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.
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