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Chatzistergos PE, Gatt A, Formosa C, Sinclair JK, Chockalingam N. Effective and clinically relevant optimisation of cushioning stiffness to maximise the offloading capacity of diabetic footwear. Diabetes Res Clin Pract 2023; 204:110914. [PMID: 37742803 DOI: 10.1016/j.diabres.2023.110914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/24/2023] [Accepted: 09/21/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Optimising the cushioning stiffness of diabetic footwear/orthoses can significantly enhance their offloading capacity. This study explores whether optimum cushioning stiffness can be predicted using simple demographic and anthropometric parameters. METHODS Sixty-nine adults with diabetes and loss of protective sensation in their feet were recruited for this cross-sectional observational study. In-shoe plantar pressure was measured using Pedar® for a neutral diabetic shoe (baseline) and after adding cushioning footbeds of varying stiffness. The cushioning stiffness that achieved maximum offloading was identified for each participant. The link between optimum cushioning stiffness and plantar loading or demographic/anthropometric parameters was assessed using multinomial regression. RESULTS People with higher baseline plantar loading required stiffer cushioning materials for maximum offloading. Using sex, age, weight, height, and shoe-size as covariates correctly predicted the cushioning stiffness that minimised peak pressure across the entire foot, or specifically in the metatarsal heads, midfoot and heel regions in 70%, 72%, 83% and 66% of participants respectively. CONCLUSIONS Increased plantar loading is associated with the need for stiffer cushioning materials for maximum offloading. Patient-specific optimum cushioning stiffness can be predicted using five simple demographic/anthropometric parameters. These results open the way for methods to optimise cushioning stiffness as part of clinical practice.
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Affiliation(s)
- Panagiotis E Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom.
| | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Cynthia Formosa
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Jonathan K Sinclair
- Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom; Faculty of Health Sciences, University of Malta, Msida, Malta
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Ohlendorf D, Kerth K, Osiander W, Holzgreve F, Fraeulin L, Ackermann H, Groneberg DA. Standard reference values of weight and maximum pressure distribution in healthy adults aged 18-65 years in Germany. J Physiol Anthropol 2020; 39:39. [PMID: 33256834 PMCID: PMC7706280 DOI: 10.1186/s40101-020-00246-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022] Open
Abstract
Background The aim of this study was to collect standard reference values of the weight and the maximum pressure distribution in healthy adults aged 18–65 years and to investigate the influence of constitutional parameters on it. Methods A total of 416 healthy subjects (208 male / 208 female) aged between 18 and 65 years (Ø 38.3 ± 14.1 years) participated in this study, conducted 2015–2019 in Heidelberg. The age-specific evaluation is based on 4 age groups (G1, 18–30 years; G2, 31–40 years; G3, 41–50 years; G4, 51–65 years). A pressure measuring plate FDM-S (Zebris/Isny/Germany) was used to collect body weight distribution and maximum pressure distribution of the right and left foot and left and right forefoot/rearfoot, respectively. Results Body weight distribution of the left (50.07%) and right (50.12%) foot was balanced. There was higher load on the rearfoot (left 54.14%; right 55.09%) than on the forefoot (left 45.49%; right 44.26%). The pressure in the rearfoot was higher than in the forefoot (rearfoot left 9.60 N/cm2, rearfoot right 9.51 N/cm2/forefoot left 8.23 N/cm2, forefoot right 8.59 N/cm2). With increasing age, the load in the left foot shifted from the rearfoot to the forefoot as well as the maximum pressure (p ≤ 0.02 and 0.03; poor effect size). With increasing BMI, the body weight shifted to the left and right rearfoot (p ≤ 0.001, poor effect size). As BMI increased, so did the maximum pressure in all areas (p ≤ 0.001 and 0.03, weak to moderate effect size). There were significant differences in weight and maximum pressure distribution in the forefoot and rearfoot in the different age groups, especially between younger (18–40 years) and older (41–65 years) subjects. Discussion Healthy individuals aged from 18 to 65 years were found to have a balanced weight distribution in an aspect ratio, with a 20% greater load of the rearfoot. Age and BMI were found to be influencing factors of the weight and maximum pressure distribution, especially between younger and elder subjects. The collected standard reference values allow comparisons with other studies and can serve as a guideline in clinical practice and scientific studies.
