Plantar pressure distribution patterns of individuals with prediabetes in comparison with healthy individuals and individuals with diabetes

Effect of Exercises for Strengthening the Intrinsic Muscles of the Foot and Improving Ankle Mobility on Patients of Diabetic Peripheral Neuropathy

Background and objectives The study aimed to compare the efficacy of standard home care versus structured ankle mobility exercises in enhancing ankle and foot joint range of motion (ROM) among individuals with diabetes mellitus (DM). Additionally, it investigated the impact of foot intrinsic muscle strengthening exercises on hallux grip force in those with Diabetic Peripheral Neuropathy (DN). Materials and methods In a study of 200 patients with Diabetic Neuropathy (DN), selected from 345 screened diabetics with stable glucose levels and routine monitoring at a tertiary care facility, the efficacy of structured exercises versus standard care was evaluated. Participants, aged 40-70 years with mild neuropathic symptoms (neuropathy disability score of 3 to 5), were divided into two groups. Group 1 received standard care per International Diabetic Foot guidelines, while Group 2 performed targeted foot intrinsic muscle strengthening and ankle mobility exercises over eight weeks. The range of motion (ROM) for ankle and first metatarsophalangeal (MTP) joints and hallux grip force were measured, showing significant improvements in Group 2. Analysis was done using IBM SPSS. Results The average age of the individuals in group 1 (n=100) was 53.87±5.42 years, whereas the average age of the subjects in group 2 (n=100) was 54.23±4.69 years. The study included a total of 97 male participants, with 48 in group 1 and 49 in group 2. The groups exhibited homogeneity in terms of age, gender, duration of DM, and BMI (p>,0.05). When comparing the ROM for ankle dorsiflexion between the groups, it was shown that subjects in group 2 had a substantially higher ROM following exercise for both the right (27.97°±5.3° Vs 19.24°±2.54°) and left (28.55°±4.61° Vs 18.22°±1.14°) ankles compared to the patients in group 1 (p<,0.01). Nevertheless, there were statistically insignificant differences (p>,0.05) observed within the groups, both before and after the exercises, for all the variables examined except for right and left ankle dorsiflexion, and right ankle plantarflexion in group 2. Group 2 subjects exhibited a considerably greater hallux grip force compared to group 1 subjects. The mean enhanced paper grip strength for the right and left big toe of group 2 was 44±3.58 N and 43.2±2.62 N respectively. The mean enhanced paper grip force for the right and left big toe of group 1 was 38±3.11 N and 37.92±2.13 N respectively. A statistically highly significant difference was observed for hallux grip force between the groups (p<,0.01). Conclusion The findings of this study suggest that performing the foot intrinsic muscle strengthening and ankle mobility exercises on the foot and ankle joints can potentially enhance ROM and hallux grip force in patient groups with DN.

Evaluating the Balancing Ability of Older Adults with Diabetes Mellitus Using the Multi-directional Reach Test

BACKGROUND

The incidence of elderly people experiencing falls is currently increasing, which results in serious medical issues, such as fear of falling, limited physical activity, disability, and bone fractures, especially hip fractures. This study aimed to investigate balancing ability using a multi-directional reach test (MDRT) in older adults with and without diabetes mellitus.

METHODS

72 older adults with and without diabetes mellitus were recruited, and divided into two groups, including older adults without diabetes mellitus (n = 36) and older adults with diabetes mellitus (n = 36). All subjects completed all directions of the MDRT.

RESULTS

There were no significant differences in MDRT scores in all directions between the two groups (p>0.05). Both groups achieved the highest MDRT scores in the forward direction. In contrast, the two groups had the lowest scores of MDRT in a backward direction. Furthermore, older adults with diabetes mellitus had lower MDRT scores in all directions than older adults without diabetes mellitus.

CONCLUSION

The current study indicated that MDRT could be used to investigate the ability of balance in individuals with diabetes mellitus.

Effective and clinically relevant optimisation of cushioning stiffness to maximise the offloading capacity of diabetic footwear

INTRODUCTION

Optimising the cushioning stiffness of diabetic footwear/orthoses can significantly enhance their offloading capacity. This study explores whether optimum cushioning stiffness can be predicted using simple demographic and anthropometric parameters.

