunteer subjects after sensorimotor training with an unstable shoe construction.

BACKGROUND: Forty-three percent of all diabetic foot ulcers occur under the medial forefoot due to a medial deviation of elevated pressures and premature forefoot ground contact in neuropathic diabetic patients. A 6-week sensorimotor training period with an unstable shoe construction reduces in-shoe peak pressures and contact times under the medial aspect of the forefoot. METHODS: The study was designed as a Randomised Control Trial with two diabetic groups (one served as intervention group and one as control group) and one non-diabetic intervention group. Measurements for barefoot pressure distribution and contact times were taken by means of an Emed® pressure measurement platform (Novel GmbH, Munich) before and after 6 weeks. During this time the diabetic and the non-diabetic intervention groups were required to wear an unstable shoe construction (Masai Barefoot Technology, MBT®) for at least four hours per day. FINDINGS: Results for the non-diabetic intervention group showed significantly later contact times for the medial portion of the forefoot, resulting in shorter contact times. Peak pressure was also reduced under the medial aspect of the foot while it was increased under the lateral aspect of the foot. Changes for the diabetic intervention group followed the same pattern while the values of the diabetic control group shifted away from the reference values. INTERPRETATION: A 6-week sensorimotor training period with an unstable shoe construction can change barefoot peak pressures and contact times in non-diabetic subjects and in diabetic patients in the most endangered area, i.e. the medial forefoot.

Progressive rehabilitation of the sprained ankle: A novel treatment method.

OBJECTIVES: This randomised, single blinded cohort study was designed to assess the immediate effect of manual fascial manipulation on walking pain and the range of ankle dorsiflexion within the first 4 days after ankle trauma. METHODS: Measurements were taken from 19 subjects, 5 female and 14 male, who presented with grade I-III ankle sprains. Ankle dorsiflexion was photographed in a standardised position and calculated by means of the Dartfish® Advanced Video Analysis Software and SPSS® (version 17) was used to compare the pre- and post-treatment data. RESULTS: After one treatment session 13 of the 19 subjects were walking pain free and 3 of the 19 where walking with only little pain. The highly significant (p<0.001) mean improvement of ankle dorsiflexion was 7.9° (±5.8°). All, apart from one subject, whom were walking pain free after treatment showed a minimum of 4° increased dorsiflexion. CONCLUSION: Early fascia work around the injured ankle improves ankle dorsiflexion and reduces walking pain. It may reduce the delay of tissue healing and, thus, optimise further rehabilitation of the sprained ankle which may also reduce socio-economic costs.

Accuracy and repeatability of a semi-quantitative barefoot pressure measurement method for clinical use: The Derks Calculation Method.

BACKGROUND: This study was designed to assess the accuracy and repeatability of the Derks Calculation Method in the normal foot during walking. METHODS: Measurements were taken from 25 healthy subjects (age 32.0 ± 12.4), 23 females and 2 males, on five separate occasions at seven days, three weeks, three months, and nine months apart by means of a mid-gait method. Values were calculated for internal rotation (IR) and external rotation of the heel (ER), heel valgus/varus (HV), heel length (HL), heel width (HW), width of the midfoot (WM) and the forefoot (WF), and the length of the foot (LF). RESULTS: For all five separate occasions and in 87.5% of the parameters investigated, the coefficient of repeatability (CR, expressed as a percentage of the mean) was less than 5%. One parameter showed a high CR - heel valgus/varus (HV) was extremely high (>800%). The maximum 95% Confidence Interval (CI) for the five different occasions was no higher than 0.2 cm for IR, ER and HV with a standard error (SE) of 0.01 and >0.01 respectively. The maximum 95% CI for WF was 0.4 cm (SE 0.1), and for HW, WM and LF the maximum 95% CI was 0.7 cm (SE 0.1 or 0.2). HL showed the highest 95% CI (0.9 cm) with an SE of 0.2. CONCLUSION: The Derks Calculation Method was found to be accurate and repeatable if HV was excluded, which renders this method a viable clinical tool in settings where sophisticated computerised systems are still unavailable.

Normal pressure values and repeatability of the Emed® ST2 system.

OBJECTIVES: This study was designed to assess the repeatability of the Emed® ST2 system and identify the range of pressure values observed in the normal foot. METHODS: Measurements were taken from twenty-three healthy subjects, 14 females and 9 males, on two occasions 7 days apart. Begin of contact (BC), end of contact (EC), contact time (CT), peak pressure (PP), instant of peak pressure (IPP), contact area (CA) and pressure-time integral (PTI) were recorded. RESULTS: The coefficient of repeatability (CR) was less than 16.0% for all 63 parameters considered. In 87.3% of the parameters investigated (55 of 63) the CR (expressed as a percentage of the mean) was less than 10%. The highest areas of PP were found under the great toe and second metatarsal heads, with mean (S.D.) equal to 435 kPa (202) and 407 kPa (146), respectively, followed by the third metatarsal head 345 kPa (96) and the hindfoot 332 kPa (93). The CT (% ROP (range of pressure)) was in the range 74-85% under the metatarsal heads, and 71% under the great toe. CA was highest under the heel at 33.8 cm(2). CONCLUSION: Emed® ST2 system was found to be repeatable. The presented range of parameters compared very well to the results presented in the literature for the Emed® ST4 system.