Common problems encountered in rehabilitation of the diabetic patient with a transmetatarsal amputation (TMA) are skin breakdown, lack of overall stability during walking, and acceptance of the cosmetic qualities of the prescribed footwear. We have developed a biomechanical model of the residuum, footwear, and orthotics to predict how plantar pressures and joint moments can be influenced to provide overall stability and skin protection. The overall goal of this research is to determine how footwear (full shoe or short shoe), a rigid rocker bottom (RRB) sole, and ankle- foot-orthotics (AFO) affect the skin integrity, overall stability, and prescription acceptance of patients with a TMA.
The specific aims of this proposal are to determine the effect of differing shoe length, presence or absence of RRB sole, and presence or absence of AFO on; l) Peak plantar pressures on the residuum, 2) Functional mobility, 3) Ankle plantar flexion moments and overall support moment measured during walking, 4) Patient satisfaction with cosmetic and functional qualities of the footwear. 41 subjects will be tested while wearing each of 6 different footwear conditions. Peak plantar pressures will be measured with an in-shoe pressure monitoring system during walking. Functional mobility will be measured using the physical performance test and the functional reach. Ankle plantar flexor moments and overall support moments will be measured using the link-segment model. Patient satisfaction with cosmetic and functional qualities of footwear will be measured using magnitude scaling procedures. This information will enhance the ability of the rehabilitation team to prescribe optimal orthotic and prosthetic devices for each patient with TMA.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
1R01HD031486-01
Application #
2204029
Study Section
Special Emphasis Panel (SRC (12))
Project Start
1994-01-01
Project End
1995-12-31
Budget Start
1994-01-01
Budget End
1994-12-31
Support Year
1
Fiscal Year
1994
Total Cost
Indirect Cost
Name
Washington University
Department
Miscellaneous
Type
Schools of Medicine
DUNS #
062761671
City
Saint Louis
State
MO
Country
United States
Zip Code
63130
Kelly, V E; Mueller, M J; Sinacore, D R (2000) Timing of peak plantar pressure during the stance phase of walking. A study of patients with diabetes mellitus and transmetatarsal amputation. J Am Podiatr Med Assoc 90:18-23
Mueller, M J; Salsich, G B; Strube, M J (1997) Functional limitations in patients with diabetes and transmetatarsal amputations. Phys Ther 77:937-43
Salsich, G B; Mueller, M J (1997) Relationships between measures of function, strength and walking speed in patients with diabetes and transmetatarsal amputation. Clin Rehabil 11:60-7
Mueller, M J; Strube, M J; Allen, B T (1997) Therapeutic footwear can reduce plantar pressures in patients with diabetes and transmetatarsal amputation. Diabetes Care 20:637-41
Mueller, M J; Strube, M J (1997) Therapeutic footwear: enhanced function in people with diabetes and transmetatarsal amputation. Arch Phys Med Rehabil 78:952-6
Mueller, M J (1996) Identifying patients with diabetes mellitus who are at risk for lower-extremity complications: use of Semmes-Weinstein monofilaments. Phys Ther 76:68-71
Mueller, M J; Allen, B T; Sinacore, D R (1995) Incidence of skin breakdown and higher amputation after transmetatarsal amputation: implications for rehabilitation. Arch Phys Med Rehabil 76:50-4
Mueller, M J (1995) Use of an in-shoe pressure measurement system in the management of patients with neuropathic ulcers or metatarsalgia. J Orthop Sports Phys Ther 21:328-36
Mueller, M J; Sinacore, D R; Hoogstrate, S et al. (1994) Hip and ankle walking strategies: effect on peak plantar pressures and implications for neuropathic ulceration. Arch Phys Med Rehabil 75:1196-200
Mueller, M J; Sinacore, D R (1994) Rehabilitation factors following transmetatarsal amputation. Phys Ther 74:1027-33