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Affiliation(s)
- D Ohlendorf
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - K Kerth
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - W Osiander
- School of Dentistry, Department of Orthodontics, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - F Holzgreve
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt, Frankfurt am Main, Germany.
| | - L Fraeulin
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - H Ackermann
- Institute of Biostatistics and Mathematical Modeling, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - D A Groneberg
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt, Frankfurt am Main, Germany
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Ohlendorf D, Fay V, Avaniadi I, Erbe C, Wanke EM, Groneberg DA. Association between constitution, axiography, analysis of dental casts, and postural control in women aged between 41 and 50 years. Clin Oral Investig 2020; 25:2595-2607. [PMID: 32986167 PMCID: PMC8060179 DOI: 10.1007/s00784-020-03571-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 09/03/2020] [Indexed: 11/24/2022]
Abstract
Objectives The aim of this study was to investigate the relationship between anamnestic, axiographic and occlusal parameters and postural control in healthy women aged between 41 and 50 years. Materials and methods A total of 100 female participants aged between 41 and 50 (45.12 ± 2.96) years participated in the study. In addition to completing a general anamnesis questionnaire, lower jaw movements were measured axiographically, dental occlusion parameters were determined using a model analysis and postural parameters were recorded using a pressure measurement platform. The significance level was 5%. Results An increasing weight and a rising BMI lead to a weight shifted from the rearfoot (p ≤ 0.01/0.04) to the forefoot (p ≤ 0.01/0.02). A limited laterotrusion on the right resulted in a lower forefoot load and an increased rearfoot load (p ≤ 0.01). Laterotrusion to the left (extended above the standard) showed a lower frontal sway (p ≤ 0.02) and a reduced elliptical area, height and width (p ≤ 0.01, 0.02, 0.03). Thus, the extent of deviation correlated with reduced right forefoot loading (p ≤ 0.03) and the extent of deflection correlated with increased left foot loading (p ≤ 0.01). The higher the extent of angle class II malocclusion, the larger the ellipse area (p ≤ 0.04) and the ellipse height (p ≤ 0.02) resulted. Conclusions There is a connection between weight, BMI and laterotrusion, as well as between angle class II malocclusion and postural control in women aged between 41 and 50 years. Interdisciplinary functional examinations of mandibular movements treating possible limitations can be conducive for an improvement of postural control. Clinical relevance Angle class II malocclusion has a negative influence on postural control.
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Affiliation(s)
- Daniela Ohlendorf
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt am Main, Germany.
| | - V Fay
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt am Main, Germany
| | - I Avaniadi
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt am Main, Germany
| | - C Erbe
- Department of Orthodontics, School of Dentistry, University Medical Center of the Johannes Gutenberg University Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - E M Wanke
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt am Main, Germany
| | - D A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt am Main, Germany
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Porubcin MG, Novak P. Diagnostic Accuracy of Electrochemical Skin Conductance in the Detection of Sudomotor Fiber Loss. Front Neurol 2020; 11:273. [PMID: 32425871 PMCID: PMC7212463 DOI: 10.3389/fneur.2020.00273] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Small fiber neuropathy (SFN) is a common health problem. SFN is associated with loss of small fibers, either sensory, autonomic or both. Reduced autonomic sudomotor sweat gland nerve fiber density (SGNFD) and sensory epidermal nerve fiber density (ENFD) can be seen in SFN. Electrochemical skin conductance (ESC) is a non-invasive test for measurement of sudomotor function. This study evaluated the diagnostic accuracy of ESC to detect abnormal SGNFD and ENFD. Methods: This was a retrospective blinded study of participants referred for evaluation of SFN. The primary outcome measure was the specificity and sensitivity of ESC to diagnose loss of small fibers using SGNFD and ENFD as reference tests. The secondary outcome measures were the correlation between ESC and neuropathy severity, pain, and autonomic clinical scales. Results: Two hundred ten patients were enrolled in the study, age (mean ± sd) 45.5 ± 16.1 years, men/women = 52/158. ESC adjusted for weight (ESC/kg) was reduced in subjects with abnormally low SGNFD (normal/abnormal, ESC/kg = 1.19 ± 0.31/0.94 ± 0.37 μS/kg, p < 0.0001) and abnormally low ENFD (normal/abnormal ESC/kg 1.20 ± 0.37/1.04 ± 0.33 μS/kg, p < 0.0011). ESC/kg correlated with SGNFD (ρ = 0.39, p < 0.0001) and ENFD (ρ = 0.47, p < 0.0001). ESC/kg did not correlate with symptom scales. ESC/kg had 64% sensitivity and 77% specificity (ROC 0.73, p = 0.0001) to predict abnormal SGNFD and 69% sensitivity and 55% specificity (ROC 0.63, p = 0.0017) to predict abnormal ENFD. In comparison, SGNFD had 50.1% sensitivity and 85.1% specificity to predict abnormal ENFD (ROC 0.69, p = 0.0001). Conclusion: ESC/kg has modest accuracy to detect SGNFD loss. ESC may be a useful test in characterization of small fiber neuropathy.
