Sacco Isabel C N, Bacarin Tatiana A, Gomes Aline A, Picon Andreja P, Cagliari Mariana F
Laboratório de Biomecânica do Movimento e Postura Humana, Depto. Fisioterapia, Fonoaudiologia e Terapia Ocupacional Universidade de São Paulo, São Paulo, Brasil; Email:
Wounds. 2010 Apr;22(4):94-9.
Background. Foot deformities have been related to diabetic neuropathy progression but their influence on plantar distribution during dynamic tasks is not completely understood. The purpose of the present study was to investigate the influence of metatarsal head prominence and claw toes on regional plantar pressures during gait in patients with diabetic neuropathy.
Seventy-one adults participated in this study categorized into three groups: a control group (CG, n = 32), patients with diabetic neuropathy without any foot deformities (DG, n = 20), and patients with diabetic neuropathy with metatarsal head prominence and/or claw toes (DMHG, n = 19). Plantar pressure variables (contact area, peak pressure, and maximum mean pressure) were evaluated during gait on rearfoot, midfoot, and forefoot using capacitive insoles (Pedar-X System, Novel Inc., Munich, Germany). A general linear model was applied to repeatedly measure and analyze variance relationships between groups and areas.
DMHG presented larger contact areas at the forefoot and midfoot along with higher peak pressure at the rearfoot compared to the other two groups. The DG showed higher mean pressure at the midfoot compared to the other two groups.
The coexistence of diabetic neuropathy and metatarsal head prominence in addition to claw toes resulted in overloading the rearfoot and enhancing the contact area of forefoot and midfoot while walking. This plantar pressure distribution is a result of a different coordination pattern adopted in order to reduce plantar loads at the anterior parts of the foot that were structurally altered. Patients with diabetic neuropathy without any forefoot deformities presented a different plantar pressure distribution than patients with deformities suggesting that both neuropathy and structural foot alterations can influence foot rollover mechanisms.
背景。足部畸形与糖尿病神经病变进展相关，但它们在动态任务中对足底压力分布的影响尚未完全明确。本研究的目的是调查糖尿病神经病变患者中跖骨头突出和爪形趾对步态期间区域足底压力的影响。
71名成年人参与了本研究，分为三组：对照组（CG，n = 32）、无任何足部畸形的糖尿病神经病变患者（DG，n = 20）以及患有跖骨头突出和/或爪形趾的糖尿病神经病变患者（DMHG，n = 19）。使用电容式鞋垫（Pedar-X系统，德国慕尼黑Novel公司）在步态期间评估后足、中足和前足的足底压力变量（接触面积、峰值压力和最大平均压力）。应用一般线性模型对组间和区域间的方差关系进行重复测量和分析。
与其他两组相比，DMHG在前足和中足的接触面积更大，后足的峰值压力更高。与其他两组相比，DG在中足的平均压力更高。
糖尿病神经病变与跖骨头突出以及爪形趾并存导致行走时后足负荷过重，并增加了前足和中足的接触面积。这种足底压力分布是为了减少足部前部结构改变部位的足底负荷而采用的不同协调模式的结果。无任何前足畸形的糖尿病神经病变患者呈现出与有畸形患者不同的足底压力分布，这表明神经病变和足部结构改变均可影响足部滚动机制。
