Abnormalities of Foot Pressure in Early Diabetic Neuropathy

Abstract

Dynamic foot pressure has been studied in 44 diabetic subjects of mean age 52 years with no clinical evidence of neuropathy and in an age and sex matched non-diabetic control group. Vibration perception threshold (VPT), sensory (SCV), and motor conduction velocities (MCV) were also measured in the diabetic subjects. Sixteen diabetic subjects (Group A) had abnormally high pressures under the metatarsal heads (greater than 10 kg/cm2), whereas the remaining 28 diabetic subjects had normal results (Group B). The ratio of toe to metatarsal head loading (normal 0.112) was significantly reduced in Group A (0.077) compared to Group B (0.127: p less than 0.05). VPT and sural nerve SCV were also significantly abnormal in Group A subjects compared with Group B (p less than 0.005 and p less than 0.02, respectively), though there were no differences in MCV. A significant inverse correlation was obtained between toe loading and VPT. It is concluded that abnormalities of foot pressure occur in early sensory neuropathy and may precede clinical abnormalities. Assessment of the toe-loading ratio may provide a sensitive measure of motor dysfunction in early diabetic neuropathy.

The diabetic foot: from art to science. The 18th Camillo Golgi lecture

“…After our initial confirmation that plantar ulcers invariably occurred at sites of high pressure [35], we demonstrated that foot pressure abnormalities occur early in the natural history of neuropathy [51]. In a longitudinal study it was confirmed that sites of peak pressure change over time, an observation with important implications for orthotists [52].…”

Biomechanics of Pressure Ulcer in Body Tissues Interacting with External Forces during Locomotion

“…In industrialized countries, diabetes mellitus with insensitive feet is the main reason for foot pressure ulcers that could ultimately lead to lower limb amputations (5,6). Amputees wearing prosthesis need to accommodate high ambulatory loadings during their daily activities.…”

Clinical and Radiographic Predictors of Scoliosis in Patients with Myelomeningocele

“…Worse, the rates of diabetes-related amputation are increasing 1 . Diabetes-associated neuropathy, peripheral vascular disease, and infection all contribute to the process that produces ulceration and diabetic foot disease 12,[14][15][16][17][18][19][20] . Altered mechanical forces, especially high plantar pressures, are also an important factor [15][16][17][21][22][23][24][25] .…”

“…Diabetes-associated neuropathy, peripheral vascular disease, and infection all contribute to the process that produces ulceration and diabetic foot disease 12,[14][15][16][17][18][19][20] . Altered mechanical forces, especially high plantar pressures, are also an important factor [15][16][17][21][22][23][24][25] . Although a specific ulcer-producing pressure threshold has not been identified and appears to vary according to patient-related characteristics, reduction of high plantar pressure in feet that have lost protective sensation is the cornerstone of current prevention and treatment 15,17,19,20,22,26,27 .…”

“…Peak plantar pressures occur in the forefoot, at the site of skin breakdown, in individuals in whom ulcers develop 16,[22][23][24] . However, few studies have detailed the structural changes in the forefoot that produce high pressures and result in ulceration in feet with reduced sensation 22,28 .…”