Tatiana de Almeida Bacarin

Plantar pressure distribution patterns during gait in diabetic neuropathy patients with a history of foot ulcers

OBJECTIVE: To investigate and compare the influence of a previous history of foot ulcers on plantar pressure variables during gait of patients with diabetic neuropathy. INTRODUCTION: Foot ulcers may be an indicator of worsening diabetic neuropathy. However, the behavior of plantar pressure patterns over time and during the progression of neuropathy, especially in patients who have a clinical history of foot ulcers, is still unclear. METHODS: Subjects were divided into the following groups: control group, 20 subjects; diabetic neuropathy patients without foot ulcers, 17 subjects; and diabetic neuropathy patients with at least one healed foot ulcer within the last year, 10 subjects. Plantar pressure distribution was recorded during barefoot gait using the Pedar-X system. RESULTS: Neuropathic subjects from both the diabetic neuropathy and DNU groups showed higher plantar pressure than control subjects. At midfoot, the peak pressure was significantly different among all groups: control group (139.4±76.4 kPa), diabetic neuropathy (205.3±118.6 kPa) and DNU (290.7±151.5 kPa) (p=0.008). The pressure-time integral was significantly higher in the ulcerated neuropathic groups at midfoot (CG: 37.3±11.4 kPa.s; DN: 43.3±9.1 kPa.s; DNU: 68.7±36.5 kPa.s; p=0.002) and rearfoot (CG: 83.3±21.2 kPa.s; DN: 94.9±29.4 kPa.s; DNU: 102.5±37.9 kPa.s; p=0.048). CONCLUSION: A history of foot ulcers in the clinical history of diabetic neuropathy subjects influenced plantar pressure distribution, resulting in an increased load under the midfoot and rearfoot and an increase in the variability of plantar pressure during barefoot gait. The progression of diabetic neuropathy was not found to influence plantar pressure distribution.

Plantar pressures during shod gait in diabetic neuropathic patients with and without a history of plantar ulceration.

BACKGROUND Diabetic neuropathy leads to progressive loss of sensation, lower-limb distal muscle atrophy, autonomic impairment, and gait alterations that overload feet. This overload has been associated with plantar ulcers even with consistent daily use of shoes. We sought to investigate and compare the influence of diabetic neuropathy and plantar ulcers in the clinical history of diabetic neuropathic patients on plantar sensitivity, symptoms, and plantar pressure distribution during gait while patients wore their everyday shoes. METHODS Patients were categorized into three groups: a control group (CG; n=15), diabetic patients with a history of neuropathic ulceration (DUG; n=8), and diabetic patients without a history of ulceration (DG; n=10). Plantar pressure variables were measured by Pedar System shoe insoles in five plantar regions during gait while patients wore their own shoes. RESULTS No statistical difference between neuropathic patients with and without a history of plantar ulcers was found in relation to symptoms, tactile sensitivity, and duration of diabetes. Diabetic patients without ulceration presented the lowest pressure-time integral under the heel (72.1+/-16.1 kPa x sec; P=.0456). Diabetic patients with a history of ulceration presented a higher pressure-time integral at the midfoot compared to patients in the control group (59.6+/-23.6 kPaxsecx45.8+/-10.4 kPaxsec; P=.099), and at the lateral forefoot compared to diabetic patients without ulceration (70.9+/-17.7 kPa secx113.2+/-61.1 kPaxsec, P=.0193). Diabetic patients with ulceration also presented the lowest weight load under the hallux (0.06+/-0.02%, P=.0042). CONCLUSIONS Although presenting a larger midfoot area, diabetic neuropathic patients presented greater pressure-time integrals and relative loads over this region. Diabetic patients with ulceration presented an altered dynamic plantar pressure pattern characterized by overload even when wearing daily shoes. Overload associated with a clinical history of plantar ulcers indicates future appearance of plantar ulcers.

Comparison of static footprints and pedobarography in obese and non-obese children.

