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visit Prof/Dr Rothbart's patient website -
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Diabetic Study - Preventing Foot Ulcerations
Physiologically, hyperglycemia is the hallmark of diabetes mellitus. Hyperglycemia results in the glycosilation of proteins. The end-products of glycosilation accumulate in almost every tissue and organ within the body. These end products are responsible for the morbidity-associated symptoms seen in the diabetic patient.
As for the locomotor system, nerve degeneration, muscle atrophy and weakness secondary to hyperglycemia can profoundly impact and compromise the performance in gait. These altered patterns of gait, in combination with connective tissue degeneration and neurovascular microangiopathy, predispose the diabetic patient to the development of plantar ulcers. Axiomatically, diabetic ulcers are one of the most serious and difficult problems to ameliorate (Giacomozzi 2003).
Using insoles and footwear to decrease peak forces underneath the metatarsal heads was seen as a promising approach in preventing or decreasing the occurrence of plantar ulcers. Unfortunately, this approach has proven to be ineffective by many investigators (Hirzel et.al. 1986, Chantelau et.al. 1990, Edmons 1987, Kustner et.al. 1991).
The hypothesis of this study is that 'normalization' of gait biomechanics via proprioceptive stimulation automatically (1) reduces abnormal pronation, (2) reduces shearing forces underneath the metatarsal heads, and (3) increases blood flow and sensation to the plantar compartment of the foot. These assumptions are based on clinical experience and published studies that:
I Clinically demonstrate the efficacy of proprioceptive stimulation in diminishing abnormal pronation (Rothbart 2004)
II Correlate abnormal pronation to forefoot shearing (Rothbart 1988)
III Correlate abnormal pronation to mechanical entrapment of the posterior tibial artery, nerve and vein against the suscentaculum tali (Rothbart 2002) (See Photo Below)
Rothbart suggests that proprioceptive stimulation will effectively reduce the risk of plantar ulcerations in the diabetic patients. A three-year diabetic study was planned at the Istituto Superiore di Sanita (Department of Biomedical Engineering) and submitted by Drs Rothbart, Giocomozzi and Macellari (Director, Rehabilitation Technologies, ISS) for funding to the National Institute of Health in October 2004. This project was personally commended and supported by the President of ISS, Dr Enrico Garaci, in a letter sent to the National Institute of Health.
Physiologically, hyperglycemia is the hallmark of diabetes mellitus. Hyperglycemia results in the glycosilation of proteins. The end-products of glycosilation accumulate in almost every tissue and organ within the body. These end products are responsible for the morbidity-associated symptoms seen in the diabetic patient.
As for the locomotor system, nerve degeneration, muscle atrophy and weakness secondary to hyperglycemia can profoundly impact and compromise the performance in gait. These altered patterns of gait, in combination with connective tissue degeneration and neurovascular microangiopathy, predispose the diabetic patient to the development of plantar ulcers. Axiomatically, diabetic ulcers are one of the most serious and difficult problems to ameliorate (Giacomozzi 2003).
Using insoles and footwear to decrease peak forces underneath the metatarsal heads was seen as a promising approach in preventing or decreasing the occurrence of plantar ulcers. Unfortunately, this approach has proven to be ineffective by many investigators (Hirzel et.al. 1986, Chantelau et.al. 1990, Edmons 1987, Kustner et.al. 1991).
The hypothesis of this study is that 'normalization' of gait biomechanics via proprioceptive stimulation automatically (1) reduces abnormal pronation, (2) reduces shearing forces underneath the metatarsal heads, and (3) increases blood flow and sensation to the plantar compartment of the foot. These assumptions are based on clinical experience and published studies that:
I Clinically demonstrate the efficacy of proprioceptive stimulation in diminishing abnormal pronation (Rothbart 2004)
II Correlate abnormal pronation to forefoot shearing (Rothbart 1988)
III Correlate abnormal pronation to mechanical entrapment of the posterior tibial artery, nerve and vein against the suscentaculum tali (Rothbart 2002) (See Photo Below)
Rothbart suggests that proprioceptive stimulation will effectively reduce the risk of plantar ulcerations in the diabetic patients. A three-year diabetic study was planned at the Istituto Superiore di Sanita (Department of Biomedical Engineering) and submitted by Drs Rothbart, Giocomozzi and Macellari (Director, Rehabilitation Technologies, ISS) for funding to the National Institute of Health in October 2004. This project was personally commended and supported by the President of ISS, Dr Enrico Garaci, in a letter sent to the National Institute of Health.
Cited References
Chantelau E, Kushner T, Spraul M, 1990. How effective is cushioned therapeutic footwear in protecting diabetic feet. A clinical study. Diabetic Medicine 7:355-359.
Edmonds ME 1987. Experience in a multidisciplinary diabetic foot clinic. In: Connor H, Boulton JM, Ward JD (eds), The Foot in Diabetes, 1st Edition, Wiley, Chichester, pp 121-134.
Giacomozzi C 2003. Methodologies and Measurement devices for an effective functional assessment of the diabetic foot. Rapporti ISTISAN 03/31.
Hirzel C, MIllan J, Boucher P, Naudin J, Diouf B 1986. Prevention des maux perforants plantaries: essai mene par una equipe mobile. Acta Leprol, (4):79-92.
Justner E, Bedyer J, Cyrus J, Lehnert H 1991. Der diabetische Fuss: Diagnose und Therapie einschlieblich rekonstruktiver Eingriffe. Med Welt, (42):957-963.
Rothbart BA and Esterbrook L 1988. Excessive Pronation. A Major Biomechanical Determinant in the Development of Chondromalacia and Pelvic Tilts. Journal Manipulative Physiologic Therapeutics 11(5):373-379.
Rothbart BA 2002. Medial Column Foot Systems. An Innovative Tool for Improving Posture. Journal Bodywork and Movement Therapies (6)1:37-46.
Rothbart BA 2004. Una teoria sul primo metatarso supinato. Il podologo in medicina. Vol 128, pp 128-132.