Open Access
Subscription Access
Open Access
Subscription Access
Rehabilitation of a Diabetic Amputee:Sequelae, Impact and Effect on the Precious Limb
Subscribe/Renew Journal
Background: In a patient who has undergone a major amputation of one lower limb, the role and function of the precious limb is of paramount importance. We assume that once the patient has been rehabilitated with a prosthesis, the static plantar pressure distribution is equal over both the amputated limb and the precious limb. There is not much published literature that actually compares the distribution of the static plantar pressure over the precious limb available in India. This study aimed at studying the characteristics of static plantar pressure distribution after a major amputation in the precious foot of diabetic patients with and without prosthesis once they have been rehabilitated.
Objectives:
1) To compare the relationship between static plantar pressure distribution in the precious limb with and without the prosthesis in diabetic patients who have undergone a below knee amputation and have been rehabilitated.
2) To identify areas of high pressure over the precious limb and suggest appropriate modifications in the prosthetic footwear so as to reduce the static plantar pressure in those high-pressure regions.
Results: The static plantar pressure distribution was found to be significantly higher without the advocated prosthetic device on the amputated limb over the 1st, 2nd, 3rd, 4th, and 5th metatarsal. . The ratio of the forefoot versus the hind foot pressures with and without a prosthesis was also noted to be significant (p = 0.002).
Conclusions: This variation in the pressure distribution over the precious foot disproved our hypothesis that there is an equal spatial redistribution in static plantar peak pressures in the precious limb following rehabilitation with a prosthetic device in a diabetic patient who has undergone a below knee amputation and that a prosthesis alone is not adequate to protect the precious limb.
Keywords
- Incidence of Diabetes and Pre-diabetes in a Selected Urban South Indian Population (Cups 19) [Internet]. [cited 2018 Jul 25]. Available from: http://www.japi.org/march2008/O-152.htm
- Deepa M, Pradeepa R, Rema M, Mohan A, Deepa R, Shanthirani S, et al. The Chennai Urban Rural Epidemiology Study (CURES)--study design and methodology (urban component) (CURES-I). J Assoc Physicians India. 2003 Sep;51:863–70.
- Most RS, Sinnock P. The epidemiology of lower extremity amputations in diabetic individuals. Diabetes Care. 1983 Feb;6(1):87–91.
- Reiber GE. Diabetic Foot Care: Financial Implications and Practice Guidelines. Diabetes Care. 1992 Mar 1;15(Supplement 1):29–31.
- Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet Lond Engl. 1998 Sep 12;352(9131):837–53.
- Shaffer S, Harrison A, Brown K, Brennan K. Reliability and Validity of Semmes-Weinstein Monofilament Testing in Older CommunityDwelling Adults. J Geriatr Phys Ther. 2005 Dec;28(3):112.
- Deshpande AD, Harris-Hayes M, Schootman M. Epidemiology of Diabetes and Diabetes-Related Complications. Phys Ther. 2008 Nov;88(11):1254– 64.
- Risk factors for diabetic peripheral sensory neuropathy. Results of the Seattle Prospective Diabetic Foot Study. - PubMed - NCBI [Internet]. [cited 2018 Aug 20]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/9203456
- Boulton AJM, Vinik AI, Arezzo JC, Bril V, Feldman EL, Freeman R, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005 Apr;28(4):956–62.
- Gonzalez ER, Oley MA. The management of lowerextremity diabetic ulcers. Manag Care Interface. 2000 Nov;13(11):80–7.
- Sugarman JR, Reiber GE, Baumgardner G, Prela CM, Lowery J. Use of the therapeutic footwear benefit among diabetic medicare beneficiaries in three states, 1995. Diabetes Care. 1998 May;21(5):777–81.
- Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care. 1990 May;13(5):513–21.
- Uccioli L, Faglia E, Monticone G, Favales F, Durola L, Aldeghi A, et al. Manufactured shoes in the prevention of diabetic foot ulcers. Diabetes Care. 1995 Oct;18(10):1376–8.
- Ledoux WR, Shofer JB, Cowley MS, Ahroni JH, Cohen V, Boyko EJ. Diabetic foot ulcer incidence in relation to plantar pressure magnitude and measurement location,,. J Diabetes Complications. 2013;27(6):621–6.
- Caselli A, Pham H, Giurini JM, Armstrong DG, Veves A. The Forefoot-to-Rearfoot Plantar Pressure Ratio Is Increased in Severe Diabetic Neuropathy and Can Predict Foot Ulceration. Diabetes Care. 2002 Jun 1;25(6):1066–71.
- Rai D, Aggarwal L, Bahadur R. Plantar pressure changes in normal and pathological foot during bipedal standing. Indian J Orthop. 2006;40(2):119.
- Fawzy OA, Arafa AI, El Wakeel MA, Abdul Kareem SH. Plantar Pressure as a Risk Assessment Tool for Diabetic Foot Ulceration in Egyptian Patients with Diabetes. Clin Med Insights Endocrinol Diabetes. 2014 Dec 2;7:31–9.
- Lavery LA, Armstrong DG, Boulton AJM, Diabetex Research Group. Ankle equinus deformity and its relationship to high plantar pressure in a large population with diabetes mellitus. J Am Podiatr Med Assoc. 2002 Oct;92(9):479–82.
- Pham H, Armstrong DG, Harvey C, Harkless LB, Giurini JM, Veves A. Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. Diabetes Care. 2000 May;23(5):606–11.
- Yavuz M, Erdemir A, Botek G, Hirschman GB, Bardsley L, Davis BL. Peak plantar pressure and shear locations: relevance to diabetic patients. Diabetes Care. 2007 Oct;30(10):2643–5.
Abstract Views: 681
PDF Views: 0