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Plantar pressures and calluses

Discussion in 'Gerontology' started by Hylton Menz, Apr 24, 2007.

  1. Hylton Menz

    Hylton Menz Guest


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    From Clinical and Experimental Dermatology:

    Menz HB, Zammit GV, Munteanu SE. Plantar pressures are higher under callused regions of the foot in older people. Clin Exp Dermatol. 2007 Apr 8; [Epub ahead of print]

    Background. Mechanically induced hyperkeratotic lesions (corns and calluses) are among the most common foot problems in older people. However, their aetiology is not well understood.

    Aim. To compare the magnitude of pressures generated under the foot when walking in older people with and without plantar calluses.

    Methods. Peak plantar pressure measurements were obtained from 292 participants (99 men and 193 women) aged 62-96 years (mean +/- SD 77.6 +/- 6.9) recruited from a retirement village and a university health sciences clinic. Comparisons were then made between callused and noncallused regions of the foot.

    Results. In total, 151 participants (52%) had at least one plantar callus. Those with plantar calluses were more likely to be female, have moderate to severe hallux valgus, and at least one lesser toe deformity. Regional peak plantar pressures were significantly higher in people with calluses under the second metatarsophalangeal joint (2.34 +/- 0.46 vs. 2.12 +/- 0.51 kg/cm(2), P = 0.001), the third to fifth metatarsophalangeal joints (1.71 +/- 0.46 vs. 1.50 +/- 0.51 kg/cm(2), P = 0.009) and the hallux (1.40 +/- 0.34 vs. 1.23 +/- 0.47 kg/cm(2), P = 0.007) compared with people without calluses under these sites.

    Conclusion. Plantar pressures are significantly higher under callused regions of the foot in older people. Raised pressure may play a role in the development of plantar calluses by accelerating the turnover rate of keratinocytes in the epidermis. Future studies should focus on evaluating the efficacy of pressure-relieving interventions in the prevention and treatment of keratotic disorders in older people.​
     
  2. wdd

    wdd Well-Known Member

    This research and research measuring differences in plantar pressure before and after callus reduction puzzle me a little.

    Is it scientifically sound to measure the pressures at different interfaces, (ie callus/ground, normal stratum corneum/ground or reduced callus/ground) and then to make statement which seem to imply that a pressure difference at one interface can necessarily be compared to a pressure difference at another interface?

    Imagine a study to compare pressures on the head, when being hit over the head with a hammer, in two situations. firstly wearing a crash helmet and secondly not wearing a crash helmet.

    Question. Where would you put your sensors?

    Using the logic of callus pressure research it would seem that with the helmet on you would put the pressure sensor on the outside of the helmet and with the helmet off you would put it on the skin of the skull.

    My suggestion would be that to say anything meaningful about the pressure differences you need to be taking measurements at the same interface. Just because you can't doesn't make it reasonable to compare the two pressures. You are not comparing like with like.

    Even if my comparison of callus to a crash helmet is not totally acceptable the basic principle holds. I think?

    wdd
     
  3. wdd

    wdd Well-Known Member

    I would love some responses to my question.

    I could have got the wrong end of the stick altogether. I may be completely wrong, I might be a little bit right.

    Because what I wrote above seems highly obvious it is likely that it was obvious to those who have done this type of research and that they have dismissed it for good reasons.

    However if my point is to any extent correct then it needs to be responded to as aspects of diabetic management are directly or indirectly underpinned by research into plantar pressure before and after callus reduction.

    Best wishes,

    Bill
     
  4. dragon_v723

    dragon_v723 Active Member

    is there any study that studies the same issue but in younger demographics who are diabetic?
     
  5. Shalom

    Shalom Active Member

    Here you go-

    http://www.japmaonline.org/cgi/content/abstract/93/3/214

    High Plantar Pressure and Callus in Diabetic Adolescents

    Incidence and Treatment

    Anthony C. Duffin, PhD*,, Robert Kidd, PhD*, Albert Chan, MAppStat and Kim C. Donaghue, PhD,
    * University of Western Sydney, Sydney, New South Wales, Australia.
    The Children’s Hospital at Westmead, Sydney, New South Wales, Australia.
    University of Sydney, Sydney, New South Wales, Australia.

    Corresponding author: Anthony C. Duffin, PhD, 29/6-8 Hannah St, Beecroft 2119, New South Wales, Australia.

    Abstract

    This study examined the incidence of high peak plantar pressure and plantar callus in 211 adolescents with diabetes mellitus and 57 nondiabetic controls. The percentage of subjects with these anomalies was the same in both groups. Although diabetic subjects were no more likely than nondiabetic controls to have high peak plantar pressure and callus, these anomalies place individuals with diabetes at greater risk of future foot problems. The effects of orthoses, cushioning, and both in combination were monitored in 17 diabetic subjects with high peak plantar pressure and in 17 diabetic subjects with plantar callus; reductions of up to 63% were achieved. Twelve-month follow-up of diabetic subjects fitted with orthoses showed a significant reduction in peak plantar pressure even when the orthoses were removed. The diabetic subjects who had not received any interventions during the same 12-month period showed no significant change in peak plantar pressure. (J Am Podiatr Med Assoc 93(3): 214-220, 2003)

    Shalom.
     
  6. andersonkchan

    andersonkchan Active Member

    "More likely to be female, Have moderate to severe HAV".. lol. Like the females need anyMORE evidence to stay away from high heels/ stilletos...
     
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