Risk Of Foot Ulceration Research Articles

Consensus-based recommendations on physical activity and exercise in patients with diabetes at risk of foot ulcerations: a Delphi study

BackgroundPatients with diabetes mellitus are exposed to important complications. Currently little evidence exist on the guidelines that these patients, at some risk of foot ulceration, should follow for physical exercise. ObjectivesTo reach a consensus among multidisciplinary and international experts on physical activity/exercise recommendations for patients with diabetes, according to foot ulcer risk. MethodsUsing a three-round Delphi method, a panel composed of 28 multidisciplinary experts in the management of diabetic foot assessed 109 recommendations on physical activity/exercise for patients with diabetes mellitus, according to their risk of foot ulcer. Consensus was assumed when 80% of responses matched the same category (agreement/disagreement). ResultsTwenty-nine experts participated in the first and second rounds of consultation, and twenty-eight did so in the third, reaching final agreement on 86 of the 109 recommendations considered (78.9%). The study, thus, generated a consensus set of recommendations concerning different aspects of diabetic footcare before, during, and after exercise (e.g. when to examine the foot, how to assess it, what type of sock and insole to use, what types of exercise to perform, and when it is advisable to return to activity after an ulceration). ConclusionThis Delphi study generated recommendations based on the consensus of international experts on physical activity and exercise by patient with diabetes at risk of ulceration. Recommendations considered the state of the foot and the patient's history and status before physical activity and included information on intensity, duration, frequency, and progressions of physical activity/exercise, and the use of custom-made plantar orthoses, shoe prescription, and the convenience of returning to physical activity after an ulceration.

Lower Limb Arterial Ischemia: An Independent Risk Factor of Sudomotor Dysfunction in Type 2 Diabetes.

As an early manifestation of diabetic peripheral neuropathy (DPN), sudomotor dysfunction significantly increases the risk of diabetic foot ulcer. The pathogenesis of sudomotor dysfunction is still unclear. Lower limb ischemia may be related to sudomotor dysfunction, but few studies have explored it. The purpose of this study is to explore the relationship between sudomotor function and comprehensive lower limb arterial ischemia including large arteries, small arteries and microvascular in type 2 diabetes mellitus (T2DM). 511 T2DM patients were enrolled in this cross-sectional study. Sudomotor function was assessed qualitatively and quantitatively by Neuropad. Lower limb arterial ischemia was defined as any abnormality of the ankle brachial index (ABI), toe brachial index (TBI) or transcutaneous oxygen tension (TcPO2). In this study, 75.1% of patients had sudomotor dysfunction. Compared with normal sudomotor function, patients with sudomotor dysfunction had a higher incidence of lower limb arterial ischemia (51.2% vs 36.2%, p = 0.004). Similarly, compared with the non-arterial ischemia group, the proportion of sudomotor disorders was higher in the arterial ischemia group (p = 0.004). Low TBI and low TcPO2 groups also had a higher proportion of sudomotor disorders (all p < 0.05).Compare with normal groups, low ABI, low TBI, and low TcPO2 groups had lower Slop4 which quantitatively reflecting Neuropad discoloration. Arterial ischemia was an independent risk factor for sudomotor dysfunction [OR = 1.754, p = 0.024]. Low TcPO2 also independently increased the risk of sudomotor disorders [OR = 2.231, p = 0.026]. Lower limb arterial ischemia is an independent risk factor of sudomotor dysfunction. Especially below the ankle (BTA) small arteries and microvascular ischemia may also be involved in the occurrence of sudomotor disorders.

Adherence and Wearing Time of Prescribed Footwear among People at Risk of Diabetes-Related Foot Ulcers: Which Measure to Use?

