Pressure distribution under the contralateral limb in Charcot arthropathy with different walking speeds

Mohamad Motawea, Mamdouh El-Nahas, David G Armstrong

Research output: Contribution to journalArticle

Abstract

Background: 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. Aim: To study the additional effect of walking speed on PP abnormalities induced by LLD. Method: The study included 16 patients with diabetes (59 ± 8.8 years; 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)15-21
Number of pages7
JournalFoot
Volume39
DOIs
StatePublished - Jun 1 2019
Externally publishedYes

Fingerprint

Joint Diseases
Leg
Extremities
Pressure
Walkers
Walking
Hallux
Walking Speed
Metatarsal Bones
Shoes
Foot

Keywords

  • Charcot
  • Contralateral foot
  • Gait speed
  • Plantar pressure
  • Walking speed

ASJC Scopus subject areas

  • Podiatry
  • Orthopedics and Sports Medicine

Cite this

Pressure distribution under the contralateral limb in Charcot arthropathy with different walking speeds. / Motawea, Mohamad; El-Nahas, Mamdouh; Armstrong, David G.

In: Foot, Vol. 39, 01.06.2019, p. 15-21.

Research output: Contribution to journalArticle

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