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Tekscan, Tenacity, Orthotics and Temp Touch |
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Patient is 71 year old non-insulin dependent diabetic with HGA1c at 5.8-6.0 who presented with a chief complaint of a large callous
formation with bleeding into lesion without frank ulceration (Figure 1). While vibratory perception threshold was elevated at 35-50 volts, the patient did perceive significant discomfort under the fifth metatarsal head at the site of lesion. Evaluation revealed evidence of focal hyperkeratotic lesions under fifth metatarsal bilaterally with hemmorhagic callous formation left foot. Biomechanical exam significant for pronounced cavus foot with claw toe deformities and prominence under first and fifth metatarsals bilaterally. Ankle joint dorsiflexion with knee extended at 0 degrees. No evidence of calcaneal varus. |
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| Figure 1 | |
| In-Shoe pressure analysis (F-Scan® by Tekscan, Inc.) was performed with subsequent evaluations and adjustment of accommodative orthotics. | |
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(Figure 2 –peak pressure profile and Figure 4 - color legend). The optional Timing Analysis Module (TAM) was also
used for analysis that provides an array of foot strike timing parameters (Figures 3 (colored boxes), 5 and 6 (graphs)),
determines the phases of gait (percentage) and illustrates left and right asymmetries. The software also provides comparison of the subject´s gait to normal range
values (not shown).
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| Figure 2 - Figure3 - Figure 4 | Figure 5 - Figure6 |
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On initial evaluation, pictured in Figure 5 (TAM Graph - Peak Pressure vs. Stance time in %), pressures were significantly
elevated at the fifth metatarsal head (43 PSI peak pressure) with a very fast rise in peak pressures early in the gait cycle (dotted blue line in TAM graph). Addition
of accommodations for the lesion alone did not significantly reduce pressures at the site. Lateral column elevation with forefoot valgus posting significantly reduced both the vertical rise and rate in pressure as well as the peak pressure, 32 PSI (Figure 6 TAM graph, dotted blue line. Note: significantly reduced total area of graph as well.) Final accommodation with cut out for first ray, maintained reduced pressures under the fifth metatarsal head as well as allowing increased loading of first metatarsal head (Figure 7 – peak pressure profile and Figure 8 - TAM graph, dotted green line). |
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The end result clinically is patient is wearing normal shoes with orthotics, minimal discomfort after prolonged walking, normal skin temperatures, equal bilaterally, as recorded with Temp Touch (Xilas Medical) as seen in Figure 9 and virtually no bleeding into the callus. 
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| Figure 7 | Figure 8 | Figure 9 |
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