Abstract

Objective To investigate the plantar pressure distribution changes in type 2 diabetic patients with peripheral neuropathy. Methods From January 2004 to December 2009, a total of 1103 patients with type 2 diabetes were enrolled and divided into diabetic peripheral neuropathy (DPN) group (n=301) or diabetic control (DC group, without DPN) group (n=802). Demographic characteristics were recorded. The lipid profile, fasting plasma glucose (FPG), hemoglobin A1c (HbA1c) and urinary albumin excretion rate (AER) were measured. Plantar pressure was recorded with the EMED-AT system by theFirst Step Approach, and the parameters were calculated by EMED software. Independent t-test or Mann-Whitney U test was applied in the data analysis. Results The patients in the DPN group had statistically higher age, waist-to-hip ratio, systolic blood pressure, FPG, HbA1c and urinary AER as compared with those in DC group (all P 0.05). However, the contact time (CT) ((1484±412) vs (1241±281)ms, t=-9.414, P<0.05), pressure-time intergrals (PTIs) ((333±115) vs (278±89) kPa·s, t=-7.446, P<0.05) and force-time intergrals ((628±187) vs (536±149) N·s, t=-7.707, P<0.05) increased significantly in DPN group in comparison with those in DC group. Compared to DC group, the peak pressure in heel (rear foot) ((396±101) vs (411±105) kPa, t=2.163, P<0.05), the second metatarsal ((240±87) vs (269±95) kPa, t=4.563, P<0.05)or third metatarsal ((241±75) vs (262±77) kPa, t=4.046, P<0.05) decreased, while the peak pressure in foot arch (midfoot) ((122±48) vs (115±31) kPa, t=-2.487, P<0.05), the fifth metatarsal ((218±116) vs (195±99) kPa, t=-3.131, P<0.05), and the third-to-fifth toes ((108±50) vs (98±46) kPa, t=-3.315, P<0.05) increased in DNP group. The PTIs in rearfoot ((228±100) vs (189±67)kPa·s, t=-6.201, P<0.05), midfoot ((82±45) vs (66±26) kPa·s, t=-6.151, P<0.05), and in each mask of whole forefoot plantar were higher in DNP group than those in DC group. Conclusions DNP patient has an abnormal plantar pressure distribution and a longer contact time. Increasing of PTIs, induced by a synergistic effect of both plantar pressure and contact time, may play a key role in the development of diabetic foot ulcer. Key words: Diabetes mellitus, type 2; Peripheral nervous system diseases; Plantar pressure

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