Motawea Mohamad, El-Nahas Mamdouh, Armstrong David G
Faculty of Medicine, Mansoura University, Egypt.
Faculty of Medicine, Port-Said University, Egypt.
Foot (Edinb). 2019 Jun;39:15-21. doi: 10.1016/j.foot.2019.01.008. Epub 2019 Jan 17.
The total contact cast has been recognized as the "gold standard" for treatment of Charcot neuro-osteoarthropathy (CN). However, removable cast walkers (RCWs) became an alternative option especially after resolution of the acute stage. RCWs with an elevated sole construction often induce leg length discrepancy (LLD) that could significantly affects plantar pressure (PP) distribution in diabetic patients with neuropathy.
To study the additional effect of walking speed on PP abnormalities induced by LLD.
The study included 16 patients with diabetes (59±8.8years; 8 men and 8 women), with unilateral CN offloaded by RCW. In-shoe PP distribution was measured using F-scan (Tekscan Inc.), whilst patients walked at their normal speed (53±4 steps/min), versus short slow steps (24±3/min) under the two walking conditions: (1) neglected LLD, and (2) corrected LLD.
The greatest reduction in PP was seen during reduction of walking speed, with corrected LLD, followed by corrected LLD with normal walking speed, followed by neglected LLD with slowing of walking speed. The highest PP was found when the patient remain on their normal walking speed and LLD was neglected.
The contralateral foot of CN offloaded with RCW, is subjected to high pressure loads beneath the hallux, 1st, 2nd, 3rd, and 5th metatarsal heads. As such, care should be taken not only to avoid minor LLD, but to also advise the patient to practice short slow steps while walking, so that pressure overload on contralateral limb and its possible contribution to the development of bilateral Charcot, could be minimized.
全接触石膏已被公认为治疗夏科特神经骨关节病（CN）的“金标准”。然而，可拆卸石膏步行器（RCW）成为了一种替代选择，尤其是在急性期过后。具有增高鞋底结构的RCW常常会导致腿长差异（LLD），这可能会显著影响患有神经病变的糖尿病患者的足底压力（PP）分布。
研究步行速度对由LLD引起的PP异常的额外影响。
该研究纳入了16例糖尿病患者（年龄59±8.8岁；8名男性和8名女性），他们因单侧CN使用RCW减轻负荷。在两种步行条件下，使用F-scan（Tekscan公司）测量鞋内PP分布，同时患者以正常速度（53±4步/分钟）行走，与短慢步（24±3/分钟）行走进行对比：（1）忽略LLD，以及（2）纠正LLD。
在纠正LLD的情况下，步行速度降低时PP下降幅度最大，其次是正常步行速度下纠正LLD，然后是步行速度减慢时忽略LLD。当患者保持正常步行速度且忽略LLD时，PP最高。
使用RCW减轻负荷的CN对侧足部，在拇趾、第1、2、3和第5跖骨头下方承受高压负荷。因此，不仅应注意避免轻微的LLD，还应建议患者在行走时练习短慢步，以便将对侧肢体的压力过载及其对双侧夏科特病发展的可能影响降至最低。
