Made available in DSpace on 2016-12-06T17:07:23Z (GMT). No. of bitstreams: 1 Graziela De Gasperi.pdf: 2356359 bytes, checksum: 6032deedc4cea19301d2e753d03b9b8c (MD5) Previous issue date: 2010-03-19 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Obesity has become one of the most serious health issues nowadays. It is estimated that about 300 million people world-wide are considered obese. Obesity is characterized by an abnormal increase of body fat, leading to health problems. BMI is widely used to represent the degree of obesity, and it is related to the presence of associated diseases. When it is equal or over 40 kg/m², the obesity is considered morbid obesity. Some researches indicate that there is an increasing in plantar pressure indexes and larger peaks of pressure during gait of obese people in comparison to non-obese. This change in the distribution of plantar pressure may have consequences in daily activities, affecting one s locomotion, tasks accomplishment and body balance, since it depends on the bodyweight on joints that support body. Yet, the excess of fat tissue leads to overloading in joints, specially knees and ankles, causing pain and discomfort. That way, the objective of this study was to analyze the influence of morbid obesity in the distribution of plantar pressure and in the perception of pain in the feet of morbid obese people in pre-operatory of bariatric surgery. Ten morbid obese individuals took part in the study, which was held in Florianópolis/SC. In order to evaluate the distribution of plantar pressure, peak pressure and center of pressure (COP) dislocation, it was used a computerized baropodometry system, Emed-AT (Novel, Germany). Data related to the presence of associated diseases and pain in the feet was also collected. Data collection occurred the day before the bariatric surgery that individuals underwent. By the use of descriptive statistics, it has been noticed the prevalence of female participants (80%), who had an average age of 34 years-old and average BMI of 39,54 kg/m². The highest plantar peak pressure and average plantar pressure were found in the region of hallux, followed by first, second and third metatarsal heads, showing significant correlation between BMI and peak plantar pressure in midfoot and hallux regions, and between BMI and average plantar pressure in midfoot only (p<0,05). The medial displacement of COP proved to be more likely to happen between participants, yet there were differences between values of each foot in the same individual. Arch index showed that obese participants presented feet classified as normal; five individuals reported not feeling pain in the feet, while among the remaining participants, the pain was present during gait, during static position or during both situations, presenting intensity of 6.2 cm according to visual analogue scale. The most prevalent associated disease was systemic arterial hypertension, referred by five individuals. The results found show that there is an influence of morbid obesity on plantar pressure distribution, but one cannot be sure about the influence on the perception of pain for the participants. / A obesidade tornou-se um dos mais graves problemas mundiais relativos à saúde. Estima-se que cerca de 300 milhões de pessoas hoje no mundo sejam portadoras dessa patologia, que é caracterizada por um aumento anormal da gordura corporal, a ponto de comprometer a saúde do indivíduo. O índice de massa corporal (IMC) é um índice amplamente utilizado para representar o grau de obesidade. Quando o IMC encontra-se em um valor igual ou acima de 40 kg/m², caracteriza-se a obesidade mórbida. Estudos mostram que há aumento nos índices de pressão plantar e maiores picos de pressão durante a marcha em obesos quando comparados com não-obesos. Essa alteração na distribuição da pressão plantar pode ter conseqüências na vida diária dos indivíduos, afetando sua locomoção, a realização de tarefas e seu equilíbrio corporal, uma vez que este depende da massa corporal imposta sobre as articulações que suportam o corpo. Ainda, o excesso de tecido adiposo leva a sobrecarga das articulações, principalmente joelho e tornozelo, levando