Plantar Pressure Distribution Patterns During Gait in Diabetic Neuropathy Patients with a History of Foot Ulcers

Laboratory of Biomechanics of the Human Movement and Posture, Physical Therapy, Speech and Occupational Therapy Department, Faculdade de Medicina, Universidade de São Paulo/SP, Brazil.
Clinics (São Paulo, Brazil) (Impact Factor: 1.42). 05/2009; 64(2):113-20. DOI: 10.1590/S1807-59322009000200008
Source: PubMed

ABSTRACT To investigate and compare the influence of a previous history of foot ulcers on plantar pressure variables during gait of patients with diabetic neuropathy.
Foot ulcers may be an indicator of worsening diabetic neuropathy. However, the behavior of plantar pressure patterns over time and during the progression of neuropathy, especially in patients who have a clinical history of foot ulcers, is still unclear.
Subjects were divided into the following groups: control group, 20 subjects; diabetic neuropathy patients without foot ulcers, 17 subjects; and diabetic neuropathy patients with at least one healed foot ulcer within the last year, 10 subjects. Plantar pressure distribution was recorded during barefoot gait using the Pedar-X system.
Neuropathic subjects from both the diabetic neuropathy and DNU groups showed higher plantar pressure than control subjects. At midfoot, the peak pressure was significantly different among all groups: control group (139.4+/-76.4 kPa), diabetic neuropathy (205.3+/-118.6 kPa) and DNU (290.7+/-151.5 kPa) (p=0.008). The pressure-time integral was significantly higher in the ulcerated neuropathic groups at midfoot (CG: 37.3+/-11.4 kPa.s; DN: 43.3+/-9.1 kPa.s; DNU: 68.7+/-36.5 kPa.s; p=0.002) and rearfoot (CG: 83.3+/-21.2 kPa.s; DN: 94.9+/-29.4 kPa.s; DNU: 102.5+/-37.9 kPa.s; p=0.048).
A history of foot ulcers in the clinical history of diabetic neuropathy subjects influenced plantar pressure distribution, resulting in an increased load under the midfoot and rearfoot and an increase in the variability of plantar pressure during barefoot gait. The progression of diabetic neuropathy was not found to influence plantar pressure distribution.

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Available from: Isabel C N Sacco, Aug 13, 2015
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    • "SHU Lin et al. A. Perrier et al. [7] developed washable socks for diabetic foot prevention using wireless sensors which communicate with phone. Many other papers [8], [9], [10] and [11] talk about the importance of these parameters in the diabetic foot ulcer prevention, principally the analysis quantifying of the plantar pressure repartition during the different phases of gait. "
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    ABSTRACT: The diabetic foot present many complications if it is not supervised. Statistics shows that 25% of diabetics that develop peripheral neuropathy will develop a foot ulcer and more than a half of them will become infected and 80 % require non-traumatic amputation which are performed yearly. This paper shows a daily instrumented shoe for the monitoring of diabetic foots to reduce the risk of ulcers and others complication dues to many effects of the shoe's environment. The system contains an insole pressure distribution sensor to monitor the pressure of critical point of high risk to prevent ulcers. Also, it contains temperatures sensors placed in critical contact points to give feedback of the friction rate, and a humidity sensor to give feedback of the sweating rate. Since the aim of the system is to be used daily by any diabetic person, the different sensors communicate wirelessly thought Bluetooth with an Android based phone application. In addition to a real-time sensor's data visualization, the application contains different alerts set according to medical preconization to give feedback such as the maximum time recommended to wear a shoe.
    4th International Conference on Wireless Mobile Communication and Healthcare - "Transforming healthcare through innovations in mobile and wireless technologies"; 11/2014
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    • "Bacarin et al. [9] and Giacomozzi et al. [15] compared two subsets of DN patients divided into groups based on their history of previous ulceration. The studies by Caselli et al. [18] and Pham et al. [11] were the only ones that divided the diabetic subjects into four severity degrees in a clear manner using a classification procedure based on a simple sum of questionnaire output scores [11] [20]. "
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    ABSTRACT: Inconsistent findings with regards to plantar pressure while walking in the diabetic population may be due to the heterogeneity of the studied groups resulting from the classification/grouping criteria adopted. The clinical diagnosis and classification of diabetes have inherent uncertainties that compromise the definition of its onset and the differentiation of its severity stages. A fuzzy system could improve the precision of the diagnosis and classification of diabetic neuropathy because it takes those uncertainties into account and combines different assessment methods. Here, we investigated how plantar pressure abnormalities evolve throughout different severity stages of diabetic polyneuropathy (absent, n = 38; mild, n = 20; moderate, n = 47; severe, n = 24). Pressure distribution was analysed over five areas while patients walked barefoot. Patients with mild neuropathy displayed an increase in pressure-time integral at the forefoot and a lower peak pressure at the heel. The peak and pressure-time integral under the forefoot and heel were aggravated in later stages of the disease (moderate and severe) compared with early stages of the disease (absent and mild). In the severe group, lower pressures at the lateral forefoot and hallux were observed, which could be related to symptoms that develop with the aggravation of neuropathy: atrophy of the intrinsic foot muscles, reduction of distal muscle activity, and joint stiffness. Although there were clear alterations over the forefoot and in a number of plantar areas with higher pressures within each severity stage, they did not follow the aggravation evolution of neuropathy classified by the fuzzy model. Based on these results, therapeutic interventions should begin in the early stages of this disease to prevent further consequences of the disease.
    Gait & Posture 09/2014; 40(4). DOI:10.1016/j.gaitpost.2014.06.018 · 2.30 Impact Factor
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    • "When the Tekscan system was in place, the examiner explained the experimental procedures to the subjects. Prior to the experiment, the subjects performed a procedure to familiarize themselves with the device for approximately five minutes (Bacarin et al, 2009). Each insole sensor was calibrated using a walk calibration procedure and set to zero prior to each activity as recommended by the Tekscan system guideline. "
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    ABSTRACT: The first purpose was to identify the plantar pressure distributions (peak pressure, pressure integral time, and contact area) during level walking, and stair ascent and descent in asymptomatic flexible flatfoot (AFF). The second purpose was to investigate whether peak pressure data during level walking could be used to predict peak pressure during stair walking by identifying correlations between the peak pressures of level walking and stair walking. Twenty young adult subjects (8 males and 12 females, age years) with AFF were recruited. A distance greater than 10 mm in a navicular drop test was defined as flexible flatfoot. Each subject performed at least 10 steps during level walking, and stair ascent and descent. The plantar pressure distribution was measured in nine foot regions using a pressure measurement system. A two-way repeated analysis of variance was conducted to examine the differences in the three dependent variables with two within-subject factors (activity type and foot region). Linear regression analysis was conducted to predict peak pressure during stair walking using the peak pressure in the metatarsal regions during level walking. Significant interaction effects were observed between activity type and foot region for peak pressure (F=9.508, p
    11/2013; 20(4). DOI:10.12674/ptk.2013.20.4.055
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