The purpose of this clinical report is to describe the healing times of plantar ulcers treated by... more The purpose of this clinical report is to describe the healing times of plantar ulcers treated by total contact casting (TCC) in nondiabetic and diabetic patients with and without evidence of severe peripheral vascular disease. Thirty patients with 33 chronic plantar ulcers were treated by applying total contact walking casts. Results demonstrate that 27 of 33 ulcers (81.8%) healed in an average time of 43.6 days. Healing times of patients with severe peripheral vascular disease secondary to diabetes mellitus are similar to those of patients without evidence of vascular disease. These results indicate that TCC is an effective and rapid treatment for chronic plantar ulcers in patients with or without vascular compromise secondary to diabetes mellitus. In addition, the results suggest that pressure reduction on the insensitive foot should be considered in treatment.
Abstract Muscle atrophy (sarcopenia) in the elderly is associated with a reduced rate of muscle p... more Abstract Muscle atrophy (sarcopenia) in the elderly is associated with a reduced rate of muscle protein synthesis. The purpose of this study was to determine if weight-lifting exercise increases the rate of muscle protein synthesis in physically frail 76-to 92-yr-old ...
The effect of a tendo-Achilles lengthening (TAL) procedure on ankle muscle performance has not be... more The effect of a tendo-Achilles lengthening (TAL) procedure on ankle muscle performance has not been clearly established. The purpose of this study was to compare the effects of TAL and total-contact casting (TCC) with TCC alone on ankle muscle performance in subjects with diabetes mellitus (DM) and a neuropathic plantar ulcer. Subjects were randomly assigned to either a TAL group (3 female and 12 male subjects) or a TCC group (4 female and 10 male subjects). Muscle performance measurements were obtained using an isokinetic dynamometer. Concentric plantar-flexor peak torque decreased 31% after TAL but returned to the baseline level after 8 months. Dorsiflexor peak torque did not change in either group. Plantar-flexor passive torque at 0 degrees of dorsiflexion decreased after TAL but increased to 60% of the baseline level after 8 months. Maximal dorsiflexion angle increased 11 degrees after TAL and remained increased at 8 months. The TAL resulted in an increase in ankle dorsiflexion range of motion and a temporary reduction in concentric plantar-flexor peak torque and passive torque at 0 degrees of dorsiflexion. If TAL is being considered for people with DM and a neuropathic forefoot ulcer, the initial compromise in plantar-flexor muscle performance should be addressed.
Although pressure-reducing interventions have been effective in the healing of neuropathic foot u... more Although pressure-reducing interventions have been effective in the healing of neuropathic foot ulcers, these ulcers frequently recur in people with diabetes mellitus (DM). This case report illustrates how sudden changes in weight-bearing activity may have affected ulcer recurrence in a patient with DM and how the physical stress theory (PST) relates to ulcer recurrence for this patient. The patient was a 66-year-old man with a history of DM, peripheral neuropathy, and recurrent plantar ulcers. His plantar ulcer healed after total contact casting. Despite relatively low peak plantar pressure (9.3 N/cm(2)), the patient's ulcer recurred within 4 weeks of healing. Plantar pressure assessment and activity monitoring suggested that a rapid and sudden increase in weight-bearing activity (steps per day) contributed to cumulative plantar tissue stress that was 3.3 times higher on the day of ulcer recurrence than his average value. Although his cumulative plantar stress was high compared with his usual value, the cumulative value was similar to the amount of daily stress of individuals without a history of recurrent ulcers. Within the context of the PST, rapid change in activity level may have an effect on cumulative stress and the risk of ulcer recurrence.
