Brain ; physiopathology ; Female ; Foot ; anatomy & histology ; physiopathology ; Humans ; Meridians

OBJECTIVETo investigate foot biomechanics characteristic of patients with type 2 diabetes mellitus.

METHODSThis study was conducted among 303 patients with type 2 diabetes. The whole foot was divided into 10 regions, namely the first toe (T1); the second to fifth toes (T2-5); the first, second, third, fourth, and fifth metatarsals (M1, M2, M3, M4, and M5, respectively); midfoot (MF), and the heel medial (HM). Foot arch index, foot angle and maximum peak pressure (MPP) of the 10 regions were measured using a Footscan gait system.

RESULTSThe maximum peak pressure of 10 regions decreased in the order of M3>M2>HM>M4>HL>M1>M5>T1>ML>T2-5 for the left foot, and in the order of M3>M2>HM>M4>HL>M1>M5>T1>ML>T2-5 for the right foot. The MPP in M1 region was higher in the right than in the left foot (P<0.05). The MPP in M3, M4, M5, and MF was higher in the left than in the right foot (P<0.05). The percentage of high-risk foot (defined by a total plantar pressure ≥70 N/cm) was 34% on the left and 17.7% on the right. An increased BMI was associated with a significant increase in high-risk foot, but not for the right foot in underweight patients. Foot flat phase was extended and forefoot push-off phase shortened in stance phase in the patients. Compared with the right foot, the left foot showed a significantly increased foot arch index and increased low and high arch rates with a decreased normal arch rate. Total plantar pressure was higher in of the left high arch foot than in normal arch foot. The foot angle was significantly larger on the right than on the left. The bilateral total plantar pressures were significantly greater in male patients (P<0.05) and increased with age but were not associated with the duration of DM, foot angle, or glycosylated hemoglobin level.

CONCLUSIONDiabetic patients have obvious alterations in foot biomechanics with abnormalities of the plantar pressure, and the percentage of high-risk foot increases in overweight and obese patients, suggesting the need of body weight control in these patients when administering offloading treatment for prevention of diabetic foot ulcer.

Biomechanical Phenomena ; Diabetes Mellitus, Type 2 ; physiopathology ; Diabetic Foot ; prevention & control ; Female ; Foot ; physiopathology ; Gait ; Heel ; physiopathology ; Humans ; Male ; Obesity ; physiopathology ; Overweight ; physiopathology ; Pressure

The plantar pressure and shear force measurement, the function and effect of joints, bones and ligaments of foot during running and walking, and the modeling and finite element analysis of human foot are three important aspects in biomechanical study of foot. They are also the basis of the study of rehabilitation. In this paper, studies on the three aspects are reviewed, and further promising developments are proposed.
Biomechanical Phenomena ; Diabetic Foot ; physiopathology ; Exercise ; physiology ; Finite Element Analysis ; Foot ; physiology ; Humans ; Pressure

OBJECTIVETo provide biomechanics basis for acupuncture improving motor function of stroke patients.

METHODSWith randomized controlled trial method, 21 cases were randomly divided into a control group (n = 10) and an acupuncture group (n = 10). The control group was only treated with basic neurology therapies, and acupuncture at Shenshu (BL 23), Qihaishu (BL 24), Dachangshu (BL 25) and Pishu (BL 20) etc. were added in the acu-puncture group. After treatment for 2 weeks, the scores of Fugl-Meyer (lower limb part) and Barthel Index assessment before and after treatment were compared, and the changes of the single-foot supporting phase rate were observed.

RESULTSAfter treatment, the scores of Fugl-Meyer (lower limb part) and Barthel Index assessment had no significant difference in the two groups as compared with those before treatment (P > 0.05), and the single-foot supporting phase rate in acupuncture group had very significant improvement as compared with both those before treatment and those in the control group (P < 0.05 and P < 0.01, respectively).

CONCLUSIONAcupuncture can increase the single-foot supporting phase rate of stroke patients and the biomechanics assessment is more sensitive than the rehabilitation scale assessment.

Acupuncture Points ; Aged ; Electroacupuncture ; Female ; Foot ; physiopathology ; Humans ; Male ; Middle Aged ; Stroke ; physiopathology ; therapy ; Treatment Outcome

OBJECTIVETo study the gait characteristics of different syndrome types based on musculature zones of the knee osteoarthritis (KOA) and to discuss the application of modern biomechanical technology in objective study on syndrome differentiation which is based on musculature zones.

METHODSThirty knees out of 19 patients suffering from KOA with the different musculature zone syndrome types were measured the step angle, the heel impulse, the internal and external rotation figures and the percentage of the maximum vertical ground reaction time in the total time of the supporting period by using the Plantar Pressure Measurement System.

