Offoading via biofeedback

NewsBot · Mar 18, 2008

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Development and test of a new plantar pressure control device for foot unloading. [Article in French]
Femery V, Potdevin F, Thevenon A, Moretto P.
Ann Readapt Med Phys. 2008 Feb 27 [Epub ahead of print]

OBJECTIVE: To validate a new plantar pressure control device able to detect excessive plantar pressure on-line and to improve the subject's awareness of the gait pattern in order to correct and optimize the load distribution patterns. The aim of this study was to verify the feasibility of a deliberate and partial unload of the first metatarsal head.

MATERIAL AND METHOD: Eight healthy subjects were equipped with the plantar pressure sensors integrated in customized insoles. They were told to unload the first metatarsal head of the right foot by 5%. During the trials, the auditory and visual signals inform the subject of an excessive, insufficient or correct unload.

RESULTS: Five subjects over eight succeeding in modifying significantly their gait pattern and in unloading by 5% the first metatarsal head. The unload is effective in 70.7% of the trials. However, the subjects were spontaneously inclined to reduce peak pressure under the first metatarsal head beyond the critical peak plantar pressure threshold (48.2% of the trials).

DISCUSSION - CONCLUSION: The results showed the feasibility of a partial and deliberate foot unloading in using biofeedback device but emphasized the subject's difficulty to control a discriminated and accurate unload of the first metatarsal head. That points out the necessity of learning period. The baropodometric biofeedback rehabilitation focuses on the subject's capacities to modify its own locomotor pattern. It would be used as primary and secondary prevention means of diabetic foot ulceration.
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Admin2 · Mar 19, 2008

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NewsBot · Jan 8, 2010

Biofeedback for foot offloading in diabetic patients with peripheral neuropathy
Diabet. Med. 27, 61–64 (2010)

Aims The reduction of high plantar pressure in diabetic patients with peripheral neuropathy is mandatory for prevention of foot ulcers and amputations. We used a new biofeedback-based method to reduce the plantar pressure at an at-risk area of foot in diabetic patients with peripheral neuropathy.

Methods Thirteen diabetic patients (age 60.8 ± 12.3 years, body mass index 29.0 ± 5.0 kg/m2) with peripheral neuropathy of the lower limbs were studied. Patients with memory impairment were excluded. The portable in-shoe foot pressure measurement system (PEDAR®) was used for foot offloading training by biofeedback. The learning procedure consisted in sequences of walking (10 steps), each followed by a subjective estimation of performance and objective feedback. The goal was to achieve three consecutive walking cycles of 10 steps, with a minimum of seven steps inside the range of 40–80% of the baseline peak plantar pressure. The peak plantar pressure was assessed during the learning period and at retention tests.

Results A significant difference in peak plantar pressure was recorded between the beginning and the end of the learning period (when the target for plantar pressure was achieved) (262 ± 70 vs. 191 ± 53 kPa; P = 0.002). The statistically significant difference between the beginning of learning and all retention tests persisted, even at the 10-day follow-up.

Conclusions Terminal augmented feedback training may positively affect motor learning in diabetic patients with peripheral neuropathy and could possibly lead to suitable foot offloading. Additional research is needed to confirm the maintenance of offloading in the long term.
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NewsBot · Oct 20, 2012

Biofeedback can reduce foot pressure to a safe level and without causing new at-risk zones in patients with diabetes and peripheral neuropathy.
De León Rodriguez D, Allet L, Golay A, Philippe J, Assal JP, Hauert CA, Pataky Z.
Diabetes Metab Res Rev. 2012 Oct 18.

BACKGROUND:
Plantar pressure reduction is mandatory for diabetic foot ulcer healing. Our aim was to evaluate the impact of a new walking strategy learned by biofeedback on plantar pressure distribution under both feet in patients with diabetic peripheral neuropathy.

METHODS:
Terminally augmented biofeedback has been used for foot off-loading training in 21 patients with diabetic peripheral sensory neuropathy. The biofeedback technique was based on a subjective estimation of performance and objective visual feedback following walking sequences. The patient was considered to have learned a new walking strategy as soon as the peak plantar pressure (PPP) under the previously defined at-risk zone was within a range of 40-80% of baseline PPP, in 70% of the totality of steps and during 3 consecutive walking sequences. The PPP was measured by a portable in-shoe foot pressure measurement system (PEDAR®) at baseline (T0), directly after learning (T1) and at 10-day retention test (T2).

RESULTS:
The PPP under at-risk zones decreased significantly at T1 (165 ± 9 kPa, p < 0.0001) and T2 (167 ± 11, p = 0.001), as compared to T0 (242 ± 12 kPa) without any increase of the PPP elsewhere. At the contra-lateral foot (not concerned by off-loading), the PPP was slightly higher under the lateral midfoot at T1 (68 ± 8 kPa, p = 0.01) and T2 (65 ± 8 kPa, p = 0.01), as compared to T0 (58 ± 6 kPa).

CONCLUSIONS:
The foot off-loading by biofeedback lead to a safe and regular plantar pressure distribution without inducing any new "at-risk" area under both feet
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