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Michael J Mueller - One of the best experts on this subject based on the ideXlab platform.
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effect of peak pressure and pressure gradient on subsurface shear stresses in the neuropathic foot
Journal of Biomechanics, 2007Co-Authors: Michael J Mueller, Donovan J LottAbstract:Abstract The pressure distribution on the Plantar surface of the foot may provide insights into the stresses within the subsurface tissues of patients with diabetes mellitus and peripheral neuropathy (PN) who are at risk for skin breakdown. The purposes of this study were to (1) estimate the stress distribution in the subsurface soft tissue from a measured surface pressure distribution and determine any differences between values in the forefoot and rearfoot, and (2) determine the relationship between maximum shear stress (MSS) (magnitude and depth) and characteristics of the pressure distribution. The measured in-shoe pressure distributions during walking characterized by the peak Plantar pressure and maximum pressure gradient on the Plantar surface of the feet for 20 subjects with diabetes, PN and history of a mid foot or forefoot Plantar Ulcer were analyzed. The effects of peak pressure and maximum pressure gradient at the peak pressure location on the stress components in the subsurface soft tissue were studied using a potential function method to estimate the subsurface tissue stress. The calculated MSSs are larger in magnitude and located closer to the surface in the forefoot, where most skin breakdown occurs, compared to the rearfoot. In addition, the MSS (magnitude and depth) is highly correlated with the pressure gradient ( r = - 0.77 & 0.61) and the peak pressure ( r = - 0.61 & 0.91). The peak pressure and the maximum pressure gradient obtained from the surface pressure distribution appear to be important variables to identify where MSSs are located in the subsurface tissues on the Plantar foot that may lead to skin break down.
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pressure gradient as an indicator of Plantar skin injury
Diabetes Care, 2005Co-Authors: Michael J Mueller, Donovan J LottAbstract:OBJECTIVE —Peak Plantar pressures (PPPs) have been studied extensively as a contributing factor to skin breakdown, especially in the forefoot where most Plantar neuropathic Ulcers occur. The purposes of this article were to 1 ) describe an additional pressure variable, the peak pressure gradient (PPG), 2 ) determine whether the PPG is higher in the forefoot than in the rearfoot (even when compared with PPP), and 3 ) determine the correlation between the PPG and PPP at the forefoot and rearfoot in subjects with diabetes, peripheral neuropathy, and a history of Plantar Ulcer. RESEARCH DESIGN AND METHODS —Twenty subjects (12 male and 8 female) with diabetes, peripheral neuropathy, and a mean ± SD age of 57 ± 9 years participated. Plantar pressures were collected during walking in footwear. The PPP and the PPG (defined as the spatial change in Plantar pressure across adjacent sites of the foot surface around the PPP) were determined for the forefoot and rearfoot, and the forefoot-to-rearfoot ratios for each variable were calculated. RESULTS —The mean PPG was 143% higher in the forefoot than in the rearfoot, whereas the mean PPP was only 36% higher in the forefoot than in the rearfoot ( P < 0.0001). The PPG forefoot-to-rearfoot ratio (2.84 ± 1.36) was nearly two times greater than the PPP forefoot-to-rearfoot ratio (1.48 ± 0.58) ( P < 0.0001). The correlation between PPP and PPG was r = 0.59 at the forefoot and r = 0.75 at the rearfoot. CONCLUSIONS —The PPG was substantially higher in the forefoot than in the rearfoot even when compared with the PPP. The PPG appears to be providing additional information about the stresses experienced by the soft tissues of the foot, especially in the forefoot. The PPG may be a useful indicator of skin trauma because spatial changes in high Plantar pressures may identify high stress concentrations within the soft tissue.
