David R Sinacore1, Mary K Hastings2, Kathryn L Bohnert3, Michael J Strube4, David J Gutekunst5, Jeffrey E Johnson6. 1. Program in Physical Therapy, Campus Box 8502, Applied Kinesiology Laboratory, Washington University School of Medicine, Saint Louis, MO, United States. Electronic address: sinacored@wustl.edu. 2. Program in Physical Therapy, Campus Box 8502, Applied Kinesiology Laboratory, Washington University School of Medicine, Saint Louis, MO, United States. Electronic address: hastingsmk@wustl.edu. 3. Program in Physical Therapy, Campus Box 8502, Applied Kinesiology Laboratory, Washington University School of Medicine, Saint Louis, MO, United States. Electronic address: bohnertk@wustl.edu. 4. Dept of Psychology, Campus Box 1125, Washington University, Saint Louis, MO, United States. Electronic address: mjstrube@wustl.edu. 5. Musculoskeletal Biomechanics Laboratory, Program in Physical Therapy, Doisy College of Health Sciences, Saint Louis University, St. Louis, MO, United States. Electronic address: djgutekunst@slu.edu. 6. Dept Orthopaedic Surgery, Campus Box 8233, Foot & Ankle Service, Washington University School of Medicine, Saint Louis, MO, United States. Electronic address: johnsonj@wudosis.wustl.edu.
Abstract
BACKGROUND: Neuropathic foot impairments treated with immobilization and off-loading result in osteolysis. In order to prescribe and optimize rehabilitation programs after immobilization we need to understand the magnitude of pedal osteolysis after immobilization and the time course for recovery. OBJECTIVE: To determine differences in a) foot skin temperature; b) calcaneal bone mineral density (BMD) after immobilization; c) calcaneal BMD after 33-53weeks of recovery; and d) percent of feet classified as osteopenic or osteoporotic after recovery in participants with neuropathic plantar ulcers (NPU) compared to Charcot neuroarthropathy (CNA). METHODS: Fifty-five participants with peripheral neuropathy were studied. Twenty-eight participants had NPU and 27 participants had CNA. Bilateral foot skin temperature was assessed before immobilization and bilateral calcaneal BMD was assessed before immobilization, after immobilization and after recovery using quantitative ultrasonometry. RESULTS: Before immobilization, skin temperature differences in CNA between their index and contralateral foot were markedly higher than NPU feet (3.0 degree C versus 0.7 degree C, respectively, p<0.01); BMD in NPU immobilized feet averaged 486±136mg/cm2, and CNA immobilized feet averaged 456±138mg/cm2, p>0.05). After immobilization, index NPU feet lost 27mg/cm2; CNA feet lost 47mg/cm2 of BMD, p<0.05. After recovery, 61% of NPU index feet and 84% of CNA index feet were classified as osteopenic or osteoporotic. CONCLUSIONS: There was a greater osteolysis after immobilization with an attenuated recovery in CNA feet compared to NPU feet. The attenuated recovery of pedal BMD in CNA feet resulted in a greater percentage of feet classified as osteoporotic and osteopenic.
BACKGROUND:Neuropathic foot impairments treated with immobilization and off-loading result in osteolysis. In order to prescribe and optimize rehabilitation programs after immobilization we need to understand the magnitude of pedal osteolysis after immobilization and the time course for recovery. OBJECTIVE: To determine differences in a) foot skin temperature; b) calcaneal bone mineral density (BMD) after immobilization; c) calcaneal BMD after 33-53weeks of recovery; and d) percent of feet classified as osteopenic or osteoporotic after recovery in participants with neuropathic plantar ulcers (NPU) compared to Charcot neuroarthropathy (CNA). METHODS: Fifty-five participants with peripheral neuropathy were studied. Twenty-eight participants had NPU and 27 participants had CNA. Bilateral foot skin temperature was assessed before immobilization and bilateral calcaneal BMD was assessed before immobilization, after immobilization and after recovery using quantitative ultrasonometry. RESULTS: Before immobilization, skin temperature differences in CNA between their index and contralateral foot were markedly higher than NPU feet (3.0 degree C versus 0.7 degree C, respectively, p<0.01); BMD in NPU immobilized feet averaged 486±136mg/cm2, and CNA immobilized feet averaged 456±138mg/cm2, p>0.05). After immobilization, index NPU feet lost 27mg/cm2; CNA feet lost 47mg/cm2 of BMD, p<0.05. After recovery, 61% of NPU index feet and 84% of CNA index feet were classified as osteopenic or osteoporotic. CONCLUSIONS: There was a greater osteolysis after immobilization with an attenuated recovery in CNA feet compared to NPU feet. The attenuated recovery of pedal BMD in CNA feet resulted in a greater percentage of feet classified as osteoporotic and osteopenic.
Authors: David R Sinacore; Mary K Hastings; Kathryn L Bohnert; Faye A Fielder; Dennis T Villareal; Vilray P Blair; Jeffrey E Johnson Journal: Phys Ther Date: 2008-09-18
Authors: David R Sinacore; Kathryn L Bohnert; Kirk E Smith; Mary K Hastings; Paul K Commean; David J Gutekunst; Jeffrey E Johnson; Fred W Prior Journal: J Diabetes Complications Date: 2017-02-14 Impact factor: 2.852