Predictors of Barefoot Plantar Pressure during Walking in Patients with Diabetes, Peripheral Neuropathy and a History of Ulceration

Abstract

ObjectiveElevated dynamic plantar foot pressures significantly increase the risk of foot ulceration in diabetes mellitus. The aim was to determine which factors predict plantar pressures in a population of diabetic patients who are at high-risk of foot ulceration.MethodsPatients with diabetes, peripheral neuropathy and a history of ulceration were eligible for inclusion in this cross sectional study. Demographic data, foot structure and function, and disease-related factors were recorded and used as potential predictor variables in the analyses. Barefoot peak pressures during walking were calculated for the heel, midfoot, forefoot, lesser toes, and hallux regions. Potential predictors were investigated using multivariate linear regression analyses. 167 participants with mean age of 63 years contributed 329 feet to the analyses.ResultsThe regression models were able to predict between 6% (heel) and 41% (midfoot) of the variation in peak plantar pressures. The largest contributing factor in the heel model was glycosylated haemoglobin concentration, in the midfoot Charcot deformity, in the forefoot prominent metatarsal heads, in the lesser toes hammer toe deformity and in the hallux previous ulceration. Variables with local effects (e.g. foot deformity) were stronger predictors of plantar pressure than global features (e.g. body mass, age, gender, or diabetes duration).ConclusionThe presence of local deformity was the largest contributing factor to barefoot dynamic plantar pressure in high-risk diabetic patients and should therefore be adequately managed to reduce plantar pressure and ulcer risk. However, a significant amount of variance is unexplained by the models, which advocates the quantitative measurement of plantar pressures in the clinical risk assessment of the patient.

Foot Kinetic and Kinematic Profile in Type 2 Diabetes Mellitus with Peripheral Neuropathy

“…The regression analysis results in Table 3 suggest that pinprick sensation, ankle reflex, MNSI score, and VPT showed a significant statistical association with peak/maximum plantar pressure at dynamic gait cycle (P , .05). These findings could be supported with similar findings suggested by Barn et al 47 and Fawzy et al 48 It could be seen that MNSI score and VPT were highly significant (P ¼ .001 and .000, respectively). This demonstrates that any increase in either of them could lead to an increase in the maximum forefoot pressure.…”

“…A high-arched foot could expose the metatarsal head to higher plantar pressure and ground reaction force, thereby increasing the risk of foot ulcerations. 47 On the other hand, flatfoot (pes planus) was observed in 53 participants. The clinical confirmation of pes planus was evident from a positive navicular drop height of more than 10 mm in 17 participants.…”

Evaluation of negative-pressure wound therapy for patients with diabetic foot ulcers: systematic review and meta-analysis

“…Two studies15,22 provided the duration of DM, which could influence the peripheral neuropathy leading to the formation of DFUs 34. It was reported that body mass was significantly associated with pressure in the mid-foot models 35. Two articles calculated average weight, and another two calculated body mass index, whereas no relevant details about local pressure on the foot were provided in the remaining seven studies.…”

Pedobarography as a clinical tool in the management of diabetic feet in New Zealand: a feasibility study

“…Pedobarographic measurements provide a clinically-relevant quantification of the stress that small areas of the plantar surface are experiencing during barefoot or shod walking, and also enable identification of any abnormalities in dynamic foot structure that may be causing these elevated plantar pressures [21]. …”