PubMed Health⌕ Search

Biomedical subjects

H H Wetz

Publications and source records attributed to H H Wetz.

At least 19 recordsLinked to original sources
PubMed2006

[Changes in shape and size of the foot during pregnancy].

Many women report an increase in foot size during their pregnancy. Our objective was to verify this anecdotal evidence. In an initial survey of 21 mothers in 2 Münster nursery schools we found a tendency towards an increase in foot size during pregnancy. We therefore developed a measuring system to measure changes in foot length, width, height and volume. A total of 40 women recruited from the antenatal clinic of the University Hospital of Münster and a participating practice were seen three times during their pregnancy. The results were analysed using the Wilcoxon test. We found a statistically significant increase in foot length, width and volume, whereas foot height decreased slightly. This difference was, however, not significant. Especially in diabetic women with polyneuropathy it is important to pay attention to shoe size to prevent pressure sores.

Anthropometry↗
PubMed2006

[Significance of microbial colonisation in materials for orthopaedic technology. New insights].

A great problem in the treatment of diabetes are infections of diabetic feet. A likely reservoir of microorganisms are contaminated orthopaedic materials. Insoles from 70 patients were examined for potential microbial colonisation. Commonly employed materials were contaminated in vitro under standardised conditions using known microorganisms. After treating with an alcoholic skin disinfectant, the organisms were counted semiquantitatively. In addition to pathogens, the surfaces showed mainly microorganisms present in the normal skin flora. In all materials tested, disinfection reduced the number of organisms by 4-5 log orders. It could be shown that simple disinfection (wiping) reduces the microorganisms present on orthopaedic materials to an acceptable number. Further studies are needed to determine whether this also reduces the incidence of diabetic skin and soft tissue infection.

Bacteria↗
PubMed2006

[The influence of proprioceptive insoles (Bourdiol) on the sagittal curvature and inclination of the trunk].

Proprioceptive insoles rely on the concept of Réné-Jaques Bourdiol, a French neurologist. The aim is to modulate plantar surface sensibility and to influence posture and statics of patients: it is hypothesized that the effect of modified afferent sensory input through proprioceptive stimulation of terminal muscle chains will have either a relaxing or stimulating effect on the whole body, which may be realized by affecting the posture. Small pads with a thickness of typically 1-3 mm are embedded into the insole to provide a specific stimulation. In fitting the insoles selectively to the individual patient the effect of the insoles on the trunk posture is taken as a feedback. This study investigates the influence of proprioceptive insoles on the sagittal curve in 20 selected patients. The protocol used a repeated measures research design. The measures of the sagittal curve were obtained using raster stereography. The four different conditions were: (1) barefoot, (2) convenient shoes without the insoles, (3) the same shoes with a placebo insole, and (4) the same shoes with neurological insoles. Evaluation of raster stereographs provided the kyphotic angle between T4 and T12 and lordotic angle between T12 and S1. Statistical evaluation was performed with the t-test for paired measurements. No significant differences were found in the sagittal profile. Only trunk inclination in normal posture was found to yield a significant difference (0.38 degrees) between placebo and neurological insoles. However, no clear statement on the efficiency of neurological insoles can be made.

Adaptation, Physiological↗
PubMed2006

[Anxiety and depression after loss of a lower limb].

A good number of psychosocial-, disease-, and disability-related variables influence the adaptation process after the loss of a lower limb. In this case psychological problems, as a result of a failed adaptation process, are common. Of the 75 patients examined who had an amputation of a lower extremity 27% showed increased depression and 25% increased anxiety scores; 18.3% showed higher than normal scores in both categories. Regression analysis showed that in addition to pain reception poor acceptance of the prosthesis is an important predictive factor for the development of psychological disorders and diseases like anxiety and depression. Therefore, measures for psychological diagnostics and care should be initiated soon after the amputation to prevent psychological abnormalities. Here interdisciplinary management and cooperation of the professions involved in the care of the patient are recommended.

Adolescent↗
PubMed2006

[Management of upper limb deformities. Treatment concepts through the years].