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relationship between changes in activity and Plantar Ulcer recurrence in a patient with diabetes mellitus
Physical Therapy, 2005Co-Authors: Donovan J Lott, Katrina S Maluf, David R Sinacore, Michael J MuellerAbstract:Background and Purpose. Although pressure-reducing interventions have been effective in the healing of neuropathic foot Ulcers, these Ulcers frequently recur in people with diabetes mellitus (DM). This case report illustrates how sudden changes in weight-bearing activity may have affected Ulcer recurrence in a patient with DM and how the physical stress theory (PST) relates to Ulcer recurrence for this patient. Case Description. The patient was a 66-year-old man with a history of DM, peripheral neuropathy, and recurrent Plantar Ulcers. His Plantar Ulcer healed after total contact casting. Outcome. Despite relatively low peak Plantar pressure (9.3 N/cm2), the patient's Ulcer recurred within 4 weeks of healing. Plantar pressure assessment and activity monitoring suggested that a rapid and sudden increase in weight-bearing activity (steps per day) contributed to cumulative Plantar tissue stress that was 3.3 times higher on the day of Ulcer recurrence than his average value. Although his cumulative Plantar stress was high compared with his usual value, the cumulative value was similar to the amount of daily stress of individuals without a history of recurrent Ulcers. Discussion. Within the context of the PST, rapid change in activity level may have an effect on cumulative stress and the risk of Ulcer recurrence.
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effect of achilles tendon lengthening on ankle muscle performance in people with diabetes mellitus and a neuropathic Plantar Ulcer
Physical Therapy, 2005Co-Authors: Gretchen B Salsich, Michael J Mueller, David R Sinacore, Mary K Hastings, Michael J Strube, Jeffrey E JohnsonAbstract:Background and Purpose. The effect of a tendo-Achilles lengthening (TAL) procedure on ankle muscle performance has not been clearly established. The purpose of this study was to compare the effects of TAL and total-contact casting (TCC) with TCC alone on ankle muscle performance in subjects with diabetes mellitus (DM) and a neuropathic Plantar Ulcer. Subjects. Subjects were randomly assigned to either a TAL group (3 female and 12 male subjects) or a TCC group (4 female and 10 male subjects). Methods. Muscle performance measurements were obtained using an isokinetic dynamometer. Results. Concentric Plantar-flexor peak torque decreased 31% after TAL but returned to the baseline level after 8 months. Dorsiflexor peak torque did not change in either group. Plantar-flexor passive torque at 0 degrees of dorsiflexion decreased after TAL but increased to 60% of the baseline level after 8 months. Maximal dorsiflexion angle increased 11 degrees after TAL and remained increased at 8 months. Discussion and Conclusion. The TAL resulted in an increase in ankle dorsiflexion range of motion and a temporary reduction in concentric Plantar-flexor peak torque and passive torque at 0 degrees of dorsiflexion. If TAL is being considered for people with DM and a neuropathic forefoot Ulcer, the initial compromise in Plantar-flexor muscle performance should be addressed.
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impact of achilles tendon lengthening on functional limitations and perceived disability in people with a neuropathic Plantar Ulcer
Diabetes Care, 2004Co-Authors: Michael J Mueller, Donovan J Lott, David R Sinacore, Mary K Hastings, Michael J Strube, Jeffrey E JohnsonAbstract:OBJECTIVE —An Achilles tendon-lengthening (ATL) procedure is effective at reducing Ulcer recurrence in patients with diabetes, peripheral neuropathy, and a Plantar Ulcer, but its effects on functional limitations and perceived disability are unknown. The purpose of this study is to report the effects of an ATL and total contact casting (TCC) on the functional limitations and perceived disability of patients with neuropathic Plantar Ulcers. RESEARCH DESIGN AND METHODS —Twenty-eight subjects with a mean age of 55 ± 10 years and a BMI of 33 ± 6 kg/m 2 participated. All subjects had a history of diabetes, loss of protective sensation, limited ankle motion, and a recurrent forefoot Ulcer. Subjects were randomized into two groups: an ATL group ( n = 14), who received treatment of ATL, and TCC and a TCC group ( n = 14), who received TCC only. Subjects completed a modified physical performance test (PPT) and the SF-36 Health Survey before treatment, after primary treatment and healing of the Plantar forefoot Ulcer, and 8 months after initial Ulcer healing. RESULTS —There were no significant changes in functional limitations as measured by the PPT between groups or over time. The physical summary score of the SF-36 decreased slightly from before treatment to 8 months after initial Ulcer healing in the ATL group (35 ± 7 to 31 ± 6), whereas the TCC group score increased during this time (34 ± 8 to 39 ± 11; P CONCLUSIONS —The ATL resulted in no measurable change in functional limitations, but patients receiving an ATL and TCC reported lower physical functioning at 8 months after initial Ulcer healing than subjects receiving TCC alone and may require additional physical therapy to address this perceived disability.
