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Barsotti E, Goodman B, Samuelson R, Carvour ML. A Scoping Review of Wearable Technologies for Use in Individuals With Intellectual Disabilities and Diabetic Peripheral Neuropathy. J Diabetes Sci Technol 2024:19322968241231279. [PMID: 38439547 DOI: 10.1177/19322968241231279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Individuals with intellectual disabilities (IDs) are at risk of diabetes mellitus (DM) and diabetic peripheral neuropathy (DPN), which can lead to foot ulcers and lower-extremity amputations. However, cognitive differences and communication barriers may impede some methods for screening and prevention of DPN. Wearable and mobile technologies-such as smartphone apps and pressure-sensitive insoles-could help to offset these barriers, yet little is known about the effectiveness of these technologies among individuals with ID. METHODS We conducted a scoping review of the databases Embase, PubMed, and Web of Science using search terms for DM, DPN, ID, and technology to diagnose or monitor DPN. Finding a lack of research in this area, we broadened our search terms to include any literature on technology to diagnose or monitor DPN and then applied these findings within the context of ID. RESULTS We identified 88 articles; 43 of 88 (48.9%) articles were concerned with gait mechanics or foot pressures. No articles explicitly included individuals with ID as the target population, although three articles involved individuals with other cognitive impairments (two among patients with a history of stroke, one among patients with hemodialysis-related cognitive changes). CONCLUSIONS Individuals with ID are not represented in studies using technology to diagnose or monitor DPN. This is a concern given the risk of DM complications among patients with ID and the potential for added benefit of such technologies to reduce barriers to screening and prevention. More studies should investigate how wearable devices can be used among patients with ID.
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Affiliation(s)
- Ercole Barsotti
- College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Bailey Goodman
- College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Riley Samuelson
- Hardin Library for the Health Sciences, University of Iowa, Iowa City, IA, USA
| | - Martha L Carvour
- College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Iijima H, Eguchi R, Aya Y, Terabe Y, Takahashi M. Compensatory gait mechanics in person with multiple toe amputation: A single case report. Clin Case Rep 2023; 11:e7675. [PMID: 37621725 PMCID: PMC10444944 DOI: 10.1002/ccr3.7675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 08/26/2023] Open
Abstract
This case highlights the biomechanical influence of toe amputation on contralateral limb force elevation, possibly through reduced ipsilateral plantar flexor torque production. These findings provide insight into toe amputation-related compensatory gait mechanics with greater inter-limb asymmetry, which may increase the risk of musculoskeletal comorbidities, including osteoarthritis in contralateral limb.
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Affiliation(s)
- Hirotaka Iijima
- Institute for Advanced ResearchNagoya UniversityNagoyaJapan
- Biomedical and Health Informatics Unit, Graduate School of MedicineNagoya UniversityNagoyaJapan
| | - Ryo Eguchi
- Graduate School of Science and TechnologyKeio UniversityYokohamaJapan
| | - Yamamoto‐Kon Aya
- Division of Fundamental Nursing, Faculty of Nursing and Medical CareKeio UniversityKanagawaJapan
| | - Yuta Terabe
- Kasukabe Chuo General Hospital Limb Salvage CenterSaitamaJapan
| | - Masaki Takahashi
- Department of System Design Engineering, Faculty of Science and TechnologyKeio UniversityYokohamaJapan
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Sonoda Y, Maeshige N, Uemura M, Imaoka S, Kawabe N, Hayashi H, Fujii M, Tsuji Y, Furukawa M, Kohzuki M, Terashi H. Effect of Partial Foot Amputation Level on Gait Independence in Patients With Chronic Lower Extremity Wounds: A Retrospective Analysis of a Japanese Multicenter Database. INT J LOW EXTR WOUND 2023:15347346231158864. [PMID: 36814399 DOI: 10.1177/15347346231158864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Partial foot amputation (PFA) is generally planned to minimize the amputation level; nonetheless, the effect of PFA levels on gait independence in amputees remains unclear. This study aimed to investigate the impact of PFA levels of the forefoot on gait independence in patients with chronic lower extremity (LE) wounds. This multicenter retrospective cohort study included 232 hospitalized Japanese patients treated and rehabilitated for chronic LE wounds. A multivariate analysis based on PFA levels was conducted for gait independence at discharge, with age and comorbidities as independent variables. Patients with Lisfranc amputation had significantly less independent gait than patients with more distal amputation and those without amputation (<22% vs >40%; P = .027; Fisher's exact test). Logistic regression analysis revealed that Lisfranc amputation (odds ratio [OR]: 0.257, P = .047), age (OR: 0.559, P = .043), and chronic limb-threatening ischemia (OR: 0.450, P = .010) were independent factors associated with gait independence. Additionally, the regression model confirmed discrimination performance using the C index (0.691, P < .001) with receiver operating characteristic analysis. In patients with chronic LE wounds undergoing PFA, Lisfranc amputation was negatively associated with gait independence.