The provision of aids and prostheses for patients with upper limb deficiencies has to be based on comprehensive knowledge in the field of orthopaedic technology. Taking into account the patient's complete background, evaluation of the possible functional benefit is mandatory in order to achieve good acceptance of a prosthesis in the long term. The extent of extremity "loss" and the remaining function of the deficient limb have an impact on the success of prosthetic fitting. Furthermore, there is a trend towards myoelectric prostheses, which seem to improve prosthetic acceptance. Bilateral congenital deficiency of the upper limbs cannot be equated with amputations. Most people affected do not push for a prosthesis, but should be provided with one, if the need arises. Decades of overuse of the deficient limbs often take their toll in terms of decreasing function as degenerative changes occur. As a consequence, artificial upper limbs may be obligatory to prevent loss of independence.

Artificial Limbs↗
PubMed2005

[The influence of the C-leg knee-shin system from the Otto Bock Company in the care of above-knee amputees. A clinical-biomechanical study to define indications].

The C-Leg microprocessor-controlled knee-shin system for the above-knee amputees is introduced as a dramatic improvement over all other prosthetic knees. This is due to its combination of on-board microprocessor and the hydraulic controls acting both on the swing and stance phase. A more secure, natural and efficient gait is expected. Following the recommendations of Otto Bock the indications for the prescription of the C-leg are: Amputees with mobility level "able to walk outdoors without limitations" (AK3) and "able to walk outdoors without limitations plus engage in high performance activities" (AK4) if they face at least one extra obstacle as listed in the Otto Bock catalogue of indications. In this article it is aimed to critically review the indications for the C-leg. In particular the question is posed, whether a different or sophisticated indication of mobility levels might be suggested. Therefore this study does not concentrate on the 3C-100 C-Leg((R)) component but on the system patient + C-leg. So the testing is done by comparing the C-Leg against the regular knee, which is assumed to be an adequate choice for this patient and to which he is accustomed. So far 25 patients with activity levels AK 2 (5), AK 3 (13) and AK 4 (7) have participated in the study. 23 patients, i.e. all patients except one AK 2 and one AK 3 exhibit functional improvement at least according to one criterion. On the other side, only three patients (2 AK 4), fulfill all criteria of functional improvement, which have been defined for this test. It is concluded, that multi-handicapped patients of all activity levels generally experience substantial improvement due to this system. AK 2 patients may show significant functional improvement. As a prerequisite, however, they must not exhibit deficiencies regarding stump movement, muscular status or cognitive abilities. Active patients (AK 3 and AK 4) benefit in the majority of cases. However, some highly active patients of AK 4 complain about interferences between their intended movement and the microprocessor control of knee movements.

Adolescent↗
PubMed2004

[Radiological and clinical aspects of diabetic-neuropathic osteoarthropathy].

AIMS: The clinical and radiological observation of patients with neuroarthropathy was carried out with the aim of determining the most significant factors and risk factors involved. METHODS AND MATERIALS: From January 1998 to December 2000, 53 patients between 29 and 79 years of age were treated in the Clinic for Technical Orthopedics for diabetic-neuropathic osteoarthropathy (DNOAP) of the foot. A comparison was made between the retrospective data for conservative and surgical treatments. RESULTS: Almost 90% of the effected patients were of working age, which is an indication of the socioeconomic consequences of DNOAP. The mean age of the diabetics was 30.3 years for diabetes mellitus type 1 and 14.6 years for type 2. Overweight was a possible risk factor for the development of orthoarthropathic lesions, in particular at the rear of the foot. An additional risk factor was the presence of claw toes. Taking the radiological data into consideration, DNOAP of the foot can be seen as a dynamic illness that is not adequately dealt with in the commonly used Sanders' classification. In the case of proximal lesions, the number of additional DNOAP changes on the same foot was more than for distal lesions. A possible explanation is the microtrauma of neighbouring bones due to changes in the statics and biomechanics of the foot. Our results indicate that type 1 diabetes plays a particularly important role. Contrary to the other forms of DNOAP, Sanders type 1 is associated with atrophic-destructive changes to the bone. In our cohort, pAVK and ulcers were common with Sanders type 1 diabetes, and overweight appeared to be insignificant. CONCLUSIONS: Our results are a plea for an early, consequent and stage specific treatment of DNOAP in order to prevent the advance of bone destruction. The clinical and radiological course show that a lasting clearance of ulcers, the removal of necrosis and the repositioning of luxations by suitable stabilisation promote healing in DNOAP.