Loretta Vileikyte - One of the best experts on this subject based on the ideXlab platform.
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neuropathic diabetic foot Ulcers
The New England Journal of Medicine, 2004Co-Authors: Andrew J M Boulton, Robert S Kirsner, Loretta VileikyteAbstract:A 58-year-old man with type 2 diabetes mellitus has an asymptomatic Plantar Ulcer on the left foot that remains unhealed after four months. The Ulcer measures 2 by 1 cm and is surrounded by callus under the first metatarsal head. Neurologic examination reveals loss of sensation of touch, pinprick, and vibration below the midcalf level bilaterally and the absence of ankle reflexes; the foot pulses are normal. How should this patient be evaluated and treated?
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clinical practice neuropathic diabetic foot Ulcers
The New England Journal of Medicine, 2004Co-Authors: Andrew J M Boulton, Robert S Kirsner, Loretta VileikyteAbstract:A 58-year-old man with type 2 diabetes mellitus has an asymptomatic Plantar Ulcer on the left foot that remains unhealed after four months. The Ulcer measures 2 by 1 cm and is surrounded by callus under the first metatarsal head. Neurologic examination reveals loss of sensation of touch, pinprick, and vibration below the midcalf level bilaterally and the absence of ankle reflexes; the foot pulses are normal. How should this patient be evaluated and treated?
Jeffrey E Johnson - One of the best experts on this subject based on the ideXlab platform.
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one stage resection and pin stabilization of first metatarsophalangeal joint for chronic Plantar Ulcer with osteomyelitis
Foot & Ankle International, 2010Co-Authors: Jeffrey E Johnson, Sarah A AndersonAbstract:Background Standard treatment of Plantar first metatarsal head neuropathic Ulceration with underlying osteomyelitis consists of extensive debridement of infected soft tissues and bone and often first ray amputation. The purpose of this study was to present a previously unreported, one stage, alternative to first ray amputation in patients with chronic first metatarsal head Ulceration and associated chronic osteomyelitis. Materials and methods A retrospective review was conducted of all patients that underwent one stage resection of the first metatarsophalangeal joint with pin stabilization for treatment of chronic Plantar first metatarsal head Ulceration with associated chronic osteomyelitis. The study included 15 patients (18 feet) who underwent 18 resections and stabilizations. All patients had a diagnosis of diabetic peripheral neuropathy, chronic Plantar first metatarsal head Ulceration of at least 3 months duration with exposed bone, and no gross purulence or acute cellulitis. Nine patients (60%) (11 feet) were available for followup telephone interviews. Four of the 15 (27%) (four feet) were deceased so they had medical record review only. The average followup was 48.8 months. Results All Ulcers healed with the exception of one foot (5%) who required a transmetatarsal amputation for worsening infection and wound complications. Three feet (17%) developed recurrent Ulcerations. No foot had amputation of only the hallux or first ray. Conclusion This study presents a previously unreported, relatively simple, one stage treatment option for chronic first metatarsal head Ulceration with underlying chronic osteomyelitis. This procedure allowed for successful healing of the Ulcer while retaining the first ray.
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effect of achilles tendon lengthening on ankle muscle performance in people with diabetes mellitus and a neuropathic Plantar Ulcer
Physical Therapy, 2005Co-Authors: Gretchen B Salsich, Michael J Mueller, David R Sinacore, Mary K Hastings, Michael J Strube, Jeffrey E JohnsonAbstract:Background and Purpose. The effect of a tendo-Achilles lengthening (TAL) procedure on ankle muscle performance has not been clearly established. The purpose of this study was to compare the effects of TAL and total-contact casting (TCC) with TCC alone on ankle muscle performance in subjects with diabetes mellitus (DM) and a neuropathic Plantar Ulcer. Subjects. Subjects were randomly assigned to either a TAL group (3 female and 12 male subjects) or a TCC group (4 female and 10 male subjects). Methods. Muscle performance measurements were obtained using an isokinetic dynamometer. Results. Concentric Plantar-flexor peak torque decreased 31% after TAL but returned to the baseline level after 8 months. Dorsiflexor peak torque did not change in either group. Plantar-flexor passive torque at 0 degrees of dorsiflexion decreased after TAL but increased to 60% of the baseline level after 8 months. Maximal dorsiflexion angle increased 11 degrees after TAL and remained increased at 8 months. Discussion and Conclusion. The TAL resulted in an increase in ankle dorsiflexion range of motion and a temporary reduction in concentric Plantar-flexor peak torque and passive torque at 0 degrees of dorsiflexion. If TAL is being considered for people with DM and a neuropathic forefoot Ulcer, the initial compromise in Plantar-flexor muscle performance should be addressed.