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Affiliation(s)
- Yuma Sonoda
- Advanced Research Center for Well-being, 12885Kobe University, Kobe, Hyogo, Japan
| | - Noriaki Maeshige
- 91723Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Hyogo, Japan
| | - Mikiko Uemura
- 91723Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Hyogo, Japan
- 38082Faculty of Health Science, Kansai University of Welfare Sciences, Kashiwara, Osaka, Japan
| | - Shinsuke Imaoka
- 38411Department of Rehabilitation, Oita Oka Hospital, Oita, Oita, Japan
| | - Nobuhide Kawabe
- 13101Faculty of Makuhari Human Care, Tohto University, Makuhari, Chiba, Japan
| | - Hisae Hayashi
- 38291Faculty of Health and Medical Sciences, Aichi Shukutoku University, Nagakute, Aichi, Japan
| | - Miki Fujii
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
- Division of Regenerative Therapy, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoriko Tsuji
- Unit of Podiatric Medicine, 38303Kobe University Graduate School of Medicine, Department of Plastic Surgery, Kobe, Hyogo, Japan
| | | | - Masahiro Kohzuki
- 13302Department of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Yamagata, Japan
| | - Hiroto Terashi
- 38303Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Hong CC, Saha S, Pearce CJ. Does a shorter residual first metatarsal length after first ray amputation in diabetic patients leads to poorer outcomes - A risk factor study. Foot Ankle Surg 2023; 29:228-232. [PMID: 36746697 DOI: 10.1016/j.fas.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 01/08/2023] [Accepted: 01/24/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND The first ray plays a vital role in the normal function of the foot and the gait cycle where in its absence can lead to abnormal changes in weight distribution to the residual first metatarsal stump and lesser metatarsals with predisposition to developing lesser toe deformities reulcerations and reamputations particularly in diabetic patients. This study aims to characterise the outcomes after first ray amputation and its associated risk factors with focus on the impact of residual first metatarsal length. METHODS All diabetic patients with first ray amputations from January 2012 to December 2016 were reviewed. Residual first metatarsal length was measured using postoperative radiographs. Risk factors for outcomes such as readmission, reulceration and/or reamputation, transfer ulceration and/or amputation of lesser toes, proximal amputations, ulcer-free duration (UFD) and mortality were analysed using bivariate logistic/linear regression followed by multiple logistic/linear regression models adjusting for confounding factors. RESULTS Among 89 patients with first ray amputations, 65.3 % needed readmission for further treatment. Although only 10.1 % had reulceration at the first ray which all led to reamputation, there were 56.2 % with transfer ulceration and 40.4 % with transfer amputation of the lesser toes in this cohort. The prevalence of transmetatarsal amputation was 18 % and proximal amputations at 12.4 % while the average UFD was 27 months. Mortality rate was 31.5 % with an average of 3-year survival. Preservation of the first metatarsal length via metatarsophalangeal joint disarticulation independently reduced likelihood of readmissions and residual metatarsal length of > one third when compared to < one third after first ray amputations had lower likelihood of transfer amputation of lesser toes. CONCLUSION First ray amputation in diabetic patients leads to significant morbidities and mortality. Preservation of the residual first metatarsal length independently reduced the likelihood of readmissions and transfer amputation to the lesser toes.
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Affiliation(s)
- Choon Chiet Hong
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore, Singapore.
| | - Soura Saha
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore, Singapore.
| | - Christopher Jon Pearce
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore, Singapore.