ABSTRACT BODY: Purpose/Hypothesis : Neuropathic Charcot arthropathy (NCA) is a common precursor t... more ABSTRACT BODY: Purpose/Hypothesis : Neuropathic Charcot arthropathy (NCA) is a common precursor to foot deformity and ulceration in individuals with diabetes mellitus (DM) and peripheral neuropathy (PN). Currently no volumetric method exists to accurately quantify bone mineral density (BMD) and bone strength indices in the diabetic neuropathic foot. The purpose of this study was to compare BMD and bone strength indices in individuals with acute NCA and DM+PN controls using clinical quantitative computed tomography (QCT) scans, in order to detect bony changes related to the development and progression of NCA. We hypothesized that individuals with NCA would have decreased BMD and decreased bone strength indices in the second (Met2) and fifth (Met5) metatarsals, common sites for NCA fracture. Number of Subjects : We studied Met2 and Met5 for 20 individuals with acute unilateral NCA and 20 age, sex, and race-matched individuals with DM+PN. Materials/Methods : Feet were imaged with a cli...
Purpose/Hypothesis : The metatarsals are a frequent site of foot fracture, particularly stress fr... more Purpose/Hypothesis : The metatarsals are a frequent site of foot fracture, particularly stress fractures. Roughly 20% of athletic stress fractures occur in the metatarsals; a majority (14-18%) occur in the second (Met2) or third metatarsal (Met3). The purposes of this study were to develop image-based indices of bone quantity and quality in human metatarsals and to assess the relationships between image-based indices and ex vivo fracture strength. We hypothesized that image-based quantity and quality indices would predict human metatarsal fracture loads. Number of Subjects : We studied Met2 and Met3 from the right feet of 10 cadavers. Materials/Methods : Intact cadaver limbs were imaged with a clinical QCT scanner. A bone mineral density (BMD) calibration phantom with known densities was included with each scan to allow direct conversion from CT values to equivalent BMD (mg/cm3). All foot bones were segmented from surrounding soft tissue using ImageJ, Analyze, and custom software. B...
The purpose of this study was to determine the clinical outcomes and objective measures of functi... more The purpose of this study was to determine the clinical outcomes and objective measures of function that can be expected for patients following the Bridle procedure (modification of the posterior tibial tendon transfer) for the treatment of foot drop. Nineteen patients treated with a Bridle procedure and 10 matched controls were evaluated. The Bridle group had preoperative and 2-year postoperative radiographic foot alignment measurements and completion of the Foot and Ankle Ability Measure. At follow-up, both groups were tested for standing balance (star excursion test) and for ankle plantarflexion and dorsiflexion isokinetic strength, and the American Orthopaedic Foot & Ankle Society and Stanmore outcome measures were collected only on the Bridle patients. There was no change in radiographic foot alignment from pre- to postoperative measurement. Foot and Ankle Ability Measure subscales of activities of daily living and sport, American Orthopaedic Foot & Ankle Society, and Stanmore ...
Background: Coronary heart disease (CHD) risk factors increase with age and body mass index (BMI;... more Background: Coronary heart disease (CHD) risk factors increase with age and body mass index (BMI; in kg/m2). However, whether lifestyle intervention ameliorates metabolic CHD risk factors in obese older adults is unknown. Objective: The objective was to determine whether lifestyle inter- vention improves metabolic CHD risk factors in obese older adults. Design: A 6-mo outpatient randomized controlled trial was con-
The American journal of clinical nutrition, Jan 20, 2015
Age-associated declines in muscle mass and function are major risk factors for an impaired abilit... more Age-associated declines in muscle mass and function are major risk factors for an impaired ability to carry out activities of daily living, falls, prolonged recovery time after hospitalization, and mortality in older adults. New strategies that can slow the age-related loss of muscle mass and function are needed to help older adults maintain adequate performance status to reduce these risks and maintain independence. We evaluated the efficacy of fish oil-derived n-3 (ω-3) PUFA therapy to slow the age-associated loss of muscle mass and function. Sixty healthy 60-85-y-old men and women were randomly assigned to receive n-3 PUFA (n = 40) or corn oil (n = 20) therapy for 6 mo. Thigh muscle volume, handgrip strength, one-repetition maximum (1-RM) lower- and upper-body strength, and average power during isokinetic leg exercises were evaluated before and after treatment. Forty-four subjects completed the study [29 subjects (73%) in the n-3 PUFA group; 15 subjects (75%) in the control group...