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impact of achilles tendon lengthening on functional limitations and perceived disability in people with a neuropathic Plantar Ulcer
Diabetes Care, 2004Co-Authors: Michael J Mueller, Donovan J Lott, David R Sinacore, Mary K Hastings, Michael J Strube, Jeffrey E JohnsonAbstract:OBJECTIVE —An Achilles tendon-lengthening (ATL) procedure is effective at reducing Ulcer recurrence in patients with diabetes, peripheral neuropathy, and a Plantar Ulcer, but its effects on functional limitations and perceived disability are unknown. The purpose of this study is to report the effects of an ATL and total contact casting (TCC) on the functional limitations and perceived disability of patients with neuropathic Plantar Ulcers. RESEARCH DESIGN AND METHODS —Twenty-eight subjects with a mean age of 55 ± 10 years and a BMI of 33 ± 6 kg/m 2 participated. All subjects had a history of diabetes, loss of protective sensation, limited ankle motion, and a recurrent forefoot Ulcer. Subjects were randomized into two groups: an ATL group ( n = 14), who received treatment of ATL, and TCC and a TCC group ( n = 14), who received TCC only. Subjects completed a modified physical performance test (PPT) and the SF-36 Health Survey before treatment, after primary treatment and healing of the Plantar forefoot Ulcer, and 8 months after initial Ulcer healing. RESULTS —There were no significant changes in functional limitations as measured by the PPT between groups or over time. The physical summary score of the SF-36 decreased slightly from before treatment to 8 months after initial Ulcer healing in the ATL group (35 ± 7 to 31 ± 6), whereas the TCC group score increased during this time (34 ± 8 to 39 ± 11; P CONCLUSIONS —The ATL resulted in no measurable change in functional limitations, but patients receiving an ATL and TCC reported lower physical functioning at 8 months after initial Ulcer healing than subjects receiving TCC alone and may require additional physical therapy to address this perceived disability.
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effect of achilles tendon lengthening on neuropathic Plantar Ulcers a randomized clinical trial
Journal of Bone and Joint Surgery American Volume, 2003Co-Authors: Michael J Mueller, David R Sinacore, Mary K Hastings, Michael J Strube, Jeffrey E JohnsonAbstract:Background:Limited ankle dorsiflexion has been implicated as a contributing factor to Plantar Ulceration of the forefoot in diabetes mellitus. The purpose of this study was to compare outcomes for patients with diabetes mellitus and a neuropathic Plantar Ulcer treated with a total-contact cast with
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structural changes in the forefoot of individuals with diabetes and a prior Plantar Ulcer
Journal of Bone and Joint Surgery American Volume, 2002Co-Authors: Douglas D Robertson, Michael J Mueller, Kirk E Smith, Paul K Commean, Thomas K Pilgram, Jeffrey E JohnsonAbstract:Background: Aseptic loosening of orthopaedic implants secondary to wear debris-induced osteolysis is a serious problem. Osteoprotegerin (OPG) is a natural decoy protein that inhibits osteoclast activation and bone resorption. This study investigated whether gene therapy using a recombinant adeno-associated viral vector that expresses OPG can inhibit wear debris-induced osteolysis. Methods: A recombinant adeno-associated virus (rAAV) vector co-expressing OPG (rAAV-OPG-IRES-EGFP) was generated. A control vector expressing b-galactosidase (rAAV-LacZ) was also prepared. In vitro validation experiments were performed to determine rAAV-OPG-IRES-EGFP transduction efficiency, OPG expression level and function in bone wafer, and osteoclastic activity. The effect of rAAV-OPG-IRES-EGFP in vivo gene therapy on wear debris-induced osteolysis was then evaluated in a mouse calvarial model in which a single intramuscular injection of the vector was administered prior to the introduction of the wear debris. The effects of the rAAV-OPG-IRES-EGFP gene therapy on wear debris-induced osteoclastogenesis and bone resorption were determined by histomorphometry on day 10. Results: In vitro experiments revealed that 100% of human embryonic kidney 293 cells were transduced at a