Adherence to prescribed footwear is essential to prevent diabetes-related foot ulcers. The aim was to compare different measures of adherence and wearing time of prescribed footwear with a reference adherence measure, among people with diabetes at high risk of foot ulceration. We followed 53 participants for 7 consecutive days. A temperature sensor measured wearing time of prescribed footwear and a triaxial accelerometer assessed weight-bearing activities. Subjective wearing time was self-reported. Reference adherence measure was proportion of weight-bearing time prescribed footwear was worn. We calculated Spearman's correlation coefficients, kappa coefficients, and areas under the curve (AUC) for the association between the reference measure and other measures of adherence and wearing time. Proportion of daily steps with prescribed footwear worn had a very strong association (r = 0.96, Κ = 0.93; AUC: 0.96-1.00), objective wearing time had a strong association (r = 0.91, Κ = 0.85, AUC: 0.89-0.99), and subjective wearing time had a weak association (r = 0.42, Κ = 0.38, AUC: 0.67-0.81) with the reference measure. Objectively measured proportion of daily steps with prescribed footwear is a valid measure of footwear adherence. Objective wearing time is reasonably valid, and may be used in clinical practice and for long-term measurements. Subjective wearing time is not recommended to be used.

Evaluation of Risk Factors for Foot Ulceration in Individuals with Chronic Kidney Disease

Introduction. CKD, like DM, is an independent risk factor for the development and course of foot ulcers. Objective. The authors studied the incidence and risk factors of foot ulceration in patients with CKD and with or without DM and in patients receiving or not receiving HD. Materials and Methods. Patients with or without DM and with renal failure were divided into 4 groups of 40 patients each according to whether or not they were receiving HD. Data were collected using a patient information form, physical examination of the foot, and risk assessment forms. Results. Lower extremity ulceration was highest in group 3 (HD+DM+) (15% [6 of 40]), that is, in patients with CKD and DM receiving HD (P = .421). Patients in group 3 were at highest risk for foot ulcers (72.5%) compared with other groups (P = .001). Risk factors associated with foot ulceration were advanced stage (ie, stage 4 or 5) CKD, HD treatment, age, BMI, history of lower extremity ulceration and/or amputation, foot deformities, skin and nail pathology, neuropathy, and vascular insufficiency. Conclusions. Patients with CKD receiving HD are at high risk for foot ulcers, and this risk increases with the presence of DM.

Objectively assessed long-term wearing patterns and predictors of wearing orthopaedic footwear in people with diabetes at moderate-to-high risk of foot ulceration: a 12 months observational study

BackgroundOrthopaedic footwear can only be effective in preventing diabetic foot ulcers if worn by the patient. Robust data on long-term wearing time of orthopaedic footwear are not available, and needed to gain more insights into wearing patterns and associated factors (i.e. participants’ demographic, disease-related characteristics, and footwear usability). We aimed to objectively assess long-term wearing patterns and identify factors associated with wearing orthopaedic footwear in people with diabetes at moderate-to-high risk of ulceration.MethodsPeople diagnosed with diabetes mellitus type 1 and 2 with loss of protective sensation and/or peripheral artery disease and prescribed with orthopaedic footwear were included and followed for 12 months. The primary outcome was mean daily wearing time, continuously measured using a temperature sensor inside the footwear (Orthotimer®). Adherence to wearing orthopaedic footwear was calculated as percentage of wearing time of a total assumed 16 h out-of-bed daytime, where adherence < 60% was a pre-determined non-adherent threshold. Wearing time patterns were assessed by calculating participants’ wearing (in)consistency. One-way analyses of variance tested for wearing time differences between subgroups, weekdays, and weekend days. Factors potentially associated with wearing time were collected by questionnaires and medical files. Univariately associated factors were included in multivariate linear regression analysis.ResultsSixty one participants were included (mean (SD) age: 68.0 (7.4) years; females: n = 17; type 2 diabetes mellitus: n = 54). Mean (SD) overall daily wearing time was 8.3 (6.1) hours/day. A total of 40 (66%) participants were non-adherent. Participants with a consistent wearing pattern showed higher daily wearing times than participants with an inconsistent pattern. Mean (SD) wearing times were 12.7 (4.3) vs 3.6 (4.8) hours/day, respectively (P < 0.001). Mean (SD) wearing time was significantly higher (P < 0.010) during weekdays (8.7 (6.0) hours/day) compared to Saturday (8.0 (6.1) hours/day) and Sunday (6.9 (6.2) hours/day). In the multivariate model (R2 = 0.28), “satisfaction with my wear of orthopaedic footwear” was positively associated (P < 0.001) with wearing time. The other seven multivariate model factors (four demographic variables and three footwear usability variables) were not associated with wearing time.ConclusionsOnly one out of three people at moderate to high risk of foot ulceration were sufficiently adherent to wearing their orthopaedic footwear. Changing people’s wearing behaviour to a more stable pattern seems a potential avenue to improve long-term adherence to wearing orthopaedic footwear. Investigated factors are not associated with daily wearing time. Based on these factors the daily wearing time cannot be estimated in daily practice.Trial registrationNetherlands Trial Register NL7710. Registered: 6 May 2019.

