Yavuz Metin
Physical Therapy, UNT Health Science Center, Fort Worth, TX 76107, USA.
Clin Biomech (Bristol). 2014 Feb;29(2):223-9. doi: 10.1016/j.clinbiomech.2013.11.003. Epub 2013 Nov 15.
The exact pathology of diabetic foot ulcers remains to be resolved. Evidence suggests that plantar shear forces play a major role in diabetic ulceration. Unfortunately, only a few manuscripts exist on the clinical implications of plantar shear. The purpose of this study was to compare global and regional peak plantar stress values in three groups; diabetic patients with neuropathy, diabetic patients without neuropathy and healthy control subjects.
Fourteen diabetic neuropathic patients, 14 non-neuropathic diabetic control and 11 non-diabetic control subjects were recruited. Subjects walked on a custom-built stress plate that quantified plantar pressures and shear. Four stress variables were analyzed; peak pressure, peak shear, peak pressure-time and shear-time integral.
Global peak values of peak shear (p = 0.039), shear-time integral (p = 0.002) and pressure-time integral (p = 0.003) were significantly higher in the diabetic neuropathic group. The local peak shear stress and shear-time integral were also significantly higher in diabetic neuropathic patients compared to both control groups, in particular, at the hallux and central forefoot. The local peak pressure and pressure-time integral were significantly different between the three groups at the medial and lateral forefoot.
Plantar shear and shear-time integral magnitudes were elevated in diabetic patients with peripheral neuropathy, which indicates the potential clinical significance of these factors in ulceration. It is thought that further investigation of plantar shear would lead to a better understanding of ulceration pathomechanics, which in turn will assist researchers in developing more effective preventive devices and strategies.
糖尿病足溃疡的确切病理学仍有待解决。有证据表明,足底剪切力在糖尿病溃疡形成中起主要作用。遗憾的是,关于足底剪切力临床意义的文献仅有少数几篇。本研究的目的是比较三组人群的整体和局部峰值足底压力值;患有神经病变的糖尿病患者、未患神经病变的糖尿病患者和健康对照者。
招募了14名患有糖尿病神经病变的患者、14名非神经病变的糖尿病对照者和11名非糖尿病对照者。受试者在定制的应力板上行走,该应力板可量化足底压力和剪切力。分析了四个应力变量;峰值压力、峰值剪切力、压力 - 时间积分和剪切力 - 时间积分。
糖尿病神经病变组的峰值剪切力(p = 0.039)、剪切力 - 时间积分(p = 0.002)和压力 - 时间积分(p = 0.003)的整体峰值显著更高。与两个对照组相比,糖尿病神经病变患者的局部峰值剪切应力和剪切力 - 时间积分也显著更高,尤其是在拇趾和前足中部。三组在前足内侧和外侧的局部峰值压力和压力 - 时间积分存在显著差异。
患有周围神经病变的糖尿病患者的足底剪切力和剪切力 - 时间积分值升高,这表明这些因素在溃疡形成中具有潜在的临床意义。据认为,对足底剪切力的进一步研究将有助于更好地理解溃疡形成的病理力学,进而有助于研究人员开发更有效的预防装置和策略。