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Logo for the Journal of Rehab R&D
Volume 35 Number 3, July 1998
Pages 289 — 293

Adaptive gait responses to plantar heel pain

Anthony D. Levins, MD; Harry B. Skinner, MD, PhD; Vince J. Caiozzo, PhD

Department of Orthopaedic Surgery, College of Medicine, UCI Medical Center, Orange, CA 92868; Neuromuscular Research Lab, Department of Orthopaedics, College of Medicine, University of California, Irvine, Irvine, CA 92717

Abstract— Neuropathic foot ulcers in people with diabetes result from repetitive stress aggravated by a lack of protective sensation. Protective sensation causes individuals without this impairment to produce alterations in their gait in response to painful stimuli. This study evaluates the adaptive gait responses to pain in individuals with sensate feet. The gaits of 18 such control subjects were studied with a foot switch gait analyzer without painful stimuli. Each then had his or her gait analyzed with three successively larger painful stimuli (2, 3.3, and 4.6 mm beads) placed below the heel. This study showed that subjects compensated for the painful stimuli by reducing the single limb support duration of the affected side at bead sizes of 3.3 and 4.6 mm and by reducing the unaffected side's swing phase and single limb support as a percentage of the gait cycle at the 4.6-mm bead size only. Gait adaptations to painful stimuli may indicate another possible avenue, in addition to pressure redistribution, in the assessment of programs aimed at prevention and treatment of diabetic foot ulcers.

Key words: diabetes, insensate foot, gait, plantar ulcer.

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