Document Detail

Can we predict outcome of surgical reconstruction of Charcot neuroarthropathy by dynamic plantar pressure assessment?--A proof of concept study.
MedLine Citation:
PMID:  19836956     Owner:  NLM     Status:  MEDLINE    
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.
Bijan Najafi; Ryan T Crews; David G Armstrong; Lee C Rogers; Kamiar Aminian; James Wrobel
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Gait & posture     Volume:  31     ISSN:  1879-2219     ISO Abbreviation:  Gait Posture     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-02-03     Completed Date:  2010-05-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9416830     Medline TA:  Gait Posture     Country:  England    
Other Details:
Languages:  eng     Pagination:  87-92     Citation Subset:  IM    
Copyright Information:
Copyright 2009 Elsevier B.V. All rights reserved.
Scholl's Center for Lower Extremity Ambulatory Research, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
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MeSH Terms
Analysis of Variance
Arthropathy, Neurogenic / surgery*
Foot Deformities / surgery*
Gait / physiology
Monitoring, Physiologic / methods
Predictive Value of Tests
Statistics, Nonparametric
Treatment Outcome
Walking / physiology*
Young Adult

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