multiplicity of infection of 1000 with both rAAV-OPG-IRES-EGFP and rAAV-LacZ. At a rAAV-OPG-IRES-EGFP multiplicity of infection of 1000, an OPG concentration of 135 ng/mL of culture media was achieved after four days. Using a bone-wafer assay for osteoclast activity, we found that treatment with rAAV-OPG-IRES-EGFP reduced resorption sevenfold compared with parathyroid hormone-stimulated controls and elevenfold compared with rAAV-LacZ controls. Furthermore, a seventeenfold decrease in RANKL and macrophage colony-stimulating factor-induced splenocyte osteoclastogenesis was observed in co-cultures containing rAAV-OPG-IRES-EGFP-infected fibroblasts. In vivo administration of rAAV-OPG-IRES-EGFP resulted in detectable transduction of myocytes at the injection site and a significant increase in expression of serum OPG levels by the second day (p < 0.05). Maximal concentrations were obtained on day 6 and then leveled off throughout the observation period. In contrast, serum OPG could not be detected in the sham-treated, uninfected titanium-stimulated, or rAAV-LacZ-infected mice. In the control mice, titanium implantation resulted in a threefold increase in the mean number of osteoclasts adjacent to the sagittal suture as well as a twofold increase in the mean area of soft tissue in the sagittal suture compared with the sham-treated mice. In contrast, osteoclast numbers remained at basal levels, and the area of soft tissue in the sagittal suture was markedly reduced in titanium-implanted animals that received rAAV-OPG-IRES-EGFP treatment, demonstrating a complete inhibition of osteolysis in response to titanium particles. Conclusions: A single intramuscular injection of the rAAV-OPG-IRES-EGFP vector can efficiently transduce myocytes to produce high levels of OPG. The OPG effectively inhibits wear debris-induced osteoclastogenesis and osteolysis. Clinical Relevance: Currently, there is no approved drug therapy to prevent or inhibit periprosthetic osteolysis. Although preclinical studies have identified potential drug therapies (i.e., bisphosphonates), there is no evidence that these drugs can effectively treat aseptic loosening in patients. This is the first evidence that in vivo OPG gene therapy can be used to prevent wear debris-induced osteolysis.
Donovan J Lott - One of the best experts on this subject based on the ideXlab platform.
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effect of peak pressure and pressure gradient on subsurface shear stresses in the neuropathic foot
Journal of Biomechanics, 2007Co-Authors: Michael J Mueller, Donovan J LottAbstract:Abstract The pressure distribution on the Plantar surface of the foot may provide insights into the stresses within the subsurface tissues of patients with diabetes mellitus and peripheral neuropathy (PN) who are at risk for skin breakdown. The purposes of this study were to (1) estimate the stress distribution in the subsurface soft tissue from a measured surface pressure distribution and determine any differences between values in the forefoot and rearfoot, and (2) determine the relationship between maximum shear stress (MSS) (magnitude and depth) and characteristics of the pressure distribution. The measured in-shoe pressure distributions during walking characterized by the peak Plantar pressure and maximum pressure gradient on the Plantar surface of the feet for 20 subjects with diabetes, PN and history of a mid foot or forefoot Plantar Ulcer were analyzed. The effects of peak pressure and maximum pressure gradient at the peak pressure location on the stress components in the subsurface soft tissue were studied using a potential function method to estimate the subsurface tissue stress. The calculated MSSs are larger in magnitude and located closer to the surface in the forefoot, where most skin breakdown occurs, compared to the rearfoot. In addition, the MSS (magnitude and depth) is highly correlated with the pressure gradient ( r = - 0.77 & 0.61) and the peak pressure ( r = - 0.61 & 0.91). The peak pressure and the maximum pressure gradient obtained from the surface pressure distribution appear to be important variables to identify where MSSs are located in the subsurface tissues on the Plantar foot that may lead to skin break down.
