Reduction of plantar peak pressure by limiting stride length in diabetic patients

Plantar peak pressure is a diagnostically significant parameter for the evaluation of the risk of foot ulceration in patients with diabetic neuropathy. The prophylaxis and therapy of the diabetic foot therefore is to a large extent oriented on peak pressure, and is aimed at an extensive reduction in...

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Bibliographic Details
Published in:Der Orthopäde 2004-09, Vol.33 (9), p.1013-1019
Main Authors: Drerup, B, Kolling, Ch, Koller, A, Wetz, H H
Format: Article
Language:ger
Subjects:
Arthropathy, Neurogenic - physiopathology
Arthropathy, Neurogenic - therapy
Biomechanical Phenomena
Body Height
Body Mass Index
Body Weight
Diabetic Foot - etiology
Diabetic Foot - physiopathology
Diabetic Foot - prevention & control
Diabetic Foot - therapy
Female
Gait - physiology
Humans
Male
Metatarsus - physiology
Metatarsus - physiopathology
Pressure
Risk Factors
Shoes
Toes - physiology
Toes - physiopathology
Walking - physiology
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Summary:Plantar peak pressure is a diagnostically significant parameter for the evaluation of the risk of foot ulceration in patients with diabetic neuropathy. The prophylaxis and therapy of the diabetic foot therefore is to a large extent oriented on peak pressure, and is aimed at an extensive reduction in this parameter. This is mainly accomplished with protective footwear including shoe modifications and cushioning. In comparison, other approaches affecting the loading and motion pattern of the patient are of minor importance--as for example control of gait pattern. In this study we examined shortening of stride length as a possible measure in reducing plantar peak pressure during gait. In 17 diabetic patients without acute foot ulcerations, stride length was reduced to 33% of leg length using an elastic hobble. This led to a reduction in stride length of 23%. At the same time, the walking speed was significantly reduced by 27% and the cadence by 5.7%. As a consequence, the peak pressure was reduced in nearly all regions of the foot--except the small toes. In the metatarsal region peak pressure is reduced by 14.5%. Thus, a reduction in stride length offers the possibility of reducing plantar peak pressure as a supplementary measure in addition to orthopaedic footwear. However, at present clinical feasibility has not yet been established.
ISSN:0085-4530
DOI:10.1007/s00132-004-0702-8