Giovanni Matricali

Body of evidence supporting the clinical use of 3D multisegment foot models: A systematic review

BACKGROUND A critical component in the characterization of foot mechanics during clinical gait analysis is the quantitative measurement of foot kinematics. Currently, the use of 3D multisegment foot models (3DMFMs) is popular in gait laboratories as it would seem to be an adequate tool for the in vivo analysis of dynamic foot kinematics. This systematic review identifies and evaluates current evidence for the use of 3DMFMs in clinical gait analysis. METHODS A targeted search strategy traced full papers that fulfilled the inclusion and exclusion criteria. The papers were classified and evaluated for quality using a custom made quality appraisal form. FINDINGS Forty-one manuscripts were included yielding a total number of fifteen 3DMFMs. Generally, study procedures and sample selection were adequately described; however, the methodological quality varied widely. Evidence regarding the repeatability of the identified models also varied widely. Models facing the highest level of scientific credibility were characterized by adequate repeatability indices obtained from between-trial, between-day and between and within assessor studies. Generally, the highest reliability indices were found for the sagittal plane kinematics. Within-subject variability was found to be the lowest, contrarily, between-subject and between-day variabilities were found to be highest. INTERPRETATION Reported repeatability indices such as the coefficient of multiple correlation, standard deviation and standard error of measurement provide evidence for the continued use of 3DMFMs. While a number of published models exist, there is no adequate evidence available to support their clinical use. More reliability and validity studies are needed to confirm adequate measurement properties of 3DMFMs.

The impact of hallux valgus on foot kinematics: A cross-sectional, comparative study

BACKGROUND Hallux valgus is a very common foot deformity in modern societies. The impact of this condition on foot function has been described qualitatively and quantitatively. Published patho-mechanical models are mainly underpinned by findings originating from plantar pressure measurements. However, the kinematical patterns of the many foot segments during gait have not been quantified. This study aims to evaluate the kinematics of the various foot segments in the presence of this deformity. METHODS Using the Oxford Foot Model and a 12-camera Motion Analysis System, gait analysis was conducted on a convenience sample of 20 participants with hallux valgus and compared to that of 22 randomly selected symptom-free volunteers. Differences between temporal and kinematical data between groups were analyzed using the unpaired parametric Student t-test (significance level p<0.01). RESULTS During specific gait events, a different range of motion was found at several inter-segment angles. Particularly, the range of motion of the hallux (sagittal plane) and hindfoot (frontal-transverse planes) during stance were significantly different (p<0.01). CONCLUSION Sagittal plane kinematics of the hallux is affected by the first ray deformity in this condition. However, the impact on other segments was found to be limited. This suggests that the patho-mechanical consequences remain limited to the weight bearing function of the first ray.

Economic aspects of diabetic foot care in a multidisciplinary setting : A review

To evaluate the economic aspects of diabetic foot care in a multidisciplinary setting.

Cost and resource utilization for prevention and treatment of foot lesions in a diabetic foot clinic in Belgium

This prospective observational study was carried out to assess the annual preventive and curative treatment costs for diabetic foot problems. Measures of resource use over the 1-year study period were taken for 151 patients whose lesions covered the entire Wagner classification. Treatment was provided under the current protocols of a multidisciplinary team. The 1993 market prices for health services were used to convert units of health service utilization to expenditures by the social insurance system and the patients. The severity of the foot problems determined the medical cost. Preventive care (47 cases), represented an average cost per case of US

Inter- and intra-observer reliability of masking in plantar pressure measurement analysis

880 (1US

Outcome and recurrence rate of diabetic foot ulcers treated by a total contact cast: Short-term follow-up

1993=BEF 30.65). Curative care (120 cases), including diagnostic tests, wound dressings, antibiotic therapy, revascularization and off loading techniques resulted in a mean cost of US

Comparison of foot segmental mobility and coupling during gait between patients with diabetes mellitus with and without neuropathy and adults without diabetes

5227 per ulcer. Care for the 16 most severe wounds and amputations involved hospitalization and surgery at a mean cost per ulcer of US

Classification of Forefoot Plantar Pressure Distribution in Persons with Diabetes: A Novel Perspective for the Mechanical Management of Diabetic Foot?

31716. The most important cost contributers were hospitalizations (72%), drugs (11%) and diagnostic examinations (4%). Preventive treatment for diabetic foot problems can represent a significant saving for the social insurance system as well as for the patients.

Repeatability of a 3D multi-segment foot model protocol in presence of foot deformities

Plantar pressure measurement is an important tool in gait analysis. Manual placement of small masks (masking) is increasingly used to calculate plantar pressure characteristics. Little is known concerning the reliability of manual masking. The aim of this study was to determine the reliability of masking on 2D plantar pressure footprints, in a population with forefoot deformity (i.e. hallux valgus). Using a random repeated-measure design, four observers identified the third metatarsal head on a peak-pressure barefoot footprint, using a small mask. Subsequently, the location of all five metatarsal heads was identified, using the same size of masks and the same protocol. The 2D positional variation of the masks and the peak pressure (PP) and pressure time integral (PTI) values of each mask were calculated. For single-masking the lowest inter-observer reliability was found for the distal-proximal direction, causing a clear, adverse impact on the reliability of the pressure characteristics (PP and PTI). In the medial-lateral direction the inter-observer reliability could be scored as high. Intra-observer reliability was better and could be scored as high or good for both directions, with a correlated improved reliability of the pressure characteristics. Reliability of multi-masking showed a similar pattern, but overall values tended to be lower. Therefore, small sized masking in order to define pressure characteristics in the forefoot should be done with care.

Implementation of a quality improvement initiative in Belgian diabetic foot clinics: feasibility and initial results

Foot ulcers in patients with diabetes present an increasing burden to healthcare. Total contact cast (TCC) is a well established treatment option for many of these ulcers, but little seems to be known about the final outcome once healing has been reached. The study examined healing and final outcome after TCC treatment among patients with diabetes. During a 22-month period, 15 consecutive patients with a total of 17 ulcers started treatment with a TCC. Three patients (three ulcers) were lost to follow-up (FU). Average FU was 91 weeks. The patients were followed with emphasis on healing, complications during FU, footwear, compliance, and frequency of visits. All ulcers healed, some after additional surgery. During FU, control visits were performed at an average of one visit every 4.7 weeks. Notwithstanding this, a high frequency of ulcer recurrence and/or other complications was noticed. Only four patients out of 12 remained without any new (ulcer) problem during FU. TCC proved to be a very efficient tool to heal neuropathic foot ulcers, but the recurrence rate and frequency of other complications remained very high. These data show how difficult it is to achieve reliable (secondary) preventive general foot care, and to prescribe and manufacture reliable footwear.