Plantar pressure distribution in patients with neuropathic diabetic foot

Purpose: To describe the plantar pressure distribution in a selected group of patients with diabetic foot and to highlight their alterations in gait cycle, which follow the involvement of the foot in systemic diabetic neuropathy. Methods: Ten patients with diabetic foot due to insulin dependent diabetes mellitus (IDDM) were studied. Gait cycle kinematics were video-recorded, both in frontal (AP view) and in sagittal (LL view) planes. Plantar pressure measurements+ APview+LLview were synchronized and compared to a computer-graphic generated skeletal model of the foot. Results: In diabetic neuropathic patients, there was a prolonged interval between heel strike and toe-off with respect to normal controls. A limited motion, quite close to frank rigidity, affecting the mid-tarsal, sub-talar and ankle joints was noted. There was an early transfer of load from rear to front-foot. Shear stresses appeared. Metatarsal heads were over-loaded both in magnitude and in time. Areas of over-load present in the static plantar pressure measurement correlated poorly with areas of overload in dynamic plantar pressure measurement and areas where ulceration was present. Conclusion: Prolonged duration of the gait cycle and shear stresses characterize the plantar pressure pattern of diabetic neuropathic patients. Furthermore, results suggest that static plantar pressure measurement has no clinical correlation with areas where ulcerations are present. © Società Italiana Biomateriali.