METHODS

Sixty-nine adults with diabetes and loss of protective sensation in their feet were recruited for this cross-sectional observational study. In-shoe plantar pressure was measured using Pedar® for a neutral diabetic shoe (baseline) and after adding cushioning footbeds of varying stiffness. The cushioning stiffness that achieved maximum offloading was identified for each participant. The link between optimum cushioning stiffness and plantar loading or demographic/anthropometric parameters was assessed using multinomial regression.

RESULTS

People with higher baseline plantar loading required stiffer cushioning materials for maximum offloading. Using sex, age, weight, height, and shoe-size as covariates correctly predicted the cushioning stiffness that minimised peak pressure across the entire foot, or specifically in the metatarsal heads, midfoot and heel regions in 70%, 72%, 83% and 66% of participants respectively.

CONCLUSIONS

Increased plantar loading is associated with the need for stiffer cushioning materials for maximum offloading. Patient-specific optimum cushioning stiffness can be predicted using five simple demographic/anthropometric parameters. These results open the way for methods to optimise cushioning stiffness as part of clinical practice.

Immediate Effects of Weight-Bearing Calf Stretching on Ankle Dorsiflexion Range of Motion and Plantar Pressure During Gait in Patients with Diabetes Mellitus

High plantar pressure is a risk factor for diabetic foot ulcers, and it is known that restriction of ankle dorsiflexion range of motion (ROM) causes high plantar pressure. Stretching is a non-invasive and general means to improve ROM; however, the effect of stretching on the ROM and plantar pressure has not been clarified in patients with diabetes mellitus. We aimed to study the effects of intermittent weight-bearing stretching on ankle dorsiflexion ROM and plantar pressure during gait in patients with diabetes mellitus. Seven patients with diabetes mellitus participated, and their triceps surae was stretched using weight-bearing stretching with a stretch board. Five minutes of stretching was performed 4 times with a rest interval of 30 s. Ankle dorsiflexion ROM was measured with the knee flexed and extended. Peak pressure and pressure-time integral during gait were measured and calculated for the rearfoot, midfoot, forefoot, and total plantar surface before and after stretching. Ankle dorsiflexion ROM with the knee extended or bent increased significantly after stretching (P < .05). Peak pressure and the pressure-time integral decreased significantly, especially in the forefoot (P < .01), and these also decreased significantly in the total plantar surface (P < .05). The duration of foot-flat decreased after stretching (P < .05). Weight-bearing stretching improved ankle dorsiflexion ROM and reduced plantar pressure during gait. These results suggest that weight-bearing calf stretching may be an effective means to prevent and treat diabetic foot ulcers.

Effect of Sensor Size, Number and Position under the Foot to Measure the Center of Pressure (CoP) Displacement and Total Center of Pressure (CoPT) Using an Anatomical Foot Model

Ambulatory instrumented insoles are widely used in real-time monitoring of the plantar pressure in order to calculate balance indicators such as Center of Pressure (CoP) or Pressure Maps. Such insoles include many pressure sensors; the required number and surface area of the sensors used are usually determined experimentally. Additionally, they follow the common plantar pressure zones, and the quality of measurement is usually strongly related to the number of sensors. In this paper, we experimentally investigate the robustness of an anatomical foot model, combined with a specific learning algorithm, to measure the static displacement of the center of pressure (CoP) and the center of total pressure (CoPT), as a function of the number, size, and position of sensors. Application of our algorithm to the pressure maps of nine healthy subjects shows that only three sensors per foot, with an area of about 1.5 × 1.5 cm², are needed to give a good approximation of the CoP during quiet standing when placed on the main pressure areas.

Prediction of Diabetes Mellitus Progression Using Supervised Machine Learning

Diabetic peripheral neuropathy (DN) is a serious complication of diabetes mellitus (DM) that can lead to foot ulceration and eventual amputation if not treated properly. Therefore, detecting DN early is important. This study presents an approach for diagnosing various stages of the progression of DM in lower extremities using machine learning to classify individuals with prediabetes (PD; n = 19), diabetes without (D; n = 62), and diabetes with peripheral neuropathy (DN; n = 29) based on dynamic pressure distribution collected using pressure-measuring insoles. Dynamic plantar pressure measurements were recorded bilaterally (60 Hz) for several steps during the support phase of walking while participants walked at self-selected speeds over a straight path. Pressure data were grouped and divided into three plantar regions: rearfoot, midfoot, and forefoot. For each region, peak plantar pressure, peak pressure gradient, and pressure-time integral were calculated. A variety of supervised machine learning algorithms were used to assess the performance of models trained using different combinations of pressure and non-pressure features to predict diagnoses. The effects of choosing various subsets of these features on the model's accuracy were also considered. The best performing models produced accuracies between 94-100%, showing the proposed approach can be used to augment current diagnostic methods.

