Abstract
Background
Diabetic Foot Ulceration in patients with diabetes could be associated with high plantar pressure caused by diabetes neuropathy. Therefore, it seems that one of the ways of identifying high-risk legs in diabetic patients with neuropathy would be characterization of elevated plantar pressure distributions.
Objective
Comparing the plantar pressure distribution in diabetic patients who suffered neuropathy with those without neuropathy.
Methods and materials
Plantar pressure distribution was recorded in the following categories: 38 diabetic patients without neuropathy, 30, 40 and 34 patients with mild neuropathy, moderate and severe neuropathy respectively.
Results
Patients suffered from severe neuropathy suggested higher maximum peak plantar pressure at midfoot, heel, and medial forefoot. The peak pressure of midfoot was significantly different in the following categories as well: patient without neuropathy (32.3 ± 17.9 kPa), mild neuropathic (24.0 ± 17.9 kPa), moderate neuropathic (21.5 ± 12.6 kPa), and severe neuropathic (22.9 ± 10.7 kPa) groups (p = 0.02).
Conclusion
The progression of diabetic neuropathy would have been increased followed by the peak plantar pressure.
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References
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047–53.
Cavanagh PR, Simoneau GG, Ulbrecht JS. Ulceration, unsteadiness, and uncertainty: the biomechanical consequences of diabetes mellitus. J Biomech. 1993;26:23–40.
Martin CL, Albers J, Herman WH, Cleary P, Waberski B, Greene DA, et al. Neuropathy among the diabetes control and complications trial cohort 8 years after trial completion. Diabetes Care. 2006;29(2):340–4.
Control D, Group CTR. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86.
Pirart J. Diabetes mellitus and its degenerative complications: a prospective study of 4,400 patients observed between 1947 and 1973. Diabetes Care. 1978;1(3):168–88.
Said G. Diabetic neuropathy—a review. Nat Clin Pract Neurol. 2007;3(6):331–40.
Bus SA, Maas M, de Lange A, Michels RP, Levi M. Elevated plantar pressures in neuropathic diabetic patients with claw/hammer toe deformity. J Biomech. 2005;38(9):1918–25.
Payne C, Turner D, Miller K. Determinants of plantar pressures in the diabetic foot. J Diabetes Complicat. 2002;16(4):277–83.
Fernando DJ, Masson EA, Veves A, Boulton AJ. Relationship of limited joint mobility to abnormal foot pressures and diabetic foot ulceration. Diabetes Care. 1991;14(1):8–11.
Cavanagh PR, Ulbrecht JS. Biomechanics of the diabetic foot: a quantitative approach to the assessment of neuropathy, deformity and plantar pressure. In: Disorders of the foot and ankle: medical and surgical management, vol. 2; 1991. p. 1864–907.
Kwon O-Y, Minor SD, Maluf KS, Mueller MJ. Comparison of muscle activity during walking in subjects with and without diabetic neuropathy. Gait Posture. 2003;18(1):105–13.
Mueller MJ, Minor SD, Sahrmann SA, Schaaf JA, Strube MJ. Differences in the gait characteristics of patients with diabetes and peripheral neuropathy compared with age-matched controls. Phys Ther. 1994;74(4):299–308.
Maluf K, Mueller M, Strube M, Engsberg J, Johnson J. Tendon Achilles lengthening for the treatment of neuropathic ulcers causes a temporary reduction in forefoot pressure associated with changes in plantar flexor power rather than ankle motion during gait. J Biomech. 2004;37(6):897–906.
Shaw JE, Van Schie C, Carrington AL, Abbott CA, Boulton A. An analysis of dynamic forces transmitted through the foot in diabetic neuropathy. Diabetes Care. 1998;21(11):1955–9.
Sacco I, Amadio A. Influence of the diabetic neuropathy on the behavior of electromyographic and sensorial responses in treadmill gait. Clin Biomech. 2003;18(5):426–34.
Stess RM, Jensen SR, Mirmiran R. The role of dynamic plantar pressures in diabetic foot ulcers. Diabetes Care. 1997;20(5):855–8.
Frykberg RG, Lavery LA, Pham H, Harvey C, Harkless L, Veves A. Role of neuropathy and high foot pressures in diabetic foot ulceration. Diabetes Care. 1998;21(10):1714–9.
Bacarin TA, Sacco IC, Hennig EM. Plantar pressure distribution patterns during gait in diabetic neuropathy patients with a history of foot ulcers. Clinics. 2009;64(2):113–20.
Stokes I, Faris I, Hutton W. The neuropathic ulcer and loads on the foot in diabetic patients. Acta Orthopaedica Scandinavica. 2009.
Caselli A, Pham H, Giurini JM, Armstrong DG, Veves A. The forefoot-to-rearfoot plantar pressure ratio is increased in severe diabetic neuropathy and can predict foot ulceration. Diabetes Care. 2002;25(6):1066–71.
Pham H, Armstrong DG, Harvey C, Harkless LB, Giurini JM, Veves A. Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. Diabetes Care. 2000;23(5):606–11.
Veves A, Murray H, Young M, Boulton A. The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. Diabetologia. 1992;35(7):660–3.
