Recently, the incidence of peripheral arterial disease (PAD) has been increasing due to aging and lifestyle changes. However, the presence of PAD is difficult to differentiate from claudication symptoms; therefore, screening tests must be performed considering the importance of early detection and prevention. In this study, we performed the ankle brachial pressure index (ABI) test periodically on 388 diabetic patients who visited the outpatient clinic of our hospital. As a result, 16 (4.1%) were diagnosed with PAD with an ABI of <0.9 and were referred to our cardiovascular department for examination. All of the patients had vascular stenosis and 15 were treated. Our results suggest that periodic ABI testing of asymptomatic diabetic patients may aid in the detection and treatment of PAD. Steady follow-up on an outpatient basis was continued for 1 of 10 patients after PAD diagnosis. This study may provide information on the status of treatment interruption in patients with PAD and the possible role of periodic ABI testing in its prevention.

View full abstract

[Background/Purpose] Accurate measurement of the ankle dorsiflexion range of motion (DFROM) is important because DFROM limitation is associated with the development of diabetic foot. This study investigated the validity of DFROM measurements using three different techniques. [Methods] Three physical therapists with different proficiency levels participated as raters. Sixteen healthy individuals were enrolled in this study. DFROM was measured by goniometry, from controlled moment using a digital inclinometer (CM), and in the weight-bearing lunge position using a digital inclinometer (Lunge). It was also measured using a three-dimensional motion analysis system. Criterion-related validity was evaluated using Pearson’s product correlation analysis. [Results] By the goniometry method, only measurements by the most experienced rater had a high validity. However, by the CM and Lunge methods, all measurements by all raters had a high validity. [Conclusion] The CM and Lunge methods can be used to accurately measure DFROM regardless of the technical proficiency of the rater. This suggests that the CM and Lunge methods are suitable for the clinical measurement of DFROM.

View full abstract

Patients with critical limb ischemia（CLI）for whom the minimally invasive technique was used for tendon Achilles lengthening（MIT-TAL）were examined. They had a limited dorsiflexion range of motion and risk of ulcer development. In total, seven patients（five males, two females）underwent MIT-TAL. Plantar forefoot ulceration, dorsiflexion range of motion, plantar pressure, ankle flexion muscle power and walking ability were measured before and after MIT-TAL. All subjects that were investigated had no plantar forefoot ulcers, and an improved dorsiflexion range of motion and plantar pressure. Ankle flexion muscle power was improved to the level before MIT-TAL. Walking ability remained unchanged. MIT-TAL is effective for patients with CLI to prevent ulcers, and improve their physical function and walking ability.

View full abstract

OASIS ^® wound matrix is a natural extracellular matrix originating from the tunica submucosa of the porcine small intestine and functions as a biological scaffold facilitating wound closure of difficult-to-heal wounds. We report four cases of difficult-to-heal wounds treated by OASIS ^®. Case 1: A 53-year-old man who works in a prolonged dependent leg position underwent stripping operations. Although careful vein stripping was performed, his wounds remained unhealed for 3-4 years. Case 2: An 85-year-old woman with previous endovascular laser treatments for venous insufficiency had a recurrent leg ulcer. In both cases, once OASIS ^® was applied, the wounds fully healed in one to three months. Case 3: A 90-year-old woman had recurrent venous leg ulcers. During OASIS ^® treatment, the wounds became infected and OASIS ^® was discontinued. Case 4: A 76-year-old man with a past medical history of vein stripping, end-stage renal failure and critical limb ischemia had non-healing foot ulcers. After revascularization, negative wound pressure treatment by OASIS ^® was applied to the foot ulcers. The wounds quickly healed. Three of our cases demonstrated the effectiveness of OASIS ^® for venous and critical limb ischemic foot ulcers.

View full abstract

［Purpose］The purpose of this study was to investigate the effects of Rocker Sole（RS）with Pivot Point（PP）on the metatarsal head（MTH）on the lower extremity joint angle during gait.［Methods］Ten healthy men participated in this study. The participants underwent three-dimensional gait analysis while walking wearing RS and postoperative shoes. The reliability of the measurements for the joint angles at heel-off（HO）and toe-off（TO）obtained wearing postoperative shoes was examined. The influence of RS with PP on the MTH was investigated by comparing the results obtained while wearing RS and postoperative shoes.［Results］No significant difference between the two conditions was noted in the ankle dorsiflexion angle at HO or TO. While wearing RS, the knee flexion angle at HO and TO significantly decreased, but the degree of change did not exceed the minimal detectable change.［Conclusion］This study suggested that RS has no effect on the lower extremity joint angle during gait in dorsiflexion-unrestricted healthy adults.

View full abstract