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Affiliation(s)
- Michal G Porubcin
- Brigham and Women's Faulkner Hospital, Harvard Medical School, Boston, MA, United States
| | - Peter Novak
- Brigham and Women's Faulkner Hospital, Harvard Medical School, Boston, MA, United States
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El-Hilaly R, El-Sherbini MH, Abd-Ella MM, Omran AA. Radiological outcome of calcaneo-cuboid-cuneiform osteotomies for planovalgus feet in cerebral palsy children: Relationship with pedobarography. Foot Ankle Surg 2019; 25:462-468. [PMID: 30321957 DOI: 10.1016/j.fas.2018.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/09/2018] [Accepted: 02/27/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Calcaneo-cuboid-cuneiform (triple C) osteotomies correct all levels of deformity of flexible planovalgus feet (PVF) in patients with cerebral palsy (CP). The objective was assessing short term results and the hypothesis was that static pedobarography correlates with radiological parameters as outcome measures. METHODS A prospective case series of consecutive skeletally immature ambulatory spastic CP patients above the age of 4 years who underwent triple C for PVF. Assessment was done using static pedobarography and standing dorsoplantar (DP) and lateral radiographs. The calcaneal pitch, lateral talocalcaneal, lateral and DP talo-first metatarsal, and DP talonavicular coverage angles were measured. RESULTS Eighteen feet (12 patients) were analyzed. Postoperative changes in lateral and DP talo-first metatarsal, and DP talonavicular coverage angles were statistically significant (P-value=0 with paired T-test). Post operative foot pressure changes were significant and highest in mid-foot. Both outcomes were related together with a p-value of 1 using McNemar test. CONCLUSIONS The triple C and associated soft tissue procedures reliably corrected PVF deformities. Static pedobarography can be used for postoperative assessment of adequate correction.
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Affiliation(s)
- Rana El-Hilaly
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Mostafa H El-Sherbini
- Department of Orthopaedic Surgery, National Institute of Neuromotor System (NINMS), GOTHI, Imbaba, Giza, Great Cairo, Egypt
| | - Mohamed M Abd-Ella
- Department of Orthopaedic Surgery, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Ahmed A Omran
- Department of Orthopaedic Surgery, National Institute of Neuromotor System (NINMS), GOTHI, Imbaba, Giza, Great Cairo, Egypt.
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Ohlendorf D, Doerry C, Fisch V, Schamberger S, Erbe C, Wanke EM, Groneberg DA. Standard reference values of the postural control in healthy young female adults in Germany: an observational study. BMJ Open 2019; 9:e026833. [PMID: 31175196 PMCID: PMC6561414 DOI: 10.1136/bmjopen-2018-026833] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/26/2019] [Accepted: 05/15/2019] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Many people of all ages suffer from vertigo due to different reasons. The comparison of patient data with standard values can highlight deteriorations or changes in postural control and thus indicate, for example, an increased risk of falling. Our aim is to measure standard values for the postural control of young healthy women. DESIGN Observational study. SETTING Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main. PARTICIPANTS 106 healthy German female subjects aged between 21 and 30 years (25±2.7 years) were measured. Their average body mass index (BMI) was 21.1±2.61 kg/m². OUTCOME MEASURES A pressure measuring platform was used to measure the weight distribution and postural sway in habitual standing. Median, tolerance range and CI were calculated. RESULTS Height, weight and BMI are comparable to the average young German female population. The load distribution between right and left foot was 49.91%:50.09%. The forefoot was less loaded than the rear foot (33.3%:66.67%). The right rear foot carried most of the body weight (34.34%). The average body sway was 9.50 mm in the frontal and 13.00 mm in the sagittal plane. CONCLUSIONS Standard values for the postural control of the women aged 21-30 years correlate with the already collected data of healthy subjects and can therefore be described as representative. The standard values enable diagnosing and treating impaired balance.
