title: Effect of simulated leg length discrepancy on plantar pressure distribution in diabetic patients with neuropathic foot ulceration.
abstract: OBJECTIVE
  To study the effect of a minor degree of artificially induced leg length discrepancy (LLD) on plantar pressure distribution in diabetic patients with neuropathic foot ulceration.
  
  
  METHODS
  In-shoe plantar pressure distributions were measured on the ulcerated foot during walking using F-scan (Tekscan Inc.). To simulate minor LLD, the contralateral leg length was changed by asking patients to walk under three different conditions: wearing shoe of the same sole thickness (NLLD), walking with a bare foot (20mm long leg) and wearing a 40mm-high platform-sole shoe (20mm short leg). These three different walking conditions were compared in a randomised, single-blinded crossover design.
  
  
  RESULTS
  The study included 28 diabetic patients with neuropathic foot ulcers (53.7 ± 6.8 years; 16 males, 12 female). Notably, the peak pressure and pressure time integral (PTI) were the most affected parameters. PTI significantly increased beneath total foot, mid-foot, 2nd, 3rd, 4th and 5th metatarsal heads (MTHs), and 3rd toe, when the 20mm short leg was simulated (79.4 ± 21.1; 61.5 ± 32.3; 59.9 ± 36.5; 69 ± 42.1; 70.6 ± 42.3; 63.9 ± 33.7; 40.± 33.2 kPa·s, respectively), compared with NLLD (73.7 ± 19.9; 55.524; 51.8 ± 30.1; 58.4 ± 37.6; 60.3 ± 39.5; 57.2 ± 32.3; 36.9 ± 33.3 kPa·s, respectively).
  
  
  CONCLUSIONS
  The short leg of diabetic patients with neuropathic foot ulcers will be subjected to greater pressure load, primarily beneath the total foot, mid-foot and 2nd, 3rd, 4th and 5th metatarsal heads. As such, care should be taken to avoid minor LLD, as it could inadvertently develop on using offloading devices.
  
  
  BACKGROUND
  The authors have nothing to declare.
authors: Diabetes and Endocrinology Unit, Internal Medicine Department, Mansoura University, Egypt. drmamdouh@mans.edu.eg
authors: M R El-
authors: MR
authors: Nahas
authors: H M
authors: HM
authors: Gawish
authors: M M
authors: MM
authors: Tarshoby
authors: O I
authors: OI
authors: State
authors: A
authors: A
authors: Aboelyazid
mesh_terms: D000328:Adult; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology; D017719:Diabetic Foot / Q000503:physiopathology*; D005260:Female; D005528:Foot / Q000503:physiopathology*; D006801:Humans; D007870:Leg Length Inequality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011312:Pressure; D016037:Single-Blind Method