Table 4 Baseline data: biomechanical assessment
Biomechanical assessments | Equipment | Procedure | Diagnosis/study definition |
|---|---|---|---|
Foot deformity | The Manchester Scale [57]. | • The presence of hammer/claw toes, hallux abducto valgus, bony prominences (e.g. prominent metatarsal heads), Charcot neuroarthropathy and any other foot deformities (e.g. forefoot pad atrophy) will be assessed visually [57] | Foot deformity will be recorded with the presence of ≥1 foot deformity on either foot. |
• Hallux abducto valgus will be graded in accordance with the Manchester Scale (no deformity = 1, mild deformity = 2, moderate deformity = 3, severe deformity = 4) [57, 58] | |||
• Foot deformity will be recorded as ‘present’ or ‘absent’ | |||
Range of motion (1st metatarsophalangeal joint) | Goniometer. | • Passive range of dorsiflexion at the 1st metatarsophalangeal joint will be measured using goniometry with the ‘static non-weightbearing technique 1’ described by Hopson et al. [60] | Range of motion <65° indicates limited joint mobility of the first metatarsophalangeal joint [60]. |
Plantar pressures | Tekscan Matscan® system (Tekscan Inc, South Boston, MA, USA). | • Plantar pressures will be assessed during level barefoot walking with the Tekscan Matscan® system [64, 94] | Mean peak plantar pressures will be investigated to determine whether they are predictive of foot ulceration. |
5.7 mm thick floor mat (436 × 369 mm), 2288 resistive sensors (1.4 sensors/cm2), dynamic events captured with scan rates of 440 Hz. | • The two-step gait initiation protocol will be used, with the technique as described by Zammit et al. [64], except that both feet will be assessed | ||
FootMat™ 7.0 software (Tekscan Inc, South Boston, MA, USA). | • The mat will be calibrated for each patient using that patient’s own weight before each testing session | ||
• Peak plantar pressure will be measured at seven regions of the foot, including the heel, midfoot, first metatarsophalangeal joint, second metatarsophalangeal joint, 3–5 metatarsophalangeal joints, hallux and lesser toes [64] | |||
• The mean peak plantar pressure values of the three trials of each foot will be used for final data analysis [64, 95] |