Search

Prashanth Vas,1– 3 Nachiappan Chockalingam2 1Department of Diabetes and Diabetic Foot, King’s College Hospital NHS Foundation Trust, London, UK; 2Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke on Trent, UK; 3Department of Diabetes and Endocrinology, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UKCorrespondence: Prashanth Vas, Consultant in Diabetes and Diabetes Foot Medicine, Department of Diabetes and Diabetic Foot, King’s College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK, Email prashanth.vas@nhs.netAbstract: Diabetic foot disease is a complex and challenging complication of diabetes mellitus, which imposes a significant burden of disease on patients, their carers, and the wider health systems. Recurrence rates are high, and current evidence indicates a high mortality associated with it. While management algorithms have primarily focused on the physical aspects of healing, there is increasing recognition of the critical role played by psychological and biomechanical factors in the development and resolution of diabetic foot disease. Therefore, in this paper, we aim to explore how diabetic foot outcomes can be improved by addressing not only the physical but also the psychological and biomechanical aspects that are integral to the development of this condition and its optimal resolution. We explore new technologies that allow for non-invasive objective assessment of the diabetic foot at risk, and we also explore the role of understanding biomechanics, which is essential to determining risk of foot disease, but also the potential for recurrence. In addition, we discuss the evidence linking depression and cognitive impairment to diabetic foot disease and offer our insight on the research direction required before implementing novel information into front-line clinics.Keywords: diabetic foot disease, diabetic foot ulceration, biomechanics, technology, mental health and cognition

Netball is associated with a high frequency of chronic injuries. There is currently a trend towards the utilisation of minimalist footwear in netball players in lieu of traditional netball trainers. The aim of the current investigation was to examine the influence of netball-specific and minimalist footwear on the kinetics and three-dimensional (3-D) kinematics of three sport specific movements. Twelve female netballers performed three movements, run, cut and vertical jump, whilst wearing a conventional netball trainer and also a minimalist trainer. 3-D kinematics of the lower extremities were measured using an eight-camera motion analysis system alongside kinetic information which was obtained using a force platform. Kinetic/3-D kinematic differences between movements wearing different footwear were examined using paired t-tests. The kinetic analysis revealed that impact parameters were significantly greater in the minimalist footwear in comparison to the netball shoe for all three movements. In addition peak ankle eversion was shown to be significantly greater in the minimalist footwear in the running movement condition. The current study therefore suggests that the utilisation of minimalist footwear for netball training/performance may place netballers at increased risk from chronic injuries based on which a continued utilisation of netball-specific footwear may be recommended. [ABSTRACT FROM PUBLISHER]

Introduction: Individuals with movement coordination impairment (MCI) experience poor control of spine and pelvis and often develop a compensatory movement strategy. Currently there is a paucity of information on differences in segmental kinematics to help understand the adopted movement strategy and its link to commonly used clinical assessment. Objective: The current pilot study is aimed at investigating the usability of a cluster spine model to assess the clinically relevant assessment, such as one-leg standing. Methods: After necessary ethical approval, nine healthy subjects, (6 men, 3 female, 22±2.0 years, 177±7.4 cm, 69±8.7 kg) were recruited to participate in the study. The marker configuration was in accordance with Needham et al.[1]. Subjects were instructed to complete 2 variants of a one-leg standing task. In both tasks they stood relaxed on both feet and were either instructed to flex the knee (90°) without hip extension (backward lifting) or to flex both hip and knee to 90° (forward lifting), starting with the right leg and followed by the left leg. Data were collected with an 8 camera opto-electronic system (Oqus, Qualisys, Göteborg, Sweden) at 100 HZ and processed in Visual3D (C-Motion Inc., Germantown, MD, USA). Motion from the upper (T3) versus lower thoracic spine (T8), from lower thoracic versus lumbar spine (L3) and between the lumbar spine and the pelvis was analyzed for 3 valid trials per subject. Results and Discussion: In the sagittal plane the main differences are seen (Figure 1) in the lumbar spine versus the pelvis, while at the higher regions, the spine is quite stable only showing minor differences. In the frontal plane the upper thoracic region shows (Figure 1) little movement, where the lower thoracic and the lumbar regions bend to the opposite side of the lifted leg. This is more pronounced during forward lifting. Rotational movements are seen in all three regions. The direction of rotation for forward leg lifting is opposed to the one during backward lifting. This is the first study to document the spine kinematics of different regions during tasks suggested for clinical assessment, e.g. two variants of one-leg standing. Future research should aim at testing more subjects, other clinically relevant movements and comparing healthy subjects with patient populations. Conclusions and Significance: Whilst the 3D cluster spine model seems to be a useful tool to document the spine kinematics, the results highlight quantitative differences which needs be considered to develop effective clinical management. [ABSTRACT FROM AUTHOR]