HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mueller, M. J Articles by Pilgram, T. K Search for Related Content PubMed PubMed Citation Articles by Mueller, M. J Articles by Pilgram, T. K Related Collections Skin Abnormalities and Diseases Adaptive/Assistive Devices Diabetes Social Bookmarking                      What's this?

Efficacy and Mechanism of Orthotic Devices to Unload Metatarsal Heads in People With Diabetes and a History of Plantar Ulcers

MJ Mueller, PT, PhD, FAPTA, is Associate Professor, Program in Physical Therapy, Washington University School of Medicine, 4444 Forest Park Blvd, Box 8502, St Louis, MO 63110 (USA)
DJ Lott, PT, MSPT, CSCS, is a doctoral student, Movement Science Program, Program in Physical Therapy, Washington University School of Medicine
MK Hastings, PT, DPT, ATC, is Assistant Professor, Program in Physical Therapy, Washington University School of Medicine
PK Commean, BEE, is Senior Research Engineer, Mallinckrodt Institute of Radiology, Washington University School of Medicine
KE Smith, BS, is Senior Research Engineer, Mallinckrodt Institute of Radiology, Washington University School of Medicine
TK Pilgram, PhD, is Instructor, Mallinckrodt Institute of Radiology, Washington University School of Medicine

(muellerm{at}wustl.edu). Address all correspondence to Dr Mueller

Background and Purpose. Total-contact inserts (TCIs) and metatarsal pads (MPs) frequently are prescribed to reduce excessive plantar stresses to help prevent skin breakdown in people with diabetes mellitus (DM) and peripheral neuropathy. The first purpose of this study was to determine the effect of a TCI and an MP on metatarsal head peak plantar pressures (PPP) and pressure-time integrals (PTI). The second purpose of this study was to determine a possible mechanism of pressure reduction by measuring contact area and loaded soft-tissue thickness (STT) under the metatarsal heads and second metatarsal shaft. Subjects. Twenty subjects (12 men and 8 women; age [mean±SD]=57±9 years) with DM (duration [mean±SD]=16±11 years), peripheral neuropathy, and a history of plantar ulcers participated. Methods. A repeated-measures research design was used, and outcome measures are reported for 3 footwear conditions: shoe, shoe with TCI, and shoe with TCI and MP. In-shoe plantar pressures were collected during walking and during spiral x-ray computed tomography (SXCT). The STT and identification of the pressure sensor and location of the MP in relationship to the metatarsal heads were determined by use of SXCT. Results. The PPP and the PTI were 16% to 24% lower at the metatarsal heads in the TCI condition than in the shoe condition. The PPP and the PTI decreased an additional 15% to 28% (for a total reduction of 29% to 47%) with the addition of the MP. The contact area increased 27% with the TCI but not with the MP. The STT did not increase under the metatarsal heads in the TCI condition (compared with the shoe condition) but did increase 8% to 22% at metatarsal heads 2 to 5 with the addition of the MP. The PPP increased substantially (308%) and the STT decreased 14% under the shaft of the second metatarsal with the addition of the MP to the TCI-plus-shoe condition. Discussion and Conclusion. The TCI and the MP caused substantial and additive reductions of pressures under the metatarsal heads. The TCI reduces excessive pressures at the metatarsal heads by increasing the contact area of weight-bearing forces. Conversely, the MP acts by compressing the soft tissues proximal to the metatarsal heads and relieving compression at the metatarsal heads. These findings can assist in the design of effective orthotic devices to relieve excessive plantar stresses that contribute to skin breakdown and subsequent amputation in people with DM and peripheral neuropathy. [Mueller MJ, Lott DJ, Hastings MK, et al. Efficacy and mechanism of orthotic devices to unload metatarsal heads in people with diabetes and a history of plantar ulcers. Phys Ther. 2006;86:833–842.]

Key Words: Biomechanics • Diabetes • Footwear • Metatarsal pad • Peripheral neuropathy • Pressure • Total contact insert • Ulcer

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				T. S. Roukis A 1-Piece Shape-Metal Nitinol Intramedullary Internal Fixation Device for Arthrodesis of the Proximal Interphalangeal Joint in Neuropathic Patients With Diabetes Foot & Ankle Specialist, June 1, 2009; 2(3): 130 - 134. [Abstract] [PDF]

				V. Scire, E. Leporati, I. Teobaldi, L. A. Nobili, L. Rizzo, and A. Piaggesi Effectiveness and Safety of Using Podikon Digital Silicone Padding in the Primary Prevention of Neuropathic Lesions in the Forefoot of Diabetic Patients J Am Podiatr Med Assoc, January 1, 2009; 99(1): 28 - 34. [Abstract] [Full Text] [PDF]

				M. J Mueller, D. Zou, K. L Bohnert, L. J Tuttle, and D. R Sinacore Plantar Stresses on the Neuropathic Foot During Barefoot Walking Physical Therapy, November 1, 2008; 88(11): 1375 - 1384. [Abstract] [Full Text] [PDF]