Search PubMed⌕ Search

Biomedical subjects

M J Mueller

Publications and source records attributed to M J Mueller.

68 records · Page 4Linked to original sources
PubMed1990

Relationship of foot deformity to ulcer location in patients with diabetes mellitus.

The purpose of this study was to determine whether a relationship existed between type of foot deformity and the location of ulcers in patients with diabetes and insensitive feet. Forty-two ulcerated feet were examined in 40 patients. All patients had severely decreased or absent sensation. Foot deformities were classified according to operational definitions as 1) Charcot's foot, 2) a compensated forefoot varus, or 3) an uncompensated forefoot varus or forefoot valgus. The plantar surface of the midfoot and forefoot was divided into three regions. Six of the 7 patients with a Charcot's foot showed ulceration at the midfoot. Nine of 18 patients with a compensated forefoot varus showed ulceration at the second, third, or fourth metatarsal head. Fifteen of 17 patients with an uncompensated forefoot varus or forefoot valgus showed ulceration at the first or fifth metatarsal. A significant relationship was found between foot deformity and location of ulcer. These results support the hypotheses 1) that insensitivity, coupled with increased, repetitive pressure, is a primary cause of plantar ulcers and 2) that certain foot types are associated with characteristic patterns of pressure distribution and callus formation.

Diabetic Neuropathies↗
PubMed1989

Reliability of a diabetic foot evaluation.

The purpose of this study was to establish the interrater and intrarater reliability of various ankle and foot measures common to a diabetic evaluation. Bilateral biomechanical, sensory, and wound-size measurements were obtained in 31 subjects with diabetes mellitus. Twenty-five subjects were retested by the initial examiner to determine intratester reliability, and all subjects were retested by another examiner to determine intertester reliability. Both examiners participated in an extensive training period prior to the initiation of this study to minimize variability between and within measurers. Intraclass correlation coefficients for interrater and intrarater measurements ranged from .58 to .89 and from .74 to .99, respectively. The results of this study indicate that ankle and foot measurements common to a diabetic evaluation can be taken reliably between testers. We believe extensive examiner training in these clinically relevant measures can improve reliability between testers.

Adult↗
PubMed1989

Insensitivity, limited joint mobility, and plantar ulcers in patients with diabetes mellitus.

The purpose of this study was to determine whether differences in sensation, ankle dorsiflexion (DF), and subtalar joint (STJ) motion exist between 1) diabetic patients with a history of plantar ulcer (DMW Group), 2) diabetic patients without a history of plantar ulcer (DMWO Group), and 3) a nondiabetic control group (NDC Group). There were 23, 23, and 24 subjects in the respective groups. The mean age for each group was 58, 63, and 60 years, respectively. The mean DF for each group was 2, 5, and 7 degrees, respectively, and the mean STJ motion was 26, 31, and 35 degrees, respectively. Mode values for sensation with Semmes-Weinstein monofilaments were 6.10, 5.07, and 4.17. The results indicate the DMW Group had significantly less sensation, DF, and STJ motion than the NDC Group (p less than .05). In the DWM Group, the ulceration was seen more often on the side with least motion. Limited DF and STJ motion may restrict the foot's ability to absorb shock and transverse rotation, contributing to the pathogenesis of plantar ulceration in the insensitive foot. Although these results demonstrate an association, not a causative relationship, we believe diabetic patients should be screened routinely for insensitivity and limited joint mobility at the feet and appropriate preventive measures should be taken.

Adolescent↗
PubMed1989

Total contact casting in treatment of diabetic plantar ulcers. Controlled clinical trial.

This study compared the treatment of total contact casting (TCC) with traditional dressing treatment (TDT) in the management of diabetic plantar ulcers. Forty patients with diabetes mellitus and a plantar ulcer but with no gross infection, osteomyelitis, or gangrene were randomly assigned to the TCC group (n = 21) or TDT group (n = 19). Age, sex, ratio of insulin-dependent diabetes mellitus to non-insulin-dependent diabetes mellitus, duration of diabetes mellitus, vascular status, size and duration of ulcer, and sensation were not significantly different between groups (P greater than .05). In the experimental group, TCC was applied on the initial visit, and subjects were instructed to limit ambulation to approximately 33% of their usual activity. Subjects in the control group were prescribed dressing changes and accommodative footwear and were instructed to avoid bearing weight on the involved extremity. Ulcers were considered healed if they showed complete skin closure with no drainage. Ulcers were considered not healed if they showed no decrease in size by 6 wk or if infection developed that required hospitalization. In the TCC group, 19 of 21 ulcers healed in 42 +/- 29 days; in the TDT group, 6 of 19 ulcers healed in 65 +/- 29 days. Significantly more ulcers healed (chi 2 = 12.4, P less than .05) and fewer infections developed (chi 2 = 4.1, P less than .05) in the TCC group. We conclude TCC is a successful method of treating diabetic plantar ulcers but requires careful application, close follow-up, and patient compliance with scheduled appointments to minimize complications.

