Edorium Journal of

Disability and Rehabilitation

 
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Original Article
 
Impact of foot progression angle modification on plantar loading in individuals with diabetes mellitus and peripheral neuropathy
Ericka N. Merriwether1, Mary K. Hastings2, Kathryn L. Bohnert3, John H. Hollman4, Michael J. Strube5, David R. Sinacore6
1PT, DPT, Ph.D., ATC, CSCS Postdoctoral Scholar, Neurobiology of Pain Laboratory, Department of Physical Therapy and Rehabilitation Science, University of Iowa, 3148 Medical Laboratories, Iowa City, IA USA 52242.
2PT, DPT, MSCI, ATC, Associate Professor, Applied Kinesiology Laboratory, Program in Physical Therapy, Washington University School of Medicine St. Louis, 4444 Forest Park Blvd., Campus Box 8502, St. Louis, MO USA 63108-2212.
3MS, Clinical Research Coordinator, Applied Kinesiology Laboratory, Program in Physical Therapy, Washington University School of Medicine St. Louis, 4444 Forest Park Blvd., Campus Box 8502, St. Louis, MO USA 63108-2212.
4PT, PhD, Program Director, Physical Therapy Doctoral Program, Mayo School of Health Sciences, Siebens Building, Fifth Floor, 200 First St. SW, Rochester, MN USA 55905.
5Ph.D, Professor, Department of Psychology, Washington University in St. Louis, Psychology Building, Room 221, Campus Box 1125, St. Louis, MO, USA 63130-4899.
6PT, Ph.D., FAPTA, Professor, Applied Kinesiology Laboratory, Program in Physical Therapy, Washington University School of Medicine St. Louis, 4444 Forest Park Blvd., Campus Box 8502, St. Louis, MO USA 63108-2212.

Article ID: 100007D05EM2016
doi:10.5348/D05-2016-7-OA-3

Address correspondence to:
Ericka N. Merriwether
PT, DPT, PhD, ATC, CSCS, Postdoctoral Scholar, Neurobiology of Pain Laboratory
Department of Physical Therapy and Rehabilitation Science
3148 Medical Laboratories, Iowa City, Iowa
USA, 52242

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How to cite this article
Merriwether EN, Hastings MK, Bohnert KL, Holl man JH, Strube MJ, Sinacore DR. Impact of foot progression angle modification on plantar loading in individuals with diabetes mellitus and peripheral neuropathy. Edorium J Disabil Rehabil 2016;2:15–23.


Abstract
Aims: To determine if participants can reduce foot progression angle (FPA), and if FPA reduction decreases regional plantar stresses and forces in individuals with diabetes.
Methods: Design: Three-group cross-sectional design with repeated measures.
Subjects: Twenty-eight participants either with diabetes mellitus (DM), diabetes and peripheral neuropathy with (DMPN+NPU) or without a prior history of ulceration (DMPN-NPU) were studied. Intervention: Participants were first instructed to walk over a 3.6 m walkway at their preferred FPA, and then to walk with their foot aligned parallel with the line of gait progression at their self-selected speed. Dynamic plantar kinetics in six masked regions were collected using an EMED-ST-P-2 pedobarograph. Main measures: Primary outcome measures were FPA, peak plantar pressure (PPP), and force-time integral (FTI). A repeated measures ANOVA was conducted to determine group differences in FPA for both walking conditions. Regional differences in PPPs and FTIs between preferred and corrected walking conditions were analyzed using repeated measures ANCOVA.
Results: Participants showed a reduction in FPA magnitude on the 'Involved' foot between the preferred and corrected walking conditions ( p<0.01). There were no differences in PPPs or FTIs in any mask between walking conditions (p>0.05).
Conclusion: Results from this investigation offer important evidence that people with diabetes can modify their FPA with a simple intervention of visual and verbal cueing. Future research should examine if gait retraining strategies in regular footwear more effectively offload areas of elevated regional plantar stresses and forces in adults with diabetes mellitus and peripheral neuropathy.

Keywords: Diabetic foot, Gait, Peripheral neuropathy, Plantar pressure


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Author Contributions:
Ericka N. Merriwether – Substantial contributions to conception and design, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Mary K. Hastings – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Kathryn L. Bohnert – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
John H. Hollman – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Michael J Strube – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
David R. Sinacore – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Ericka N. Merriwether et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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