Podiatry /Foot care

Transcutaneous oxygen pressure monitoring (tcpO2) is a non-invasive monitoring of the oxygen tension in the skin. The monitoring is done by placing a Clark-type electrode on the skin so that it heats up the skin and provides tcpO2 values.
tcpO2 is a direct indication of the microvascular function. As opposed to pressure and volume assessments, tcpO2 maps the actual oxygen supply available for the skin tissue cells. tcpO2 also responds to macrocirculatory events, e.g. change in blood pressure and prevocational maneuvers.
tcpO2 can be used in a number of clinical situations.

Using advanced technology Neurolite delivers safe and effective infrared and visible red light. When delivered at a heat specific wavelength and frequency produced by this revolutionary unit, this spectrum of light produces exceptional results. Neurolite improves circulation in the extremities for a longer period of time, and produces other positive physiological changes, so patients experience increases sensation and decreased pain. Coupled with standard physical therapy treatment, Neurolite can improve the outcomes and quality of life for patients who suffer from the ill effects of this devastating disease.

Assessment of peripheral vascular flow, which can be asymptomatically decreased in diabetics.
Calculation of Ankle-Branchial index (ABI) will also be done.
This instrument provide information about blood velocity, blood pressure and vascular images.

Toe blood flow will be analysed with this equipment and also toe blood pressure will be calculated, which Photo plethysmography (PPG) permits three types of analysis.

The diagnosis of neuropathy is an important consideration in determining if a foot is particularily vulnerable to painless injury, leading to chronic and spreading ulcer. This has terminal consequences and could lead to high level amputations.
Conventional assessment of neuropathy with cotton wool, vibrating tuning fork, pinprickle and hot and cold sensation give qualitative diagnosis. It is necessary to decide quantitatively how deficient the protecting sensations have become to help decide the incremental risks the foot is at with diminishing sensations and increasing threshold.
The vibrometer Vibration perception test (VPT) helps us, if used properly and with due precautions, to establish this threshold in the form of vibration perception threshold. This is done by applying a vibrator that gives minute last normally detectable vibration, in the foot. The failure to detect the same can be quantitatively to decide the incremental risks.

The loss of nerve fibers in diabetic neuropathy is neither uniform nor simultaneously. The damage to small thinly myelinated and unmyelinated nerve fibers is usually the beginning. This results in diminishing thermal and pain sensation. Hot perception test/Cold perception test (HPT/CPT) helps in detecting diabetic polyneuropathy at an early stage.

The pressure picture of the neuropathic diabetic patient can be influenced by foot deformities and incorrect foot function. In any case, the specific foot regions with higher pressures indicate greater risk for tissue breakdown. Pedography may aid early detection of deformed feet and malfunction. In addition to the standard therapy for diabetic patients, an altered load on the foot with localized high pressures may require immediate foot treatment with appropriate footwear and pressure relieving orthotics. Under no circumstances should these individuals walk barefoot because plantar pressures will increase dramatically and the foot is left unprotected. Shoes and orthotics should be fabricated by a trained professional. The 1:1 hardcopy of the pedography platform measurement provides a baseline for the construction of the shoe insert. The patient can then be measured inside the modified shoe for quantification of the load.In-shoe pressure distribution measurement systems were designed for that purpose.

The in-shoe dynamic pressure measuring system with diabetes database medical.

The pedar system is an accurate and reliable pressure distribution measuring system for monitoring local loads between the foot and the shoe. The pedar system connects to highly conforming, elastic sensor insoles that cover the whole plantar surface of the foot or sensor pads for the dorsal, medial or lateral areas of the foot.
With the pedar system the patient can move freely, untethered from a computer in a natural environment under real life conditions Applications of pedar systems.

shoe research and design

aid in orthotic design

rehabilitation assessment

kinetic analysis of free gait

long term load monitoring

sport biomechanics

biofeedback

Diabetic Autonomic Neuropathy (DAN) often goes completely unrecognized by patient and physician alike because of its insidious onset and protean multiple organ involvement.
The CANS tests are two independent clinical tests (or studies) designed to determine the ability of both branches of the autonomic nervous system (ANS) to respond to and relax from a challenge. The two branches that make up the ANS are the sympathetic and parasympathetic (SNS and PSNS, respectively). The challenges are:

Interest in, and measurement of the velocity of arterial wave propagation as an index of vascular stiffness and vascular health dates back to the early part of the last century. Many methodologies; both invasive and non-invasive have been applied to the assessment of arterial elasticity in vivo. The assessment of cardiovascular risk is one of the most important tasks. The predictive value of pulse wave velocity (PWV) is becoming increasingly recognized and it is one of the classical indices of arterial stiffness (AS). Several arterial assessments improve risk stratification. Three of the most cost-effective assessment parameters are pulse pressure, arterial stiffness and ankle brachial index. Arterial stiffness can be directly measured by non-invasive techniques like computerized oscilometry, tonometry and ultrasonography. The pulse wave velocity calculated from pulse wave recording by other methods like Doppler or tonometry is tedious, time-consuming and above all their reproducibility depends on the operator skills. It requires intensive resource involvement. For epidemiological studies these methods are not suitable. This new automatic device for measurement of pulse wave velocity can be used in such studies.