Plantar Loading Reflects Ulceration Risks of Diabetic Foot with Toe Deformation

Abstract

Diabetes has been one of the most common chronic diseases all over the world. The purpose of this study was to quantitatively assess the foot loading characteristics of diabetic patients with fifth-toe deformity through a comparative analysis with diabetic patients with healthy and normal feet. Six neuropathic diabetic female subjects with the fifth-toe deformation and six age-matched neuropathic diabetic controls without any feet deformities participated in the walking test. Dynamic barefoot plantar pressure was measured with Novel EMED force plate. Peak pressure and pressure-time integral for all 7 foot regions (rearfoot, midfoot, lateral forefoot, central forefoot, medial forefoot, great toe, and other toes) were collected. Peak pressure was significantly higher in the patients with toe deformity in rearfoot, central forefoot, and great toe regions compared with the control group. Meanwhile, loading sustaining period extended longer in great toe region of deformed group than in that of the control group, and the center of pressure was nearly in the big toe region during toe offstage. Diabetic patients with fifth-toe deformity could have plantar contact area reduction in the other toes part and increased loading to the great toe part. The result showed that fifth-toe deformity was associated with potential ulceration risk especially in hallux region.

Effects of walking speeds and durations on the plantar pressure gradient and pressure gradient angle

“…The CoP progression is a path formed by a series of coordinates passing from the hindfoot through to the forefoot during the stance phase [ 47 ]. CoP trajectory time progress in the medial forefoot region is near terminal stance (60% to 90%) of walking stance time [ 48 ]. The giant CoP medial–lateral displacement is believed to be an adaptation strategy and the redistributed plantar pressure [ 49 , 50 ], especially to the medial forefoot regions [ 49 , 51 ].…”

Effects of contoured insoles with different materials on plantar pressure offloading in diabetic elderly during gait

“…Calibration was conducted according to the manufacturer instructions before each trial. Pedar sensors of the appropriate size were inserted into the shoes and placed on the top of the insoles, after which the participants underwent a biomechanical plantar pressure analysis in five conditions (i.e., barefoot, and using the four different insoles) on a straight 10 m walkway with self-selected walking speed to perform their normal gait characteristic 8 , their average walking speed was 6.1 ± 1.2 m/s. For barefoot condition, the proper size Pedar sensors were attached with plantar and fixed by sock wearing without shoes.…”

Toward improved understanding of foot shape, foot posture, and foot biomechanics during running: A narrative review

“…For example, foot types (mainly, normal, planus, and cavus feet) ( Buldt et al, 2015a ), foot posture (mainly, normal, pronated, and supinated feet) ( Hollander et al, 2019 ), toe morphology ( Mei et al, 2015a ), hallux valgus ( Hannah et al, 2016 ), and manipulated forefoot shapes (abducted hallux versus adducted hallux) ( Mei et al, 2016 ; Xiang et al, 2020a ; Xiang et al, 2020b ) have been previously reported in the literature. Pathological conditions, such as diabetic-related foot deformities ( Guiotto et al, 2013 ; Lu et al, 2015 ) can also influence the biomechanics. Figure 1 outlines the most common popular shape metrics ( Figure 1 ) and postures in the foot ( Figure 1 and Figure 2 ) with highlighted regions of variations in pronation (blue) and supination (red) when compared to those of the neutral foot posture.…”

“…Computational modeling of the foot ( Morales-Orcajo et al, 2016 ) revealed a higher concentrated von Mises stress at the metatarsals and higher contact pressure in the first metatarsophalangeal joint ( Zhang et al, 2018c ). Furthermore, the diabetic foot presented toe deformation with focalized pressure at the hallux ( Lu et al, 2015 ). Habitually, barefoot populations with increased hallux spacing have been associated with active gripping function ( Lambrinudi, 1932 ; Wallden, 2016 ), which expands the supporting area in the forefoot ( Mei et al, 2015a ; Mei et al, 2015b ; Shu et al, 2015 ; Wang et al, 2016 ) and higher medial longitudinal arch in the barefoot children’s cohorts ( Hollander et al, 2017 ).…”