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pressure gradient as an indicator of Plantar skin injury
Diabetes Care, 2005Co-Authors: Michael J Mueller, Donovan J LottAbstract:OBJECTIVE —Peak Plantar pressures (PPPs) have been studied extensively as a contributing factor to skin breakdown, especially in the forefoot where most Plantar neuropathic Ulcers occur. The purposes of this article were to 1 ) describe an additional pressure variable, the peak pressure gradient (PPG), 2 ) determine whether the PPG is higher in the forefoot than in the rearfoot (even when compared with PPP), and 3 ) determine the correlation between the PPG and PPP at the forefoot and rearfoot in subjects with diabetes, peripheral neuropathy, and a history of Plantar Ulcer. RESEARCH DESIGN AND METHODS —Twenty subjects (12 male and 8 female) with diabetes, peripheral neuropathy, and a mean ± SD age of 57 ± 9 years participated. Plantar pressures were collected during walking in footwear. The PPP and the PPG (defined as the spatial change in Plantar pressure across adjacent sites of the foot surface around the PPP) were determined for the forefoot and rearfoot, and the forefoot-to-rearfoot ratios for each variable were calculated. RESULTS —The mean PPG was 143% higher in the forefoot than in the rearfoot, whereas the mean PPP was only 36% higher in the forefoot than in the rearfoot ( P < 0.0001). The PPG forefoot-to-rearfoot ratio (2.84 ± 1.36) was nearly two times greater than the PPP forefoot-to-rearfoot ratio (1.48 ± 0.58) ( P < 0.0001). The correlation between PPP and PPG was r = 0.59 at the forefoot and r = 0.75 at the rearfoot. CONCLUSIONS —The PPG was substantially higher in the forefoot than in the rearfoot even when compared with the PPP. The PPG appears to be providing additional information about the stresses experienced by the soft tissues of the foot, especially in the forefoot. The PPG may be a useful indicator of skin trauma because spatial changes in high Plantar pressures may identify high stress concentrations within the soft tissue.
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relationship between changes in activity and Plantar Ulcer recurrence in a patient with diabetes mellitus
Physical Therapy, 2005Co-Authors: Donovan J Lott, Katrina S Maluf, David R Sinacore, Michael J MuellerAbstract:Background and Purpose. Although pressure-reducing interventions have been effective in the healing of neuropathic foot Ulcers, these Ulcers frequently recur in people with diabetes mellitus (DM). This case report illustrates how sudden changes in weight-bearing activity may have affected Ulcer recurrence in a patient with DM and how the physical stress theory (PST) relates to Ulcer recurrence for this patient. Case Description. The patient was a 66-year-old man with a history of DM, peripheral neuropathy, and recurrent Plantar Ulcers. His Plantar Ulcer healed after total contact casting. Outcome. Despite relatively low peak Plantar pressure (9.3 N/cm2), the patient's Ulcer recurred within 4 weeks of healing. Plantar pressure assessment and activity monitoring suggested that a rapid and sudden increase in weight-bearing activity (steps per day) contributed to cumulative Plantar tissue stress that was 3.3 times higher on the day of Ulcer recurrence than his average value. Although his cumulative Plantar stress was high compared with his usual value, the cumulative value was similar to the amount of daily stress of individuals without a history of recurrent Ulcers. Discussion. Within the context of the PST, rapid change in activity level may have an effect on cumulative stress and the risk of Ulcer recurrence.