Background: Static footprints have been widely used clinically. However, since this measure provides only indirect information about the medial longitudinal arch height, it is not clear if it can be indicative of dynamic foot function especially in obese children. This study aimed to verify whether static footprints can predict dynamic plantar pressures in obese children. Materials and Methods: Twenty children aged 9 to 11 years, divided into obese and non obese, voluntarily participated in this study. Static footprints and dynamic plantar pressures were analyzed by using a pedograph and the Pedar system (Novel GMbH, Munich, GER), respectively. Results: In general, correlations between static and dynamic measures were observed to be significant for the non obese children, while no significant correlations were found for the obese ones. Conclusion: Since obesity may affect the relationship between static and dynamic measures, footprints should be used with caution when inferring the characteristics of obese childrens feet under dynamic conditions. Clinical Relevance: Footprints and pedobarography should not be used at this time for clinical decision making regarding the feet of obese children.

Envelhecimento, atividade física, massa corporal e arco plantar longitudinal influenciam no equilíbrio funcional de idosos?

Este estudo visou buscar relacoes entre caracteristicas antropometricas e de equilibrio funcional em uma amostra de 45 idosos fisicamente ativos, relacionando algumas variaveis selecionadas entre si - IMC, faixa etaria, tempo de pratica de atividade fisica, indice do arco longitudinal medial, alcance funcional e escore do teste de Tinetti. Estas relacoes foram investigadas com o intuito de verificar se as variaveis antropometricas, idade e pratica de atividade fisica tem influencia no equilibrio funcional de idosos. O arco longitudinal foi mensurado por meio da impressao plantar e entao classificado de acordo com o Indice do Arco de CAVANAGH E RODGERS (1987). O Indice do Arco apresentou significantes mudancas de acordo com o IMC, tendo uma maior incidencia de pes planos com o IMC ≥ 25 kg/m² (p = 0,0173). O tempo de pratica da atividade fisica ou a idade dos sujeitos nao influenciaram de maneira significativa nas variaveis de equilibrio. A faixa etaria tambem nao influenciou no tipo de pe. O equilibrio funcional de idosos fisicamente ativos nao sofreu influencia do tempo de pratica de atividade fisica, IMC e tipo de arco longitudinal plantar.

Alteração do arco longitudinal medial na neuropatia periférica diabética

OBJECTIVE: To describe and compare foot anthropometry in healthy and diabetic subjects using Medial Longitudinal Arch (MLA) classificatory indexes: Arch Index (AI), Chippaux-Smirak Index (CSI) and  Angle (Â), as well as to compare the classification of these methods in each group. MATERIALS AND METHODS: Control Group (CG) composed by 21 healthy subjects and Diabetic Group (DG), with 46 diabetic neuropathy subjects. The indexes were calculated from footprints. RESULTS: A larger proportion of flat feet was seen in DG for the three indexes (AI: 32,2%, CSI: 59,7%, A: 17,5%), while highly arched feet acted oppositely. The groups were statistically different for the proportion of flat feet in AI (p=0,0080) and CSI (p=0,0000) and high feet in  (p=0,0036). There were significant differences when compared GC and GD in the three indexes: IA (p=0,0027), CSI (p=0,0064),  (p=0,0296). CONCLUSION: Data showed motor and orthopedic changes originated by peripheral neuropathy, which is responsible for foot changes, causing longitudinal arch crumbling. It was seen that A Angle strongly disagreed when compared with the arch classification made by the other two indexes and therefore, its application needs care.

Mecanismos de ativação agonista e antagonista no joelho de indivíduos com reconstrução de ligamento cruzado anterior: estudo cinético e eletromiográfico

PURPOSE: To assess and compare torque and electromyographic activity of the vastus lateralis and biceps femoris muscles upon knee extension and flexion in open kinetic chain. METHODS: Fifteen male subjects were distributed in two groups: Test Group (TG) (32.2 ± 7.1 years) composed by five subjects who had previously been submitted to anterior cruciate ligament arthroscopic reconstruction (patellar tendon); and Control Group (CG) (30.1 ± 10.7 years) composed by ten uninjured subjects. Data acquisition was performed using Cybex 6000 at 100°.s-1; 10 seconds of electromyography data were obtained using active differential electrodes (Delsys-Bagnoli 8) at a sample rate of 1000 Hz. Root Mean Square (RMS) values and temporal pattern of muscles activation based on movement phase were considered (linear envelope). RESULTS: Injured legs showed greater flexor peak torque and smaller extension peak torque; greater agonist activation and smaller antagonist activation for the biceps femoris muscle, and smaller agonist activation for the vastus lateralis muscle. Linear envelope showed that test group showed smaller vastus lateralis muscle activation comparing to control group. CONCLUSION: Despite the rehabilitation period, injured legs still showed extensor torque deficit, which may explain the remaining complains presented by anterior cruciate ligament reconstructed subjects.

