Plantar pressure measurements and the prevention of ulceration in the diabetic foot

Duckworth, T.; Aj, Boulton; Betts, R. P.; Franks, C. I.; Ward, J. D.

doi:10.1302/0301-620x.67b1.3968150

Cited by 142 publications

(63 citation statements)

References 5 publications

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“…Sixth, measurements were made with the patients in bare feet. Even though we rarely walk barefoot, because there is such a wide variety of shoe wear and shoes alter the pedobarographic examination to such a degree that meaningful results cannot be measured, measurements frequently are made with the patient barefoot [2,6,14,16,19,20,26,28,40,41]. We cannot presume we would have the same findings were the patients wearing shoes.…”

Section: Discussionmentioning

confidence: 99%

“…This dynamic alignment can be measured by pedobarography, allowing measurement of pressure distribution of the foot during the rollover process [6,7,9,23,32]. Barefoot pedobarography has been used to observe correlation of foot pain and abnormally high pressure areas in clubfeet [6,14], to identify high pressure areas at risk for ulceration [2,16,41], and to investigate the mechanical change in patients with rheumatoid arthritis in the feet [28,40], metatarsalgia [19], hallux valgus [20], and cavovarus deformity [26].…”

Section: Introductionmentioning

confidence: 99%

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Does Alignment in the Hindfoot Radiograph Influence Dynamic Foot-floor Pressures in Ankle and Tibiotalocalcaneal Fusion?

Frigg

Nigg

Davis

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background The Saltzman-el-Khoury hindfoot alignment view (HAV) is considered the gold standard for assessing the axis from hindfoot to tibia. However, it is unclear whether radiographic alignment influences dynamic load distribution during gait. Questions/purposes We evaluated varus-valgus alignment by the HAV and its influence on dynamic load distribution in ankle and tibiotalocalcaneal (TTC) arthrodesis. Patients and Methods We clinically assessed 98 patients (ankle, 56; TTC, 42) with SF-36 and American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual hindfoot alignment, HAV angle, and dynamic pedobarography using a five-step method. For comparison, 70 normal feet were evaluated. Minimum followup was 2 years (average, 4.11 years; range, 2-6 years). Results The mean HAV angle was À0.8°± 7.8°for ankle and À1.2°± 6.9°for TTC arthrodesis. The HAV angle correlated with pedobarographic load distribution (r = 0.35-0.53). Radiographic alignment did not influence SF-36 or AOFAS scores; however, load distribution correlated to qualities of these scores. Visual alignment only predicted the corresponding HAV angle in 48%. To reproduce the dynamic load of healthy subjects, HAV angles of 5°to 10°valgus were needed. Conclusions Visual positioning is inadequate to determine intraoperative positioning and resulted in a varus position with a relatively large SD. The HAV should be used to assess the hindfoot alignment correctly. HAV angles of 5°to 10°valgus are needed to reproduce a physiologic gait pattern.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does Alignment in the Hindfoot Radiograph Influence Dynamic Foot-floor Pressures in Ankle and Tibiotalocalcaneal Fusion?

Frigg

Nigg

Davis

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…The callus (callosity) contributes to high pressure areas and ulcer formation [27]. In the words of Duckworth et al [28] "abnormally high pressures are more common in patients with diabetic neuropathy and almost all patients with a history of ulceration show high-pressure areas which correlate well with the site of previous ulceration. " Usually, ulcers occur on the plantar aspect of great toe and heel..…”

Section: Vasculopathymentioning

confidence: 99%

Diabetic Foot Ulcer – Diagnosis and Management

Pai¹

2013

Clin Res Foot Ankle

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Diabetes Mellitus is known to have many complications and one of the most distressing is diabetic foot ulcer which affects 15% of people with diabetes. It puts enormous financial burden on the patient and the health care services, even though it is preventable. Diabetic foot ulcer is characterized by a classical triad of neuropathy, ischemia, and infection. Each of these has a multifactorial aetiopathogenesis. These factors are compounded by mechanical stress created by foot deformities. The most commonly used classification systems are the Wagner-Ulcer Classification system and the University of Texas Wound Classification. These classifications help to predict the outcome of this condition. Prevention of this condition is paramount to prevent long term morbidity and sometimes mortality. This can be achieved by patient self-awareness and emphasis on regular foot examinations during follow-up. Care of the diabetic foot should be multidisciplinary. Debridement, dressings and offloading are the pillars of local management. Simultaneous glycemic and infection control is also essential. Amputations are usually the treatment of last resort but occasionally can be considered early to allow for faster mobilization and rehabilitation. Causative factors like peripheral vasculopathy and neuropathy must also be appropriately treated.

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“…Plantar pressure measurements provide relevant information on the foot and ankle role during gait and other functional activities [4,22]. Although plantar pressure data is an important element in the assessment and prevention of ulceration of patients with diabetes [1,5] and peripheral neuropathy, the information derived can also assist in the diagnosis and rehabilitation of impairments associated with various musculoskeletal, integumentary, and neurological disorders. The information gathered can be used to define suitable rehabilitation programs through alterations of footwear [1,2], foot orthoses, exercise programs, and restrictions in the amount of weight-bearing [19,20].…”

Section: Introductionmentioning

confidence: 99%

Spatio-temporal alignment of pedobarographic image sequences

Oliveira

Sousa

Santos

et al. 2011

Med Biol Eng Comput

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The total number of words of the manuscript, including entire text from title page to figure legends: 4300The number of words of the abstract: 237The number of figures: 4The number of tables: 1 2 Abstract This paper presents a methodology to align plantar pressure image sequences simultaneously in time and space. The spatial position and orientation of a foot in a sequence are changed to match the foot represented in a second sequence. Simultaneously with the spatial alignment, the temporal scale of the first sequence is transformed with the aim of synchronizing the two input footsteps. Consequently, the spatial correspondence of the foot regions along the sequences as well as the temporal synchronizing is automatically attained, making the study easier and more straightforward. In terms of spatial alignment, the methodology can use one of four possible geometric transformation models: rigid, similarity, affine or projective. In the temporal alignment, a polynomial transformation up to the 4 th degree can be adopted in order to model linear and curved time behaviors. Suitable geometric and temporal transformations are found by minimizing the mean squared error (MSE) between the input sequences. The methodology was tested on a set of real image sequences acquired from a common pedobarographic device. When used in experimental cases generated by applying geometric and temporal control transformations, the methodology revealed high accuracy. Additionally, the intra-subject alignment tests from real plantar pressure image sequences showed that the curved temporal models produced better MSE results (p<0.001) than the linear temporal model. This paper represents an important step forward in the alignment of pedobarographic image data, since previous methods can only be applied on static images.

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Plantar pressure measurements and the prevention of ulceration in the diabetic foot

Cited by 142 publications

References 5 publications

Does Alignment in the Hindfoot Radiograph Influence Dynamic Foot-floor Pressures in Ankle and Tibiotalocalcaneal Fusion?

Does Alignment in the Hindfoot Radiograph Influence Dynamic Foot-floor Pressures in Ankle and Tibiotalocalcaneal Fusion?

Diabetic Foot Ulcer – Diagnosis and Management

Spatio-temporal alignment of pedobarographic image sequences

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