Diabetic peripheral neuropathy (DN) is a serious complication of diabetes mellitus (DM) that can lead to foot ulceration and eventual amputation if not treated properly. Therefore, detecting DN early is important. This study presents an approach for diagnosing various stages of the progression of DM in lower extremities using machine learning to classify individuals with prediabetes (PD; n = 19), diabetes without (D; n = 62), and diabetes with peripheral neuropathy (DN; n = 29) based on dynamic pressure distribution collected using pressure-measuring insoles. Dynamic plantar pressure measurements were recorded bilaterally (60 Hz) for several steps during the support phase of walking while participants walked at self-selected speeds over a straight path. Pressure data were grouped and divided into three plantar regions: rearfoot, midfoot, and forefoot. For each region, peak plantar pressure, peak pressure gradient, and pressure–time integral were calculated. A variety of supervised machine learning algorithms were used to assess the performance of models trained using different combinations of pressure and non-pressure features to predict diagnoses. The effects of choosing various subsets of these features on the model’s accuracy were also considered. The best performing models produced accuracies between 94–100%, showing the proposed approach can be used to augment current diagnostic methods.
Background: Foot ulcers are a serious complication associated with diabetes peripheral neuropathy (DPN). Diabetes foot complications associated with increased ulcer risk include: 1) decreases in plantar soft-tissue thickness, 2) increases in plantar tissue stiffness, and 3) increases in forefoot (FF) to rearfoot (RF) loading. Aim: The purpose of this study was to determine whether patients with DPN demonstrate higher forefoot to rearfoot pressures during barefoot walking compared to diabetes patients without peripheral neuropathy (DWPN) and prediabetes patients without peripheral neuropathy (PWPN). Methods: Eight PWPN, twenty-six DWPN and fourteen DPN patients participated in the study. Barefoot walking trials were performed while wearing Medilogic® pressure-measuring insoles. Peak plantar pressure (PPP) and peak pressure gradient (PPG) were measured on the right foot for the FF and RF regions. FF to RF PPP and PPG ratios were then calculated and normalized to body mass. Walking velocity was used as a co-variate for ANCOVAs. A priori statistical significance was set at α=0.05. Results: No significant interactions were observed for Group*Region for PPP (F(2, 89)=1.454, p=0.239) and PPG (F(2, 89)=0.579, p=0.563). Main effects of region revealed significantly higher FF to RF loading in both PPP (F(1, 89)=6.67, p=0.011) and PPG (F(1, 89)=4.02, p=0.048) measures driven by DWPN and DPN patients. No significant differences were observed between groups for FF to RF PPP (F(2, 44)=2.624, p=0.084) or PPG (F(2, 44)=1.331, p=0.275) ratios. Conclusion: Our findings suggest DWPN and DPN patients demonstrate a pattern of loading related to elevated foot ulcer risk. However, no significant difference was observed between groups for FF to RF PPP and PPG ratios. Inclusion of a more robust sample size will allow better testing of our hypothesis. Disclosure K. Izuora: None. M. Trabia: None. J. DeBerardinis: None. D.E. Lidstone: None. M. Varre: None. A.L. Trotter: None. J.S. Dufek: None.
The distal radioulnar joint (DRUJ) is a joint of the wrist which allows forearm rotation and force transmission in the upper limb while preserving stability independent of flexion and extension of the forearm and wrist. The DRUJ is a frequently injured joint in the body. Conditions affecting the joint could be positive ulnar variance (Ulnar Impaction Syndrome) or negative ulnar variance (ulnar impingement), which may be congenital or may result from a poorly reduced distal radius fracture or both bone forearm fracture. The DRUJ is also adversely affected by other injuries near the joint. In fact, a significant correlation has been found between negative ulnar variance and scapholunate dissociation [1, 2, 3]. While this could be a predisposing factor, the associate also leads to the question of whether or not scapholunate dissociation may cause changes in the radioulnar joint mechanics. Altered joint mechanics are highly associated with onset of secondary osteoarthritis. An understanding of in vivo distal radioulnar joint contact mechanics in the normal and pathological wrist could help physicians make better clinical recommendations and improve treatment for the primary injury and avoid DRUJ pathology. Successful treatment may possibly reduce risk of or prevent the onset of osteoarthritis.
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