The motivation of this article is to diagnose local insulin related dystrophies and their dynamic with an ultrasound (US) subcutis (SC) map, by comparison with clinical data. To improve insulin injection technique by identifying the real cutis/subcutis thickness (CST).We have enrolled 53 type 1 diabetic children (33 boys and 20 girls, aged between 2 and 15 years), with diabetes duration between 1 and 13 years. The clinical examination puts into evidence three types of local dystrophies: hypertrophy, nodular lumps and atrophy. The US technique has confirmed clinical findings and moreover has diagnosed their location, size, depth and echostructure. While mapping dystrophies we simultaneously have taken into consideration the CST of the nearest non-injured areas in order to be compared. The screening was also made again after a 6 months period.The US interrogation revealed a larger diversity of dystrophic phenomenon than the clinic one: SC diffuse hypertrophy, dominant nodular aspects, atrophies, associated muscular dystrophy or multiple layer dystrophies. After a 6 months period of not injecting, the clinical examination diagnosed the remission of some hypertrophies and nodular aspects. Also as a confirmation, the US technique identified more residual images and certified which types of echostructures had recovered or not.Local insulin dystrophy would be diagnosed, typified and mapped effectively by US unlike clinical severity. Reinjecting would be safer done after the US re-examination has certified the level of recovery. Being a comparative term as well as a condition for improving the injection technique the mapping of normal CST might be also part of a continuous specific education of insulin treated patients.
Objective: Potential pain relief from foot pain can come from a shoe insert foot orthotic. This study assessed foot pressure distribution and balance in off the shelf foot orthotics versus a custom made foot orthotic compared to no orthotic.
Methods:The subjects (8) were both men and women. The average age was 25.1 ± 2.8 years, the average weight was 68.8 ± 13.7 kg, and BMI 24.5 ± 6.4. Each patient was fit for both off the shelf and custom shoe insert foot orthotics and needed orthotics to reduce pain. Once fit, they were evaluated by standing and then walking 12 meters on a level surface while being monitored by a Tactilus Pressure Mapping system. Balance was also evaluated with a pressure platform during 8 balance tests.
Results:With the subjects accomplishing quiet standing, the average pressure and peak pressure was shifted from the hind foot and forefoot to the mid foot when wearing foot inserts (p<0.05). During walking, the average pressure was significantly shifted from the forefoot and hind foot to the mid foot in both orthotic groups with the greatest reduction in forefoot pressure in the off the shelf orthotic group (p<0.05). This is especially seen when measuring the peak pressures on the foot, where, during standing the peak pressures on the fore foot were 20% higher with no orthotic than seen for the 2 orthotics tested here. Balance was best in the custom orthotic group while both orthotic groups had better balance than the no orthotic studies for the most difficult balance tests. Conclusion: At least in this small group of subjects, off the shelf foot orthotics help gait or balance but custom orthotics are better.
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