The influence of isometric resisted ankle strength on dynamic foot plantar pressure in diabetes and non-diabetes participants

<b>Introduction</b>: Patients with diabetes are more likely to fall due to increased plantar pressure and decreased strength in the lower extremities.<br /> <b>Objectives:</b> To determine the influence of isometric ankle strength on dynamic foot plantar pressure in diabetes and non-diabetes participants.<br /> <b>Methods: </b>Twenty diabetes patients and twenty non-diabetes participants with age 28-54 years, height 150-182 cm, weight 48-90 kg, and BMI 25-54 kg/m² participated in the study. The diabetes level was determined based on fasting plasma glucose levels. The resisted isometric muscle strength of the foot during dorsiflexion, plantar flexion, inversion, and eversion was measured using an electronic handheld dynamometer. The plantar pressure distribution during dynamic conditions was determined by using a 48.7×44.7 cm pressure platform. The outcome measures between diabetes and non-diabetes groups were statistically compared by student t-test. The correlation coefficient was determined by the Pearson correlation coefficient test. A p-value of less than 0.05 was considered significant.<br /> <b>Result: </b>The significant differences were found between diabetes and non-diabetes participants for the dorsiflexion (p=.048), plantarflexion (p=.031), inversion (p=.011), eversion (p=.024), peak pressure (p=.024), pressure per square inch (p=.012), pressure time integral (p=.014), and peak pressure gradient (p=.009). Significant relationships between resisted isometric ankle joint strength and foot plantar pressure for diabetes patients and non-diabetes participants were found.<br /> <b>Conclusion: </b>The present study’s findings reflect the higher frequency of plantar pressure distribution and higher muscle weakness in diabetes patients than in non-diabetes participants. These findings suggested that pressure data could help us to customize therapy strategies for patients with diabetes and prescribe a proper exercise intervention’s short-and long-term effects on gait biomechanics.

Increased exposure to loading is associated with decreased plantar soft tissue hardness in people with diabetes and neuropathy

AIMS

Literature indicates that altered plantar loading in people with diabetes could trigger changes in plantar soft tissue biomechanics which, in turn, could affect the risk for ulceration. To stimulate more research in this area, this study uses in vivo testing to investigate the link between plantar loading and tissue hardness.

METHODS

Tissue hardness and plantar pressure distribution were measured for six plantar areas in 39 people with diabetes and peripheral neuropathy.

RESULTS

Spearman correlation analysis revealed that increased pressure time integral at the 1st metatarsal-head region (r = -0.354, n = 39, P = 0.027) or at the heel (r = -0.378, n = 39, P = 0.018) was associated with reduced hardness in the same regions. After accounting for confounding parameters, generalised estimating equations analysis also showed that 10% increase in pressure time integral at the heel was associated with ≈ 1 unit reduction in hardness in the same region.

CONCLUSIONS

For the first time, this study reveals that people with diabetes and neuropathy who tend to load their feet more heavily also tend to have plantar soft tissues with lower hardness. The observed difference in tissue hardness is likely to affect the tissue's vulnerability to overload injury. More research will be needed to explore the implications of the observed association for the risk of ulceration.

Diabetes Status is Associated With Plantar Soft Tissue Stiffness Measured Using Ultrasound Reverberant Shear Wave Elastography Approach

INTRODUCTION

The purpose of this study was to investigate the association between the mechanical properties of plantar soft tissue and diabetes status.

METHOD

51 (M/F: 21/30) participants with prediabetes onset (fasting blood sugar [FBS] level > 100 mg/dL), age >18 years, and no lower limb amputation were recruited after ethical approval was granted from Pontificia Universidad Catolica del Peru ethical review board. Ultrasound reverberant shear wave elastography was used to assess the soft tissue stiffness at the 1st metatarsal head (MTH), 3rd MTH, and the heel at both feet.

