David Hudson1. 1. Physical Therapy Department, College of Health and Human Sciences, Western Carolina University, Health and Human Sciences Building, Suite 230, 4121 Little Savannah Road, Cullowhee, NC 28723(∗). Electronic address: dhudson@wcu.edu.
Abstract
BACKGROUND: Elevated pressures on the plantar surface of the foot increases the potential of developing foot ulcers in patients who are at risk. Walking with poles has been shown to reduce ground reaction and joint forces; however, the effect on plantar pressures is unknown. OBJECTIVE: To determine the effectiveness of walking with poles on reducing plantar pressure on the foot after brief instructions and 1 week of self-guided practice. It was hypothesized that there would be a significant reduction in pressure in the foot when walking with poles. DESIGN: This was a nonblinded, randomized, crossover study. SETTING: This study took place in a motion analysis laboratory located at an academic institution. METHODS:Thirty-five healthy subjects were instructed on 2 gait patterns when using walking poles. When walking with the 2-point pattern, the subjects placed the poles of the opposite side with the foot in stance. The 3-point pattern required the subjects to place both poles with the right foot. After 1 week of unsupervised practice, plantar pressures under the metatarsal heads and hallux of the right foot were measured by using a pedobarograph mat while walking with and without the poles. MAIN OUTCOME MEASUREMENTS: Mean plantar pressures and impulses were recorded from 5 trials for each walking condition: no poles, 2-point, and 3-point styles. RESULTS: Walking with the poles resulted in significant reductions (P ≤ .01) in mean and impulse of pressure under the metatarsal heads region of up to 24%; no significant changes were seen under the heel or hallux. The 3-point style resulted in a significantly greater reduction of pressure compared with the 2-point style (P = .002) in the metatarsal region but not the hallux. CONCLUSIONS: Walking with poles was easy to learn and may be a useful part of the management of persons at risk for developing plantar foot ulcers.
RCT Entities:
BACKGROUND: Elevated pressures on the plantar surface of the foot increases the potential of developing foot ulcers in patients who are at risk. Walking with poles has been shown to reduce ground reaction and joint forces; however, the effect on plantar pressures is unknown. OBJECTIVE: To determine the effectiveness of walking with poles on reducing plantar pressure on the foot after brief instructions and 1 week of self-guided practice. It was hypothesized that there would be a significant reduction in pressure in the foot when walking with poles. DESIGN: This was a nonblinded, randomized, crossover study. SETTING: This study took place in a motion analysis laboratory located at an academic institution. METHODS: Thirty-five healthy subjects were instructed on 2 gait patterns when using walking poles. When walking with the 2-point pattern, the subjects placed the poles of the opposite side with the foot in stance. The 3-point pattern required the subjects to place both poles with the right foot. After 1 week of unsupervised practice, plantar pressures under the metatarsal heads and hallux of the right foot were measured by using a pedobarograph mat while walking with and without the poles. MAIN OUTCOME MEASUREMENTS: Mean plantar pressures and impulses were recorded from 5 trials for each walking condition: no poles, 2-point, and 3-point styles. RESULTS: Walking with the poles resulted in significant reductions (P ≤ .01) in mean and impulse of pressure under the metatarsal heads region of up to 24%; no significant changes were seen under the heel or hallux. The 3-point style resulted in a significantly greater reduction of pressure compared with the 2-point style (P = .002) in the metatarsal region but not the hallux. CONCLUSIONS: Walking with poles was easy to learn and may be a useful part of the management of persons at risk for developing plantar foot ulcers.