Influence of ankle devices in the jump and landing biomechanical responses in basketball

FUNDAMENTOS E OBJETIVO: O segmento mais frequentemente lesado no basquetebol e o tornozelo, sendo a entorse por inversao a lesao mais comum. Para evita-la, e comum o uso de implementos. O objetivo deste estudo foi avaliar a forca reacao do solo (FRS) em jogadores de basquete durante execucao do salto em tres situacoes: uso de tenis, bandagem e tenis, e tenis e ortese tipo Aircast. METODOS: Oito atletas foram analisados durante o salto, atraves de uma plataforma de forca, nas tres situacoes citadas, para analise das componentes vertical e horizontal medio-lateral da FRS. RESULTADOS E CONCLUSAO: Nao houve diferenca estatistica significativa entre as tres situacoes na componente vertical da FRS durante o salto, embora o uso de bandagem tenda a apresentar, na impulsao, maiores valores do pico de forca vertical (3,10 ± 0,46PC; 3,01 ± 0,39PC; 3,03 ± 0,41PC) e do gradiente de crescimento (GC) (12,33 ± 12,21PC; 8,16 ± 3,89PC; 8,46 ± 3,85PC), e durante a aterrissagem, menores valores de pico de forca vertical (5,18 ± 1,35PC; 5,56 ± 1,31PC; 5,49 ± 1,44PC) e do GC (88,83 ± 33,85PC; 95,63 ± 42,64PC; 94,53 ± 31,69PC). Durante a impulsao, a forca medial do salto com Aircast foi significativamente menor que com tenis (p = 0,0249) e apresentou valor semelhante ao do uso da bandagem, enquanto a forca lateral foi significativamente maior com a bandagem do que com tenis (p = 0,0485) e tendeu a ser maior do que o Aircast. Na aterrissagem o componente medio-lateral da FRS ficou inalterado nas tres situacoes. Concluiu-se que a bandagem potencializou a forca direcionada ao salto vertical durante a impulsao, porem nao estabilizou tanto quanto o Aircast os movimentos de inversao e eversao do pe. Durante a aterrissagem, os implementos nao foram efetivos para reduzir a forca medio-lateral, mas com a bandagem, houve um tempo maior para absorcao do impacto.Bases and objective: The segment most frequently injured in basketball is the ankle, being the inversion sprain the most common lesion. In order to avoid it, ankle devices are frequently used. The objective of this study was to evaluate the ground reaction force (GRF) in basketball players during jump performance in three situations: use of basketball sport shoes, sport shoes with bracing and sport shoes with Aircast-type orthosis. Methods: Eight athletes were analyzed during jump through a force platform in the three situations mentioned for the analysis of the medial-lateral vertical and horizontal components of the ground reaction force. Results and conclusion: No significant statistical differences between the three situations were verified in the vertical ground reaction force during jump, although the use of bracing trends to present, during impulsion, higher peak values of the vertical force (3.10 ± 0.46PC; 3.01 ± 0.39PC; 3.03 ± 0.41PC) and the growth gradient (GC) (12.33 ± 12.21PC; 8.16 ± 3.89PC; 8.46 ± 3.85PC), and during landing, lower peak values of the vertical force (5.18 ± 1.35PC; 5.56 ± 1.31PC; 5.49 ± 1.44PC) and the GC (88.83 ± 33.85PC; 95.63 ± 42.64PC; 94.53 ± 31.69PC). During impulsion, the jump medial force with Aircast was significantly lower than with sport shoes (p = 0.0249) and presented values similar to values obtained with the use of bracing, while the lateral force was significantly higher with bracing than with the use of the sport shoes (p = 0.0485) and trended to be higher than with the use of the Aircast. In the landing, the medial-lateral component of the ground reaction force remained unchanged in the three situations. One concludes that the use of bracing has potentialized the force towards the vertical jump during impulsion, however, it did not stabilize the foot inversion and eversion movements as much as the Aircast. During landing, the devices were not effective to reduce the medial-lateral force, however, with the use of the bracing, a longer time for the impact absorption was verified.