RESULTS

Spearman's rank-order correlation (rho) test indicated a significant (P < .05) positive correlations between FBS level and the plantar soft tissue shear wave speed at the 1st MTH: rho = 0.402 (@400 Hz), rho = 0.373 (@450 Hz), rho = 0.474 (@500 Hz), rho= 0.395 (@550 Hz), and rho = 0.326 (@600 Hz) in the left foot and rho = 0.364 (@450 Hz) in the right foot. Mann-Whitney U test indicated a significantly (P < .05) higher shear wave speed in the plantar soft tissue with the following effect sizes (r) at the 1st MTH of the left foot at all tested frequencies: r = 0.297 (@450 Hz), r = 0.345 (@500 Hz), r = 0.322 (@550 Hz), and r = 0.275 (@600 Hz), and at the 1st MTH of right foot r = 0.286 (@400 Hz) in diabetes as compared with the age and body mass index matched prediabetes group.

CONCLUSION

An association between fasting blood sugar level and the stiffness of the plantar soft tissue with higher values of shear wave speed in diabetes versus prediabetes group was observed. This indicated that the proposed approach can improve the assessment of the severity of diabetic foot complications with potential implications in patient stratification.

Mechanical Impedance of Rat Glabrous Skin and Its Relation With Skin Morphometry

The mechanical impedance of intact and epidermis-peeled rat glabrous skin was studied at two sites (digit and sole) and at two frequencies (40 Hz and 250 Hz). The thicknesses of skin layers at the corresponding regions were measured histologically from intact- and peeled-skin samples in every subject. Compared to intact sole skin, digital rat skin has thicker layers and higher mechanical resistance, and it is less stiff. The resistance of the skin significantly decreased after epidermal peeling at both the digit and the sole. Furthermore, peeling caused the reactance to become positive due to inertial effects. As the frequency was increased from 40 to 250 Hz, the resistance and stiffness also increased for the intact skin, while the peeled skin showed less frictional (i.e., resistance) but more inertial (i.e., positive reactance) effects. We estimated the mechanical properties of epidermis and dermis with lumped-element models developed for both intact and peeled conditions. The models predicted that dermis has higher mass, lower stiffness, and lower resistance compared to epidermis, similar to the experimental impedance results obtained in the peeled condition which consisted mostly of dermis. The overall impedance was simulated more successfully at 40 Hz. When both frequencies are considered, the models produced consistent results for resistance in both conditions. The results imply that most of the model parameters should be frequency-dependent and suggest that mechanical properties of epidermis can be related to its thickness. These findings may help in designing artificial skin for neuroprosthetic limbs.

Plantar Pressure Distribution Among Diabetes and Healthy Participants: A Cross-sectional Study

Background:

Plantar Pressure distribution refers to the distribution of force over the sole of the foot. Recently many studies indicate plantar pressure distribution assisted in determining and managing the impairment related to musculoskeletal disorders.

Methods:

This cross-sectional study was conducted with forty participants (20 diabetes type 2 patients +20 healthy) from Imam Abdulrahman bin Faisal University. All the measurements were taken in the morning session. To measure height and weight, participants took off their shoes and stood on the stadiometer. The body mass index determined with the help of a bioelectric impedance device to get the health level of the participants—Proclaimed diabetes type 2 patients selected for the data collection. Tekscan's Mobile Mat was used to determine the plantar pressure of healthy and diabetes participants.

Results:

The finding revealed that diabetes participants have more pressure in the mid-foot section, whereas healthy participants showed more pressure on the heel section. The metatarsal section showed similar types of pressure distribution in both participants. The result also revealed that diabetes participants have more peak pressures, time integral, and gradient than healthy participants. Significant differences between diabetes and healthy participants were existing.

Conclusions:

The findings highlight the importance of measuring plantar pressure distribution since these are known to incorporate in the main parts of the foot and thus provide a shred of constructive evidence for the total load exposer of a single leg static task.

A novel concept for low-cost non-electronic detection of overloading in the foot during activities of daily living

Identifying areas in the sole of the foot which are routinely overloaded during daily living is extremely important for the management of the diabetic foot. This work showcases the feasibility of reliably detecting overloading using a low-cost non-electronic technique. This technique uses thin-wall structures that change their properties differently when they are repeatedly loaded above or below a tuneable threshold. Flexible hexagonal thin-wall structures were produced using three-dimensional printing, and their mechanical behaviour was assessed before and after repetitive loading at different magnitudes. These structures had an elastic mechanical behaviour until a critical pressure (P _crit = 252 kPa ± 17 kPa) beyond which they buckled. Assessing changes in stiffness after simulated use enabled the accurate detection of whether a sample was loaded above or below P _crit (sensitivity = 100%, specificity = 100%), with the overloaded samples becoming significantly softer. No specific P _crit value was targeted in this study. However, finite-element modelling showed that P _crit can be easily raised or lowered, through simple geometrical modifications, to become aligned with established thresholds for overloading (e.g. 200 kPa) or to assess overloading thresholds on a patient-specific basis. Although further research is needed, the results of this study indicate that clinically relevant overloading could indeed be reliably detected without the use of complex electronic in-shoe sensors.