RESULTSIn the knees with abnormal musculature zones, the figures of step angle and the heel impulse of Foot Shaoyang Meridian and three foot yin meridians were significantly increased than normal (all P<0.05), while those figures of Foot Yangming Meridian were normal; in the knees of Foot Yangming Meridian with abnormal musculature zones, the external rotation mean figure in the midstance was significantly increased than normal (P<0.05); in the knees of Foot Shaoyang Meridian with abnormal musculature zones, the internal rotation mean figure in the propulsion was significantly increased than normal (P<0.05); in the knees of the three foot yin meridians with abnormal musculature zones, the mean external rotation figure in propulsion was significantly increased than normal (P<0.05); in the knees of the Foot Yangming Meridian with abnormal musculature zones, the time of maximum vertical ground reaction was significantly delayed (P<0.05).

CONCLUSIONThe figures of the gait index in KOA patients with different musculature zone types are different, including the step angle, heel impulse, the internal and external rotation figures, the time of the maximum vertical ground reaction and so on, which could be used as the objective basis of syndrome differentiation based on musculature zones for KOA patients. Therefore, biomechanical technology can be applied in the syndrome differentiation based on musculature zones for KOA patients.

Adult ; Foot ; physiopathology ; Gait ; Humans ; Male ; Meridians ; Middle Aged ; Osteoarthritis, Knee ; diagnosis ; physiopathology

Plantar pressure distribution can reflect the force of several key points on foot while standing and walking. A comprehensive understanding of the plantar pressure distribution makes great sense in the following aspects: the understanding of the normal foot biomechanics and function, clinical diagnosis, measurement of disease extent, postoperative efficacy evaluation, and rehabilitation research. A simple plantar pressure measurement device was designed in this study. This paper uses FlexiForce flexible sensor to pickup plantar pressure signal and USB A/D board to do data acquisition. The data are transferred into a laptop and processed by a VB-based software which can display, remember and replay the data. We chose patients with hallux valgus and normal people to measure the pressure distribution and make contrast analysis of plantar pressure with this device. It can be concluded that people with hallux valgus have higher pressure on the second metatarsophalangeal joint and the distribution move outward. The plantar pressure of patients postoperative could be greatly improved compared to the preoperative. The function of this device has been confirmed.
Foot ; physiology ; Hallux Valgus ; physiopathology ; Humans ; Metatarsophalangeal Joint ; physiopathology ; Monitoring, Physiologic ; instrumentation ; Pressure ; Walking

BACKGROUNDPlantar pressure serves as a key factor for predicting ulceration in the feet of diabetes patients. We designed this study to analyze plantar pressure changes and correlating risk factors in Chinese patients with type 2 diabetes.

METHODSWe recruited 65 patients with type 2 diabetes. They were invited to participate in the second wave 2 years later. The patients completed identical examinations at the baseline point and 2 years later. We obtained maximum force, maximum pressure, impulse, pressure-time integral, and loading rate values from 10 foot regions. We collected data on six history-based variables, six anthropometric variables, and four metabolic variables of the patients.

RESULTSOver the course of the study, significant plantar pressure increases in some forefoot portions were identified (P < 0.05), especially in the second to forth metatarsal heads. Decreases in heel impulse and pressure-time integral levels were also found (P < 0.05). Plantar pressure parameters increased with body mass index (BMI) levels. Hemoglobin A1c (HbA1c) changes were positively correlated with maximum force (β = 0.364, P = 0.001) and maximum pressure (β = 0.366, P = 0.002) changes in the first metatarsal head. Cholesterol changes were positively correlated with impulse changes in the lateral portion of the heel (β = 0.179, P = 0.072) and pressure-time integral changes in the second metatarsal head (β = 0.236, P = 0.020). Ankle-brachial index (ABI) changes were positively correlated with maximum force changes in the first metatarsal head (β = 0.137, P = 0.048). Neuropathy symptom score (NSS) and common peroneal nerve sensory nerve conduction velocity (SCV) changes were positively correlated with some plantar pressure changes. In addition, plantar pressure changes had a correlation with the appearance of infections, blisters (β = 0.244, P = 0.014), and calluses over the course of the study.

CONCLUSIONSWe should pay attention to the BMI, HbA1c, cholesterol, ABI, SCV, and NSS changes in the process of preventing high plantar pressure and ulceration. Some associated precautions may be taken with the appearance of infections, blisters, and calluses.

Adult ; Aged ; Asian Continental Ancestry Group ; Diabetes Mellitus, Type 2 ; physiopathology ; Diabetic Foot ; diagnosis ; physiopathology ; Female ; Foot ; physiopathology ; Humans ; Male ; Middle Aged ; Pressure ; Prospective Studies ; Risk Factors