The purpose of this clinical report is to describe the healing times of plantar ulcers treated by... more The purpose of this clinical report is to describe the healing times of plantar ulcers treated by total contact casting (TCC) in nondiabetic and diabetic patients with and without evidence of severe peripheral vascular disease. Thirty patients with 33 chronic plantar ulcers were treated by applying total contact walking casts. Results demonstrate that 27 of 33 ulcers (81.8%) healed in an average time of 43.6 days. Healing times of patients with severe peripheral vascular disease secondary to diabetes mellitus are similar to those of patients without evidence of vascular disease. These results indicate that TCC is an effective and rapid treatment for chronic plantar ulcers in patients with or without vascular compromise secondary to diabetes mellitus. In addition, the results suggest that pressure reduction on the insensitive foot should be considered in treatment.
Abstract Muscle atrophy (sarcopenia) in the elderly is associated with a reduced rate of muscle p... more Abstract Muscle atrophy (sarcopenia) in the elderly is associated with a reduced rate of muscle protein synthesis. The purpose of this study was to determine if weight-lifting exercise increases the rate of muscle protein synthesis in physically frail 76-to 92-yr-old ...
The effect of a tendo-Achilles lengthening (TAL) procedure on ankle muscle performance has not be... more The effect of a tendo-Achilles lengthening (TAL) procedure on ankle muscle performance has not been clearly established. The purpose of this study was to compare the effects of TAL and total-contact casting (TCC) with TCC alone on ankle muscle performance in subjects with diabetes mellitus (DM) and a neuropathic plantar ulcer. Subjects were randomly assigned to either a TAL group (3 female and 12 male subjects) or a TCC group (4 female and 10 male subjects). Muscle performance measurements were obtained using an isokinetic dynamometer. Concentric plantar-flexor peak torque decreased 31% after TAL but returned to the baseline level after 8 months. Dorsiflexor peak torque did not change in either group. Plantar-flexor passive torque at 0 degrees of dorsiflexion decreased after TAL but increased to 60% of the baseline level after 8 months. Maximal dorsiflexion angle increased 11 degrees after TAL and remained increased at 8 months. The TAL resulted in an increase in ankle dorsiflexion range of motion and a temporary reduction in concentric plantar-flexor peak torque and passive torque at 0 degrees of dorsiflexion. If TAL is being considered for people with DM and a neuropathic forefoot ulcer, the initial compromise in plantar-flexor muscle performance should be addressed.
Although pressure-reducing interventions have been effective in the healing of neuropathic foot u... more Although pressure-reducing interventions have been effective in the healing of neuropathic foot ulcers, these ulcers frequently recur in people with diabetes mellitus (DM). This case report illustrates how sudden changes in weight-bearing activity may have affected ulcer recurrence in a patient with DM and how the physical stress theory (PST) relates to ulcer recurrence for this patient. The patient was a 66-year-old man with a history of DM, peripheral neuropathy, and recurrent plantar ulcers. His plantar ulcer healed after total contact casting. Despite relatively low peak plantar pressure (9.3 N/cm(2)), the patient's ulcer recurred within 4 weeks of healing. Plantar pressure assessment and activity monitoring suggested that a rapid and sudden increase in weight-bearing activity (steps per day) contributed to cumulative plantar tissue stress that was 3.3 times higher on the day of ulcer recurrence than his average value. Although his cumulative plantar stress was high compared with his usual value, the cumulative value was similar to the amount of daily stress of individuals without a history of recurrent ulcers. Within the context of the PST, rapid change in activity level may have an effect on cumulative stress and the risk of ulcer recurrence.
