School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, PO Box 127, Ourimbah, NSW, 2258, Australia.
Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia.
J Foot Ankle Res. 2021 Oct 27;14(1):56. doi: 10.1186/s13047-021-00494-4.
High plantar pressures are associated with increased foot ulcer risk in people with diabetes. Identification of high plantar pressures in people with diabetes is clinically challenging due to time and cost constraints of plantar pressure testing. Factors affecting foot biomechanics, including reduced joint range of motion and foot deformity, are implicated in the development of high plantar pressures and may provide a method to clinically identify those at risk of pressure related complications. The aim of this study was to investigate the contribution of joint range of motion and foot deformity measures on plantar pressures in a community dwelling group with diabetes.
Barefoot (Tekscan HR Mat™) and in-shoe (Novel Pedar-X®) plantar pressure variables, weight bearing ankle dorsiflexion, hallux range of motion, lesser toe deformities and hallux abductus (HAV) scale were assessed in 136 adults with diabetes (52.2% male; mean age 68.4 years). Multivariate multiple linear regression was used to assess the effect of the four biomechanical factors plus neuropathy and body mass index on plantar pressure variables. Non-parametric bootstrapping was employed to determine the difference in plantar pressure variables for participants with two or more foot biomechanical pathologies compared to those with less than two pathologies.
Almost one third (32%) of the cohort had two or more foot biomechanical pathologies. Participants with two or more foot biomechanical pathologies displayed significant increases in all barefoot plantar pressure regions (except forefoot), compared to those with less than two pathologies. No significant changes were found for the in-shoe plantar pressure variables. The regression model explains between 9.9% (95%CI: 8.4 to 11.4%) and 29.6% (95% CI: 28.2 to 31%), and between 2.5% (1.0 to 4.0%) and 43.8% (95% CI: 42.5-44.9%), of the variance in the barefoot and in-shoe plantar pressure variables respectively.
Participants presenting with two or more factors affecting foot biomechanics displayed higher peak pressures and pressure time integrals in all foot regions compared to those with less than two factors. The tests used in this study could help clinicians detect elevated plantar pressures in people with diabetes and present an opportunity for early preventative interventions.
高足底压力与糖尿病患者足部溃疡风险增加有关。由于足底压力测试受到时间和成本的限制，因此对于糖尿病患者来说，识别高足底压力具有临床挑战性。影响足部生物力学的因素，包括关节活动范围减小和足部畸形，与高足底压力的发展有关，并且可能为临床识别有压力相关并发症风险的患者提供一种方法。本研究的目的是探讨在社区居住的糖尿病患者中，关节活动范围和足部畸形测量值对足底压力的贡献。
在 136 名患有糖尿病的成年人（52.2%为男性；平均年龄 68.4 岁）中评估了赤脚（Tekscan HR Mat™）和穿鞋（Novel Pedar-X®）足底压力变量、承重踝关节背屈、大脚趾活动范围、小趾畸形和大脚趾外展（HAV）量表。使用多元多线性回归评估了四个生物力学因素加上神经病和体重指数对足底压力变量的影响。采用非参数引导法确定了有两种或多种足部生物力学病理的参与者与少于两种病理的参与者之间的足底压力变量差异。
将近三分之一（32%）的队列有两种或多种足部生物力学病理。与少于两种病理的参与者相比，有两种或多种足部生物力学病理的参与者在所有赤脚足底压力区域（前足除外）均显示出明显的压力增加。穿鞋的足底压力变量没有发现显著变化。回归模型解释了 9.9%（95%CI：8.4-11.4%）至 29.6%（95%CI：28.2-31%）之间的差异，以及 2.5%（1.0-4.0%）至 43.8%（95%CI：42.5-44.9%）之间的差异，分别用于赤脚和穿鞋的足底压力变量。
与少于两种因素的参与者相比，出现两种或多种影响足部生物力学的因素的参与者在所有足部区域的峰值压力和压力时间积分均较高。本研究中使用的测试可以帮助临床医生检测糖尿病患者的高足底压力，并为早期预防性干预提供机会。
