Abnormal foot function in diabetic patients: the altered onset of Windlass mechanism

D’Ambrogi, Emanuela; Giacomozzi, Claudia; Macellari, Velio; Uccioli, Luigi

doi:10.1111/j.1464-5491.2005.01699.x

Cited by 78 publications

(92 citation statements)

References 35 publications

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“…This conversely refutes those other studies that attribute this condition with increased pressure (20)(21)(22).…”

Section: Discussionsupporting

confidence: 88%

“…According to a series of studies performed by D'Ambrogi and colleagues, plantar fasciitis causes the fascia to thicken which in turn increases stiffness of the medial longitudinal arch resulting in an increase in plantar pressures during gait. However, this relationship was seen in diabetic participants, which made the authors speculate as to whether the increase in pressure had a systemic or a mechanical origin (20)(21)(22).…”

Section: Introductionmentioning

confidence: 97%

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The Relationship between Plantar Fasciitis and Plantar Heel Pressure

2017

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Objective: The presence of increased medial heel plantar pressure in plantar fasciitis has been debated, with clinicians often utilizing pressure-relieving devices, such as heel pads and cups, as a means of management. Method: Plantar pressures in a sample of 15 adult participants with chronic plantar fasciitis were compared to plantar pressures of the 15 adult participants forming the control group, who were matched for age, gender and weight. Results: There were no significant differences in peak heel plantar pressure (p = 0.244), lateral peakplantar pressure (p = 0.876), forefoot peak plantar pressure (p = 0.576) and the Forefoot to Rearfoot peak pressure ratio (p = 0.242) between the 2 groups. However, there was a significant difference (p = 0.015) in medial heel peak plantar pressure between the 2 groups, with the plantar fasciitis group having lower medial heel pressure than the control group. Conclusion: The findings in this study suggest that there is no relationship between peak medial heel plantar pressures and chronic medioplantar heel pain in plantar fascitis. There is also no shift in pressure from the symptomatic medio-plantar heel region to the latero-plantar heel and forefoot regions. As a result, pressure may not play a part in the pathophysiology of plantar fascitis.Key Words: plantar fasciitis; plantar pressure; heel pain. ResumenObjetivos: La presencia de incremento de presión plantar en la zona medial del talón en la fascitis plantar ha sido estudiado, y los clínicos a menudo utilizan dispositivos de alivio de la presión, como almohadillas de talón y cazoletas, como medio de manejo. Método: Las presiones plantares en una muestra de 15 participantes adultos con fascitis plantar crónica se compararon con las presiones plantares de los 15 participantes adultos que formaron el grupo control, que fueron comparados por edad, sexo y peso. Resultados: No hubo diferencias significativas en la presión plantar en el pico pico (p = 0,244), en la presión pico lateral (p = 0,876), en la presión plantar pico en el antepié (p = 0,576) Los 2 grupos. Sin embargo, hubo una diferencia significativa (p = 0,015) en la presión plantar del talón medial entre los 2 grupos, con el grupo de fascitis plantar con menor presión en el talón medial que en el grupo control. Conclusión: Los hallazgos en este estudio sugieren que no hay relación entre el pico medial del talón de las presiones plantares y crónico medio-plantar talón dolor en la fascitis plantar. Tampoco hay cambio en la presión de la región sintomática del talón medio-plantar a las regiones del talón latero-plantar y del antepié. Como resultado, la presión puede no desempeñar un papel en la fisiopatología de la fascitis plantar.Palabras Clave: fascitis plantar; presión plantar; dolor de talón.

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“…This conversely refutes those other studies that attribute this condition with increased pressure (20)(21)(22).…”

Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 97%

The Relationship between Plantar Fasciitis and Plantar Heel Pressure

2017

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“…In fact, this mechanism is embodied by a distinct eversion and adduction of the metatarsus with respect to the calcaneus creating a rigid lever for propulsion. However, alterations in elastic properties of the plantar fascia and non-enzymatic glycosylation of other tissues affect the functional behaviour between different segments (Cronin et al, 2010;D'Ambrogi et al, 2005). This altered windlass mechanism has also been pinpointed as causative factor for increased forefoot plantar loading (D'Ambrogi et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

“…However, alterations in elastic properties of the plantar fascia and non-enzymatic glycosylation of other tissues affect the functional behaviour between different segments (Cronin et al, 2010;D'Ambrogi et al, 2005). This altered windlass mechanism has also been pinpointed as causative factor for increased forefoot plantar loading (D'Ambrogi et al, 2005). Reduced transverse plane midfoot and forefoot mobility has also been highlighted as potential evolutional factor of Charcot changes at the midfoot as a result of increased torsional moments about the midfoot (Rao et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

Comparison of foot segmental mobility and coupling during gait between patients with diabetes mellitus with and without neuropathy and adults without diabetes

Deschamps

Matricali

Roosen

et al. 2013

Clinical Biomechanics

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Background: Reduction in foot mobility has been identified as a key factor of altered foot biomechanics in individuals with diabetes mellitus. This study aimed at comparing in vivo segmental foot kinematics and coupling in patients with diabetes with and without neuropathy to control adults. Methods: Foot mobility of 13 diabetic patients with neuropathy, 13 diabetic patients without neuropathy and 13 non-diabetic persons was measured using an integrated measurement set-up including a plantar pressure platform and 3D motion analysis system. In this age-, sex-and walking speed matched comparative study; differences in range of motion quantified with the Rizzoli multisegment foot model throughout different phases of the gait cycle were analysed using one-way repeated measures analysis of variance (ANOVA). Coupling was assessed with cross-correlation techniques. Findings: Both cohorts with diabetes showed significantly lower motion values as compared to the control group. Transverse and sagittal plane motion was predominantly affected with often lower range of motion values found in the group with neuropathy compared to the diabetes group without neuropathy. Most significant changes were observed during propulsion (both diabetic groups) and swing phase (predominantly diabetic neuropathic group). A trend of lower cross-correlations between segments was observed in the cohorts with diabetes. Interpretation: Our findings suggest an alteration in segmental kinematics and coupling during walking in diabetic patients with and without neuropathy. Future studies should integrate other biomechanical measurements as it is believed to provide additional insight into neural and mechanical deficits associated to the foot in diabetes.

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“…Giacomozzi and colleagues demonstrated reduced ankle mobility in patients with DM with and without peripheral neuropathy suggesting another mechanism is responsible for alterations in foot-ankle biomechanics (Giacomozzi et al). Abnormal thicknesses of plantar fascia and Achilles tendon have been measured (D'Ambrogi et al, 2005;Salsich et al, 2005).…”

Section: Biomechanical Factors and Ulcerationmentioning

confidence: 99%