Nouman Muhammad, Leelasamran Wipawan, Chatpun Surapong
1 Institute of Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
2 Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand.
Foot Ankle Int. 2017 Aug;38(8):901-908. doi: 10.1177/1071100717704427. Epub 2017 Apr 29.
Using a total contact orthosis (TCO) is an effective method to offload in diabetic patients with foot neuropathy. However, the redistribution of peak plantar pressure is mostly observed during level walking, which may differ from other walking activities. The aim of this study was to investigate the plantar pressure from 4 regions of the foot during different walking activities (level walking, ramp ascending, ramp descending, stair ascending, and stair descending) in neuropathic diabetic patients with and without a TCO.
Sixteen neuropathic diabetic patients aged 40 to 60 years with calluses and hallux valgus were included in this study and were provided with TCOs made up of multifoam, Plastazote, and microcellular rubber. The plantar pressure and contact area with the TCO and without the TCO were recorded using the Pedar X system during different walking activities.
A significant reduction of plantar pressure during different walking activities at the toes and forefoot regions was observed while walking with the TCO compared with walking without the TCO (control condition). Plantar pressure increased at the midfoot region when walking with the TCO, and no significant difference was observed at the hindfoot region between the control and TCO conditions. Furthermore, maximum contact area was observed during level walking with the TCO compared with other walking activities.
The TCO significantly reduced and redistributed the peak plantar pressure from the sites where the ulceration rate is higher at the toes and forefoot compared with the other regions of the foot.
Therapeutic level II, lesser quality randomized controlled trial.
使用全接触矫形器（TCO）是减轻糖尿病足神经病变患者足部负荷的有效方法。然而，足底压力峰值的重新分布大多在平路行走时观察到，这可能与其他行走活动不同。本研究的目的是调查在有无TCO的糖尿病神经病变患者中，不同行走活动（平路行走、上坡、下坡、上楼梯和下楼梯）期间足部4个区域的足底压力。
本研究纳入了16名年龄在40至60岁之间、患有胼胝和拇外翻的糖尿病神经病变患者，并为他们提供了由多层泡沫、Plastazote和微孔橡胶制成的TCO。在不同行走活动期间，使用Pedar X系统记录有TCO和无TCO时的足底压力和与TCO的接触面积。
与不使用TCO行走（对照情况）相比，使用TCO行走时，在不同行走活动期间，脚趾和前足区域的足底压力显著降低。使用TCO行走时，中足区域的足底压力增加，对照和TCO情况在后足区域未观察到显著差异。此外，与其他行走活动相比，使用TCO平路行走时观察到最大接触面积。
与足部其他区域相比，TCO显著降低并重新分布了脚趾和前足溃疡率较高部位的足底压力峰值。
治疗水平II，质量较低的随机对照试验。
