To Compare the Role of Conventional Assistive Devices Versus Prosthesis in reducing Dynamic Plantar Pressures of the precious limb post trans-tibial amputation during gait in Diabetic patients: An Observational study

Jalaz Joezer Rahmi, (2019) To Compare the Role of Conventional Assistive Devices Versus Prosthesis in reducing Dynamic Plantar Pressures of the precious limb post trans-tibial amputation during gait in Diabetic patients: An Observational study. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION: Diabetes has been described as an epidemic by the World Health Organization with lower limb amputations resulting as one of its most devastating complications. After a unilateral major lower limb amputation, the likelihood of a contralateral amputation is very high according to current literature. A serious infection is often precipitated by ulcers that form due to trauma or areas of high plantar pressure. In our clinical setting, patients who have undergone a lower limb amputation may use either an orthosis (crutches or walkers) or prosthesis to ambulate. There is no published data comparing both modalities with regards to plantar pressures in the contralateral limb. The study aims at determining the plantar pressure distribution while walking with either prosthesis or orthosis and determining which is a better mode of rehabilitation in offloading the precious limb. AIMS AND OBJECTIVES: AIM OF THE STUDY: To compare the role of conventional assistive devices and prosthesis in reducing dynamic plantar pressures on precious limb, post transtibial amputation, during gait in diabetic patients. OBJECTIVES: 1. To compare plantar pressure points during gait in the precious limb while using axillary crutches or walkers and while using prosthesis. 2. To identify areas of high pressures and suggest appropriate modifications in the footwear or prosthesis so as to reduce pressure at those points and prevent ulcers and subsequent amputations. METHODS: This was designed as an observational study, approved by the institutional review Board with a financial grant for the same. A total of 51 Diabetic patients, who had undergone emergency or elective below knee amputation, and had been rehabilitated with a below knee prosthesis were recruited for the study. The precious limb was the main focus of the study and dynamic plantar pressures were measured with and without the prosthesis once the patient ambulated. The tools used to measure plantar pressures were an in-house device, in the form of pressure sensing probes fitted into an insole which could be easily inserted into the patient footwear. The device was connected to a computer which showed waveforms suggestive of the plantar pressure distribution. The following parameters were also assessed: a) Sensory testing assessment, b) Routine diabetic profile in the form of glycosylated hemoglobin, c) Height, weight and Body Mass Index. RESULTS AND CONCLUSION: The dynamic plantar pressures were lower with prosthesis as compared to without prosthesis. The mean pressure difference was found to be about 6.8 kiloPascals. (p < 0.001). The highest pressure difference amongst individual plantar points was found to be at the first metatarsal, with a mean difference of 24.3 kiloPascals. (p < 0.001) The forefoot to rear-foot ratio was also found to be significant (p < 0.001) with prosthesis (0.9) as compared to without prosthesis (0.4). Body Mass Index and glycemic control did not contribute to pressure changes during gait while using prosthesis. Hence, this proves our hypothesis, that prosthesis are more effective in reduction of plantar pressures in the precious limb in Diabetics during gait, as compared to orthotic devices like crutches or walkers. Hence, it is recommended that Diabetic amputees be encouraged to undergo pre-prosthetic training and eventually use prosthesis for ambulation. Also, even though the patient may have been rehabilitated with a prosthesis, it is imperative that regular inspection of the precious foot is done. This said, the device can be used as a standard, economic, diagnostic and therapeutic tool in detecting early pressure changes and that plantar pressure distribution become a routine part during diabetic foot assessment.

Item Type: Thesis (Masters)
Additional Information: Reg. No. 221611456
Uncontrolled Keywords: Conventional Assistive Devices, Prosthesis, Dynamic Plantar Pressures, precious limb post trans-tibial amputation, Gait, Diabetic patients.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 02 Sep 2019 06:25
Last Modified: 02 Sep 2019 06:25

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