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Tamir E, Rabau O, Beer Y, Smorgick Y, Kaufman H, Finestone AS. A Novel Classification for Diabetic Foot Ulcers of the First Ray. Adv Skin Wound Care 2023; 36:30-34. [PMID: 36537772 DOI: 10.1097/01.asw.0000902868.19186.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Diabetic foot ulcers of the first ray result from several distinct biomechanical mechanisms related to anatomical deformities, which must be addressed if surgical offloading is contemplated. The objective of this study was to create a classification of the anatomical deformities of first-ray ulcers that could lead to better standardization of treatment and reporting. METHODS The authors performed a file review of patients with diabetic neuropathy diagnosed with first-ray ulcers over a period of 3 years in an outpatient setting. Anatomical deformities were diagnosed clinically and reported with ulcer location. The primary classification was the metatarsophalangeal joint, the interphalangeal joint, and the distal phalanx. RESULTS Records for 59 patients (mean age, 62 years) with University of Texas A1 and A2 ulcers were reviewed. Mean ulcer duration was 2 months. The more common deformities were hallux valgus (41%), hallux valgus interphalangeus (14%), and hallux malleus (20%), and these were primarily associated with metatarsophalangeal, interphalangeal joint, and tip-of-toe ulcers, respectively (P < .0001). CONCLUSIONS By classifying ulcer locations, the relevant corrective surgery may be chosen. Although some prophylactic procedures may be safe and effective, prophylactic hallux valgus correction in the diabetic foot requires further study.
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Affiliation(s)
- Eran Tamir
- In the Department of Orthopedic Surgery, Shamir Medical Center, Zerrifin, Israel, Eran Tamir, MD, is Senior Physician; Oded Rabau, MD, is Orthopedic Surgeon; Yiftah Beer, MD, is Head of Department; and Yossi Smorgick, MD, is Senior Physician. Hanna Kaufman, MD, is Head of Wound Care, Maccabi Health Services, Haifa. Aharon S. Finestone, MD, MHA, is Orthopedic Surgeon, Shamir Medical Center. The authors have disclosed no financial relationships related to this article
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de Oliveira FCL, Williamson S, Ardern CL, Fagher K, Heron N, Janse van Rensburg DCC, Jansen MGT, Kolman N, O'Connor SR, Saueressig T, Schoonmade L, Thornton JS, Webborn N, Pluim BM. Association between the level of partial foot amputation and gait: a scoping review with implications for the minimum impairment criteria for wheelchair tennis. Br J Sports Med 2022; 57:bjsports-2022-105650. [PMID: 36588404 DOI: 10.1136/bjsports-2022-105650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This scoping review examines how different levels and types of partial foot amputation affect gait and explores how these findings may affect the minimal impairment criteria for wheelchair tennis. METHODS Four databases (PubMed, Embase, CINAHL and SPORTDiscus) were systematically searched in February 2021 for terms related to partial foot amputation and ambulation. The search was updated in February 2022. All study designs investigating gait-related outcomes in individuals with partial foot amputation were included and independently screened by two reviewers based on Arksey and O'Malley's methodological framework and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. RESULTS Twenty-nine publications with data from 252 participants with partial foot amputation in 25 studies were analysed. Toe amputations were associated with minor gait abnormalities, and great toe amputations caused loss of push-off in a forward and lateral direction. Metatarsophalangeal amputations were associated with loss of stability and decreased gait speed. Ray amputations were associated with decreased gait speed and reduced lower extremity range of motion. Transmetatarsal amputations and more proximal amputations were associated with abnormal gait, substantial loss of power generation across the ankle and impaired mobility. CONCLUSIONS Partial foot amputation was associated with various gait changes, depending on the type of amputation. Different levels and types of foot amputation are likely to affect tennis performance. We recommend including first ray, transmetatarsal, Chopart and Lisfranc amputations in the minimum impairment criteria, excluding toe amputations (digits two to five), and we are unsure whether to include or exclude great toe, ray (two to five) and metatarsophalangeal amputations. TRIAL REGISTRATION The protocol of this scoping review was previously registered at the Open Science Framework Registry (https://osf.io/8gh9y) and published.