Foot complications are a well known factor which contribute to the morbidity of diabetes and increases the chance of amputation. A total of 126 consecutive diabetic patients were evaluated by diabetic foot screening. Forty-one patients showed an impaired protective sense when tested with Semmes-Weinstein monofilament 5.07 (10 g), and 92% of them showed peripheral polyneuropathy in nerve conduction study (NCS). The mean vibration score of the Rydel-Seiffer graduated tuning fork in patients with peripheral polyneuropathy in nerve conduction (NCV) study was 5.38+/-2.0, which was significantly different from that of patients without polyneuropathy in NCS. Among the deformities identified on examination, callus, corn, and hallux valgus were the greatest. While checking the ankle/ brachial index (ABI), we also evaluated the integrity of vasculature in the lower extremities. After extensive evaluation, we classified the patients into eight groups (category 0,1,2,3,4A,4B,5,6). The result of this study suggested that the Semmes-Weinstein monofilament test, Rydel-Seiffer graduated tuning fork test, and checking the ankle/brachial index were simple techniques for evaluating pathologic change in the diabetic foot by office screening, and that this screening based on treatment-oriented classification helps to reduce pedal complications in a diabetic population
Diabetic Angiopathies/diagnosis ; Diabetic Angiopathies/complications ; Diabetic Foot/physiopathology ; Diabetic Foot/diagnosis* ; Diabetic Foot/classification ; Diabetic Neuropathies/diagnosis ; Diabetic Neuropathies/complications ; Female ; Foot/physiopathology ; Human ; Male ; Mass Screening ; Middle Age ; Podiatry/methods ; Sensory Thresholds

PURPOSE: The purpose of our study was to investigate the effect of gait training with rhythmic auditory stimulation (RAS) on both kinematic and temporospatial gait patterns in patients with hemiplegia. MATERIALS AND METHODS: Eighteen hemiplegic patients diagnosed with either cerebral palsy or stroke participated in this study. All participants underwent the 4-week gait training with RAS. The treatment was performed for 30 minutes per each session, three sessions per week. RAS was provided with rhythmic beats using a chord progression on a keyboard. Kinematic and temporospatial data were collected and analyzed using a three-dimensional motion analysis system. RESULTS: Gait training with RAS significantly improved both proximal and distal joint kinematic patterns in hip adduction, knee flexion, and ankle plantar flexion, enhancing the gait deviation index (GDI) as well as ameliorating temporal asymmetry of the stance and swing phases in patients with hemiplegia. Stroke patients with previous walking experience demonstrated significant kinematic improvement in knee flexion in mid-swing and ankle dorsiflexion in terminal stance. Among stroke patients, subacute patients showed a significantly increased GDI score compared with chronic patients. In addition, household ambulators showed a significant effect on reducing anterior tilt of the pelvis with an enhanced GDI score, while community ambulators significantly increased knee flexion in mid-swing phase and ankle dorsiflexion in terminal stance phase. CONCLUSION: Gait training with RAS has beneficial effects on both kinematic and temporospatial patterns in patients with hemiplegia, providing not only clinical implications of locomotor rehabilitation with goal-oriented external feedback using RAS but also differential effects according to ambulatory function.
Acoustic Stimulation/*methods ; Aged ; Ankle Joint/physiopathology ; Biomechanical Phenomena ; Cerebral Palsy/*diagnosis/physiopathology ; Female ; Foot Joints/physiopathology ; *Gait ; Gait Disorders, Neurologic/etiology/physiopathology/*rehabilitation ; Hemiplegia ; Humans ; Knee/physiopathology ; Knee Joint/physiopathology ; Male ; Middle Aged ; Stroke/*diagnosis/physiopathology

OBJECTIVETo evaluate the clinical value of sweat function examination in early diagnosis of diabetic peripheral neuropathy (DPN).

METHODSNinety-eight hospitalized type 2 diabetic patients with or without DPN (DN and DC groups) according to Michigan Diabetic Neruopathy Score (DNS) and 40 healthy volunteers (NC group) were evaluated for their sweat function of the feet in relation to the peripheral autonomic nerve with sweat printing method using Neuropad. The Neuropad color-changing time was recorded to assess the sensitivity and specificity of sweat printing methods relative to DNS for DNP evaluation, and the correlation of the Neuropad color-changing time to DNS score was analyzed.

RESULTSThe average Neuropad color-changing time was 4.0-/+0.6, 4.3-/+1.2 and 23.0-/+6.1 min in NC, DC, and DN groups, respectively, showing significant differences between the 3 groups (P<0.05). The morbidity rate detected by sweat printing method was 62.2%, similar to that detected by DNS (57.1%, P>0.05). The sensitivity of the sweat printing method for DPN diagnosis was 92.8%, with specificity of 78.5%, positive predictive value of 93.2%, and negative predictive value of 78.6%. DNS showed significant positive correlation with the Neuropad color-changing time (r=0.46, P<0.05).

CONCLUSIONSweat printing method provides an objective, simple and reliable method for sweat function evaluation of the feet of type 2 diabetic patients to help in early DPN diagnosis, and quantification of the results of sweat printing method can be indicative of the DPN severity.

Case-Control Studies ; Color ; Diabetic Neuropathies ; diagnosis ; physiopathology ; Early Diagnosis ; Foot ; physiopathology ; Humans ; Male ; Middle Aged ; Sweating ; physiology ; Time Factors