a dores e desconfortos. Dessa forma, o objetivo deste estudo foi analisar a influência da obesidade mórbida na distribuição da pressão plantar e na percepção de dor nos pés de indivíduos obesos mórbidos no pré-operatório de cirurgia bariátrica. Dez indivíduos obesos mórbidos participaram do estudo, que ocorreu na cidade de Florianópolis/SC. Para a avaliação da distribuição da pressão plantar, picos de pressão plantar e deslocamento do centro de pressão (COP), utilizou-se um sistema de baropodometria computadorizado, Emed-AT (Novel, Alemanha). Foram também coletados dados relativos à presença de doenças associadas à obesidade e dores na região dos pés. A coleta dos dados foi realizada no dia anterior a cirurgia bariátrica a que se submeteram os indivíduos. A partir do uso da estatística descritiva, observou-se a prevalência do gênero feminino entre os participantes do estudo (80%), que obtiveram média de idade de 34 anos e média de IMC de 39,54 kg/m². Os maiores valores de pico de pressão plantar e pressão plantar média foram encontrados na região do hálux, seguido pelas cabeças dos primeiro, segundo e terceiro metatarsos, ocorrendo correlação significativa entre o IMC e os picos de pressão plantar para as regiões do mediopé e hálux e entre o IMC e a pressão plantar média para a região do mediopé (p<0,05). O deslocamento medial do COP mostrou-se mais provável de ocorrer entre os participantes do estudo, ainda que tenham sido encontradas diferenças entre os valores de cada pé em um mesmo indivíduo. O índice do arco plantar mostrou que os obesos participantes apresentaram tipo de pé caracterizado como normal; cinco indivíduos relataram não sentir dores na região do pé, enquanto entre os participantes restantes, a dor foi presente durante a deambulação, durante a posição estática ou durante as duas situações, tendo intensidade média de 6,2 cm de acordo com a Escala Visual Analógica. A doença associada mais prevalente foi a hipertensão arterial sistêmica, relatada por cinco indivíduos. A partir dos resultados encontrados, concluiu-se que há influência da obesidade mórbida sobre a distribuição plantar, mas não se pode afirmar que haja influência sobre a percepção de dor nos indivíduos do estudo.

Tikslas: nustatyti pėdos lenkiamųjų raumenų statinės ir dinaminės jėgos įtaką šuolininkių rezultatams. Tyrimo objektas: pėdos lenkiamųjų raumenų jėga. Tiriamieji: Dvi grupės įvairaus amžiaus merginų – šuolininkių į tolį, aukštį, trišuolį bei šuolinkių su kartimi.Pirmoji grupė: 12 merginų. Amžiaus vidurkis. 19,3±2,5 m, ūgis 168,6 cm± 3,8 cm, kūno masė 54, 70 kg± 2,3 kg. Antroji – 11 merginų. Amžiaus vidurkis 17,9± 3,9 m, ūgis 172.9 cm ±9,1 cm, kūno masė 60, 5 kg±6 kg. Tyrimo metodai: dinamometrija, statistinė analizė, pedagoginis testavimas. Tyrimo organizavimas: Pirmoji tiriamųjų grupė atliko pėdos lenkiamųjų raumenų statinės maksimalios valingos jėgos (MVJ) testą prieš ir po pramankštos, kelią fiksuojant 900 ir čiurną 700 kampu. Antrąjai grupei buvo testuojama pėdos lenkiamųjų raumenų jėga izokinetiniame rėžime prie 600/s, 1200/s, 1800/s. kampinių greičių. Taip pat buvo atlikti, vertikalaus šuolio į aukštį iš vietos, greito šuolio į aukštį nuo 10 cm paaukštinimo (drop jump) ir šuolio į tolį iš vietos testai. Rezultatai: atsispiriamosios kojos buvo 120,08 ±22 Kg, mojamosios kojos – 114,21± 22 Kg. Pėdos lenkiamųjų raumenų statinė MVJ prieš pramankštą buvo 119,2 ± 19, 8 Kg, po pramankštos – 121,7 ±24,1 Kg. Atsispiriamosios kojos jėga, izokinetiniame rėžime, prie 600/s buvo 88,70 ±3,95 Nm, mojamosios kojos –87,94. ±7,13 Nm. Prie 1200/s atsispiriamosios kojos –82,74±4,11 Nm, mojamosios kojos –72,75±3,36 Nm. Prie 1800/s. atsispiriamosios kojos buvo 71,79±3,32 Nm, Mojamosios... [toliau žr. visą tekstą] / Aim: to identify the influence of static and dynamic forces to ankle flexion muscles and to the results of jumpers. Objective: the force of ankle flexion muscles. Participants: Two various age groups of women – long jumpers, high jumpers, triple jumpers and pole vaulters. The first age group consisted of 12 women. The age mean: 19,3 ± 2,5 years, height: 168,6 cm ± 3,8 cm, weight: 54, 70 kg ± 2,3 kg. The second age group consisted of 11 