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Affiliation(s)
- Fábio Carlos Lucas de Oliveira
- Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Research Unit in Sport and Physical Activity (CIDAF), University of Coimbra, Coimbra, Portugal
| | | | - Clare L Ardern
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
- Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Kristina Fagher
- Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden
| | - Neil Heron
- Center for Public Health, Queen's University Belfast, Belfast, UK
- School of Medicine, Keele University, Staffordshire, UK
| | | | - Marleen G T Jansen
- Toptennis Department, Royal Netherlands Lawn Tennis Association (KNLTB), Amstelveen, The Netherlands
- Center for Human Movement Sciences, University Medical Centre Groningen, Groningen, The Netherlands
| | - Nikki Kolman
- Center for Human Movement Sciences, University Medical Centre Groningen, Groningen, The Netherlands
- Knowledge Centre for Sport & Physical Activity, Utrecht, The Netherlands
| | | | | | - Linda Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jane S Thornton
- Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Nick Webborn
- IPC Medical Committee, Bonn, Germany
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Babette M Pluim
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center of Excellence, Amsterdam, The Netherlands
- Medical Department, Royal Netherlands Lawn Tennis Association (KNLTB), Amstelveen, The Netherlands
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7
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Shi QQ, Li PL, Yick KL, Jiao J, Liu QL. Influence of Contoured Insoles with Different Materials on Kinematics and Kinetics Changes in Diabetic Elderly during Gait. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12502. [PMID: 36231798 PMCID: PMC9566611 DOI: 10.3390/ijerph191912502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Alterations in the lower limb kinematics and kinetics of diabetic patients have been reported in previous studies. Inappropriate choices of orthopedic insole materials, however, fail to prevent diabetic foot ulcers and modify abnormal gait. The aim of this study was to quantitatively compare the effects of contoured insoles with different materials on the kinematics of and kinetics changes in the diabetic elderly during gait. METHODS There were 21 diabetic patients who participated in this study. Three-dimensional (3D) experimental contoured insoles constructed of soft (i.e., Nora Lunalastik EVA and PORON® Medical 4708) and rigid (i.e., Nora Lunalight A fresh and Pe-Lite) materials with Langer Biomechanics longitudinal PPT® arch pads were adopted. An eight-camera motion capture system (VICON), two force plates, and an insole measurement system-Pedar® with 99 sensors-were utilized to obtain the kinematics and kinetics data. The plug-in lower body gait model landmarks were used for dynamic data acquisition during gait. The corresponding data from five gait cycles were selected and calculated. RESULTS The range of motions (ROMs) of the ankle joint (p = 0.001) and knee joint (p = 0.044) were significantly influenced when the contoured insoles were worn in comparison to the barefoot condition. The joint moments of the lower limbs with maximum ankle plantarflexion during the loading response and maximum knee and hip flexions were significantly influenced by the use of contoured insoles with different materials in the diabetic elderly. The peak plantar pressure (PPP) of the forefoot (p < 0.001), midfoot (p = 0.009), and rearfoot (p < 0.001) was significantly offloaded by the contoured insoles during the stance phase, whilst the PPP of the rearfoot (p < 0.001) was significantly offloaded during the swing phase. CONCLUSIONS The contoured insoles, especially those constructed with soft materials, significantly offloaded the PPP during gait-hence accommodating certain abnormal gait patterns more effectively compared to going barefoot.
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Affiliation(s)
- Qiu-Qiong Shi
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China
| | - Pui-Ling Li
- Laboratory for Artificial Intelligence in Design, Hong Kong, China
| | - Kit-Lun Yick
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China
- Laboratory for Artificial Intelligence in Design, Hong Kong, China
| | - Jiao Jiao
- Dr. Stephen Hui Research Centre for Physical Recreation and Wellness, Hong Kong Baptist University, Hong Kong, China
| | - Qi-Long Liu
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong, China
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Blanchette V, Houde L, Armstrong DG, Schmidt BM. Outcomes of Hallux Amputation Versus Partial First Ray Resection in People with Non-Healing Diabetic Foot Ulcers: A Pragmatic Observational Cohort Study. INT J LOW EXTR WOUND 2022:15347346221122859. [PMID: 36069031 PMCID: PMC10018408 DOI: 10.1177/15347346221122859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There are few data comparing outcomes after hallux amputation or partial first ray resection after diabetic foot ulcer (DFU). In a similar context, the choice to perform one of these two surgeries is attributable to clinician preference based on experience and characteristics of the patient and the DFU. Therefore, the purpose of this study was to determine the more definitive surgery between hallux amputation and partial first ray resection. We abstracted data from a cohort of 70 patients followed for a 1-year postoperative period to support clinical practice. We also attempted to identify patient characteristics leading to these outcomes. Our results suggested no statistical difference between the type of surgery and outcomes such as recurrence of DFU and amputation at 3, 6, and 12 months or death. However, there was a statistically significantly increased likelihood of re-ulceration for patients with CAD who underwent hallux amputation (p = 0.02). There was also a significantly increased likelihood of re-ulceration for people with depression or a history when the partial ray resection was performed (p = 0.02). Patients with prior amputation showed a higher probability of undergoing another re-amputation with partial ray resection (p = 0.01). Although the trends that emerge from this project are limited to what is observed in this statistical context, where the number of patients included and the number of total observations per outcome were limited, it highlights interesting data for future research to inform clinical decisions to support best practices for the benefit of patients.
