找到正确的平衡：鞋垫设计会改变糖尿病和神经病变患者的静态平衡。

Getting the right balance: insole design alters the static balance of people with diabetes and neuropathy.

作者信息

Paton Joanne, Glasser Sam, Collings Richard, Marsden Jon

机构信息

School of Health Professions, Peninsula Allied Health Centre, Plymouth University, Marjon Campus, Derrifod Road, Plymouth, PL6 8BH UK.

Podiatry Service Torbay and South Devon Health and Care NHS Trust, Castle Circus Health Centre, Abbey Road, Torquay, TQ2 5YH UK.

出版信息

J Foot Ankle Res. 2016 Oct 5;9:40. doi: 10.1186/s13047-016-0172-3. eCollection 2016.

DOI:10.1186/s13047-016-0172-3

PMID:27752287

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5053070/

Abstract

BACKGROUND

Over 1 in 3 older people with diabetes sustain a fall each year. Postural instability has been identified as independent risk factor for falls within people with Diabetic Peripheral Neuropathy (DPN). People with DPN, at increased risk of falls, are routinely required to wear offloading insoles, yet the impact of these insoles on postural stability and postural control is unknown. The aim of this study was to evaluate the effect of a standard offloading insole and its constituent parts on the balance in people with DPN.

METHODS

A random sample of 50 patients with DPN were observed standing for 3 × 30 s, and stepping in response to a light, under five conditions presented in a random order; as defined by a computer program; 1) no insole, 2) standard diabetic: a standard offloading insole made from EVA/poron®, and three other insoles with one design component systematically altered 3) flat: diabetic offloading insole with arch fill removed, 4) low resilient memory: diabetic offloading insole with the cover substituted with low resilience memory V9, 5) textured: diabetic offloading insole with a textured PVC surface added (Algeos Ltd). After each condition participants self-rated perceived steadiness.

RESULTS

Insole design effected static balance and balance perception, but not stepping reaction time in people with DPN. The diabetic and memory shaped insoles (with arch fill) significantly increased centre of pressure velocity (14 %, = 0.006), (13 %, = 0.001), and path length (14 %, = 0.006), (13 %, = 001), when compared to the no insole condition. The textured shaped and flat soft insole had no effect on static balance when compared to the no insole condition ( > 0.05).

CONCLUSION

Insoles have an effect on static balance but not stepping reaction time. This effect is independent of neuropathy severity. The addition of a textured cover seems to counter the negative effect of an arch fill, even in participants with severe sensation loss. Static balance is unaffected by material softness or resilience. Current best practice of providing offloading insoles, with arch fill, to increase contact area and reduce peak pressure could be making people more unstable. Whilst flat, soft insoles maybe the preferable design option for those with poor balance. There is a need to develop an offloading insole that can reduce diabetic foot ulcer risk, without compromising balance.

摘要

背景

超过三分之一的老年糖尿病患者每年都会跌倒。姿势不稳已被确定为糖尿病周围神经病变（DPN）患者跌倒的独立危险因素。DPN患者跌倒风险增加，通常需要穿戴减压鞋垫，然而这些鞋垫对姿势稳定性和姿势控制的影响尚不清楚。本研究的目的是评估标准减压鞋垫及其组成部分对DPN患者平衡能力的影响。

方法

随机抽取50例DPN患者，按照计算机程序定义的随机顺序，在五种条件下观察他们站立3×30秒以及对光线做出反应时的迈步情况；1）不穿鞋垫，2）标准糖尿病鞋垫：由EVA/泡棉制成的标准减压鞋垫，以及另外三种分别系统改变了一个设计组件的鞋垫3）扁平型：去除足弓填充物的糖尿病减压鞋垫，4）低弹性记忆型：用低弹性记忆材料V9替换覆盖层的糖尿病减压鞋垫，5）纹理型：添加了纹理PVC表面的糖尿病减压鞋垫（Algeos有限公司）。在每种条件之后，参与者对自己感觉到的稳定性进行自我评分。

结果

鞋垫设计对DPN患者的静态平衡和平衡感知有影响，但对迈步反应时间没有影响。与不穿鞋垫的情况相比，糖尿病鞋垫和记忆形状鞋垫（有足弓填充物）显著增加了压力中心速度（分别为14%，P = 0.006），（13%，P = 0.001），以及路径长度（分别为14%，P = 0.006），（13%，P = 0.001）。与不穿鞋垫的情况相比，纹理形状鞋垫和扁平软鞋垫对静态平衡没有影响（P > 0.05）。

结论

鞋垫对静态平衡有影响，但对迈步反应时间没有影响。这种影响与神经病变严重程度无关。添加纹理覆盖层似乎可以抵消足弓填充物的负面影响，即使是在感觉严重丧失的参与者中也是如此。静态平衡不受材料柔软度或弹性的影响。目前提供有足弓填充物的减压鞋垫以增加接触面积并降低峰值压力的最佳做法可能会使人们更加不稳定。对于平衡能力差的人来说，扁平、柔软的鞋垫可能是更可取的设计选择。有必要开发一种既能降低糖尿病足溃疡风险又不影响平衡的减压鞋垫。