Interobserver Agreement of the Static Methods of Evaluating the Types of Footprint in Runners

Objective  To evaluate the accuracy of interobserver diagnostic methods of the type of footprint among running athletes using three evaluation methods: physical examination, podoscopy, and baropodometry compared with radiographic measurement of Meary angles and calcaneal pitch.

Methods  This is a cross-sectional study of athletes who practice running. The inclusion criteria were: individuals with minimum age of 18 years and maximum age of 65, male or female, healthy and without comorbidities that interfere with running performance; regular practitioners who run at least twice a week; body mass index between 18.5 and 29.99 Kg/m ² ; acceptance of the written informed consent form (WICF). The non-inclusion criteria included: presence of previous or active injuries that compromise sports activity; previous foot surgeries; obesity. Forty patients were selected, 29 (72.5%) male and 11 (27.5%) female, whose mean age was 39 years (minimum 19 years and maximum 61 years). The body mass index (BMI) of the 40 patients ranged from 21.00 to 29.99 kg/m ² (mean 25.48 kg/m ² with standard deviation of 2.39 kg/m ² and a median of 25.50 kg/m ² ). We excluded those with values above 29.99. Running frequency ranged from 2 to 5 times per week (average 3.13 times per week, with standard deviation of 0.79 times per week and median of 3 times per week). Physical examination, podoscopy, and baropodometry were performed, and their evaluation was made by 4 examiners. Additionally, the results were compared with the radiographic classification of the footprint type obtained by measuring the Meary angles and the calcaneal pitch.

Results  The interobserver agreement of these parameters was verified by the weighted Kappa agreement index, in which we obtained a significant agreement between the participants considering physical examination, podoscopy, and baropodometry, and according to the Kappa index. The agreement was marginal when comparing the results of the three methods with the radiographic angular classification.

Conclusion  We obtained excellent agreement among observers when considering physical examination, podoscopy, and baropodometry for the diagnosis of the footprint type among runners. However, when comparing the results obtained with the radiographic measurements, the agreement for the diagnosis of footprint type was low.

Effectiveness of a Combined Intervention on Psychological and Physical Capacities of Frail Older Adults: A Cluster Randomized Controlled Trial

BACKGROUND

Older adults experience physical and psychological declines affecting independency. Adapted and structured combined interventions composed of cognitive stimulation and physical exercise contribute to comorbidities' reduction. Methods: Multicenter single-blinded two-arm cluster randomized controlled trial conducted to assess effectiveness of a combined intervention (CI), composed of a cognitive stimulation program (CSP) and a physical exercise program (PEP), on psychological and physical capacities of frail older adults as to on their activities of daily living. Were recruited 50 subjects from two elderly end-user organizations. Of these, 44 (65.9% females, mean age of 80.5 ± 8.47 years) were considered eligible, being randomly allocated in experimental (EG) or control group (CG). Data collected at baseline and post-intervention. EG received CI three times a week during 12 weeks. CG received standard care. Non-parametric measures were considered. Results: At baseline, groups were equivalent for study outcomes. The comparison of pre- and post-intervention data revealed that subjects receiving CI reduced depressive symptomatology and risk of fall based on gait and balance, and improved gait speed. Simultaneously, in the CG a significant decline on activities of daily living was observed. Significant results were found among biomechanical parameters of gait (BPG). EG' effect size revealed to be small (0.2 ≤ r < 0.5). CG' effect size was also small; but for activities of daily living there was an evident decrease. Conclusion: The CI is effective on managing older adults' psychological and physical capacities.

The influence of population characteristics and measurement system on barefoot plantar pressures: A systematic review and meta-regression analysis

BACKGROUND

The measurement of plantar pressure distributions during gait can provide insights into the effects of musculoskeletal disease on foot function. A range of hardware, software, and protocols are available for the collection of this type of data, with sometimes disparate and conflicting results reported between individual studies. In this systematic review and meta-regression analysis of dynamic regional peak pressures, we aimed to test if 1) the system used to obtain the pressure measurements and 2) the characteristics of the study populations had a significant effect on the results.