women. The age mean: 17,9 ± 3,9 years, height: 172.9 cm ±9,1 cm, weight: 60, 5 kg±6 kg. Methods: dynamometry, statistical analysis, pedagogical testing. Process of the study: The first group took part in the maximum contraction force (MCF) test in order to measure the static force of the ankle flexion muscles. We have used MCF test before and after the warm-up with the knee fix at 900 angle and the ankle fixed at 700. The second group was tested in isokinetic regime using the 600/s, 1200/s, 1800/s peak torque. In addition, the participants also took part in vertical standing high jump, the 10cm drop jump, and standing long jump tests. Results: the result of the main leg: 120,08 ±22 Kg, the result of the other leg: 114,21± 22 Kg. The MCF result before the warm-up: 119,2 ± 19, 8 Kg, and after the warm-up: 121,7 ±24,1 Kg. The test result of the main leg force in isokinetic regime using 600/s was 88,70 ±3,95 Nm, the result of the other leg: 87,94. ±7,13 Nm. Using 1200/s, main leg: 82,74±4,11 Nm, the other leg: 72,75±3,36 Nm. Using 1800/s, the... [to full text]

Adult Acquired Flatfoot Deformity (AAFD) is a progressive disease characterized by mechanical degeneration of the soft tissue structure in the arch of the foot that leads to changes in joint alignment. Surgical intervention commonly via tendon transfer and bony osteotomy is used to restore arch architecture, however there is a lack of quantitative assessments that measure the success of the surgical correction in vivo. Using plantar pressures via Tekscan® HR Mat and surveys (SF-36, FAOS), pre-operative and post-operative measures for six participants were defined, analyzed and compared. A paired t-test showed significant lateral shift for percent body weight during walking postoperativelyin the forefoot and midfoot regions. However, arch index measurement showed no significant change. The FAOS survey score also improved statistically postoperatively. The surgical correction was successful as deemed by some of these quantitative and qualitative measures.

1 Abstract: The aim of this study quantify and compare the differences in the dynamics of foot movement compared with static in adulthood and old age, focusing on the midstance phase. A secondary objective is to outline the relationship with the angular distribution of pressure on the sole. For measurements two measuring methods were used. The kinematic analysis named Qualysis was used as a main method and system of plantar pressure insoles Pedar X as a complementary method. The difference in measured distance of 1-MP calcaneus, 5MP - calcaneus and pronate angle of calcaneus was prooved using the statistical calculation, which confirmed the hypothesis of half clear a significant degree. Subsequently, the changes were further specified using the results of the distribution of maximum force and contact time of the soles.

Author: Bc. Lenka Pitnerová Title: The effectiveness of high intensity laser therapy for plantar fasciitis Objectives: The aim of this work is to assess the effect of high and low intensity laser therapy for plantar fasciitis compared with therapeutic ultrasound. Methods: The study included 50 patients with diagnose of heel spur syndrome. Patients were divided into three groups according to undergoing therapy. Group A (n = 20) received 10 applications of high intensity laser therapy, group B (n = 20) obtained 10 applications of low intensity laser therapy and group C (n=10) received 10 applications of therapeutic ultrasound. Intensity and character of the pain were assessed before and after therapeutic intervention using non- standardized questionnaire and numeric pain rating scale. For the assessment and description of the results were used standard statistical indicators and methods. Results: High intensity laser therapy had according to the obtained results positive effect on the clinical course of the disease and was markedly more effective than therapeutic ultrasound in treatment of plantar fasciitis. Almost all parameters reached the highest percentage improvement in the group treated with high intensity laser. The results are influenced by a smaller sample of patients and by inhomogeneity of...