Casts, Surgical↗
PubMed1988

Biomechanical treatment approach to diabetic plantar ulcers. A case report.

The purpose of this case report is to describe a physical therapy approach designed to reduce the mechanical pressure at the site of a diabetic plantar ulcer. The patient was a 69-year-old man with diabetes mellitus for 24 years, insensitive feet, and a right plantar ulcer at the first metatarsal head for 21 months. He had a fixed equinus and rear-foot varus deformity, which seemed to place increased pressure on his forefoot. The patient was treated with total contact casting and showed progressive healing until he refused additional casting. One week later, the ulcer was considerably larger. He consented to resume casting, and the ulcer was completely healed in 85 days from the initial treatment. We provided the patient with extra-depth shoes with rigid rocker-bottom soles and a polyethylene-lined ankle-foot orthosis. The ulcer remained healed at one-week and six-month follow-up visits. The primary cause of diabetic plantar ulcers is often excessive pressure on an insensitive foot, and physical therapists should utilize biomechanical principles to reduce these excessive plantar pressures.

Aged↗
PubMed1987

Diabetic plantar ulcers treated by total contact casting. A clinical report.

The purpose of this clinical report is to describe the healing times of plantar ulcers treated by total contact casting (TCC) in nondiabetic and diabetic patients with and without evidence of severe peripheral vascular disease. Thirty patients with 33 chronic plantar ulcers were treated by applying total contact walking casts. Results demonstrate that 27 of 33 ulcers (81.8%) healed in an average time of 43.6 days. Healing times of patients with severe peripheral vascular disease secondary to diabetes mellitus are similar to those of patients without evidence of vascular disease. These results indicate that TCC is an effective and rapid treatment for chronic plantar ulcers in patients with or without vascular compromise secondary to diabetes mellitus. In addition, the results suggest that pressure reduction on the insensitive foot should be considered in treatment.

Casts, Surgical↗
PubMed1987

Molded double-rocker plaster shoe for healing a diabetic plantar ulcer. A case report.

The purpose of this case report is to document the successful healing of a chronic neuropathic plantar ulcer with the molded double-rocker plaster shoe (MDRPS) in a lower extremity that also had stasis changes and poor blood flow. The patient was a 67-year-old woman with insulin-dependent diabetes mellitus, insensitive feet, a right ankle-arm index of 0.48, and an ulcer beneath the right cuneonavicular joint measuring 0.94 cm2 in area and 2 mm deep. Reported onset of the ulcer was 10 months before referral for physical therapy. The MDRPS was chosen as an alternative treatment to conventional below-knee total contact casting (TCC) because of the stasis changes and fragile skin in the patient's lower extremities. The ulcer healed in 39 days after initiating treatment with the MDRPS. We consider the MDRPS the preferred treatment with those patients with neuropathic plantar ulcers who cannot tolerate the below-knee TCC.

Aged↗
PubMed1987

Physical therapy director as professional value setter. A special communication.

The purpose of this special communication is to emphasize the importance of balancing the physical therapy director's dual roles as fiscal manager and professional value setter. We will discuss the need for balancing these roles and our perception that professional values are underemphasized in many hospital-based physical therapy departments. The physical therapy director's professional values of commitment to high standards of patient care, professional growth, and self-discipline are presented, in addition to specific methods of conveying these values to others. These specific methods include providing a clear focus for the department, being active in patient care, and providing specific mechanisms to allow professional growth of staff members in a directed, but flexible, environment. Our contention is that these dual roles are required to maximize fiscal productivity and professional growth of the staff.

Financial Management↗
PubMed1986

Stroke hemiplegia and subsequent lower extremity amputation: which side is at risk?