ABSTRACT BODY: Purpose/Hypothesis : Neuropathic Charcot arthropathy (NCA) is a common precursor t... more ABSTRACT BODY: Purpose/Hypothesis : Neuropathic Charcot arthropathy (NCA) is a common precursor to foot deformity and ulceration in individuals with diabetes mellitus (DM) and peripheral neuropathy (PN). Currently no volumetric method exists to accurately quantify bone mineral density (BMD) and bone strength indices in the diabetic neuropathic foot. The purpose of this study was to compare BMD and bone strength indices in individuals with acute NCA and DM+PN controls using clinical quantitative computed tomography (QCT) scans, in order to detect bony changes related to the development and progression of NCA. We hypothesized that individuals with NCA would have decreased BMD and decreased bone strength indices in the second (Met2) and fifth (Met5) metatarsals, common sites for NCA fracture. Number of Subjects : We studied Met2 and Met5 for 20 individuals with acute unilateral NCA and 20 age, sex, and race-matched individuals with DM+PN. Materials/Methods : Feet were imaged with a cli...
Purpose/Hypothesis : The metatarsals are a frequent site of foot fracture, particularly stress fr... more Purpose/Hypothesis : The metatarsals are a frequent site of foot fracture, particularly stress fractures. Roughly 20% of athletic stress fractures occur in the metatarsals; a majority (14-18%) occur in the second (Met2) or third metatarsal (Met3). The purposes of this study were to develop image-based indices of bone quantity and quality in human metatarsals and to assess the relationships between image-based indices and ex vivo fracture strength. We hypothesized that image-based quantity and quality indices would predict human metatarsal fracture loads. Number of Subjects : We studied Met2 and Met3 from the right feet of 10 cadavers. Materials/Methods : Intact cadaver limbs were imaged with a clinical QCT scanner. A bone mineral density (BMD) calibration phantom with known densities was included with each scan to allow direct conversion from CT values to equivalent BMD (mg/cm3). All foot bones were segmented from surrounding soft tissue using ImageJ, Analyze, and custom software. B...
The purpose of this study was to determine the clinical outcomes and objective measures of functi... more The purpose of this study was to determine the clinical outcomes and objective measures of function that can be expected for patients following the Bridle procedure (modification of the posterior tibial tendon transfer) for the treatment of foot drop. Nineteen patients treated with a Bridle procedure and 10 matched controls were evaluated. The Bridle group had preoperative and 2-year postoperative radiographic foot alignment measurements and completion of the Foot and Ankle Ability Measure. At follow-up, both groups were tested for standing balance (star excursion test) and for ankle plantarflexion and dorsiflexion isokinetic strength, and the American Orthopaedic Foot & Ankle Society and Stanmore outcome measures were collected only on the Bridle patients. There was no change in radiographic foot alignment from pre- to postoperative measurement. Foot and Ankle Ability Measure subscales of activities of daily living and sport, American Orthopaedic Foot & Ankle Society, and Stanmore ...
Background: Coronary heart disease (CHD) risk factors increase with age and body mass index (BMI;... more Background: Coronary heart disease (CHD) risk factors increase with age and body mass index (BMI; in kg/m2). However, whether lifestyle intervention ameliorates metabolic CHD risk factors in obese older adults is unknown. Objective: The objective was to determine whether lifestyle inter- vention improves metabolic CHD risk factors in obese older adults. Design: A 6-mo outpatient randomized controlled trial was con-
The American journal of clinical nutrition, Jan 20, 2015
Age-associated declines in muscle mass and function are major risk factors for an impaired abilit... more Age-associated declines in muscle mass and function are major risk factors for an impaired ability to carry out activities of daily living, falls, prolonged recovery time after hospitalization, and mortality in older adults. New strategies that can slow the age-related loss of muscle mass and function are needed to help older adults maintain adequate performance status to reduce these risks and maintain independence. We evaluated the efficacy of fish oil-derived n-3 (ω-3) PUFA therapy to slow the age-associated loss of muscle mass and function. Sixty healthy 60-85-y-old men and women were randomly assigned to receive n-3 PUFA (n = 40) or corn oil (n = 20) therapy for 6 mo. Thigh muscle volume, handgrip strength, one-repetition maximum (1-RM) lower- and upper-body strength, and average power during isokinetic leg exercises were evaluated before and after treatment. Forty-four subjects completed the study [29 subjects (73%) in the n-3 PUFA group; 15 subjects (75%) in the control group...
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