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A novel shear reduction insole effect on the thermal response to walking stress, balance, and gait.

ABSTRACT: Shear stresses have been implicated in the formation of diabetes-related foot ulcers. The aim of this study was to evaluate the effect of a novel shear-reducing insole on the thermal response to walking, balance, and gait. Twenty-seven diabetes peripheral neuropathy patients were enrolled and asked to take 200 steps in both intervention and standard insoles. Thermal foot images of the feet were taken at baseline (1) following a 5-minute temperature acclimatization and (2) after walking. Testing order was randomized, and a 5-minute washout period was used between testing each insole condition. Sudomotor function was also assessed. Gait and balance were measured under single and dual task conditions using a validated body worn sensor system. The mean age was 65.1 years, height was 67.3 inches, weight was 218 pounds, and body mass index was 33.9, 48% were female, and 82% had type 2 diabetes. After walking in both insole conditions, foot temperatures increased significantly in standard insoles. The intervention insole significantly reduced forefoot and midfoot temperature increases (64.1%, P = .008; 48%, P = .046) compared to standard insoles. There were significant negative correlations with sudomotor function and baseline temperatures (r = .53-.57). The intervention demonstrated 10.4% less gait initiation double support time compared to standard insoles (P = .05). There were no differences in static balance measures. We found significantly lower forefoot and midfoot temperature increases following walking with shear-reducing insoles compared to standard insoles. We also found improvements in gait. These findings merit future study for the prevention of foot ulcer.

SUBMITTER: Wrobel JS

PROVIDER: S-EPMC4455476 | biostudies-literature | 2014 Nov

REPOSITORIES: biostudies-literature

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A novel shear reduction insole effect on the thermal response to walking stress, balance, and gait.

Wrobel James S JS Ammanath Peethambaran P Le Tima T Luring Christopher C Wensman Jeffrey J Grewal Gurtej S GS Najafi Bijan B Pop-Busui Rodica R

Journal of diabetes science and technology 20140807 6

Shear stresses have been implicated in the formation of diabetes-related foot ulcers. The aim of this study was to evaluate the effect of a novel shear-reducing insole on the thermal response to walking, balance, and gait. Twenty-seven diabetes peripheral neuropathy patients were enrolled and asked to take 200 steps in both intervention and standard insoles. Thermal foot images of the feet were taken at baseline (1) following a 5-minute temperature acclimatization and (2) after walking. Testing ...[more]

PMID: 25107709

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Project description:BackgroundThe human foot typically changes temperature between pre and post-locomotion activities. However, the mechanisms responsible for temperature changes within the foot are currently unclear. Prior studies indicate that shear forces may increase foot temperature during locomotion. Here, we examined the shear-temperature relationship using turning gait with varying radii to manipulate magnitudes of shear onto the foot.MethodsHealthy adult participants (N = 18) walked barefoot on their toes for 5 minutes at a speed of 1.0 m s-1 at three different radii (1.0, 1.5, and 2.0 m). Toe-walking was utilized so that a standard force plate could measure shear localized to the forefoot. A thermal imaging camera was used to quantify the temperature changes from pre to post toe-walking (ΔT), including the entire foot and forefoot regions on the external limb (limb farther from the center of the curved path) and internal limb.ResultsWe found that shear impulse was positively associated with ΔT within the entire foot (P < 0.001) and forefoot (P < 0.001): specifically, for every unit increase in shear, the temperature of the entire foot and forefoot increased by 0.11 and 0.17 °C, respectively. While ΔT, on average, decreased following the toe-walking trials (i.e., became colder), a significant change in ΔT was observed between radii conditions and between external versus internal limbs. In particular, ΔT was greater (i.e., less negative) when walking at smaller radii (P < 0.01) and was greater on the external limb (P < 0.01) in both the entire foot and forefoot regions, which were likely explained by greater shear forces with smaller radii (P < 0.0001) and on the external limb (P < 0.0001). Altogether, our results support the relationship between shear and foot temperature responses. These findings may motivate studying turning gait in the future to quantify the relationship between shear and foot temperature in individuals who are susceptible to abnormal thermoregulation.

Project description:Impaired mobility and falls are clinically important complications of Parkinson's disease (PD) and a major detractor from quality of life for which there are limited therapies. Pathological, neuroimaging and clinical evidence suggest that degeneration of cholinergic systems may contribute to impairments of balance and gait in PD. The proposed trial will examine the effects of augmentation of the cholinergic system on balance and gait.The study is a single-site, proof of concept, randomized, double-blind, cross-over trial in patients with PD. Each treatment period will be 6 weeks with a 6-week washout between treatments for a total of 18 weeks for each subject. Donepezil in 2.5 mg capsules or identical appearing placebo capsules will be increased from two per day (5 mg) to four capsules (10 mg) after 3 weeks, if tolerated. Subjects will have idiopathic Parkinson's disease, Hoehn and Yahr stages 2 to 4. We anticipate recruiting up to 100 subjects for screening to have 54 enrolled and 44 subjects complete both phases of treatment. Dropouts will be replaced. As this is a crossover trial, all subjects will be exposed to both donepezil and to placebo. The primary outcome measures will be the root mean square of the mediolateral sway when standing and the variability of the stride duration when walking for two minutes. Secondary outcomes will be the computerized Attention Network Test to examine three domains of attention and the Short-latency Afferent Inhibition (SAI), a physiological marker obtained with transcranial magnetic stimulation as a putative marker of cholinergic activity.The results of this study will be the most direct test of the hypothesized role of cholinergic neurotransmission in gait and balance. The study is exploratory because we do not know whether donepezil will affect gait, balance or attention, nor which measures of gait, balance or attention will be sensitive to drug manipulation. We hypothesize that change in cholinergic activity, as measured with SAI, will predict the relative effectiveness of donepezil on gait and balance. Our immediate goal is to determine the potential utility of cholinergic manipulation as a strategy for preventing or treating balance and gait dysfunction in PD. The findings of this trial are intended to lead to more sharply focused questions about the role of cholinergic neurotransmission in balance and gait and eventually to Phase II B trials to determine clinical utility of cholinergic manipulation to prevent falls and improve mobility.This trial is registered at clinical trials.gov ( NCT02206620).

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A novel shear reduction insole effect on the thermal response to walking stress, balance, and gait.

Publications

A novel shear reduction insole effect on the thermal response to walking stress, balance, and gait.

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