Insight on development and management of neuropathic pain

Diabetic peripheral neuropathy (DPN) impacts up to 50% of diabetic people and is a major cause of illness and death. Its neuropathic symptoms, which can be painful, and insensitivity increase the risk of burns, injuries, and foot ulcers. Several recent studies have identified several risk factors for developing DPN, including obesity, poor glycemic control, diabetes duration, hyperlipidemia, impaired insulin signaling, and lipid oxidation and inflammation. Inspection of the lower limbs is necessary for the diagnosis. Anticonvulsant or tricyclic medications, which are typically used, may be needed. Peripheral neuropathy patients should be treated by a podiatrist and given preventative education since they risk developing insensate foot ulcers. A multidisciplinary approach to preventing and managing foot problems, promptly diagnosing and treating neuropathic pain, and controlling specific cardiometabolic objectives should all be included in treating patients with DPN. The concept of categorizing patients based on different aspects of their pain to enhance analgesic response is being researched, and new drugs are being developed to manage painful DPN.

Prediction of Foot Ulcers Using Artificial Intelligence for Diabetic Patients at Cairo University Hospital, Egypt.

In Egypt, diabetic foot ulcers markedly contribute to the morbidity and mortality of diabetic patients. Accurately predicting the risk of diabetic foot ulcers could dramatically reduce the enormous burden of amputation. The aim of this study is to design an artificial intelligence-based artificial neural network and decision tree algorithms for the prediction of diabetic foot ulcers. A case-control study design was utilized to fulfill the aim of this study. The study was conducted at the National Institute of Diabetes and Endocrine Glands, Cairo University Hospital, Egypt. A purposive sample of 200 patients was included. The tool developed and used by the researchers was a structured interview questionnaire including three parts: Part I: demographic characteristics; Part II: medical data; and Part III: in vivo measurements. Artificial intelligence methods were used to achieve the aim of this study. The researchers used 19 significant attributes based on medical history and foot images that affect diabetic foot ulcers and then proposed two classifiers to predict the foot ulcer: a feedforward neural network and a decision tree. Finally, the researchers compared the results between the two classifiers, and the experimental results showed that the proposed artificial neural network outperformed a decision tree, achieving an accuracy of 97% in the automated prediction of diabetic foot ulcers. Artificial intelligence methods can be used to predict diabetic foot ulcers with high accuracy. The proposed technique utilizes two methods to predict the foot ulcer; after evaluating the two methods, the artificial neural network showed a higher improvement in performance than the decision tree algorithm. It is recommended that diabetic outpatient clinics develop health education and follow-up programs to prevent complications from diabetes.

Fragile Feet and Trivial Trauma: Communicating the Etiology of Diabetic Foot Ulcers to Patients.

