Drerup B, Hafkemeyer U, Möller M, Wetz H H
Institut für Experimentelle Biomechanik, Universität Münster, Domagkstrasse 3, 48129 Münster.
Orthopade. 2001 Mar;30(3):169-75. doi: 10.1007/s001320050591.
Lesions to the diabetic foot have various causes. However, there is broad consensus that excessive plantar pressure plays a major role in the chain of events leading to ulcerations and gangrenes. During walking, on the other hand, peak values of plantar pressure are likely to increase with velocity even in therapeutic shoes. Therefore, the question arises whether a moderate velocity should be recommended to diabetic patients to reduce the risk of foot lesions. In this study, two velocities were compared for different types of therapeutic footwear. The velocities selected were considered moderate (0.7 m/s) and normal (1.3 m/s) for diabetic patients. A specially designed mathematical algorithm (velocity normalization) provided the pressure distributions from a common set of measurements: seven trials at different velocities for each subject and each type of footwear. Ten test subjects with healthy feet were studied. The shoes were ready-made and all had a midfoot rocker. The following four conditions were tested: flexible or rigid outsole respectively in combination with a flat insole or molded foot bed respectively. Pressure distribution measurements were performed with the Pedar in-shoe system, and the Pedar software package was used for analysis. The foot was divided into six regions: first toe, second to fifth toes, metatarsal region, medial midfoot, lateral midfoot, and heel. Only peak pressures were taken into account. Gait velocity was found to have an effect on plantar pressure distribution, mainly in the toes and heel region. Peak pressure in the heels increased significantly by about 20%. In the toe region, the increase was about the same, but was not statistically significant. At a higher velocity, pressure even slightly decreased in the midfoot region. The percentage variation was similar for all four conditions. Thus, walking slowly prevented the foot from high peak pressures, and the combination of rigid outsole and molded foot bed was best suited for both slow and higher velocities.
糖尿病足病变有多种病因。然而，人们普遍认为足底压力过大在导致溃疡和坏疽的一系列事件中起主要作用。另一方面，在行走过程中，即使穿着治疗性鞋子，足底压力峰值也可能随速度增加。因此，是否应建议糖尿病患者采用适中速度以降低足部病变风险的问题随之而来。在本研究中，针对不同类型的治疗性鞋类比较了两种速度。所选择的速度对于糖尿病患者而言被认为是适中的（0.7米/秒）和正常的（1.3米/秒）。一种专门设计的数学算法（速度归一化）从一组常见测量中得出压力分布：每个受试者和每种鞋类在不同速度下进行七次试验。对十名足部健康的测试对象进行了研究。鞋子均为成品，且都有中足摇椅。测试了以下四种情况：分别将柔性或刚性外底与平底鞋垫或模压足床相结合。使用Pedar鞋内系统进行压力分布测量，并使用Pedar软件包进行分析。足部被分为六个区域：第一趾、第二至第五趾、跖骨区域、内侧中足、外侧中足和足跟。仅考虑峰值压力。发现步态速度对足底压力分布有影响，主要在脚趾和足跟区域。足跟处的峰值压力显著增加约20%。在脚趾区域，增加幅度大致相同，但无统计学意义。在较高速度下，中足区域的压力甚至略有下降。所有四种情况下的变化百分比相似。因此，慢走可防止足部承受高峰值压力，并且刚性外底和模压足床的组合最适合慢走和快走两种速度。