Rich J, Veves A. Forefoot and rearfoot plantar pressures in diabetic patients: correlation to foot ulceration. WOUNDS-A COMPENDIUM OF CLINICAL RESEARCH AND PRACTICE. 2000;12(4):82–7.
Reiber GE, Smith DG, Wallace C, Sullivan K, Hayes S, Vath C, et al. Effect of therapeutic footwear on foot reulceration in patients with diabetes: a randomized controlled trial. JAMA. 2002;287(19):2552–8.
Lavery LA, Vela SA, Fleischli JG, Armstrong DG, Lavery DC. Reducing plantar pressure in the neuropathic foot: a comparison of footwear. Diabetes Care. 1997;20(11):1706–10.
Sarnow MR, Veves A, Giurini JM, Rosenblum BI, Chrzan JS, Habershaw GM. In-shoe foot pressure measurements in diabetic patients with at-risk feet and in healthy subjects. Diabetes Care. 1994;17(9):1002–6.
Abouaesha F, van Schie CH, Griffths GD, Young RJ, Boulton AJ. Plantar tissue thickness is related to peak plantar pressure in the high-risk diabetic foot. Diabetes Care. 2001;24(7):1270–4.
Schoenhaus H, Wernick E, Cohen R. Biomechanics of the diabetic foot. The high risk foot in diabetes mellitus. 1991;125.
Young M, Cavanagh P, Thomas G, Johnson M, Murray H, Boulton A. The effect of callus removal on dynamic plantar foot pressures in diabetic patients. Diabet Med. 1992;9(1):55–7.
Mueller MJ. Application of plantar pressure assessment in footwear and insert design. J Orthop Sports Phys Ther. 1999;29(12):747–55.
Cavanagh PR, Owings TM. Nonsurgical strategies for healing and preventing recurrence of diabetic foot ulcers. Foot Ankle Clin. 2006;11(4):735–43.
Cavanagh PR, Bus SA. Off-loading the diabetic foot for ulcer prevention and healing. J Am Podiatr Med Assoc. 2010;100(5):360–8.
Yavuz M, Erdemir A, Botek G, Hirschman GB, Bardsley L, Davis BL. Peak plantar pressure and shear locations relevance to diabetic patients. Diabetes Care. 2007;30(10):2643–5.
Giacomozzi C, Caselli A, Macellari V, Giurato L, Lardieri L, Uccioli L. Walking strategy in diabetic patients with peripheral neuropathy. Diabetes Care. 2002;25(8):1451–7.
Sinacore DR, Bohnert KL, Hastings MK, Johnson JE. Mid foot kinetics characterize structural polymorphism in diabetic foot disease. Clin Biomech. 2008;23(5):653–61.
Sacco I, Amadio A. A study of biomechanical parameters in gait analysis and sensitive cronaxie of diabetic neuropathic patients. Clin Biomech. 2000;15(3):196–202.
Fang F, Wang Y, Gu M, Chen H, Wang D, Xiao K, et al. Pedobarography-a novel screening tool for diabetic peripheral neuropathy. Eur Rev Med Pharmacol Sci. 2013;17(23):3206–12.
Syed N, Maiya A, Hanifa N, Goud S. Plantar pressures in diabetes with no known neuropathy. Journal of diabetes. 2013;5(3):302–8.
Adler A. Risk factors for diabetic neuropathy and foot ulceration. Current diabetes reports. 2001;1(3):202–7.
Taylor AJ, Menz HB, Keenan A-M. Effects of experimentally induced plantar insensitivity on forces and pressures under the foot during normal walking. Gait Posture. 2004;20(3):232–7.
Shen J, Liu F, Zeng H, Wang J, Zhao J-G, Zhao J, et al. Vibrating perception threshold and body mass index are associated with abnormal foot plantar pressure in type 2 diabetes outpatients. Diabetes Technol Ther. 2012;14(11):1053–9.
Salsich GB, Mueller MJ, Sahrmann SA. Passive ankle stiffness in subjects with diabetes and peripheral neuropathy versus an age-matched comparison group. Phys Ther. 2000;80(4):352–62.
Gefen A. Plantar soft tissue loading under the medial metatarsals in the standing diabetic foot. Med Eng Phys. 2003;25(6):491–9.
Turner D, Helliwell PS, Burton AK, Woodburn J. The relationship between passive range of motion and range of motion during gait and plantar pressure measurements. Diabet Med. 2007;24(11):1240–6.
Waaijman R, Bus S. The interdependency of peak pressure and pressure–time integral in pressure studies on diabetic footwear: no need to report both parameters. Gait Posture. 2012;35(1):1–5.
Acknowledgements
This project was supported by Endocrinology and Metabolism Research Institute. We gratefully acknowledge the substantial contribution of all scientific and executive personnel of this institution. We would also like to extend our sincere thanks to all the diabetic patients who participated in this research project.
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Abri, H., Aalaa, M., Sanjari, M. et al. Plantar pressure distribution in diverse stages of diabetic neuropathy. J Diabetes Metab Disord 18, 33–39 (2019). https://doi.org/10.1007/s40200-019-00387-1
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DOI: https://doi.org/10.1007/s40200-019-00387-1