Mohamad Motawea1, Mamdouh El-Nahas2, David G Armstrong3. 1. Faculty of Medicine, Mansoura University, Egypt. Electronic address: drmotawe3@mans.edu.eg. 2. Faculty of Medicine, Port-Said University, Egypt. Electronic address: drmamdouh@hotmail.com. 3. Southwestern Academic Limb Salvage Alliance (SALSA), Keck School of Medicine of University of Southern California, 1520 San Pablo Street, Suite 4300, Los Angeles, CA, United States. Electronic address: armstrong@usa.net.
Abstract
BACKGROUND: The total contact cast has been recognized as the "gold standard" for treatment of Charcot neuro-osteoarthropathy (CN). However, removable cast walkers (RCWs) became an alternative option especially after resolution of the acute stage. RCWs with an elevated sole construction often induce leg length discrepancy (LLD) that could significantly affects plantar pressure (PP) distribution in diabetic patients with neuropathy. AIM: To study the additional effect of walking speed on PP abnormalities induced by LLD. METHOD: The study included 16 patients with diabetes (59±8.8years; 8 men and 8 women), with unilateral CN offloaded by RCW. In-shoe PP distribution was measured using F-scan (Tekscan Inc.), whilst patients walked at their normal speed (53±4 steps/min), versus short slow steps (24±3/min) under the two walking conditions: (1) neglected LLD, and (2) corrected LLD. RESULTS: The greatest reduction in PP was seen during reduction of walking speed, with corrected LLD, followed by corrected LLD with normal walking speed, followed by neglected LLD with slowing of walking speed. The highest PP was found when the patient remain on their normal walking speed and LLD was neglected. CONCLUSION: The contralateral foot of CN offloaded with RCW, is subjected to high pressure loads beneath the hallux, 1st, 2nd, 3rd, and 5th metatarsal heads. As such, care should be taken not only to avoid minor LLD, but to also advise the patient to practice short slow steps while walking, so that pressure overload on contralateral limb and its possible contribution to the development of bilateral Charcot, could be minimized.
BACKGROUND: The total contact cast has been recognized as the "gold standard" for treatment of Charcot neuro-osteoarthropathy (CN). However, removable cast walkers (RCWs) became an alternative option especially after resolution of the acute stage. RCWs with an elevated sole construction often induce leg length discrepancy (LLD) that could significantly affects plantar pressure (PP) distribution in diabeticpatients with neuropathy. AIM: To study the additional effect of walking speed on PP abnormalities induced by LLD. METHOD: The study included 16 patients with diabetes (59±8.8years; 8 men and 8 women), with unilateral CN offloaded by RCW. In-shoe PP distribution was measured using F-scan (Tekscan Inc.), whilst patients walked at their normal speed (53±4 steps/min), versus short slow steps (24±3/min) under the two walking conditions: (1) neglected LLD, and (2) corrected LLD. RESULTS: The greatest reduction in PP was seen during reduction of walking speed, with corrected LLD, followed by corrected LLD with normal walking speed, followed by neglected LLD with slowing of walking speed. The highest PP was found when the patient remain on their normal walking speed and LLD was neglected. CONCLUSION: The contralateral foot of CN offloaded with RCW, is subjected to high pressure loads beneath the hallux, 1st, 2nd, 3rd, and 5th metatarsal heads. As such, care should be taken not only to avoid minor LLD, but to also advise the patient to practice short slow steps while walking, so that pressure overload on contralateral limb and its possible contribution to the development of bilateral Charcot, could be minimized.
Authors: Felix W A Waibel; Martin C Berli; Viviane Gratwohl; Kati Sairanen; Dominik Kaiser; Laura Shin; David G Armstrong; Madlaina Schöni Journal: Foot Ankle Int Date: 2020-07-22 Impact factor: 2.827
Authors: David C Kingston; Sarah Ferwerda; Curtis Fontaine; Marhanda Keeping; Jeffrey Stewart; Rachel Ward; Jenelle Zapski; Kassondra Collins; Samuel K Essien; Audrey R Zucker-Levin Journal: Foot Ankle Orthop Date: 2021-03-19