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Affiliation(s)
- Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, Canada, G9A 5H7
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, 1520 San Pablo, St. Los Angeles, CA, 90031, USA
| | - Louis Houde
- Department of Mathematic and Informatic, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières, Canada, G9A 5H7
| | - David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, 1520 San Pablo, St. Los Angeles, CA, 90031, USA
| | - Brian M. Schmidt
- University of Michigan Medical School, Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, Domino’s Farms (Lobby C, Suite 1300) 24 Frank Lloyd Wright Drive, Ann Arbor, MI, 48106, USA
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Hoffler HL, Powers NS, Evans JK, Blazek CD. Metatarsal Protrusion Distance and Its Influence on Recurrent Ulceration Rates After Partial First-Ray Amputations: A Retrospective Study. J Am Podiatr Med Assoc 2022; 112:20-104. [PMID: 36115035 DOI: 10.7547/20-104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Recurrent ulceration is a common problem after partial first-ray amputations. Loss of the first metatarsophalangeal joint contributes to altered biomechanics and increased pressure on the foot. This may increase risk of adjacent ulcerations and additional amputations. Preserving first-ray length maintains the metatarsal parabola and limits transfer lesions, but few data support this. We aimed to evaluate the incidence of ulceration after partial first-ray amputations and to assess the association between metatarsal protrusion distance and recurrent ulceration. METHODS Thirty-two consecutive patients underwent unilateral partial first-ray amputation at various levels along the first metatarsal, and the metatarsal protrusion distance was measured after surgery. Incidence of ulceration was evaluated on the ipsilateral foot. We hypothesized that patients with a longer first metatarsal were less likely to ulcerate again on the ipsilateral foot. RESULTS Fourteen patients (43.8%) ulcerated again after partial first-ray amputation. Mean time to ulceration was 104 days. Active smoking status was associated with increased risk of another ulceration (P = .02), and chronic kidney disease was associated with a decreased risk of recurrent ulceration (P = .03). The average metatarsal protrusion distance for patients who ulcerated again after surgery was 36.1 mm versus 25.9 mm for patients who did not (P = .04). Logistic regression analysis of the receiver operating characteristic curve demonstrated an ideal cutoff length for recurrent ulceration of 37 mm (area under the curve = 0.7381). Patients with a protrusion distance greater than 37 mm were nine times as likely to ulcerate again (95% CI, 1.7-47.0). CONCLUSIONS Partial first-ray amputations can be a good initial salvage procedure to clear infection and prolong bipedal ambulatory status. Unfortunately, these patients are prone to recurrent ulceration. Significant loss of first metatarsal length is a poor prognostic indicator for recurrent ulceration.
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Affiliation(s)
- Hayden L Hoffler
- *Podiatric Medicine and Surgery Residency Program, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Nicholas S Powers
- †Lower Extremity Limb Salvage/Trauma, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Joni K Evans
- ‡Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Cody D Blazek
- §Podiatric Medicine and Surgery Residency, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC
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10
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Hoffler HL, Honeycutt BJ, Brackney CK, Evans JK, Blazek CD, Powers NS, Burns PR. Reulceration and Reoperation Incidence After Isolated Partial Fifth Ray Amputations: A Multicenter Study. J Foot Ankle Surg 2022; 61:298-304. [PMID: 34565665 DOI: 10.1053/j.jfas.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/05/2021] [Accepted: 08/11/2021] [Indexed: 02/03/2023]
Abstract
Ulceration or reulceration is a common complication following partial or total fifth ray amputations. The primary aim of this study was to evaluate the incidence of reulceration following partial fifth ray amputations. This was a multicenter review of 117 consecutive limbs that underwent partial fifth ray amputations at the University of Pittsburgh Medical Center and Wake Forest Baptist Medical Centers. Procedures were performed at various levels along the fifth metatarsal. Incidence of postoperative ulceration was evaluated on the ipsilateral foot. We hypothesized there would be an association between location of resection and development of reulceration. Seventy-one of 117 patients (60.7%) experienced repeat ulceration following a partial fifth ray amputation. Median follow-up time was 19 months. There was no statistical difference based on location of amputation (proximal, middle, distal, isolated base) with regards to reulceration (p = .166), further amputation (p = .271), transmetatarsal amputation (p = .160), or below knee amputation (p = .769). There was statistical significance in the follow up time between study sites (p = .013), fifth ray amputation reoperation rate between study sites (p = .001), and reulceration rates between study sites (p = .017). Partial fifth ray amputations can be a good initial salvage procedure to clear infection and prolong bipedal ambulatory status. The results of the present study put forward that there is not an association between location of amputations of the fifth ray and development of reulceration, transfer lesions or more proximal amputations.