People at risk for diabetic foot ulcer (DFU) often misunderstand why foot ulcers develop and what self-care strategies may help prevent them. The etiology of DFU is complex and difficult to communicate to patients, which may hinder effective self-care. Thus, we propose a simplified model of DFU etiology and prevention to aid communication with patients. The Fragile Feet & Trivial Trauma model focuses on two broad sets of risk factors: predisposing and precipitating. Predisposing risk factors (eg, neuropathy, angiopathy, and foot deformity) are usually lifelong and result in "fragile feet." Precipitating risk factors are usually different forms of everyday trauma (eg, mechanical, thermal, and chemical) and can be summarized as "trivial trauma." We suggest that the clinician consider discussing this model with their patient in three steps: 1) explain how a patient's specific predisposing risk factors result in fragile feet for the rest of life, 2) explain how specific risk factors in a patient's environment can be the trivial trauma that triggers development of a DFU, and 3) discuss and agree on with the patient measures to reduce the fragility of the feet (eg, vascular surgery) and prevent trivial trauma (eg, wear therapeutic footwear). By this, the model supports the communication of two essential messages: that patients may have a lifelong risk of ulceration but that there are health-care interventions and self-care practices that can reduce these risks. The Fragile Feet & Trivial Trauma model is a promising tool for aiding communication of foot ulcer etiology to patients. Future studies should investigate whether using the model results in improved patient understanding and self-care and, in turn, contributes to lower ulceration rates.

The correlation between biomechanical parameters of lower limb and overall risk for diabetic foot ulcer

Background/Aim: Preventing lower limb diabetic complications begins with identifying those at risk for diabetic foot ulceration (DFU). DFU development is related to abnormal pattern of plantar pressure distribution caused by alterations in foot rollover process due to loss of foot-ankle muscular strength, impaired range of motion (ROM) and nervous function, as their integrity is needed to enable proper load absorption on plantar surface. Objective of study was to determine correlation between biomechanical parameters of lower limb: ankle and foot muscle strength, ROM at ankle joint (AJ), subtalar joint (SJ) and first metatarsophalangeal joint (I MTP) and overall risk for DFU assessed by IWGDF 2019 Guidance risk stratification system. Methods: A cross-sectional study included 100 diabetic patients, both types. Patients were classified into 4 DFU risk categories applying IWGDF Guidelines 2019 stratification risk system. Function of ten foot and ankle muscles was evaluated by manual muscle testing applying Michigan Diabetic Neuropathy Score system and was expressed by muscle score (MS) on dominant leg. ROM at AJ, SJ and I MTP was measured with a goniometer on dominant leg and was expressed by degree (°). Results: Average MS in specified categories were as follows: Category 0: 9.2; Category 1: 13.9; Category 2: 13.3; Category 3: 15.2 and they were significantly different. Average ROM at AJ in specified categories were as follows: Category 0: 49.3°; Category 1: 48.8°; Category 2: 45.5°; Category 3: 44.6° and they were not significantly different. Average ROM at SJ in specified categories were as follows: Category 0: 37.8°; Category 1: 31.3°; Category 2: 35.0°; Category 3: 28.7° and they were significantly different. Average ROM at I MTP in specified categories were as follows: Category 0: 78.60 ; Category 1: 74.4°; Category 2: 65.5°; Category 3: 57.9° and they were significantly different. Conclusions: Risk for DFU ulcer significantly correlates with decreased ankle and foot muscle strength and ROM at SJ and I MTP but does not correlate with ROM at AJ.

Artificial Intelligence Methodologies Applied to Technologies for Screening, Diagnosis and Care of the Diabetic Foot: A Narrative Review.

Diabetic foot syndrome is a multifactorial pathology with at least three main etiological factors, i.e., peripheral neuropathy, peripheral arterial disease, and infection. In addition to complexity, another distinctive trait of diabetic foot syndrome is its insidiousness, due to a frequent lack of early symptoms. In recent years, it has become clear that the prevalence of diabetic foot syndrome is increasing, and it is among the diabetes complications with a stronger impact on patient's quality of life. Considering the complex nature of this syndrome, artificial intelligence (AI) methodologies appear adequate to address aspects such as timely screening for the identification of the risk for foot ulcers (or, even worse, for amputation), based on appropriate sensor technologies. In this review, we summarize the main findings of the pertinent studies in the field, paying attention to both the AI-based methodological aspects and the main physiological/clinical study outcomes. The analyzed studies show that AI application to data derived by different technologies provides promising results, but in our opinion future studies may benefit from inclusion of quantitative measures based on simple sensors, which are still scarcely exploited.