Influência de implementos para o tornozelo nas respostas biomecânicas do salto e aterrissagem no basquete

FUNDAMENTOS E OBJETIVO: O segmento mais frequentemente lesado no basquetebol e o tornozelo, sendo a entorse por inversao a lesao mais comum. Para evita-la, e comum o uso de implementos. O objetivo deste estudo foi avaliar a forca reacao do solo (FRS) em jogadores de basquete durante execucao do salto em tres situacoes: uso de tenis, bandagem e tenis, e tenis e ortese tipo Aircast. METODOS: Oito atletas foram analisados durante o salto, atraves de uma plataforma de forca, nas tres situacoes citadas, para analise das componentes vertical e horizontal medio-lateral da FRS. RESULTADOS E CONCLUSAO: Nao houve diferenca estatistica significativa entre as tres situacoes na componente vertical da FRS durante o salto, embora o uso de bandagem tenda a apresentar, na impulsao, maiores valores do pico de forca vertical (3,10 ± 0,46PC; 3,01 ± 0,39PC; 3,03 ± 0,41PC) e do gradiente de crescimento (GC) (12,33 ± 12,21PC; 8,16 ± 3,89PC; 8,46 ± 3,85PC), e durante a aterrissagem, menores valores de pico de forca vertical (5,18 ± 1,35PC; 5,56 ± 1,31PC; 5,49 ± 1,44PC) e do GC (88,83 ± 33,85PC; 95,63 ± 42,64PC; 94,53 ± 31,69PC). Durante a impulsao, a forca medial do salto com Aircast foi significativamente menor que com tenis (p = 0,0249) e apresentou valor semelhante ao do uso da bandagem, enquanto a forca lateral foi significativamente maior com a bandagem do que com tenis (p = 0,0485) e tendeu a ser maior do que o Aircast. Na aterrissagem o componente medio-lateral da FRS ficou inalterado nas tres situacoes. Concluiu-se que a bandagem potencializou a forca direcionada ao salto vertical durante a impulsao, porem nao estabilizou tanto quanto o Aircast os movimentos de inversao e eversao do pe. Durante a aterrissagem, os implementos nao foram efetivos para reduzir a forca medio-lateral, mas com a bandagem, houve um tempo maior para absorcao do impacto.Bases and objective: The segment most frequently injured in basketball is the ankle, being the inversion sprain the most common lesion. In order to avoid it, ankle devices are frequently used. The objective of this study was to evaluate the ground reaction force (GRF) in basketball players during jump performance in three situations: use of basketball sport shoes, sport shoes with bracing and sport shoes with Aircast-type orthosis. Methods: Eight athletes were analyzed during jump through a force platform in the three situations mentioned for the analysis of the medial-lateral vertical and horizontal components of the ground reaction force. Results and conclusion: No significant statistical differences between the three situations were verified in the vertical ground reaction force during jump, although the use of bracing trends to present, during impulsion, higher peak values of the vertical force (3.10 ± 0.46PC; 3.01 ± 0.39PC; 3.03 ± 0.41PC) and the growth gradient (GC) (12.33 ± 12.21PC; 8.16 ± 3.89PC; 8.46 ± 3.85PC), and during landing, lower peak values of the vertical force (5.18 ± 1.35PC; 5.56 ± 1.31PC; 5.49 ± 1.44PC) and the GC (88.83 ± 33.85PC; 95.63 ± 42.64PC; 94.53 ± 31.69PC). During impulsion, the jump medial force with Aircast was significantly lower than with sport shoes (p = 0.0249) and presented values similar to values obtained with the use of bracing, while the lateral force was significantly higher with bracing than with the use of the sport shoes (p = 0.0485) and trended to be higher than with the use of the Aircast. In the landing, the medial-lateral component of the ground reaction force remained unchanged in the three situations. One concludes that the use of bracing has potentialized the force towards the vertical jump during impulsion, however, it did not stabilize the foot inversion and eversion movements as much as the Aircast. During landing, the devices were not effective to reduce the medial-lateral force, however, with the use of the bracing, a longer time for the impact absorption was verified.

