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.

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Available from: Isabel C N Sacco
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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.
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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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    • "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. "
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