Effect of BMI on plantar pressures in a total contact cast

NewsBot · Jul 23, 2014

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A comparison of two total contact cast constructs with variable body mass.
Pirozzi K, McGuire J, Meyr AJ.
J Wound Care. 2014 Jul;23 Suppl 7:S4-S14

Objective: There is a growing body of evidence implicating obesity as having a negative effect on the development and treatment of diabetic foot disease. The aim of this study was to increase the body of knowledge on the effects of obesity on foot function, specifically as it relates to peak plantar pressures in the total contact cast (TCC). Our investigational objectives were to compare the effect of two different TCC designs on mean peak plantar pressures, and to evaluate the efficacy of two TCC constructs with increasing body mass.

Method: The primary outcome measure was mean peak plantar pressure in the heel, midfoot, forefoot and first metatarsal as measured with an in-shoe pressure measurement system. The variables were patient weight (from 'normal' body mass index (BMI) to 'overweight', 'obese' and 'morbidly obese') and the TCC construct (with both a standard and alternate cast design). The standard TCC is considered the gold standard for off-loading of the diabetic foot. The alternate TCC was designed to use the essential offloading component of the traditional TCC, namely the total contact leg section, with use of an open cell polyurethane foam to transfer load from the foot to the lower leg, thereby offloading the foot by suspending it within a padded fiberglass walking cast.

Results: We did not observe statistically significant differences in mean peak plantar pressures in any plantar foot anatomic area or with any body mass between the two TCC designs.

Conclusion: Based on the results, we concluded that the alternate TCC design provides another viable TCC construct option for practitioners working with the neuropathic foot. This investigation also provides specific data on changes that occur in peak plantar pressures with use of the total contact cast and variable BMIs. Declaration of interest: none.
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NewsBot · Jun 24, 2015

Effect of variable body mass on plantar foot pressure and off-loading device efficacy.
Pirozzi K, McGuire J, Meyr AJ
J Foot Ankle Surg. 2014 Sep-Oct;53(5):588-97

An increasing body of evidence has implicated obesity as having a negative effect on the development, treatment, and outcome of lower extremity pathologic entities, including diabetic foot disease. The objective of the present study was to increase the body of knowledge with respect to the effects of obesity on foot function. Specifically, we attempted to (1) describe the relationship between an increasing body mass index (BMI) on plantar foot pressures during gait, and (2) evaluate the efficacy of commonly prescribed off-loading devices with an increasing BMI. A repeated measures design was used to compare the peak plantar foot pressures under multiple test conditions, with the volunteers acting as their own controls. The primary outcome measure was the mean peak plantar pressure in the heel, midfoot, forefoot, and first metatarsal, and the 2 variables were modification of patient weight (from "normal" BMI to "overweight," "obese," and "morbidly obese") and footwear (from an athletic sneaker to a surgical shoe, controlled ankle motion walker, and total contact cast). Statistically significant increases in the peak plantar pressures were observed with increasing volunteer BMI weight class, regardless of the off-loading device used. The present investigation has provided unique and specific data with respect to the changes that occur in the peak plantar pressures with variable BMIs across different anatomic levels and with commonly used off-loading devices. From our results, we have concluded that although the plantar pressures increase with increasing weight, it appears that at least some reduction in pressure can be achieved with an off-loading device, most effectively with the total contact cast, regardless of the patient's BMI.
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NewsBot · Mar 5, 2020

The effect of body weight reduction using a lower body positive pressure treadmill on plantar pressure measures while running
Laura Hodges-Long et al
Physical Therapy in Sport; 24 February 2020

Highlights
•As body weight is reduced, there is a decrease in plantar pressure measures
•Decreased body weight may reduce the stress of ambulation to promote healing
•Center of pressure at initial contact migrates anterior with decreased body weight
•LBPPT may provide a sensory cue to shift footstrike anteriorly for force reduction
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Objective
To evaluate the effects of body weight reduction at 10% intervals on pressure distribution variables across regions of the foot while running.

Study Design
Crossover Study Design

Setting
Laboratory

Participants
12 recreational runners

Main outcome measures
Pressure-time integral, peak pressure, instance of peak pressure, contact area, contact time and center of pressure (COP) location at initial contact across four foot regions were measured while participants ran at self-selected speed on the Lower Body Positive Pressure Treadmill (LBPPT) at 100%, 90%, 80%, 70% and 60% of their body weight (%BW)

Results
As the %BW decreased, there were corresponding significant decreases in the pressure-time integral and peak pressures in all four regions of the foot. Significant differences within foot region and %BW for the other variables were infrequent. There was a significant anterior shift of the COP location at initial contact as the %BW decreased.

Conclusion
LBPPT is useful for reducing the pressure across the entire foot. Additionally, the anterior translation of the COP location at initial contact with reduced %BW may provide an additional gait retraining tool for prevention and treatment of running injuries as reducing %BW moves the runner away from a rearfoot strike pattern.
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