Title: Quantification of plantar pressure distribution and geometry of forefoot according to the character of shoes Objectives: The main purpose of this thesis is to describe and verify the changes in the sole of the foot according to the style of shoe which are manifested by changes in the values of the maximum pressure, contact area, contact time and changes in pressure time integral. The next object is to verify the changes in forefoot geometry according to the style of shoes. Methodology: The sample consisted of 6 healthy women of average age 25 ± 1 year. All study participants reported wearing high-heeled shoes occasionally which means not more than twice per week. The measurement was realized with the Pedar-X in-shoe pressure measurement system (Novel) and motion capture system Qualisys. Results were analysed statistically using Wilcoxon test. Statistical significance was set at p < 0,05. Results: From the received data we could find out the changes that footwear causes in healthy people. The findings of this study indicate that the use of different style of shoes affect all measured parameters such as maximum pressure, contact area, contact time and pressure time integral.From the experiment evaluation, it is clear that the style of shoes may also affect the geometry of forefoot. Keywords:...

Author: Bc. Kateřina Průchová Title: The effectiveness of shock wave therapy for plantar fasciitis Objectives: The main goal of this work is to assess the effect of the radial and focused shock wave therapy for plantar fasciitis compared with therapeutic ultrasound. Methods: The study included 55 patients with diagnose of heel spur syndrome. Patients were divided into three groups according to undergoing therapy. Group A (n = 20) received 6 applications of radial shock wave, group B (n = 20) obtained 3 applications of focused shock wave and group C received 8 applications of therapeutic ultrasound. Intensity and character of the pain were assessed before and after therapeutic intervention using non-standardized questionnaire. For the assessment and description of the results were used standard statistical indicators and methods. Results: Radial and focused shockwave therapy had according to the obtained results in the selected treatment protocol positive effect on the clinical course of the disease and was markedly more effective than therapeutic ultrasound. Almost all parameters reached the highest percentage improvement in the group treated with 6 applications of radial shock waves. There were no complications and side effects during the experiment. Keywords: heel spur, plantar fasciitis,...

O objetivo desse estudo é: (a) verificar o efeito do desgaste do calçado na Força de Reação do Solo (FRS) e na distribuição de pressão plantar e (b) verificar a influência do desgaste em calçados de diferentes destinações de uso. Três sujeitos participaram desse estudo, usando cada um quatro calçados de corrida, sendo dois de treinamento (T1 e T2) e dois de competição (C1 e C2). Os calçados foram submetidos ao uso correspondente a 300km. As coletas de dados foram feitas, com o calçado novo e após 100, 200 e 300km de uso, utilizando o sistema Gaitway e o sistema F-Scan. Nos calçados novos, na FRS, a Taxa de Crescimento1 (TC1) foi significativamente maior no calçado C2, do que nos calçados C1 e T2. Na distribuição de pressão plantar, pequena diferença foi observada na Área total (AT) e nos picos de pressão, entre os calçados. Na influência do desgaste nos resultados de grupo, na FRS, o TC1 apresentou valores semelhantes entre as condições Novo e 300km, portanto o choque mecânico não se alterou. Na fase ativa da FRS, oscilações pequenas foram observadas e atribuídas a possíveis variações naturais do movimento, conforme descrito por SERRÃO (1999) e WINTER (1991). Na distribuição de pressão, a AT apresentou um aumento significativo da condição Novo, para as demais condições de uso. O aumento da área foi atribuído à possível compactação do calçado, sendo que essa alteração justificaria a crença de que o calçado novo precise ser amaciado. Entre os picos de pressão analisados, apenas o Pico de Pressão do Antepé (PPA) apresentou diminuição significativa nos valores, da condição Novo para os 300km. Observou-se que após o desgaste imposto, o estresse mecânico se manteve ou se apresentou menor que nas condições iniciais. Na análise da influência do desgaste nos diferentes calçados, para TC1, as diferenças que inicialmente eram significativas tornaram-se não significativas, a partir dos 200km, entre os calçados C1, C2 e T2. Os parâmetros da fase ativa foram pouco influenciados, porém influenciados de forma distinta pelo desgaste, nos calçados analisados. Na distribuição de pressão plantar, a área de contato foi influenciada de forma distinta em cada calçado. Nos picos de pressão plantar, grandes variações foram observadas, porém não atribuíveis ao desgaste promovido no