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Affiliation(s)
- Hayden L Hoffler
- Resident, Podiatric Medicine and Surgery Residency Program, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC.
| | - Benjamin J Honeycutt
- Resident, Podiatric Medicine and Surgery Residency Program, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Clark K Brackney
- Resident, Podiatric Medicine and Surgery Residency Program, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Joni K Evans
- Biostatistician, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Cody D Blazek
- Assistant Professor, Podiatric Medicine and Surgery Residency, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Nicholas S Powers
- Assistant Professor, Podiatric Medicine and Surgery Residency, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Patrick R Burns
- Assistant Professor, Podiatric Medicine and Surgery Residency, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
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11
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Acceptance of illness, quality of life and nutritional status of patients after lower limb amputation due to diabetes mellitus. Ann Vasc Surg 2021; 79:208-215. [PMID: 34644635 DOI: 10.1016/j.avsg.2021.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Diabetes mellitus is one of the most common chronic diseases with a high number of sufferers worldwide. Diabetic neuropathy and diabetic angiopathy lead to serious infectious complications which are very difficult to combat and may finally lead to the amputation of a lower limb. The aim of the study was to evaluate the quality of life, the level of acceptance of the illness and the nutritional status of patients after lower limb amputation due to diabetes. METHODS Ninety-nine patients (23 men and 76 women) were enrolled into the study. They had all undergone lower limb amputation due to diabetic foot and were treated in the Department of General and Oncological Surgery. The following questionnaires were used: the WHO Quality of Life-BREF (WHOQOL-BREF), the Mini Nutritional Assessment (MNA), the Acceptance of Illness Scale (AIS) and the anonymous specific socio-demographic characteristics questionnaire. RESULTS The diabetes-related amputees were revealed to have a higher QoL within the social domain (mean score 64.48), an intermediate QoL - within the environmental domain (mean score 63.04) and the mental domain (mean score 59.61), and a lower QoL - within physical (somatic) domain (mean score 54.69). There was no statistical correlation between genders or between all the domains of QoL (P > 0.05). The mean MNA score was 22.66, which means that patients were at risk of malnutrition. There were statistical differences between women and men as regards nutritional status (P = 0.034). The mean AIS score was 27.65 (27.09 women and 29.48 men), which means that the respondents accept their disease. There was no statistical correlation between gender and the acceptance of the disease (P = 0.288). There was not statistical correlation between age and QoL (P > 0.05). There were statistical differences between age and nutritional status (P < 0.05), and between age and acceptance of the illness (P = 0.044). CONCLUSIONS The better the quality of life was in all the domains, the better the level of acceptance of illness was. The less malnourished the patient was, the better their quality of life was in all the domains.
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Evaluating the Symmetry in Plantar Pressure Distribution under the Toes during Standing in a Postural Pedobarographic Examination. Symmetry (Basel) 2021. [DOI: 10.3390/sym13081476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pedobarography is a safe, non-invasive diagnostic method that enables estimation of plantar pressure distribution. This article aims to describe the symmetry between right and left toes in the Polish adult population using data obtained during postural pedobarographic examinations. Eighty-two patients, both sexes, with a mean age of 42.12 (range 19–70), without significant pathologies, participated in the study. Plantar pressure was evaluated using a PEL38 pressure plate. The study applies the elements of Cavanagh’s classification to identify the foot sole regions: Hallux, Second Toe and Lateral Toe areas and the entire foot surface. The parameters measured included maximal and average pressures, total support area for each foot, and contact area of the foot with the ground at individual moments of standing. The results showed significantly greater loading under the right Hallux in women. As regards men, higher values in the whole foot pressure distribution were noted on the left side. Plantar pressure distribution does not increase along with the global factors such as age and body mass. The findings suggest that the asymmetry in the morphological structure of the foot does not determine the asymmetry in the plantar pressure distribution. None of the feet studied had full symmetry on the entire surface.
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Choi Y. Rehabilitation of patients after diabetic foot amputation. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.8.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Diabetic foot is a diabetes-related complication that often requires amputation due to ulcer, necrosis, infection, and wound healing problems. Amputation decreases ambulation ability and worsens the patient’s general condition. Thus, active gait training is important after amputation.Current Concepts: The level of amputation depends on the anatomical position, for example, toe amputation and transfemoral amputation. The impairment of ambulatory function is also determined by the position of amputation. Continuous rehabilitation exercise is encouraged for ambulation before surgery. Wound management and pain control are needed for early rehabilitation exercise after surgery. The maturation of the amputation stump is especially important and needed for prosthesis wearing. If the general condition of the patient permits, muscle strengthening exercises, joint range of motion exercises, and ambulation exercises should be started as soon as possible.Discussion and Conclusion: Sufficient understanding of functional decline after amputation is required. The clear goal of ambulation should be set in consideration of the patient’s general condition and ability to walk before surgery. The ultimate goal of amputation is not only to remove necrosis, ulcers, and infected tissues but also to restore ambulatory function. Thus, expertise and significant effort before and after surgery are required.