Adult↗
PubMed2004

[Reconstructive foot surgery in cases of diabetic-neuropathic osteoarthropathy].

QUESTION: Neurogenic osteoarthropathy often results in a debilitating deformity of the foot which can not be handled conservatively. Indications for surgery are recurrent ulcers, deep tissue infection and decompensated statics with progressing deformity. External fixation as a possible method of correction has to show its efficiency and methods. METHODS: Between 1997 and 2003, 65 feet which could be examined retrospectively, were operated for neuroarthropathy in 21 women and 43 men. A diabetic polyneuropathy was present in 56 patients. In 59 cases, an external fixation was used while in nine cases Steinmann pins were used. Follow-up treatment consisted of mobilisation in a ankle-foot-orthosis (AFO) for up to a year. RESULTS: For diabetics, the mean duration of illness was 24.8 years (Type 1) and 13.7 years (Type 2). All feet were Levin stage 3 or 4 and for the classification types II-V. In five cases there was only luxation, another nine had a combination of luxation and osseous changes. Surgical revision was necessary in seven cases, sometimes more than once. Additional operations as the illness progressed were necessary 13 times, in six cases due to loss of correction. The application of a prosthesis was necessary in three cases following amputations in two patients after an average of 752 days. Pin infections and disturbances in healing wound were common but could be successfully treated conservatively and were independent of previous ulceration or infection. Within the first year after operation, 13.9% of the feet developed an ulcer. All of the patients could be mobilised with the help of an orthosis (47 cases) or orthopedic shoes (15 cases) CONCLUSIONS: External fixation is a suitable and variable method for correcting malalignment of the foot in cases of neuroarthropathy. It has a low complication rate and can be used for rapidly developing as well as non-progressing osteoarthropathies. In general, a fibrous ankylosis is the result of treatment, which allows pain free mobilisation under full weight bearing. In suitable cases, with a good alignment of the foot and good patient cooperation, the use of the AFO can be changed to orthopedic shoes after about 12 months.

Aged↗
PubMed2004

[Reduction of plantar peak pressure by limiting stride length in diabetic patients].

Plantar peak pressure is a diagnostically significant parameter for the evaluation of the risk of foot ulceration in patients with diabetic neuropathy. The prophylaxis and therapy of the diabetic foot therefore is to a large extent oriented on peak pressure, and is aimed at an extensive reduction in this parameter. This is mainly accomplished with protective footwear including shoe modifications and cushioning. In comparison, other approaches affecting the loading and motion pattern of the patient are of minor importance--as for example control of gait pattern. In this study we examined shortening of stride length as a possible measure in reducing plantar peak pressure during gait. In 17 diabetic patients without acute foot ulcerations, stride length was reduced to 33% of leg length using an elastic hobble. This led to a reduction in stride length of 23%. At the same time, the walking speed was significantly reduced by 27% and the cadence by 5.7%. As a consequence, the peak pressure was reduced in nearly all regions of the foot--except the small toes. In the metatarsal region peak pressure is reduced by 14.5%. Thus, a reduction in stride length offers the possibility of reducing plantar peak pressure as a supplementary measure in addition to orthopaedic footwear. However, at present clinical feasibility has not yet been established.

Arthropathy, Neurogenic↗
PubMed2004

[Comorbidity of mental and internal medical disorders in inpatients treated at the clinic for technical orthopedics].

Due to the severity of their clinical picture and their shattered sense of physical inviolability that almost always is associated with their condition as well as their changed physical appearance, inpatients being treated at the clinic for technical orthopedics frequently exhibit comorbid mental disorders. This article examines these mental health comorbidities. The proportion of adjustment disorders in this group was shown to be noticeably higher than in a comparative group of outpatients attending a psychosomatic/psychotherapeutic clinic. Furthermore, diabetes mellitus proved to be another statistically significant organic comorbidity in the patients treated at the clinic for technical orthopedics. This article discusses the extent to which the chronicity of this disease affects the psychosomatic diagnoses but also the course of the treatment in the clinic for technical orthopedics. In conclusion, this article emphasizes the need for close interdisciplinary management for this highly selected patient group because of the high rates of comorbidity.

