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Immediate Effects of Acute Postural Correction on Plantar Pressures and Gait Characteristics in an Individual with Diabetic Peripheral Neuropathy: A Case Report

Andrea Franz, Greg Rickert and Mansoo Ko

Purpose: The purpose of this case report is to assess the immediate effects of acute postural changes on plantar pressure distribution and gait characteristics during comfortable walking speed in an individual with diabetic peripheral neuropathy.

Case description/intervention: Subject is a 71 year old Caucasian male with a BMI of 31.3 and a medical diagnosis of Type II Diabetes given 8 years ago. The patient exhibits mild peripheral neuropathy as scored by the Michigan Neuropathy Screening Instrument (MNSI; 7/23) as well as callous formation over the 2nd and 3rd metatarsal heads. The patient performed 3 separate walking conditions at a comfortable walking speed. The 3 conditions were: (1) Normal walking (NW), (2) Forward bending walking (FBW), and (3) Upright walking (UW). Measurements were recorded and averaged from these 3 conditions. NW condition was used as a control for comparing gait characteristics and plantar pressure parameters with the other gait conditions.

Results: UW may be the most mechanically efficient condition for distributing plantar pressure with increased gait speed (1.441 m/s), largest contact surface area of the foot, and increased hip range of motion; however, for this individual the increased plantar pressure in the forefoot (FF) area may contribute to the risk of ulceration. The FBW condition showed the limited medial to lateral excursion of the center of forceand lowest pressure in the FF area; therefore, FBW may be the most beneficial for this patient in decreasing the risk of ulceration in the area of greatest concern.

Conclusion: Variations in gait characteristics during UW and FBW indicate that alterations in posture may serve as another method to reduce the risk of plantar ulcer formation; however, further research is needed to examine the long term effects of such an intervention.