METHODS

A systematic review of the literature was undertaken to identify articles reporting regional peak plantar pressures during barefoot walking. A mixed-effects modeling approach was used to analyze the extracted data. Initially, the effect of the system used to collect the data was tested. Following this, the effect of participant characteristics on the results were analyzed, using moderators of cohort type (defined as the primary health characteristic of the participants), age, sex, and BMI.

RESULTS

115 participant groups were included in the analysis. Sufficient cohorts were available to test those that consisted of healthy individuals, and those with diabetes and diabetic neuropathy. Significant differences were found between results reported by studies using different pressure measurement systems in 8 of the 16 regions analyzed. The analysis of participant characteristics revealed a number of significant relationships between regional peak pressures and participant characteristics, including: BMI and midfoot plantar pressures; elevated forefoot pressures as a result of diabetic neuropathy; and sex-differences in regional loading patterns.

CONCLUSIONS

At the level of the literature, we confirmed significant effects of disease status, age, BMI, and sex on regional peak plantar pressures. Researchers and clinicians should be aware that measurements of peak plantar pressure variables obtained from different collection equipment are not directly comparable.

Significance of prediabetes as a nosological entity

Prediabetes is a glucose metabolism disorder considered as a distinct nosological entity which strongly predicts the development of type 2 diabetes mellitus. This nosological entity itself is a serious condition indicating an increased risk of atherosclerotic and oncological complications. In patients with prediabetes, other components of metabolic syndrome are usually present, such as arterial hypertension, obesity or dyslipidaemia, further increasing an individual's risk of morbidity and mortality. Prediabetes is a long-developing disorder which offers enough time for early diagnosis and intervention; it may even be reversible. This review summarizes current knowledge on the definition, detection, epidemiology, cardiovascular and other consequences of prediabetes. It also gives suggestions for future research, along with recommendations for clinical practice.

Modulation of plantar pressure and gastrocnemius activity during gait using electrical stimulation of the tibialis anterior in healthy adults

High plantar flexor moment during the stance phase is known to cause high plantar pressure under the forefoot; however, the effects on plantar pressure due to a change of gastrocnemius medialis (GM) activity during gait, have not been investigated to date. Reciprocal inhibition is one of the effects of electrical stimulation (ES), and is the automatic antagonist alpha motor neuron inhibition which is evoked by excitation of the agonist muscle. The aim of this study was to investigate the influences of ES of the tibialis anterior (TA) on plantar pressure and the GM activity during gait in healthy adults. ES was applied to the TAs of twenty healthy male adults for 30 minutes at the level of intensity that causes a full range of dorsiflexion in the ankle (frequency; 50 Hz, on-time; 10 sec, off-time; 10 sec). Subjects walked 10 meters before and after ES, and we measured the peak plantar pressure (PP), pressure time integral (PTI), and gait parameters by using an F-scan system. The percentage of integrated electromyogram (%IEMG), active time, onset time, peak time, and cessation time of TA and GM were calculated. PP and PTI under the forefoot, rear foot, and total plantar surface significantly decreased after the application of ES. Meanwhile, changes of gait parameters were not observed. %IEMG and the active time of both muscles did not change; however, onset time and peak time of GM became significantly delayed. ES application to the TA delayed the timing of onset and peak in the GM, and caused the decrease of plantar pressure during gait. The present results suggest that ES to the TA could become a new method for the control of plantar pressure via modulation of GM activity during gait.

Relationship of planter pressure and glycemic control in type 2 diabetic patients with and without neuropathy

INTRODUCTION

Foot disease is a common complication of type 2 diabetes that can have tragic consequences. Abnormal plantar pressures are considered to play a major role in the pathologies of neuropathic ulcers in the diabetic foot.

AIM

To examine Relationship of Planter Pressure and Glycemic Control in Type 2 Diabetic Patients with and without Neuropathy.

MATERIALS AND METHODS

The study was conducted on 50 type 2 diabetic patients and 30 healthy volunteers. BMI calculation, disease duration, Hemoglobin A1c and presence of neuropathy (by history, foot examination and DN4 questionnaire) were recorded. Plantar pressure was recorded for all patients using the Mat-scan (Tekscan, Inc.vers. 6.34 Boston USA) in static conditions (standing) and dynamic conditions (taking a step on the Mat-scan). Plantar pressures (kPa) were determined at the five metatarsal areas, mid foot area, medial and lateral heel areas and medial three toes.

