Biomechanical Profile of People with Diabetic Neuropathy Attended in Primary Care In East Paulista, Brazil

Abstract

Diabetic neuropathy is one of the main complications of Diabetes Mellitus, which can lead to loss of protective sensation, motor alteration, in plantar pressure, generating deformities, abnormal gait and mechanical trauma to the feet. OBJECTIVEto evaluate the distribution of plantar pressure, sensory, motor changes and balance in people with peripheral diabetic neuropathy. METHODCross-sectional study conducted with individuals registered in the municipal public health network of a city in the east of São Paulo - Brazil, with Diabetes Mellitus and Peripheral Neuropathy identified by the Michigan Screening Instrument, sensory-motor changes by the International Consensus, static and dynamic assessments of plantar pressure using Baropodometry with BaroScan and balance using the Berg scale. RESULTSOf the 200 individuals evaluated, 52.55% had no plantar protective sensitivity, the static evaluation did not identify changes in the peak of plantar pressure, however in the dynamics the average in the right foot was 6.08 (± 2) kgf / cm2 and 6 , 7 (± 1.62) kgf / cm2 on the left foot, the center of static pressure on the right foot was lower (10.55 ± 3.82) than on the left foot (11.97 ± 3.90), pointing hyper plantar pressure. The risk of falling was high, ranging from 8 to 56 points, with an average of 40.96 (± 10.77). CONCLUSIONThe absence of protective plantar sensitivity, increased pressure, biomechanical changes lead to loss of balance and are predictive of complications in the feet due to diabetic neuropathy.

Effectiveness of Rebounder and Foot-ankle Exercises on Biomechanics and Quality of Life in Peripheral Neuropathy Patients

“…These results were consistent with the findings of Kankanasamut et al [29], Sartor et al [31], Fayed et al [32], Cerrahoglu et al [33], Jorgetto et al [8], Jiang et al [3], Prokai et al [1], de Oliveira Lima et al [34], and Monterio et al [10]. Kankanasamut et al [29] demonstrated that eight weeks of weight-bearing exercises increases vibration perception.…”

“…The development of diabetic peripheral neuropathy impairs the integrity of tiny joints and internal muscles of the feet which are the main causes of deformity and high plantar pressures [5][6][7][8][9][10]. Improving the feeling of the soles of the feet and the perception of vibration is one of the changes that have been reported as a result of some exercise activities.…”

“…Lower limb injuries account for about 20% of the causes of hospitalization in people with diabetes, and 85% are attributable to amputation of the lower limb in patients with diabetes before the development of a wound, the main factors associated with which are foot deformity and trauma. Sensorimotor neuropathy, one of DPN's symptoms, causes a gradual loss of tactile sensation and pain sensitivity, often known as the loss of protective sensation of the feet, which makes the feet more vulnerable to damage and increases the risk of ulceration [8]. More than half of diabetic neuropathy patients experience severe pain that interferes with work and social activities.…”

“…Such abnormalities result in pressure point changes in the soles of the feet, as well as overload and skin reactions with localized hyperkeratosis (callus), which escalates to sole ulcers with continued walking. Healthy people have a higher plantar pressure peak in the posterior area of the foot (up to 6 kg/cm 2 ) in static conditions; however, people with DPN may have different balance and plantar load distribution, which causes an increase in plantar pressure in some areas of the foot and damage to other areas, making them prone to injury [8].…”