Effects of Walking Speeds and Durations on Peak Plantar Pressures.

Walking at various speeds and durations may result in different peak plantar pressure (PPP). However, there is no study comparing the effect of walking speeds and durations on PPP. The purpose of this study was to explore whether different walking speeds and durations significantly change PPP and establish a normal response in healthy people. An in-shoe plantar pressure system was used to measure PPP under the first toe, first metatarsal, second metatarsal, and heel regions in 12 healthy, young people. All participants performed six walking trials at three speeds (3, 6, and 9 km/h) and for two durations (10 and 20 min). The 3 × 2 two-way analysis of variance was used to examine the main effects of speeds and durations and their interaction. The results showed that walking speeds significantly affected PPP and that walking duration did not. No interaction between the walking speed and duration was observed. Peak plantar pressure values under the first toe and the first metatarsal head were significantly higher (P < .05) at 9 km/h (509.1 ± 314.2 kPa and 591.4 ± 302.4 kPa, respectively) than at 3 km/h (275.4 ± 168.7 kPa and 369.4 ± 205.4 kPa, respectively) after 10-min walking. People at risk for foot ulcers may use slow and brisk walking for exercise to reduce PPP, thus reducing risk for foot ulcers. Our study demonstrated that slow running at 9 km/h significantly increases PPP.

Effect of integrating health belief model in a prophylactic diabetic foot care program on knowledge, believes, practices and risk for foot ulcer of diabetic elderly

Effect of integrating health belief model in a prophylactic diabetic foot care program on knowledge, believes, practices and risk for foot ulcer of diabetic elderly

Preventing diabetes-related foot ulcers through early detection of peripheral neuropathy.

Peripheral neuropathy, peripheral arterial disease and diabetes-related foot ulcers are the most important risk factors for future amputation. Up to 50% of people with diabetes have distal symmetrical polyneuropathy as a complication of diabetes. Distal symmetrical polyneuropathy results in loss of protective sensation in the feet, increasing the risk of diabetes-related foot ulceration. The aim of this article is to provide structured guidance for detecting diabetes-related peripheral neuropathy, appropriate referral based on risk assessment and prevention of diabetes‑related foot ulceration. As a result of the often-asymptomatic nature of diabetes-related peripheral neuropathy, general practice is an ideal location for screening all adults with diabetes for loss of protective sensation. Loss of protective sensation in a person with diabetes indicates an at-risk foot. Increased frequency of foot examination, education in self-care, appropriate footwear and referral to podiatry for non‑ulcerative foot problems can reduce the development of diabetes-related footulcers.

Interest of Sudoscan in the detection of diabetic peripheral neuropathy

Introduction: Disturbance of pain sensation is considered one of the major initial risk factors for diabetic foot ulcers. Sweat dysfunction leading to abnormal skin conditions, including dryness and fissures, may increase the risk of foot ulcer. The objective of this study was to evaluate the Sudoscan, a new rapid, non-invasive, quantitative method for early detection of diabetic peripheral neuropathy by measuring sweat electrical conduction (SEC). Patients and methods: We conducted this study on 85 type 2 diabetic patients. The data of the study were collected through a questionnaire, clinical examination (DN4, monofilament) and sudoscan for SEC. Results: We recruited 85 patients, the average age of the subjects was 58.32 ± 10.89 years. 77.6% were women and 22.4% were men. A significant proportion (67%) of our study population had a duration of diabetes of less than 10 years, Among 85 patients 40% had a positive DN4 and only 17.2% of the participants had a positive monofilamant test. 52.9% of the patients had a moderate dysfunction of the electrical conduction of sweat (SEC) and only 29.4% had a severe dysfunction, and 17.6% of the patients had a normal conduction we did not objectify a significant correlation between the sudoscan and the other tests notably the DN4 and the monofilament. Conclusion: The Sudoscan is a reproducible technique, with a high specificity, it is a simple test for the detection of neuropathy diabetic peripheral allowing an early prevention of foot lesions.

