Impairment characteristics of static balance and plantar load distribution of patients undergoing tibial cortex transverse distraction for diabetic foot ulcers

Abstract

Objective Tibial cortex transverse distraction (TCTD) has been recently reported for the treatment of diabetic foot ulcers. Herein, we explored the characteristics of the impairments in static balance and plantar load distribution in patients. Methods We performed a retrospective study of 21 patients with diabetic foot ulcers who underwent TCTD, who were regularly followed up for > 1 year after surgery, and 20 healthy individuals (control group). A pressure platform was used to assess the standing balance functions of the lower extremities and the plantar load distribution. Results One patient underwent amputation because of severe infection. In patient group, center of pressure (COP) ellipse sway area, COP path length and angle θ were all larger, compared with those of control group (250.15 ± 98.36 mm2 vs. 135.67 ± 53.21 mm2, 145.15 ± 67.43 mm vs. 78.47 ± 34.15 mm, 39.75 ± 17.61° vs. 22.17 ± 14.15°), with statistically significant differences (P < 0.01). The average plantar load and backfoot load of the unaffected side was significantly larger than that of the affected side (58.4 ± 5.5% vs. 41.6 ± 5.5%, 45.3 ± 6.4% vs. 36.5 ± 5.6%), but they were similar for the two feet of members of the control group. Conclusions Although TCTD may represent an appropriate method for the treatment of diabetic foot ulcers, postoperative impairments in static balance and plantar load distribution remain in the long term. These potential long-term problems should be taken into account in further rehabilitation planning. Type of study/level of evidence: Therapeutic III.

Effectiveness of transverse tibial bone transport in treatment of diabetic foot ulcer: A systematic review and meta-analysis

“…All of the studies were published after 2019, in China. The study designs include single-arm RCT (n=1) ( 3 ), case-control study (n=4) ( 16 , 18 – 20 ), and case-series study (n=2) ( 15 , 17 ). A total of 818 participants were included, with 661 participants treated with TTT operation.…”

“…The type of diabetes was reported in 4 studies ( 3 , 16 , 17 , 19 ), with an overall percentage of type II diabetes of 98.91% (type I: 8; type II: 727). Data about Wagner and TEXAS ulceration grades were reported in 4 ( 3 , 15 , 18 , 20 ) and 3 ( 16 , 17 , 19 ) studies, respectively. In TTT and non-TTT groups, 3 and 2 patients were lost to follow-up respectively.…”

“…The detailed operation process is summarized in Table 2 . A routine debridement on the ulceration site was performed at the same time in most of the studies ( 15 – 17 , 19 , 20 ). Vacuum sealing drainage (VSD) and antibiotic bone cement (ABC) were applied at ulceration site in 2 ( 17 , 20 ) and 1 ( 16 ) studies, respectively.…”

“…A routine debridement on the ulceration site was performed at the same time in most of the studies ( 15 – 17 , 19 , 20 ). Vacuum sealing drainage (VSD) and antibiotic bone cement (ABC) were applied at ulceration site in 2 ( 17 , 20 ) and 1 ( 16 ) studies, respectively. In the peri-operative period, the managements mainly include the following four aspect: (1) antibiotics treatment according to drug sensitivity test; (2) debridement and drainage; (3) blood sugar controlling; and (4) dressing changing and disinfection.…”

“…Then, the full-text of 37 studies were screening for final eligibility. A total of 7 studies (3,(15)(16)(17)(18)(19)(20) were finally included for analysis.…”