Article

The joint deformity that arises as a result of Charcot neuroarthropathy, leads to
gait modification. Ulceration risk associated with the deformity is generally
assessed by measuring plantar pressure magnitude (PPM). However, as PPM is
partially dependent on gait speed and treatment interventions may impact speed,
the use of PPM to validate treatment is not ideal. This study suggests a novel
assessment protocol, which is speed independent and can objectively (1)
characterize abnormality in dynamic plantar loading in patients with foot Charcot
neuroarthropathy and (2) screen improvement in dynamic plantar loading after foot
reconstruction surgery. To examine whether the plantar pressure distribution
(PPD) measured using EMED platform, was normal, a customized normal distribution
curve was created for each trial. Then the original PPD was fitted to the
customized normal distribution curve. This technique yields a regression factor
(RF), which represents the similarity of the actual pressure distribution with a
normal distribution. RF values may range from negative 1 to positive 1 and as the
value increases positively so does the similarity between the actual and
normalized pressure distributions. We tested this novel score on the plantar
pressure pattern of healthy subjects (N=15), Charcot patients pre-operation (N=4)
and a Charcot patient post-foot reconstruction (N=1). In healthy subjects, the RF
was 0.46+/-0.1. When subjects increased their gait speed by 29%, PPM was
increased by 8% (p<10(-5)), while RF was not changed (p=0.55), suggesting that RF
value is independent of gait speed. In preoperative Charcot patients, the RF<0,
however, RF increased post-surgery (RF=0.42), indicating a transition to normal
plantar distribution after Charcot reconstruction.
CI - Copyright 2009 Elsevier B.V. All rights reserved.

Langue : ANGLAIS