calçado. Conclui-se que o desgaste, correspondente a 300km, pouco alterou o choque mecânico e o estresse mecânico nos calçados analisados. Por meio da destinação de uso, não é possível prever a resposta de calçados de treinamento e de competição ao indivíduo, nem supor que a durabilidade do calçado de competição seja menor do que a do calçado de treinamento / The objective of this study is: (a) to verify the effect of footwear usage on the Ground Reaction Force (GRF) and on the Plantar Pressure Distribution and (b) to verify the influence of usage in footwear of different destinations of use. Three subjects had participated of this study, each one received four running shoes, two of them are designated for training regimen (T1 and T2) and two of them for competition (C1 and C2). The footwears were used for 300km. The data collections were made in four different moments, with new footwear and after 100, 200 and 300km of use, using the Gaitway system and the F-Scan system. When footwear was new, the Loading Rate1 (LR1) was significantly higher in footwear C2, than in the footwears C1 and T2. Analyzing plantar pressure distribution, small differences were observed in the Total Contact Area (TCA) and in the peak of pressure, between the footwears. In the analysis of the different usage stages, the LR1 presented similar values between the conditions New and 300km, therefore the mechanical shock did not enhanced. In the active phase of the GRF, small oscillations were observed and attributed to the possible natural variations of the movement itself, as described before by SERRÃO (1999) and WINTER (1991). In pressure distribution, the TCA showed a significant increase from the New condition, for the other conditions of use. The increase of contact area was attributed to the possible compactation of the footwear?s material, if so this would justify the belief that the new footwear needs to be softened. Considering all peak pressure variables, only Forefoot Peak Pressure (FPP) presented significant reduction in its values, from the New condition for 300km. Therefore it could be assumed that after corresponding usage of 300km, the mechanical stress remained the same or decreased compared with the earlier conditions of use. The shoes of different destinations when analyzed through the conditions, showed that the differences for LR1 that initially were significant had become not significant, from 200km, between the footwear C1, C2 and T2. In the pressure peaks plantar, great variations had been observed, however not attributable to the usage. The conclusion is that usage, correspondent 300km, has little effect on mechanical shock and on mechanical stress on the footwear analyzed in this study. By means of the use destination, it is not possible to foresee the answer of footwear to the individual, nor to assume that the durability of the footwear are worse in competition shoes than in training shoes

O exercício excêntrico tem sido utilizado na prevenção/reabilitação de lesões e em programas de treinamento de força para melhorar o condicionamento físico de indivíduos saudáveis. O entendimento das adaptações causadas pelo treinamento excêntrico nos músculos flexores plantares se justifica: 1) pela importância desta musculatura na manutenção de posturas e no ciclo da marcha; 2) pela alta incidência de lesões do tendão de Aquiles; e 3) pelo uso sistemático deste tipo de treinamento em programas de prevenção e reabilitação do tríceps sural. Assim, a presente tese de doutorado busca verificar os efeitos do treinamento excêntrico nas propriedades neuromecânicas e morfológicas dos músculos flexores plantares. No capítulo I foram compiladas informações acerca das adaptações neuromusculares dos flexores plantares e do tendão de Aquiles de indivíduos saudáveis submetidos à programas de treinamento excêntrico. Os estudos encontrados indicam que o treinamento excêntrico pode aumentar a produção de força e ativação muscular, especialmente em testes excêntricos. No entanto, resultados conflitantes e lacunas identificadas na literatura motivaram a realização de dois estudos originais. Os objetivos dos estudos originais foram: 1) determinar a temporalidade das adaptações na ativação e massa muscular de flexores plantares, bem como sua contribuição para os ganhos de força em contrações excêntricas, isométricas e concêntricas ao longo do programa de treinamento (Capítulo II); e 2) avaliar os efeitos de 12 semanas de treinamento excêntrico nas propriedades morfológicas, mecânicas e materiais do tendão de Aquiles de indivíduos saudáveis (Capítulo III). Vinte participantes do sexo masculino realizaram um programa de treinamento excêntrico isocinético (duas vezes por semana, 3-5 séries de 10 repetições máximas). As avaliações das propriedades neuromecânicas e morfológicas dos flexores plantares foram realizadas a cada quatro semanas. Ao final de 12 semanas, o programa de treinamento