Chi-Square Distribution↗
PubMed2004

[Diabetic neuropathic osteoarthropathy of the knee joint. A rare but increasing complication--case report].

Since the clinical entity of diabetic neuropathic osteoarthropathy has become known as a possible complication of the diabetic foot syndrome, the number of cases reported in the literature has increased. Up to 50 cases worldwide have been described since 1970 although the number of unknown cases is likely much higher. This dreaded complication poses a difficult challenge for the orthopedic surgeon. Reports on long-term results seem to show that surgical intervention is a relative indication. This contribution describes a case of acute neuro-osteoarthropathy of the knee joint and subsequent successful conservative management after an unsuccessful osteosynthesis. In addition, the literature published since 1970 dealing with this rare complication is examined and critically discussed.

Adult↗
PubMed2004

[Lower limb orthosis to relieve stress forces on the foot and its use in patients with diabetic neuropathic osteoarthropathy: Case examples].

In the daily routine of treating patients with diabetic neuropathic osteoarthropathy (DNOAP), their history often reveals a prolonged course of therapy caused in part by incorrect diagnosis but also by inadequate provision of orthopedic devices. A "classic" case is that of undetected osteoarthropathy, which is erroneously interpreted as osteomyelitis. Thus, subsequent to frustrating attempts at therapy and persistence of the clinical symptoms, patients are not infrequently "offered" the option of amputation, which is performed quite proximal to the osseous lesion to "ensure treatment success." The fact that major amputations lead to a statistically significant decrease of the patient's life span is usually not taken into consideration during the decision making process for amputation. Orthopedic surgical procedures to preserve the leg should be given precedence for the sake of maintaining quality of life just as orthopedic devices and orthopedic shoes should be preferred to retain mobility before amputation is indicated in patients with DNOAP. The cases reports presented here should encourage others to implement treatment concepts with the aim of avoiding unnecessary amputations.

Aged↗
PubMed2003

[Effect of body weight on plantar peak pressure in diabetic patients].

The goal was a better understanding of the correlation between body mass and plantar peak pressure in patients with diabetic neuropathy. A further aim was to obtain insight into the practicability of simulated weight increase and weight release and to delineate more clearly the indications for reducing body weight in order to lower the risk of ulcerations. Simulated change of body weight: (1) +20 kg by a waistcoat and (2)-20 kg by a movable overhead suspension. While normal forces and thus mean normal pressures depend directly on body mass, this does not necessarily apply to peak normal pressures. As shown in a transversal study by Cavanagh with pressure measurements in the bare foot, there is only a poor correlation between body mass and peak pressure. Therefore, peak pressure in heavy persons cannot be expected to be higher than in lighter weight persons. However, from these results it cannot be concluded that peak pressure is likely to remain unchanged irrespective of a change in body weight in a specific subject. Ten subjects were investigated: five controls and five patients suffering from diabetes without neuropathy or preceding ulcerations. All subjects wore the same kind of ready made shoes with ready made standard fitting insoles of cork. Each subject was measured in three modes of weight simulation: normal weight,20 kg weight increase (waistcoat with weight pieces), and 20 kg weight release. Weight release was effected by a modified rescue harness attached to an overhead suspension rail with 6m free walking distance. Individual alignment of the waistcoat and the suspension was checked by a force platform. In-shoe pressure measurement was done with the PEDAR in-shoe system (by Novel, Munich,Germany). For data analysis with the PEDAR standard software only peak pressures were considered. The foot was divided into six regions, particularly metatarsal region and heel. No significant difference between diabetics and controls was found. In the regions at highest risk (metatarsals and heel),peak pressure increased and decreased with weight. In the combined group (n=10), a simulated weight loss of 20 kg decreased metatarsal peak pressure by 5.4+/-1.9 N/cm(2), a 20 kg weight gain increased it by 7.4+/-5.1 N/cm(2). Therefore, without a significant deviation from linearity, peak pressure was found to be a linear function of weight. The results of this study show that weight increase or weight loss in the individual patient has an effect on the plantar peak pressure. The effect is significant in the metatarsal and heel regions. The linearity allows for a simple method of predicting the effect of weight loss by inverting the effect of simulated weight gain.