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Affiliation(s)
- Daniela Ohlendorf
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Germany
- School of Dentistry, Department of Orthodontics, Goethe-University Frankfurt, Germany
| | - Charlotte Doerry
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Germany
| | - Vanessa Fisch
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Germany
| | - Sebastian Schamberger
- Department for Orthodontics, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Christina Erbe
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Germany
| | - Eileen M Wanke
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Germany
| | - David A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Germany
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Sutkowska E, Sutkowski K, Sokołowski M, Franek E, Dragan S. Distribution of the Highest Plantar Pressure Regions in Patients with Diabetes and Its Association with Peripheral Neuropathy, Gender, Age, and BMI: One Centre Study. J Diabetes Res 2019; 2019:7395769. [PMID: 31380446 PMCID: PMC6652074 DOI: 10.1155/2019/7395769] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 04/18/2019] [Accepted: 05/12/2019] [Indexed: 12/28/2022] Open
Abstract
The abnormal plantar pressure distribution and value play a key role in the formation of plantar calluses and diabetic foot ulcer. The prevalence of the highest pressure different distribution and its association with various factors among patients with diabetes is not well known. The study purpose was to evaluate the prevalence of different regions for the highest pressure on the sole and its association with selected factors among patients with diabetes. Medical records of nonulcer patients were retrospectively analysed. The relationship between pressure patterns on the sole obtained during a pedobarographic test as a semiquantitative assessment with colourful print analysis and neuropathy, gender, age, and BMI was searched. The most common location of the highest pressure was the central part of the forefoot. No association was found between the different highest pressure regions and age, sensory neuropathy, calluses, and foot deformities. The highest pressure on the lateral part of the foot and midfoot was observed more often in females and in patients with a BMI ≥ 35. The prevalence of the highest pressure on the forefoot was more common in patients with a BMI < 35. Conclusions. The most frequent regions of the highest pressure on the sole in patients with diabetes were the central part of the forefoot (2-3 metatarsal heads) with no simple relationship to the assessed variables other than BMI < 35. Female gender and higher BMI seem to be responsible for shifting the place of the highest pressure to other places of the foot.
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Affiliation(s)
- Edyta Sutkowska
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Poland
| | - Krzysztof Sutkowski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Poland
| | - Michał Sokołowski
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Poland
| | - Edward Franek
- Mossakowski Clinical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Szymon Dragan
- Department and Clinic of Orthopaedic and Traumatologic Surgery, Wroclaw Medical University, Poland
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Ramalho F, Santos-Rocha R, Branco M, Moniz-Pereira V, André HI, Veloso AP, Carnide F. Effect of 6-month community-based exercise interventions on gait and functional fitness of an older population: a quasi-experimental study. Clin Interv Aging 2018; 13:595-606. [PMID: 29670343 PMCID: PMC5896669 DOI: 10.2147/cia.s157224] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Gait ability in older adults has been associated with independent living, increased survival rates, fall prevention, and quality of life. There are inconsistent findings regarding the effects of exercise interventions in the maintenance of gait parameters. Objectives The aim of the study was to analyze the effects of a community-based periodized exercise intervention on the improvement of gait parameters and functional fitness in an older adult group compared with a non-periodized program. Methods A quasi-experimental study with follow-up was performed in a periodized exercise group (N=15) and in a non-periodized exercise group (N=13). The primary outcomes were plantar pressure gait parameters, and the secondary outcomes were physical activity, aerobic endurance, lower limb strength, agility, and balance. These variables were recorded at baseline and after 6 months of intervention. Results Both programs were tailored to older adults’ functional fitness level and proved to be effective in reducing the age-related decline regarding functional fitness and gait parameters. Gait parameters were sensitive to both the exercise interventions. Conclusion These exercise protocols can be used by exercise professionals in prescribing community exercise programs, as well as by health professionals in promoting active aging.
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Affiliation(s)
- Fátima Ramalho
- Sport Sciences School of Rio Maior (ESDRM), Polytechnic Institute of Santarém, Rio Maior, Portugal.,Laboratory of Biomechanics and Functional Morphology, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
| | - Rita Santos-Rocha
- Sport Sciences School of Rio Maior (ESDRM), Polytechnic Institute of Santarém, Rio Maior, Portugal.,Laboratory of Biomechanics and Functional Morphology, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
| | - Marco Branco
- Sport Sciences School of Rio Maior (ESDRM), Polytechnic Institute of Santarém, Rio Maior, Portugal.,Laboratory of Biomechanics and Functional Morphology, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
| | - Vera Moniz-Pereira
- Laboratory of Biomechanics and Functional Morphology, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
| | - Helô-Isa André
- Laboratory of Biomechanics and Functional Morphology, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
| | - António P Veloso
- Laboratory of Biomechanics and Functional Morphology, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
| | - Filomena Carnide
- Laboratory of Biomechanics and Functional Morphology, Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
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