excêntrico aumentou a produção de torque máximo excêntrico, isométrico e concêntrico; aumentou a atividade eletromiográfica máxima excêntrica e isométrica; e aumentou a espessura muscular. Além disso, os ângulos do pico de torque excêntrico e concêntrico foram deslocados para posições em que os músculos estavam mais alongados. O torque máximo e a espessura muscular aumentaram progressivamente até a oitava semana de treinamento. A ativação neural durante contrações excêntricas e isométricas aumentou após quatro semanas de treino e permaneceu constante até o final do treinamento, enquanto que a ativação neural durante contrações concêntricas permaneceu inalterada durante todo o período de treinamento. Além disso, houve aumento da área de secção transversa, da rigidez e do módulo de Young do tendão de Aquiles. Os incrementos na rigidez e no módulo de Young foram observados após quatro semanas de treinamento, enquanto que o aumento significativo da área de secção transversa tendínea ocorreu após oito semanas de treinamento. Quando tomados em conjunto, estes resultados nos possibilitam entender de que forma as adaptações neuromecânicas e morfológicas dos flexores plantares ocorrem. O aumento da força isométrica e excêntrica nas primeiras quatro semanas de treinamento parece ocorrer devido a adaptações neurais, musculares e tendíneas. No entanto, após maiores períodos de treinamento (i.e. acima de quatro semanas), o aumento da força ocorre devido a incrementos na massa muscular e na rigidez tendínea. Além disso, a ausência de adaptações neurais evidencia que os ganhos de força concêntrica podem estar relacionados apenas com adaptações musculares e tendíneas. / Eccentric exercises are commonly used in prevention, rehabilitation and conditioning training programs. Understanding the adaptations caused by eccentric training on the plantar flexor muscles is justified by: 1) the importance of these muscles in maintaining posture and during gait cycle; 2) the high incidence of Achilles tendon injuries; and 3) the systematic use of this type of training in triceps surae prevention and rehabilitation programs. Thus, the present PhD thesis aims to verify the effects of eccentric training in neuromechanical and morphological properties of the plantar flexor muscles. Chapter I compiled information about the neuromuscular adaptations of the plantar flexors and Achilles tendon of healthy subjects undergoing eccentric training programs. The studies found indicate that eccentric training can increase the production of muscle strength and muscle activation, especially in eccentric tests. The studies found indicate that eccentric training can increase muscle strength and muscle activation, especially in eccentric tests. The purposes of the original studies were: 1) to determine the adaptations time course in plantar flexors activation and muscle mass, as well as their contribution to the strength gains in eccentric, isometric and concentric contractions during the training program (Chapter II); and 2) to evaluate the effects of 12 weeks of eccentric training on Achilles tendon morphological, mechanical and material properties in healthy subjects (Chapter III). Twenty male subjects performed an eccentric isokinetic training program (twice a week, 3-5 sets of 10 maximal repetitions). Plantar flexor neuromechanical and morphological evaluations were performed every 4 weeks. The 12-week training program led to increases in maximum eccentric, isometric and concentric torques; maximum eccentric and isometric electromyographic activity; and muscle thickness. The angles of peak torque in eccentric and concentric tests were shifted towards longer muscle lengths. Maximum torque and muscle thickness increased progressively until the 8th training week. Eccentric and isometric activation increased up to the 4th training week and remained constant until the 12th training week, while no change was found in concentric activation. In addition, Achilles tendon cross-sectional area, stiffness and Young's modulus were increased. The increases in stiffness and Young's modulus were observed after four weeks of training, while the significant increase in tendon cross-sectional area occurred after eight weeks of training. Taken together, these results allow us to understand how the neuromechanical and morphologic adaptations occur in the plantar flexors muscles subjected to a 12-week eccentric training program. The increase in isometric and eccentric strength in the first four weeks of training seems to be related to neural, morphological and tendinous adaptations. However, after longer training periods (i.e. up to four weeks), the strength increase is due to increases in muscle mass and tendon stiffness. Moreover, the absence of evidence in terms of neural adaptations during concentric contractions suggest that the concentric strength gains seem to be related only with muscle and tendon adaptations.