RESULTS

Static and dynamic plantar pressures in both right and left feet were significantly higher in diabetic with neuropathy group than in control group in measured areas (P<0.05). Static and dynamic pressures in right and left feet were significantly higher in diabetic with neuropathy group than in diabetic without neuropathy group in measured areas (P<0.05). On comparison between controls and diabetic without neuropathy group there was a significant difference in plantar pressures especially in metatarsal areas (P<0.05). No significant correlations were present between the studied variables age, disease duration, BMI and HbA1c and plantar pressures in all studied areas.

CONCLUSION

Persons with diabetic neuropathy have elevated peak plantar pressure (PPP) compared to patients without neuropathy and control group. HbA1c% as a surrogate for glycemic control had no direct impact on peak planter pressure, yet it indirectly impacts neuropathy evolution through out disease duration eventually leading to the drastic planter pressure and gait biomechanics changes.

Reliability of Baropodometry on the Evaluation of Plantar Load Distribution: A Transversal Study

Introduction. Baropodometry is used to measure the load distribution on feet during rest and walking. The aim of this study was to evaluate changes in plantar foot pressures distribution due to period of working and due to stretching exercises of the posterior muscular chain. Methods. In this transversal study, all participants were submitted to baropodometric evaluation at two different times: before and after the working period and before and after stretching the muscles of the posterior chain. Results. We analyzed a total of 54 feet of 27 participants. After the working period, there was an average increase in the forefoot pressure of 0.16 Kgf/cm² and an average decrease in the hindfoot pressure of 0.17 Kgf/cm². After stretching the posterior muscular chain, the average increase in the forefoot pressure was 0.56 Kgf/cm² and the hindfoot average pressure decrease was 0.56 Kgf/cm². These changes were not statistically significant. Discussion. It was reported that the strength of the Achilles tendon generates greater forefoot load transferred from the hindfoot. In our study, no significant variation in the distribution of plantar pressure was observed. It can be inferred that baropodometry was a reliable instrument to determine the plantar pressure, regardless of the tension of the posterior chain muscles.

A Comparison of Screening Tools for the Early Detection of Peripheral Neuropathy in Adults with and without Type 2 Diabetes

OBJECTIVE

Examine the effectiveness of the 128 Hz tuning fork, two monofilaments, and Norfolk Quality of Life Diabetic Neuropathy (QOL-DN) questionnaire as tools for the early detection of diabetic peripheral neuropathy (DPN) in overweight, obese, and inactive (OOI) adults or those who have prediabetes (PD) or type 2 diabetes (T2D).

RESEARCH DESIGN AND METHODS

Thirty-four adults (mean age 58.4 years ± 12.1) were divided by glycemia (10 OOI normoglycemic, 13 PD, and 11 T2D). Sural nerves were tested bilaterally with the NC-stat DPNCheck to determine sural nerve amplitude potential (SNAP) and sural nerve conduction velocity (SNCV). All other testing results were compared to SNAP and SNCV.

RESULTS

Total 1 g monofilament scores significantly correlated with SNAP values and yielded the highest sensitivity and specificity combinations of tested measures. Total QOL-DN scores negatively correlated with SNAP values, as did QOL-DN symptoms. QOL-DN activities of daily living correlated with the right SNAP, and the QOL-DN small fiber subscore correlated with SNCV.

CONCLUSIONS

The 1 g monofilament and total QOL-DN are effective, low-cost tools for the early detection of DPN in OOI, PD, and T2D adults. The 128 Hz tuning fork and 10 g monofilament may assist DPN screening as a tandem, but not primary, early DPN detection screening tools.

Range of Motion and Plantar Pressure Evaluation for the Effects of Self-Care Foot Exercises on Diabetic Patients with and Without Neuropathy

BACKGROUND

We aimed to investigate whether a home exercise for self-care program that consists of range of motion (ROM), stretching, and strengthening exercises could improve ROM for foot joints and plantar pressure distribution during walking in diabetic patients to prevent diabetic foot complications.

METHODS

Seventy-six diabetic patients were recruited (38 with neuropathy and 38 without neuropathy). Neuropathy and nonneuropathy groups were randomly divided into a home exercise group (n = 19) and a control group (n = 19). Exercise groups performed their own respective training programs for 4 weeks, whereas no training was done in the control group. Total contact area and plantar pressure under six foot areas before and after the exercise program were measured. Ankle and first metatarsophalangeal joint ROM were measured before and after the exercise program.

