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: 1.19). 05/2009; 64(2):113-20. DOI: 10.1590/S1807-59322009000200008
Source: PubMed


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.

Download full-text


Available from: Isabel C N Sacco,
38 Reads
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    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 · 2.75 Impact Factor
  • Source
    • "Sample size was calculated on the basis of the primary outcome (PP at the lateral forefoot) and was accomplished using a moderate effect size (f = 0.36). Standard deviation estimates were taken from one of the authors’ previous studies, wherein a similar patient cohort had been recruited [42]. A sample size of 46 subjects initially was calculated to detect a moderate effect difference between the highest and lowest group pressure means, with a power of 81%, an alpha level of 0.05, a statistical design of F test of repeated measures (between and within effects), and assuming a 10% loss to follow-up. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Foot musculoskeletal deficits are seldom addressed by preventive medicine despite their high prevalence in patients with diabetic polyneuropathy. To investigate the effects of strengthening, stretching, and functional training on foot rollover process during gait. A two-arm parallel-group randomized controlled trial with a blinded assessor was designed. Fifty-five patients diagnosed with diabetic polyneuropathy, 45 to 65 years-old were recruited. Exercises for foot-ankle and gait training were administered twice a week, for 12 weeks, to 26 patients assigned to the intervention group, while 29 patients assigned to control group received recommended standard medical care: pharmacological treatment for diabetes and foot care instructions. Both groups were assessed after 12 weeks, and the intervention group at follow-up (24 weeks). Primary outcomes involved foot rollover changes during gait, including peak pressure (PP). Secondary outcomes involved time-to-peak pressure (TPP) and pressure-time integral (PTI) in six foot-areas, mean center of pressure (COP) velocity, ankle kinematics and kinetics in the sagittal plane, intrinsic and extrinsic muscle function, and functional tests of foot and ankle. Even though the intervention group primary outcome (PP) showed a not statistically significant change under the six foot areas, intention-to-treat comparisons yielded softening of heel strike (delayed heel TPP, p=.03), better eccentric control of forefoot contact (decrease in ankle extensor moment, p<.01; increase in function of ankle dorsiflexion, p<.05), earlier lateral forefoot contact with respect to medial forefoot (TPP anticipation, p<.01), and increased participation of hallux (increased PP and PTI, p=.03) and toes (increase in PTI, medium effect size). A slower COP mean velocity (p=.05), and an increase in overall foot and ankle function (p<.05) were also observed. In most cases, the values returned to baseline after the follow-up (p<.05). Intervention discreetly changed foot rollover towards a more physiological process, supported by improved plantar pressure distribution and better functional condition of the foot ankle complex. Continuous monitoring of the foot status and patient education are necessary, and can contribute to preserving the integrity of foot muscles and joints impaired by polyneuropathy. Trial registration: Identifier: NCT01207284, registered in 20th September 2010.
    BMC Musculoskeletal Disorders 04/2014; 15(1):137. DOI:10.1186/1471-2474-15-137 · 1.72 Impact Factor
Show more