The Effect of Diabetic Foot Exercises on Ankle Brachial Index Values and the Degree of Diabetic Foot Risk in Diabetes Melitus Patients

Background: The prevalence of Diabetic Foot Ulcers (DFU) in diabetics is 4-10% where this condition more often affects the elderly. DFU is a serious marker of a disease that if optimal prevention is not carried out from the start, the wound deteriorates rapidly, and the worst is amputation. Diabetic foot exercises are used as leg exercises and are beneficial in reducing pain, reducing nerve damage, controlling blood sugar and increasing blood circulation in the feet. The purpose of this study was to analyze the effect of diabetic foot exercise on the degree of risk of diabetic foot ulcers and the Ankle brachial index value in Diabetes Mellitus patients in the Work Area of the Mamboro Health Center. Methods: This type of research is quasi-experimental with a one group pretest posttest design. The sample is 16 people. The instruments used were a monofilament test, sphygmomanometer, stethoscope, and an instrument for assessing the risk of diabetic foot. Data analysis used is paired t test and Wilcoxon test. Results The results showed that diabetic foot exercise had an effect on changes in the value of blood circulation (ABI) with a p value (0.000) and a score of degrees of risk of diabetic foot with a p value (0.001). Conclusion of this study is that diabetic foot exercise has a statistical effect on both the ABI value and the diabetic foot degree score. Suggestions from this study are that nurses more often conduct DM foot exercise education in an effort to prevent DFU

Effectiveness Of Foot Care Practice Tool On Diabetes Control Among Diabetic Patients With Risk For Foot Ulcers In South India

Introduction: Diabetic foot ulcer (DFU) is very susceptible to infection, which rapidly spreads in the foot and ultimately leads toamputation. Diabetic foot infection (DFI) is a serious threat to public health around the world because it can lead to death. The aim ofthis study was to design a foot care practice tool and evaluate the effectiveness on diabetics in terms of knowledge, skill and hemoglobinA1c.Methods: An experimental pretest - posttest study design was used for this study. A total of 200 diabetics participated in this study inwhich 100 diabetics in the control group and 100 diabetics in the experimental group.Results: The present study findings show that 48.1 % improvement in foot care knowledge in the experimental group and 7.1%improvement in the control group. Experimental group showed 0.46 % reduction in HbA1C level comparing to a 0.05% reduction inHbA1C in the control group.Conclusions: This study showed an increase in the foot care knowledge and skill of diabetics after the intervention and drastic reductionin HbA1C in the experimental group compared to the control group. The study conveys a strong message to diabetes health careproviders about the critical need for foot care awareness programmes among diabetics.

Development of Gymnastics Models to Lower the Risk of Diabetic Ulcers in Diabetics

Diabetes mellitus (DM) is a condition characterized by increased glucose levels in the blood. DM patients are at risk of diabetic foot ulcers. To lower the risk, DM patients need to exercise to train aerobics, balance, endurance, and legs. For this reason, this study aims to produce a gymnastics model that combines aerobics, balance training, resistance training, and leg training. Research using the Research and Development method refers to the Borg &Gall development model, which aims to produce products. Instrument development involves six stages: needs analysis, initial product development, expert assessment, initial product revision, trial, and final product. The results showed that the percentage of the results of expert assessments and trials was more significant than 80%, so this model is said to be very feasible. So it can be concluded that the gymnastics model which combines aerobics, balance exercises, resistance training, and leg training is feasible and applied to diabetic patients. The gymnastics help prevent or lower the risk of diabetic foot ulcers in people with DM.

