Computer-Aided Gait Analysis in Patients With Diabetes

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Alex Lakner, DPM:

My name is Alex Lakner. I am a fellow in the Department of Vascular Surgery doing a fellowship in limb preservation under the direction of Ron Sherman, DPM here at Johns Hopkins Hospital in Baltimore, Maryland. The title of our study is the Advanced Computer-Aided Gait Analysis, or CAGA, with Comparison Barefoot Two Shot Intervention of a Diabetic Cohort. The preliminary results of a long-term IRB Diabetic Ulcer Reduction Study as we quote, "DURS" meaning Diabetic Ulcer Reduction Study, and this is a clinical trial.

And, basically, what we've found is that biomechanical and structural deformities create conditions that directly impact areas of identifiable risk on the plantar foot of the diabetic. And this is secondary to a multifactorial diabetic comorbidities, which include both a sensory and motor neuropathy. And as a sequela of the neuropathy and deformities, these patients are generally demonstrating an abnormal gait pattern, including a less stable gait. They have a truncated center of pressure meaning that they're less stable and they develop multiple abnormal temporal spatial parameters in the stance of gait. And these basically in turn create altered gait kinematics and increase peak plantar pressures, which basically overall impact the ability for these patients to heal.

So, what's noted is that 85% of diabetic ulcerations are preceded by other diabetic foot ulcerations, and 19% to 45% of patients with diabetes are likely affected by diabetic foot ulcerations in their lifetime. So utilizing our computer-assisted or aided gait analysis technology, the understanding of a diabetic gait and the identification of those high peak plantar pressures, which we can identify utilizing this temporal spatial sensing treadmill is possible even prior to the apparent clinical signs or symptoms, which are identified by both the patient as well as the clinician. And this computer-aided gait analysis allows on a focused evaluation of custom orthotic efficiency, its efficacy, and overall an ulcer reduction, and therefore, limb preservation.

Our biggest finding is that when we analyzed these patients and we looked at their gait analysis, we found that from their initial barefoot, which shows us the most hotspots or the most peak plantar pressures that were noted in specific hotspots, these might be out places where they had former ulcerations or potential for future ulcerations. We were able to generate a reduction of 68% of peak plantar pressure in those specific areas. Overall, between that plus elongating their gait line, it's going to disperse their forces and allow them to propulse through their gait at a more efficient speed so that they're able to stay less on those focal areas where they're generating those high peak plantar pressures. Therefore, reduction in ulcers is accomplished.

Gait analysis and shoe modification are so paramount in our field. Unfortunately, I think it's underutilized and people need to take so much time to analyze how these patients walk. And by utilizing these advancements that internally are not readily available. Hopefully, they will be available in the future because the ability to use computer gait analysis or computer-assisted gait analysis can allow these patients to obtain the best objective and quantitative measurement of these patients' gaits far beyond what the human eye can actually see. And therefore, we're able to make such a even further dramatic impact on these patients and manage their problematic areas or future possibly problematic areas even further. So I hope that people in the future clinicians are able to utilize this technology and better the care of these diabetic patients going forward.