Zimny Stefan, Schatz Helmut, Pfohl Martin
Evangelisches Krankenhaus Bethesda, Akademisches Lehrkrankenhaus der Universität Düsseldorf, Medizinische Klinik I, Duisburg, Germany.
Diabetes Care. 2004 Apr;27(4):942-6. doi: 10.2337/diacare.27.4.942.
To assess the role of limited joint mobility (LJM) in causing abnormal high plantar pressures in the forefoot of diabetic patients with an at-risk foot.
A total of 70 type 1 or type 2 diabetic patients and 30 control subjects participated in this cross-sectional study. Thirty-five diabetic patients with an at-risk foot, defined as a foot with neuropathy but without ulceration or previous ulceration, and 35 diabetic control subjects without neuropathy were selected for the subgroups. Joint mobility was assessed in the foot at the ankle and metatarsophalangeal I (first MTP) joints. Using the FastScan plantar pressure analyzer, the pressure-time integrals (PTIs) as dynamic variables were measured in each foot. The clinical assessment included standard measures of peripheral neuropathy.
The mobility at the ankle and first MTP joint were significantly reduced in the foot-at-risk group compared with the diabetic control group and the control subjects (P < 0.0001). The PTIs were significantly higher in the foot-at-risk group compared with the two other groups (P < 0.0001). There was a strong inverse correlation between the mobility of the ankle or first MTP joint and the PTI of the diabetic patients (r = -0.67, P < 0.0001, and r = -0.71, P < 0.0001, respectively). The vibration perception threshold was positively correlated with the PTI of the diabetic patients (r = 0.44, P = 0.0001).
Diabetic patients with an at-risk foot have reduced joint mobility and elevated PTIs on the plantar forefoot, placing them at risk for subsequent ulceration. Therefore, LJM may be a possible factor in causing high plantar pressures and may contribute to foot ulceration in the susceptible neuropathic at-risk foot.
评估关节活动受限（LJM）在患有高危足的糖尿病患者前足异常高足底压力形成中的作用。
共有70例1型或2型糖尿病患者和30名对照者参与了这项横断面研究。选择35例患有高危足的糖尿病患者（定义为患有神经病变但无溃疡或既往无溃疡的足部）和35例无神经病变的糖尿病对照者作为亚组。对足部的踝关节和第一跖趾关节（第一MTP）的关节活动度进行评估。使用快速扫描足底压力分析仪，测量每只脚作为动态变量的压力-时间积分（PTIs）。临床评估包括周围神经病变的标准测量。
与糖尿病对照组和对照者相比，高危足组的踝关节和第一MTP关节活动度显著降低（P < 0.0001）。与其他两组相比，高危足组的PTIs显著更高（P < 0.0001）。糖尿病患者踝关节或第一MTP关节的活动度与PTIs之间存在强烈的负相关（分别为r = -0.67，P < 0.0001和r = -0.71，P < 0.0001）。振动觉阈值与糖尿病患者的PTIs呈正相关（r = 0.44，P = 0.0001）。
患有高危足的糖尿病患者关节活动度降低，足底前足的PTIs升高，使他们面临随后溃疡的风险。因此，LJM可能是导致高足底压力的一个可能因素，并且可能促成易感神经病变高危足的足部溃疡。
