The first ray in neuropathic diabetic patients: Implications for support of the longitudinal arch

NewsBot · Jan 5, 2017

Members do not see these Ads. Sign Up.
Shear and pressure under the first ray in neuropathic diabetic patients: Implications for support of the longitudinal arch
Brian Davis, Mariam Crow, Visar Berki, Daniela Ciltea
Jnl Biomechanics; Articles in Press

Objective
To assess dynamic arch support in diabetic patients at risk for Charcot neuroarthopathy whose arch index has not yet shown overt signs of foot collapse.

Methods
Two indirect measures of toe flexor activation (ratios: peak hallux pressure to peak metatarsal pressure – Ph/Pm; peak posterior hallux shear to peak posterior metatarsal shear – Sh/Sm) were obtained with a custom built system for measuring shear and pressure on the plantar surface of the foot during gait. In addition, the tendency of the longitudinal arch to flatten was measured by quantifying the difference in shear between the 1st metatarsal head and the heel (Sflatten) during the first half of the stance phase. Four stance phases from the same foot for 29 participants (16 control and 13 neuropathic diabetic) were assessed.

Results
The peak load ratio under the hallux (Ph/Pm) was significantly higher in the control group (2.10 ± 1.08 versus 1.13 ± 0.74, p = 0.033). Similarly, Sh/Sm was significantly higher in the control group (1.87 ± 0.88 versus 0.88 ± 0.45, p = 0.004). The difference in anterior shear under the first metatarsal head and posterior shear under the lateral heel (Sflatten) was significantly higher in the diabetic group (p <0.01). Together these findings demonstrate reduced plantar flexor activity in the musculature responsible for maintaining the longitudinal arch.

Conclusions
With no significant difference in arch index between the two groups, but significant differences in Ph/Pm, Sh/Sm and Sflatten the collective results suggest there are changes in muscle activity that precede arch collapse.
Click to expand...

Craig Payne · Jan 5, 2017

No mention what-so-ever of the windlass mechanism in the paper. It is the most likely explanation for the results. Next.

NewsBot · Jan 17, 2021

A Systematic Review of Angular Deformities in Charcot Neuroarthropathy
Nicole K Cates et al
J Foot Ankle Surg. 2020 Oct 7;S1067-2516(20)30380-X

Charcot neuroarthropathy of the foot and ankle is associated with periarticular deformities and progressive radiographic changes. There have been studies analyzing the radiographic angulations and deformity progression in Charcot neuroarthropathy deformity. The aim of this paper is to provide systematic review of studies that evaluate foot and ankle radiographic parameters in patients with Charcot neuroarthropathy. A multidatabase search including, medline, EMBASE, Google Scholar, Cochrane Library, Clinicaltrials.gov and reference lists of included studies, was performed from 1980 to 2020. A total of 7 articles were included that analyzed radiographic angulations in Charcot neuroarthropathy deformity. The articles could be categorized into nonoperative angulation measurements, and pre- versus postoperative angulation measurements. The presence of ulcerations and the severity of the Charcot neuroarthropathy deformity were found to result from predominantly sagittal plane deformity. The deformity initiates with medial column collapse and progresses to continual lateral column collapse. Surgical intervention resulting in immediate postoperative improvement in angular measurements, however, without beaming of both the medial and lateral column, there was recurrence of the lateral column deformity. This systematic review of articles analyzing angular deformities in Charcot neuroarthropathy patients, demonstrates the progressive sagittal plane breakdown patterns of Charcot as well as the benefits of surgical intervention.
Click to expand...

NewsBot · Oct 10, 2022

Second Ray Amputation in Diabetic Foot - Functionally Better than Proximal Foot Amputations, but Beware of Charcot Arthropathy: A Case Report and Review of Literature
Amit Gupta et al
J Orthop Case Rep. 2022 Mar;12(3):13-17

Introduction: Lower limb amputations secondary to diabetic foot infection/osteomyelitis (OM) are the most common cause for non-traumatic amputations of the lower extremity. Hind/midfoot amputations are commonly done for metatarsal (MT) OM. They are, however, associated with higher complication and revision rates and often lead to below knee amputation. In comparison, distal/forefoot toe disarticulation/ray amputation (R amp) have lesser revision rates/complications and give better functional outcome. Here, we report a case of 2nd R amp with an uncommon complication.

Case report: A 42-year-old male with uncontrolled diabetes and bilateral diabetic neuropathy presented with discharging sinus over plantar aspect of the left foot since 1 week. There was no evidence of underlying OM on MRI. Wound healed with soft-tissue debridement and empirical antibiotics (culture negative) for 2 weeks. Re-debridement was done for a wound gape 6 weeks later. Infection resolved with targeted antibiotics (oral ciprofloxacin and doxycycline) for Enterobacter cloacae given for 1 month. Six months later, he developed pain and swelling in the left foot following prolonged barefoot walking and possible injury with a stone. There was local redness, swelling, and a plantar sinus. MRI revealed septic arthritis of the left 2nd metatarsophalangeal (MTP) joint, OM of the 2nd MT head, and an encapsulated soft-tissue abscess. Aggressive debridement with 2nd R amp and careful separation of encapsulated abscess was done leaving behind base of 2nd MT to maintain stability of the Lisfranc joint. Wound healed primarily. Targeted antibiotics for Methicillin Susceptible Staphylococcus aureus were given for 6 weeks. Good diabetic control and avoiding bare foot walking were advised and he is infection free, fully functional, and asymptomatic at 36 months. However, he was noted to have developed valgus deformity of the midfoot secondary to Charcot osteoarthropathy of the Lisfranc joints at 36 months follow-up, involving 1st, 3rd, and 4th TMT joints. The other foot did not show any evidence of Charcot arthropathy.

Conclusion: Recurrent wound infections with subsequent OM are a common feature of diabetic foot. R amps have better functional outcomes with preserved foot stability, shorter length of hospitalization, and associated costs as compared to hind/midfoot amputations. They may, however, develop Charcot osteoarthropathy due to the void between adjoining MTs resulting in altered forces across the Lisfranc joints. Surgeons must beware of this complication, especially following R amps and monitor these patients with serial clinical and radiographic examination.
Click to expand...

NewsBot The Admin that posts the news.

Craig Payne Moderator

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Cannabinoid Spray Improves Neuropathic Pain

2-Midmark 417, 2-Boyd power chairs mid 90's, x-cel x-ray machine best reasonableoffer

Raynaud's

Sesamoid View X-ray

X-ray Cassettes- 10" x 12" Spectroline- 2 new/5 used; Viking 10" x 12" film

X-CEL X-RAY 715A-BD DOM Digital Podiatry xray

Experience with CareRay digital X-ray system

Share This Page