Pengetahuan Perawatan Kaki terhadap Resiko Ulkus Diabetik Pasien Diabetes Melitus (DM)

This study aims to determine the relationship between foot care knowledge and the risk of foot ulcers in Diabetes Mellitus (DM) patients. This type of research is quantitative using a cross-sectional design. The results showed that most DM patients had moderate knowledge (68.2%) with an average risk of foot injuries (63.5%). In conclusion, there is no significant relationship between knowledge about foot care and the risk of developing diabetic foot ulcers.&#x0D; &#x0D; Keywords: Knowledge, Foot Care, Diabetic Ulcer Risk

Exercise intervention to reduce the risk of diabetic foot ulcers in diabetics with the health belief model approach

Diabetic foot ulcers are common complication in diabetics. This study aims to explore the effect of exercise on the risk of diabetic foot ulcers in diabetics using the Health Belief Model approach. One of the essential benefits of this study is to reduce the risk of developing diabetic foot ulcers, thereby reducing disability rates. The problem of diabetic foot ulcers can be prevented by implementing exercise interventions. In this experimental study, there were three groups, with 161 diabetics as respondents. Group one and group two were given different interventions, while group three was the control group. In this study, changes in the ankle-brachial index and the effect of Health Belief Model on activeness in the intervention were measured. Follow-up was done after three months of intervention. All aspects of the Health Belief Model scale were different in the three groups. Perceptions of obstacles showed the most significant difference (p=&lt;0.001). All aspects of the Health Belief Model scale also affect the activity of diabetics in doing exercise (p=0.001). The results of the ankle-brachial index measurement showed that there were differences between the three groups (p=0.019) and the “MULDA” exercise group had the highest median value.

Effects of walking speeds and durations on the plantar pressure gradient and pressure gradient angle

BackgroundWalking exercise has been demonstrated to improve health in people with diabetes. However, it is largely unknown the influences of various walking intensities such as walking speeds and durations on dynamic plantar pressure distributions in non-diabetics and diabetics. Traditional methods ignoring time-series changes of plantar pressure patterns may not fully capture the effect of walking intensities on plantar tissues. The purpose of this study was to investigate the effect of various walking intensities on the dynamic plantar pressure distributions. In this study, we introduced the peak pressure gradient (PPG) and its dynamic patterns defined as the pressure gradient angle (PGA) to quantify dynamic changes of plantar pressure distributions during walking at various intensities.MethodsTwelve healthy participants (5 males and 7 females) were recruited in this study. The demographic data were: age, 27.1 ± 5.8 years; height, 1.7 ± 0.1 m; and weight, 63.5 ± 13.5 kg (mean ± standard deviation). An insole plantar pressure measurement system was used to measure plantar pressures during walking at three walking speeds (slow walking 1.8 mph, brisk walking 3.6 mph, and slow running 5.4 mph) for two durations (10 and 20 min). The gradient at a location is defined as the unique vector field in the two-dimensional Cartesian coordinate system with a Euclidean metric. PGA was calculated by quantifying the directional variation of the instantaneous peak gradient vector during stance phase of walking. PPG and PGA were calculated in the plantar regions of the first toe, first metatarsal head, second metatarsal head, and heel at higher risk for foot ulcers. Two-way ANOVA with Fisher’s post-hoc analysis was used to examine the speed and duration factors on PPG and PGA.ResultsThe results showed that the walking speeds significantly affect PPG (P < 0.05) and PGA (P < 0.05), and the walking durations does not. No interaction between the walking duration and speed was observed. PPG in the first toe region after 5.4 mph for either 10 or 20 min was significantly higher than 1.8 mph. Meanwhile, after 3.6 mph for 20 min, PPG in the heel region was significantly higher than 1.8 mph. Results also indicate that PGA in the forefoot region after 3.6 mph for 20 min was significantly narrower than 1.8 mph.ConclusionsOur findings indicate that people may walk at a slow speed at 1.8 mph for reducing PPG and preventing PGA concentrated over a small area compared to brisk walking at 3.6 mph and slow running at 5.4 mph.