Adult↗
PubMed2003

[Effect of weight load and carrying conditions on plantar peak].

Knowledge is limited regarding the effects exerted by carrying a load on the distribution of plantar peak pressures. It is unknown whether a special technique might exist which keeps peak pressures low when carrying a load. This question is important to diabetic neuropathic patients at risk for tissue damage and pressure ulcerations and therefore with a need for minimized plantar peak pressures. The study included 19 healthy volunteers (14 M, 5 F, mean age: 34.2+/-15.2 years). They walked three times each along a 7-m walkway with an EMED pressure measurement platform under five different carrying conditions. The conditions were: carrying no load (reference), carrying a load of 20 kg in a backpack, carrying a load of 20 kg in a waistcoat, and carrying 20 kg in two bags. A fifth condition, carrying a waistcoat with a load of 10 kg only,was used to check the linearity of peak pressure and weight. Velocity and step length were measured to check the gait parameters. Peak pressures were determined in six regions: large toe, small toes,metatarsals, lateral and medial midfoot, and heel. In agreement with the literature, the reference measurements showed peak pressure to be widely independent of body weight. On the other hand, a significant increase of peak pressure was observed in a single person when a carried load was added. In the regions of the large toe,metatarsals, and heel the peak pressure increased linearly with the carried weight and amounted to 0.54, 0.76, and 0.38 N/cm(2) per kg additional load, respectively. No significant difference between the various techniques of carrying was detected. The plantar peak pressure increases with weight load,however, this is independent of the way the load is carried. No specific recommendation on the technique of carrying a load can be given in order to take care of diabetic feet.

Adult↗
PubMed2003

[Link-Witzel operation for diabetics].

The inner Chopart's amputation for tuberculosis of the tarsal as performed by Link and Witzel at the end of the nineteenth century laid the groundwork for a foot-saving surgical procedure in cases of neuropathic osteoarthropathy with concomitant infection. The question was posed whether such an inner amputation can represent an alternative to the classic hindfoot amputation. Six patients with neuropathic osteoarthropathy, five of whom had diabetes mellitus,who had been operated between 1989 and 2002 were analyzed retrospectively. In all of the cases, surgery had been indicated by chronic osteomyelitis of the tarsal with concomitant, extensive, mainly plantar ulcerations. During the average follow-up period of 55 weeks, no recurrence of an ulcer or infection occurred and therefore no further proximal amputation was necessary. In addition to being provided with orthotics, the remaining five patients could be fitted with made-to-measure orthopedic shoes. In selected cases, the inner Chopart's amputation can represent a solution even in such problematic cases that cannot be solved by a typical hindfoot amputation. The surgical procedure according to Link and Witzel should thus not only be considered as an alternative to Chopart's amputation, but also as a further method to spare diabetics major amputations.

Adult↗
PubMed2003

[Brunner's technique for open wedge resection].

The interaction of different risk factors exposes the feet of diabetics to a very high risk of infection. Therapeutic measures that are often implemented too late or are inappropriate result in major amputation. A retrospective analysis was performed to assess whether surgical reconstruction with an open wedge resection could also be achieved in cases of serious infections. An open wedge resection was performed between 1996 and 2001 on ten patients who had been suffering from diabetes mellitus for an average of 14 years. After V-shaped excision of necrotic tissue and metatarsal osteotomy close to the base, the wound was treated with wet compresses. The patients were mobilized with interim shoes or orthotics. None of the patients with an average age of 45 years experienced a recurrent ulcer or infection during the average follow-up period of 19 months. Eight patients were fitted with made-to-measure orthopedic shoes while modified standard shoes sufficed for two patients. Brunner's technique for open wedge resection is adequately radical to repair deep forefoot defects and simultaneously appropriate to avoid major amputation. The afflicted patients thus retain the highest measure of mobility and quality of life.

Adult↗