Hip and ankle walking strategies: Effect on peak plantar pressures and implications for neuropathic ulceration

• Published in: Archives of physical medicine and rehabilitation Vol. 75; no. 11; pp. 1196 - 1200
• Main Authors: Mueller, Michael J., Sinacore, David R., Hoogstrate, Sara, Daly, Lise
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 01.11.1994
• Subjects: Adult; Aged; Ankle Joint - physiopathology; Biological and medical sciences; Diabetic Foot - physiopathology; Diabetic Foot - rehabilitation; Endocrine glands; Female; Foot - physiopathology; Foot Ulcer - physiopathology; Foot Ulcer - rehabilitation; Gait - physiology; Hip Joint - physiopathology; Humans; Male; Medical sciences; Middle Aged; Pressure; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Range of Motion, Articular; Walking - physiology; Endocrinopathy; Skin disease; Sole of the foot; Sore; Lower limb; Peripheral neuropathy; Prevention; Disease of the foot; Kinematics; Complication; Peripheral nerve disease; Human; Nervous system diseases; Diabetes mellitus; Support(construction); Physical rehabilitation; Hip; Foot; Biomechanics; Ankle; Locomotion; Walking; Treatment; Rehabilitation; Pressure measurement
• ISSN: 0003-9993
• DOI: 10.1016/0003-9993(94)90004-3

Treatment of neuropathic plantar ulcers often is directed at reducing excessive, repeated peak plantar pressures (PPP). The purposes of this study were to determine whether instructing a subject to walk using a hip strategy would reduce forefoot PPP and change the kinematics of walking during a single session of testing. Thirteen subjects, 7 with peripheral neuropathy and a history of a recent plantar ulcer, and 6 controls participated. PPPs were measured with an in-shoe pressure monitoring system. Kinematics were measured with a computer-assisted motion analysis system. After data were collected as subjects walked using their normal walking pattern, subjects were instructed to walk using the hip strategy by decreasing their push-off, pulling their leg forward from their hips, decreasing step length, and maintaining their normal walking velocity. Compared with using the normal (ankle) strategy, using the hip strategy showed a significant 27% decrease in forefoot PPP and a 24% increase in heel PPP. Kinematic changes were decreased plantar flexion angular velocity, hip extension range-of motion (ROM), and step length, increased dorsiflexion ROM, and hip flexion ROM, but no change in walking velocity. These findings indicate that a change in walking pattern can result in lower forefoot PPP during a single session. Assuming patients can maintain the alterations in their walking pattern, these adaptations may help to heal plantar ulcers in some patients with peripheral neuropathy.