Motor learning of a gait pattern to reduce forefoot plantar pressures in individuals with diabetic peripheral neuropathy.

OBJECTIVE: To examine the role of visual feedback in the reduction of plantar pressures through teaching a "new" gait pattern to diabetic peripheral neuropathy subjects. Immediate, next day, and 1-week retention were studied to determine if motor pattern changes could occur. DESIGN: Randomized controlled trial. SETTING: VA Urban Healthcare System. PARTICIPANTS: Twenty-nine community-dwelling older adults with diabetic peripheral neuropathy volunteered. INTERVENTIONS: Subjects were randomized into feedback and no-feedback groups. All subjects received instruction and 2 days of practice and returned for a 1-week retention test. Instruction to pull the leg forward from the hip to initiate swing rather than push off the ground with the foot while walking was given to all subjects. The feedback group received visual feedback regarding peak plantar pressures after each practice trial. The no-feedback group received no feedback. MAIN OUTCOME MEASURES: Peak plantar pressures in the forefoot region for immediate retention (retention 1), next day retention (retention 2), and long-term retention (1-week retention). RESULTS: Peak plantar pressures were significantly (P < .01) reduced from baseline to retention 2 testing at the first metatarsal area in the feedback group. The feedback group walked significantly (P < .01) slower at retention 1 and 1-week testing compared with baseline. CONCLUSIONS: Individuals with diabetic peripheral neuropathy were unable to use a "new" strategy gait pattern to reduce peak plantar pressures long term (1 week). The use of visual feedback following the trial did not assist in the learning of a new walking pattern.

Effect of optically modified polyethylene terephthalate fiber socks on chronic foot pain.

BACKGROUND: Increasing experimental and clinical evidence suggests that illumination of the skin with relatively low intensity light may lead to therapeutic results such as reduced pain or improved wound healing. The goal of this study was to evaluate prospectively whether socks made from polyethylene terephthalate (PET) incorporating optically active particles (Celliant) ameliorates chronic foot pain resulting from diabetic neuropathy or other disorders. Such optically modified fiber is thought to modify the illumination of the skin in the visible and infrared portions of the spectrum, and consequently reduce pain. METHODS: A double-blind, randomized trial with 55 subjects (38 men, 17 women) enrolled (average age 59.7 +/- 11.9 years), 26 with diabetic neuropathy and 29 with other pain etiologies. Subjects twice completed the Visual Analogue Scale (VAS), Brief Pain Inventory (BPI), McGill Pain Questionnaire (MPQ), and SF-36 a week apart (W(1+2)) before receiving either control or Celliant socks. The same questionnaires were answered again one and two weeks (W(3+4)) later. The questionnaires provided nine scores for analyzing pain reduction: one VAS score, two BPI scores, five MPQ scores, and the bodily pain score on the SF-36. Mean W(1+2) and W(3+4) scores were compared to measure pain reduction. RESULTS: More pain reduction was reported by Celliant subjects for 8 of the 9 pain questions employed, with a significant (p = 0.043) difference between controls and Celliant for McGill question III. In neuropathic subjects, Celliant caused more pain reduction in 6 of the 9 questions, but not significantly. In non-neuropathic subjects 8 of 9 questions showed more pain reduction with the Celliant socks. CONCLUSION: Socks with optically modified PET (Celliant) appear to have a beneficial impact on chronic foot pain. The mechanism could be related to the effects seen with illumination of tissues with visible and infrared light. TRIAL REGISTRATION: ClinicalTrials.gov NCT00458497.