Influencia de los implementos para el tobillo en las respuestas biomecanicas del salto y el aterrizaje en el basquetbol

FUNDAMENTOS E OBJETIVO: O segmento mais frequentemente lesado no basquetebol e o tornozelo, sendo a entorse por inversao a lesao mais comum. Para evita-la, e comum o uso de implementos. O objetivo deste estudo foi avaliar a forca reacao do solo (FRS) em jogadores de basquete durante execucao do salto em tres situacoes: uso de tenis, bandagem e tenis, e tenis e ortese tipo Aircast. METODOS: Oito atletas foram analisados durante o salto, atraves de uma plataforma de forca, nas tres situacoes citadas, para analise das componentes vertical e horizontal medio-lateral da FRS. RESULTADOS E CONCLUSAO: Nao houve diferenca estatistica significativa entre as tres situacoes na componente vertical da FRS durante o salto, embora o uso de bandagem tenda a apresentar, na impulsao, maiores valores do pico de forca vertical (3,10 ± 0,46PC; 3,01 ± 0,39PC; 3,03 ± 0,41PC) e do gradiente de crescimento (GC) (12,33 ± 12,21PC; 8,16 ± 3,89PC; 8,46 ± 3,85PC), e durante a aterrissagem, menores valores de pico de forca vertical (5,18 ± 1,35PC; 5,56 ± 1,31PC; 5,49 ± 1,44PC) e do GC (88,83 ± 33,85PC; 95,63 ± 42,64PC; 94,53 ± 31,69PC). Durante a impulsao, a forca medial do salto com Aircast foi significativamente menor que com tenis (p = 0,0249) e apresentou valor semelhante ao do uso da bandagem, enquanto a forca lateral foi significativamente maior com a bandagem do que com tenis (p = 0,0485) e tendeu a ser maior do que o Aircast. Na aterrissagem o componente medio-lateral da FRS ficou inalterado nas tres situacoes. Concluiu-se que a bandagem potencializou a forca direcionada ao salto vertical durante a impulsao, porem nao estabilizou tanto quanto o Aircast os movimentos de inversao e eversao do pe. Durante a aterrissagem, os implementos nao foram efetivos para reduzir a forca medio-lateral, mas com a bandagem, houve um tempo maior para absorcao do impacto.Bases and objective: The segment most frequently injured in basketball is the ankle, being the inversion sprain the most common lesion. In order to avoid it, ankle devices are frequently used. The objective of this study was to evaluate the ground reaction force (GRF) in basketball players during jump performance in three situations: use of basketball sport shoes, sport shoes with bracing and sport shoes with Aircast-type orthosis. Methods: Eight athletes were analyzed during jump through a force platform in the three situations mentioned for the analysis of the medial-lateral vertical and horizontal components of the ground reaction force. Results and conclusion: No significant statistical differences between the three situations were verified in the vertical ground reaction force during jump, although the use of bracing trends to present, during impulsion, higher peak values of the vertical force (3.10 ± 0.46PC; 3.01 ± 0.39PC; 3.03 ± 0.41PC) and the growth gradient (GC) (12.33 ± 12.21PC; 8.16 ± 3.89PC; 8.46 ± 3.85PC), and during landing, lower peak values of the vertical force (5.18 ± 1.35PC; 5.56 ± 1.31PC; 5.49 ± 1.44PC) and the GC (88.83 ± 33.85PC; 95.63 ± 42.64PC; 94.53 ± 31.69PC). During impulsion, the jump medial force with Aircast was significantly lower than with sport shoes (p = 0.0249) and presented values similar to values obtained with the use of bracing, while the lateral force was significantly higher with bracing than with the use of the sport shoes (p = 0.0485) and trended to be higher than with the use of the Aircast. In the landing, the medial-lateral component of the ground reaction force remained unchanged in the three situations. One concludes that the use of bracing has potentialized the force towards the vertical jump during impulsion, however, it did not stabilize the foot inversion and eversion movements as much as the Aircast. During landing, the devices were not effective to reduce the medial-lateral force, however, with the use of the bracing, a longer time for the impact absorption was verified.