The purpose of this study was to see 1) if there is a relationship between side of hemiparesis and subsequent lower extremity amputation and 2) if time from onset of cerebrovascular accident (CVA) to onset of amputation is less in patients with diabetes mellitus than in those without that disease. Twenty-two subjects with a mean age of 63.9 +/- 11.4 years met the criterion of having a CVA followed by a lower extremity amputation. Date and side of hemiparesis and amputation were noted and a relationship was determined using the two-tailed chi-square test. Twenty-one of 22 subjects had the amputation on the same side as their hemiparesis which represents a significant relationship (chi 2 = 18.16, p less than 0.001). Mean time from CVA to amputation was 32.5 +/- 26.12 mo for diabetics and 55.0 +/- 33.1 mo for nondiabetics which also represents a significant difference (t = 1.74, p less than 0.05). It is concluded there is a strong relationship between side of hemiparesis and subsequent lower extremity amputation with the amputation occurring most often on the hemiparetic side and earlier in patients with diabetes mellitus. The causal relationship between side of CVA and subsequent same sided amputation may be due to altered autonomic nervous system control, altered sensation with increased incidence of local unobserved trauma or decreased/altered muscle fiber use on the affected side. Implications for clinical rehabilitation include education for skin protection and attempting to increase muscle fiber activity.

Aged↗
PubMed1985

Selective criteria for successful long-term prosthetic use.

The purpose of this study was to identify criteria contributing to successful long-term prosthetic use in patients with an amputation secondary to vascular disease. All elderly patients with a unilateral below-knee amputation or an above-knee amputation, secondary to vascular disease, seen in our clinic between 1977 and 1982 were included in this telephone survey. Of those contacted, 37 of 38 below-knee amputees (BKAs) and 7 of 18 above-knee amputees (AKAs) still wore their prostheses at least part of every day (success). We used a two-tailed chi-square to compare the success of the BKAs with the success of the AKAs. The BKAs were successful more often (X2 = 24.81, df = 1, p less than .001). All AKAs also were characterized according to age, time from prescription, obesity, ambulatory status, strength, range of motion, sex, general compliance, and medical problems after prosthetic prescription. Of these criteria, only compliance and medical problems after prescription showed a significant difference between successful and nonsuccessful long-term AKA prosthetic users (X2 = 5.76, df = 1, p less than .05 for each criterion). As the demands of quality assurance and diagnostic related groupings increase, these results can assist the physical therapy clinician in setting realistic goals for the geriatric amputee and help predict if the patient will be a successful prosthetic user.

Aged↗
PubMed1982

Comparison of removable rigid dressings and elastic bandages in preprosthetic management of patients with below-knee amputations.

The purpose of this study was to determine if the removable rigid dressing is more effective in preprosthetic management than the conventional support dressing with elastic bandages. Residual limb circumference, independent application of the dressing, tendency of the dressing to remain secure, development of pressure areas, and presence of pain were evaluated in two groups of below-knee amputees. Subjects were randomly assigned to use either removable rigid dressings or conventional elastic bandages. Residual limb circumference was measured three times a week, and the other variables were measured weekly. The results indicated that the removable rigid dressing is more effective in preprosthetic management than the elastic bandage.

Aged↗
PubMedDate not supplied

Assessment of the diabetic foot using spiral computed tomography imaging and plantar pressure measurements: a technical report.

Persons with diabetes mellitus (DM) and peripheral neuropathy are at high risk for skin breakdown due to unnoticed excessive pressures to the plantar foot during walking. We developed methods that combined spiral x-ray computed tomography (SXCT) imaging and plantar pressure analysis to quantify internal foot structure and external pressure during plantar loading. Methods were tested using a subject with DM who had a plantar ulcer, and a healthy control. SXCT measurements were within 2 mm of truth and SXCT plantar recordings were within 6.5% of walking trials. Hammer toe deformity (second toe), severe atrophy of the intrinsic muscles and less contact area during plantar loading, and a peak plantar pressure three times greater at the site of the ulcer were measured in the diabetic foot as compared with the healthy control. This preliminary investigation suggests that these methods are accurate for structural and pressure measurements of diabetic and healthy feet.

Adult↗
PubMedDate not supplied

Thin on the details.

Explore the source record for details and available documents.

Ethics, Medical↗