RESULTS

In the exercise group, there were significant improvements in ROM for the ankle and first metatarsophalangeal joints (P < .001); static pedobarographic values showed significant reduction in right forefoot-medial pressure (P = .010); and significant decreases were seen in dynamic pedobarographic values of peak plantar pressure at the left forefoot medial (P = .007), right forefoot lateral (P = .018), left midfoot (P < .001), and right hindfoot (P = .021) after exercise. No significant positive or negative correlation was found between the neuropathy and nonneuropathy groups (P > .05).

CONCLUSIONS

A home exercise program could be an effective preventive method for improving ROM for foot joints and plantar pressure distribution in diabetic patients independent of the presence of neuropathy.

Quantitative assessment of early biomechanical modifications in diabetic foot patients: the role of foot kinematics and step width

BACKGROUND

Forefoot ulcers (FU) are one of the most disabling and relevant chronic complications of diabetes mellitus (DM). In recent years there is emerging awareness that a better understanding of the biomechanical factors underlying the diabetic ulcer could lead to improve the management of the disease, with significant socio-economic impacts. Our purpose was to try to detect early biomechanical factors associated with disease progression.

METHODS

Thirty subjects (M/F: 22/8; mean age ± SD: 61,84 ± 10 years) with diagnosis of type II DM were included. The participants were divided into 3 groups (10 subjects per group) according to the stage of evolution of the disease: Group 1, subjects with newly diagnosed type II DM, without clinical or instrumental diabetic peripheral neuropathy (DPN) nor FU (group called "DM"); Group 2, with DPN but without FU (group called "DPN"); Group 3, with DPN and FU (group called "DNU"). All subjects underwent 3-D Gait Analysis during walking at self-selected speed, measuring spatio-temporal, kinematic and kinetic parameters and focusing on ankle and foot joints. The comparative analysis of values between groups was performed using 1-way ANOVA. We also investigated group to group differences with Tukey HSD test. The results taken into consideration were those with a significance of P < 0,05. 95 % confidence interval was also calculated.

RESULTS

A progressive and significant trend of reduction of ROM in flexion-extension of the metatarso-phalangeal joint (P = 0.0038) and increasing of step width (P = 0.0265) with the advance of the disease was evident, with a statistically significant difference comparing subjects with recently diagnosed diabetes mellitus and subjects with diabetic neuropathy and foot ulcer (P = 0.0048 for ROM and P = 0.0248 for step width at Tukey's test).

CONCLUSIONS

The results provide evidence that foot segmental kinematics, along with step width, can be proposed as simple and clear indicators of disease progression. This can be the starting point for planning more targeted strategies to prevent the occurrence and the recurrence of a FU in diabetic subjects.

Variation of plantar pressure in Chinese diabetes mellitus

To investigate dynamic changes in plantar pressure in Chinese diabetes mellitus patients and to provide a basis for further preventing diabetic foot. This is a cross-sectional investigation including 649 Chinese diabetes mellitus patients (diabetes group) and 808 "normal" Chinese persons (nondiabetes group) with normal blood glucose levels. All the subjects provided a complete medical history and underwent a physical examination and a 75-g oral glucose tolerance test. All subjects walked barefoot with their usual gait, and their dynamic plantar forces were measured using the one-step method with a plantar pressure measurement instrument; 5 measurements were performed for each foot. No significant differences were found in age, height, body weight, or body mass index between the two groups. The fasting blood glucose levels, plantar contact time, maximum force, pressure-time integrals and force-time integrals in the diabetes group were significantly higher than those in the nondiabetes group (p < 0.05). However, the maximum pressure was significantly higher in the nondiabetes group than in the diabetes group (p < 0.05). No difference was found in the contact areas between the two groups (p > 0.05). The maximum plantar force distributions were essentially the same, with the highest force found for the medial heel, followed by the medial forefoot and the first toe. The peak plantar pressure was located at the medial forefoot for the nondiabetes group and at the hallucis for the diabetes group. In the diabetes group, the momentum in each plantar region was higher than that in the nondiabetes group; this difference was especially apparent in the heel, the lateral forefoot and the hallucis. The dynamic plantar pressures in diabetic patients differ from those in nondiabetic people with increased maximum force and pressure, a different distribution pattern and significantly increased momentum, which may lead to the formation of foot ulcers.