Comparison of Peak Plantar Pressure and Peak Pressure Gradient among Patients with Prediabetes and Diabetes

Abstract

Background: Foot ulcers are a serious complication associated with diabetes peripheral neuropathy (DPN). Diabetes foot complications associated with increased ulcer risk include: 1) decreases in plantar soft-tissue thickness, 2) increases in plantar tissue stiffness, and 3) increases in forefoot (FF) to rearfoot (RF) loading. Aim: The purpose of this study was to determine whether patients with DPN demonstrate higher forefoot to rearfoot pressures during barefoot walking compared to diabetes patients without peripheral neuropathy (DWPN) and prediabetes patients without peripheral neuropathy (PWPN). Methods: Eight PWPN, twenty-six DWPN and fourteen DPN patients participated in the study. Barefoot walking trials were performed while wearing Medilogic® pressure-measuring insoles. Peak plantar pressure (PPP) and peak pressure gradient (PPG) were measured on the right foot for the FF and RF regions. FF to RF PPP and PPG ratios were then calculated and normalized to body mass. Walking velocity was used as a co-variate for ANCOVAs. A priori statistical significance was set at α=0.05. Results: No significant interactions were observed for Group*Region for PPP (F(2, 89)=1.454, p=0.239) and PPG (F(2, 89)=0.579, p=0.563). Main effects of region revealed significantly higher FF to RF loading in both PPP (F(1, 89)=6.67, p=0.011) and PPG (F(1, 89)=4.02, p=0.048) measures driven by DWPN and DPN patients. No significant differences were observed between groups for FF to RF PPP (F(2, 44)=2.624, p=0.084) or PPG (F(2, 44)=1.331, p=0.275) ratios. Conclusion: Our findings suggest DWPN and DPN patients demonstrate a pattern of loading related to elevated foot ulcer risk. However, no significant difference was observed between groups for FF to RF PPP and PPG ratios. Inclusion of a more robust sample size will allow better testing of our hypothesis. Disclosure K. Izuora: None. M. Trabia: None. J. DeBerardinis: None. D.E. Lidstone: None. M. Varre: None. A.L. Trotter: None. J.S. Dufek: None.