Diabetic foot ulceration (DFU) is a known major complication of diabetes mellitus which contributes to lower extremities amputation. This study aimed to investigate the use of interventional devices either as a preventative or therapeutic strategy to improve clinical management of this pathology, as well as investigating the impaired function of endothelial progenitor cells in the diabetic condition. The first element targeted plantar callus formation among diabetic neuropathic (NRP) patients through the use of a SurroSenseRxTM biofeedback device. Reducing foot pressure with improved walking strategy in the 6 months study in diabetic neuropathy patients (n=20) appeared to minimise the size of non-ulcerative plantar callus (p < 0.05), potentially reducing future ulcer recurrence. The 2nd study focused on the use of a GekoTM electrical stimulation device to enhance DFU healing in 24 patients. Wounds were characterised as being neuroischaemic (NRI) or neuropathic (NRP) based on standard parameters adopted in the Manchester diabetes clinic. The device was worn by 11 intervention subjects and compared to 13 controls without any electrical stimulus. Results suggested healing and wound closure have potentially increased in participants with electrical stimulation. In addition, Neuropathy Disability Score (NDS) was improved among intervention patients compared to control (p < 0.0001). The 3rd, in vitro and mechanistic study focuses on the outgrowth of endothelial cells (OECs), abnormal angiogenic responses and inflammatory microenvironment which could contribute to impaired wound healing in diabetic patients. OECs were isolated from diabetic patients and healthy controls (HCs), characterised by immunohistochemistry and Polymerase Chain Reaction (PCR). The functions of the three OEC groups from NRI, NRP diabetic patients and healthy controls respectively were compared using in vitro proliferation, transwell migration and wound healing scratch assays, together with matrigel tube formation assays. Scratch assays showed 100% closure in HCs over 24 hours, while 86.6% closure was apparent in NRI vs 38.1% in NRP. Seahorse mitochondrial stress test was conducted and demonstrated mitochondrial dysfunction in NRP vs NRI vs HCs (p < 0.05). Western blot analysis showed a lack of ERK phosphorylation by NRP OECs and an up-regulation of plasma inflammatory cytokines (TNFa and IL-6) in diabetic samples vs HC (p < 0.0001), while the angiogenic factors ang-2, FGF-2, VEGF-D, HGF and IL-8, and nitric oxide bioavailability were all significantly reduced in diabetic samples vs HC (p < 0.05). The functional defects of the diabetic OECs were partially restored through glycomimetic (synthesis compounds for endothelial damage protection) treatment (p < 0.05). In summary, this study has highlighted areas worthy of future development both in terms of preventative and therapeutic strategies. With improvements in digital technology and the need to empower patients to take responsibility of their health and well-being as well as greater understanding of the cellular and molecular biological repair processes that may be exploited, there may be potentials to reduce the risk of future ulceration among patients using these novel approaches in the future.