Proximal influences on plantar pressures

NewsBot · Jul 28, 2021

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The effect of induced joint restriction on plantar pressure during gait A pilot study
EricaBartolo et al
Gait & Posture; 28 July 2021

Highlights
•The effect of induced lower limb joint restriction on plantar pressure was analysed.
•Significant increase in rearfoot PTI with restriction of the contralateral hip.
•Significant increase in first MTPJ MPP and PTI with hip joint restriction.
•Significant decrease in first MTPJ MPP with knee and ankle joint restriction.
•Increased loading duration might be the cause of ulcers rather than increased MPP.
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Background
The aim of this study was to analyse the effect of induced lower limb joint restriction on plantar pressures during gait. Focusing on restricting a single joint, without the effect of other co-morbidities, would provide better understanding as to the resultant plantar loadings during gait, which would be especially beneficial in patients requiring offloading procedures.

Research Question
Does induced lower limb joint restriction affect plantar pressure distribution during gait?

Methods
A prospective, quasi-experimental study was conducted, recruiting ten healthy, adult participants who were instructed to walk barefoot over a Tekscan HR Mat™. This procedure was repeated after separately inducing restriction of the hip, knee and ankle joints. Mean peak plantar pressure (MPP) and pressure-time integral (PTI) data were analysed to compare between unrestricted and restricted data.

Results
Significant plantar pressure changes were observed in the heel and first metatarsal regions. Rearfoot PTIs were increased with restriction of the contralateral hip (left p <0.001) (right p =0.02) and knee joints (left p =0.01) (right p =0.04). Both MPPs (left p =0.01; right p =0.01) and PTIs (left p =0.004; right p =0.03) were increased in the first metatarsal when restricting the hip joint of the same limb. MPP was decreased in the left first metatarsal with induced knee (left p =0.01; right p =0.04) and ankle (left and right p <0.001) joint restriction. Finally, MPP was decreased in the right first metatarsal with knee (left and right p =0.01) and ankle (left p =0.04; right p =0.01) joint restriction.

Significance
Limited joint mobility may have a direct effect on plantar pressure, particularly with restriction in the hip and knee joints, hence careful attention should be given especially in patients with conditions involving plantar loadings. Results in this study also show that PTI changes during gait should be equally evaluated clinically along with peak plantar pressure analysis.
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