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impact of achilles tendon lengthening on functional limitations and perceived disability in people with a neuropathic Plantar Ulcer
Diabetes Care, 2004Co-Authors: Michael J Mueller, Donovan J Lott, David R Sinacore, Mary K Hastings, Michael J Strube, Jeffrey E JohnsonAbstract:OBJECTIVE —An Achilles tendon-lengthening (ATL) procedure is effective at reducing Ulcer recurrence in patients with diabetes, peripheral neuropathy, and a Plantar Ulcer, but its effects on functional limitations and perceived disability are unknown. The purpose of this study is to report the effects of an ATL and total contact casting (TCC) on the functional limitations and perceived disability of patients with neuropathic Plantar Ulcers. RESEARCH DESIGN AND METHODS —Twenty-eight subjects with a mean age of 55 ± 10 years and a BMI of 33 ± 6 kg/m 2 participated. All subjects had a history of diabetes, loss of protective sensation, limited ankle motion, and a recurrent forefoot Ulcer. Subjects were randomized into two groups: an ATL group ( n = 14), who received treatment of ATL, and TCC and a TCC group ( n = 14), who received TCC only. Subjects completed a modified physical performance test (PPT) and the SF-36 Health Survey before treatment, after primary treatment and healing of the Plantar forefoot Ulcer, and 8 months after initial Ulcer healing. RESULTS —There were no significant changes in functional limitations as measured by the PPT between groups or over time. The physical summary score of the SF-36 decreased slightly from before treatment to 8 months after initial Ulcer healing in the ATL group (35 ± 7 to 31 ± 6), whereas the TCC group score increased during this time (34 ± 8 to 39 ± 11; P CONCLUSIONS —The ATL resulted in no measurable change in functional limitations, but patients receiving an ATL and TCC reported lower physical functioning at 8 months after initial Ulcer healing than subjects receiving TCC alone and may require additional physical therapy to address this perceived disability.
Andrew J M Boulton - One of the best experts on this subject based on the ideXlab platform.
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gait related strategies for the prevention of Plantar Ulcer development in the high risk foot
Current Diabetes Reviews, 2011Co-Authors: Frank L Bowling, Neil D Reeves, Andrew J M BoultonAbstract:High Plantar pressures lead to Ulceration in the diabetic foot, particularly in the forefoot region around the metatarsal heads. High Plantar pressures persist during gait due to factors such as peripheral neuropathy, foot deformities, limited ankle dorsi flexion range of motion and reduced Plantar tissue thickness. Strategies impinging upon gait such as the use of appropriate therapeutic footwear, custom-moulded insoles and injectable silicone can help to reduce Plantar pressures and attenuate the risk for Ulceration. Shoes adapted with external rocker profiles facilitate Plantar flexion and restrict sagittal plane motion of the metatarsophalangeal joint, reducing pressures in the region of the metatarsal heads. Insoles custom-moulded to patient's feet help to reduce Plantar pressures and minimise the risk of Ulceration in the forefoot region. The loss of subcutaneous fat tissue in the diabetic foot enhances bony prominences and predisposes the foot to high-pressure areas. Silicone is a biocompatible material that can be safely injected into Plantar soft tissue to augment tissue thickness and prevent the development of Ulceration. This enhancement to the subcutaneous layer is remarkably well retained and is a generally well-adopted procedure in the clinical setting.
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neuropathic diabetic foot Ulcers
The New England Journal of Medicine, 2004Co-Authors: Andrew J M Boulton, Robert S Kirsner, Loretta VileikyteAbstract:A 58-year-old man with type 2 diabetes mellitus has an asymptomatic Plantar Ulcer on the left foot that remains unhealed after four months. The Ulcer measures 2 by 1 cm and is surrounded by callus under the first metatarsal head. Neurologic examination reveals loss of sensation of touch, pinprick, and vibration below the midcalf level bilaterally and the absence of ankle reflexes; the foot pulses are normal. How should this patient be evaluated and treated?
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clinical practice neuropathic diabetic foot Ulcers
The New England Journal of Medicine, 2004Co-Authors: Andrew J M Boulton, Robert S Kirsner, Loretta VileikyteAbstract:A 58-year-old man with type 2 diabetes mellitus has an asymptomatic Plantar Ulcer on the left foot that remains unhealed after four months. The Ulcer measures 2 by 1 cm and is surrounded by callus under the first metatarsal head. Neurologic examination reveals loss of sensation of touch, pinprick, and vibration below the midcalf level bilaterally and the absence of ankle reflexes; the foot pulses are normal. How should this patient be evaluated and treated?