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Friedman A, Zilberman S, Genis A, Khutornyuk T, Lutsky L, Treger I. Leg dominance as a determinant in laterality of lower extremity amputation in diabetic patients: retrospective study and literature review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Diabetic patients with peripheral vascular manifestations often develop foot ulcers and sometimes have to undergo lower extremity amputation. This retrospective study investigated leg dominance and laterality of lower extremity amputation in diabetic, dysvascular amputees. Methods All patients who met the inclusion criteria had their medical records reviewed for their dominant side and a correlation with a side of amputation was analysed. This information is routinely obtained as part of the admission history. For the literature review, PubMed, Google Scholar, ScienceDirect and Cochrane Library were searched with no date restriction until February 2018. Relevant studies were included and analysed. Results Of all the patients (n=27), 16 had diabetes and of these, 12 (75%) had their dominant leg amputated. Conclusions The data and literature analysis suggest that diabetic, dysvascular patients' dominant legs may be at higher risk for amputation than the non-dominant side. Larger studies are needed to clarify the relationship between leg dominance and laterality of lower extremity amputation.
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Affiliation(s)
- Alan Friedman
- Department of Physical Medicine and Rehabilitation, Soroka University Medical Center, Beer Sheva, Israel
| | - Steven Zilberman
- Medical School for International Health, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Alex Genis
- Department of Physical Medicine and Rehabilitation, Soroka University Medical Center, Beer Sheva, Israel
| | - Tamara Khutornyuk
- Department of Physical Medicine and Rehabilitation, Soroka University Medical Center, Beer Sheva, Israel
| | - Lena Lutsky
- Department of Physical Medicine and Rehabilitation, Soroka University Medical Center, Beer Sheva, Israel
| | - Iuly Treger
- Department of Physical Medicine and Rehabilitation, Soroka University Medical Center, Beer Sheva, Israel
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Higuchi A, Shiraishi J, Kurita Y, Shibata T. Effects of Gait Inducing Assist for Patients with Parkinson’s Disease on Double Support Phase During Gait. JOURNAL OF ROBOTICS AND MECHATRONICS 2020. [DOI: 10.20965/jrm.2020.p0798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Parkinson’s disease (PD) is a common progressive neurodegenerative disease that affects a wide range of motor and non-motor symptoms. Freezing of gait (FOG) is such a motor symptom of PD that frequently results in falling, and almost half of PD patients suffer from FOG. In this study, we investigated the effectiveness of a robotic assistance system called UPS-PD, which was developed to suppress FOG. The double limb support phase (DLS) in a 10-m straight-line walking task, the gait time and step counts were measured in five PD subjects. In addition, the safety of the UPS-PD in a healthy person was investigated using OpenSim, and the DLS parameters in four healthy elderly subjects were evaluated. In the experiment with the PD patients, the DLS parameters of two subjects showed an improvement. Furthermore, the step length of one subject and the step length and walking speed of the other subject were improved. Moreover, there were no problems in terms of instability of gait in both the PD patients. The UPS-PD did not adversely affect the gait of healthy elderly subjects and the walking of a healthy subject model in the simulation. Therefore, the UPS-PD is considered to be a useful device for improving walking in PD patients.
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Rosenblatt NJ, Girgis C, Avalos M, Fleischer AE, Crews RT. The Role of the Podiatrist in Assessing and Reducing Fall Risk: An Updated Review. Clin Podiatr Med Surg 2020; 37:327-369. [PMID: 32146988 DOI: 10.1016/j.cpm.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Falls present a tremendous challenge to health care systems. This article reviews the literature from the previous 5 years (2014-2019) in terms of methods to assess fall risk and potential steps that can be taken to reduce fall risk for patients visiting podiatric clinics. With regard to assessing fall risk, we discuss the role of a thorough medical history and podiatric assessments of foot problems and deformities that can be performed in the clinic. With regard to fall prevention we consider the role of shoe modification, exercise, pain relief, surgical interventions, and referrals.
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Affiliation(s)
- Noah J Rosenblatt
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA.
| | - Christopher Girgis
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Marco Avalos
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Adam E Fleischer
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Ryan T Crews
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
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Zulkifli SS, Loh WP. A state-of-the-art review of foot pressure. Foot Ankle Surg 2020; 26:25-32. [PMID: 30600155 DOI: 10.1016/j.fas.2018.12.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 12/14/2018] [Indexed: 02/04/2023]
Abstract
The science of foot pressure studies the forces acting on the bottom and different regions of the foot along with the pressure exerted on the plantar surface with the interacting surface in contact. The information derived gave impact to human biomechanical assessment on body balance and ergonomics posture during gait. Various experiments designed at generating foot pressure data returns only with limited knowledge generated. Obviously, the procedure for experiment design needs to be properly understood from the foot morphology aspects; healthiness, footwear, surface in contact, load and forces impacts, and the foot sensitivity as well as the specification for the foot pressure. This paper reviews the proper preliminary experimental setups for foot pressure measurement analysis during static or dynamic gait. The strength and limitations of recent devices used and considerable variables are also discussed. The overall review explains that the comfortable natural gait in relation to the aspects of sensitivity, load, time duration, and stability are the standard considerations for plantar pressure experiments.
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Affiliation(s)
- Siti Syazni Zulkifli
- School of Mechanical Engineering, Engineering Campus, Universiti Sains Malaysia, 14300 Nibong Tebal, Seberang Perai Selatan, Penang, Malaysia
| | - Wei Ping Loh
- School of Mechanical Engineering, Engineering Campus, Universiti Sains Malaysia, 14300 Nibong Tebal, Seberang Perai Selatan, Penang, Malaysia.
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Erdem MM, Koc G, Kismet K, Yasti C, Topuz S. Evaluation of spatio-temporal gait parameters and gait symmetry in diabetic polyneuropathic patients with burn injury: A pilot study. Burns 2019; 46:897-905. [PMID: 31843285 DOI: 10.1016/j.burns.2019.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 10/17/2019] [Accepted: 10/26/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to investigate the effects of burn injury on spatio-temporal gait parameters and gait symmetry in individuals with diabetic polyneuropathy (DPN)-related lower extremity burn injury. METHODS Demographic information and the physical examinations of the lower extremities of 14 patients with unilateral lower extremity burn injury due to DPN (DPNB) and 14 uninjured patients with DPN (DPN0) were recorded. The GAITRite computerized gait analysis system was used to evaluate the spatio-temporal parameters of gait. Symmetry Index (SI) was calculated to determine gait symmetry. The Mann Whitney U test was used to determine the demographical and clinical differences between the groups, the Wilcoxon's test was used to compare both sides of all the participants for all gait parameters and linear regression analysis was used to find the variables that affect gait parameters. RESULTS The groups were similar in terms of their demographic information except for age. Compared with the DPN0 group, DPNB group had increased extent of area with sensory loss and severity of DPN, decreased ankle joint range of motions and intrinsic foot muscles strength and they displayed lower gait speed, step length, stride length and swing percentage but their double support and stance percentage were increased. CONCLUSION This study results have shown that, spatio-temporal gait parameters of DPNB patients are different. These differences in spatiotemporal parameters are found on both sides, probably owing to the symmetric and bilateral sensory loss is superior to unilateral burn injury due to symmetrical and bilateral sensory loss. Gait analysis should be considered in order to reveal the changes in gait parameters and to improve appropriate healing process of patients with DPN-related lower extremity burn injury.
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Affiliation(s)
- Melek Merve Erdem
- Guneysu Vocational School of Physical Therapy and Rehabilitation, Department of Physical Therapy, Recep Tayyip Erdogan University, Rize, Turkey.
| | - Gonul Koc
- Department of Endocrinology and Metabolic Diseases, Ankara Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Kemal Kismet
- Department of General Surgery, Ankara Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Cınar Yasti
- Department of General Surgery, Numune Education and Research Hospital, Ankara, Turkey
| | - Semra Topuz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Lower Extremity Amputations in At-Risk Patients: A Focus on Tissue Viability and Function in the Compromised Limb. Clin Podiatr Med Surg 2019; 36:483-498. [PMID: 31079612 DOI: 10.1016/j.cpm.2019.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Amputations distal to the ankle joint are commonly performed in efforts to preserve a limb. Thorough examination of lower extremity biomechanics, patient functional status, and patient goals must be used to help prevent reulceration and further amputation. Once infection is resolved in the acute setting, musculotendon balancing should be considered at the time of amputation closure to maintain functionality of the limb. Patients should be closely followed postoperatively and monitored for biomechanical deformity that needs to be addressed. Careful attention to detail and adherence to surgical principles can help keep patients active and prevent further amputation.
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