Contribution of plantar fascia to the increased forefoot pressures in diabetic patients
Contribution of plantar fascia to the increased forefoot pressures in diabetic patients
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DOI：
10.2337/diacare.26.5.1525
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发表时间：
2003-05-01
期刊：
影响因子：
16.2
通讯作者：
Uccioli, L
中科院分区：
文献类型：
--
作者：
D'Ambrogi, E;Giurato, L;Uccioli, L
目的-继发于周围神经病变，足底高压是足溃疡的一个已证实的危险因素，但关节活动受限（LJM）和软组织异常也可能起作用。本研究的目的是评估足底筋膜的厚度之间的关系，跖趾关节的流动性，并表示在跖骨heads.Research设计和方法的力量-我们评估了61名糖尿病患者：27没有神经病变（D组），19与神经病变（DN组），和15与以前的神经性足溃疡（DNPU组）。我们还检查了21名对照受试者（C）。使用高分辨率8- 10-MHz线性阵列（Toshiba Tosbee SSA 240）进行超声评价。足部负荷模式进行了评价与压电测力平台。第一跖趾关节活动度用机械测角器进行评估。结果-糖尿病患者表现为足底筋膜厚度增加（D 2.9 +/- 1.2 mm，DN 3.0 +/- 0.8 mm，DNPU 3.1 +/- 1.0 mm，C 2.0 +/- 0.5 mm; P < 0.05），并显著减少跖趾关节的活动范围（D 54.0 +/-29.4度，DN 54.9 +/- 17 2度，DNPU 46.8 +/-20.7度，C 100.0 +/-10.0度; P < 0.05）。跖骨头下足-地板相互作用的评价显示DN和DNPU的垂直力增加，DNPU的内外向力增加。足底筋膜厚度与跖趾关节活动度呈负相关（r = -0.53）。足底筋膜的厚度与跖骨头下的垂直力直接相关（r = 0.52）。结论-在糖尿病患者中，软组织受累可能有助于增加跖骨头下的垂直力。足底筋膜结构的改变也可能影响第一跖趾关节的活动度。
Objectives - Secondary to peripheral neuropathy, plantar hyperpressure is a proven risk factor for foot ulceration, But limited joint mobility (LJM) and soft tissue abnormalities may also contribute. The aim Of this study was to evaluate the relationships among thickness of plantar fascia, mobility of the metatarso-phalangeal joint, and forces expressed under the metatarsal heads.Research Design and Methods - We evaluated 61 diabetic patients: 27 without neuropathy (D group), 19 with neuropathy (DN group), and 15 with previous neuropathic foot ulceration (DNPU group). We also examined 21 control subjects (C). Ultrasound evaluation was performed with a high resolution 8- to 10-MHz linear array (Toshiba Tosbee SSA 240). The foot loading pattern was evaluated with a piezo-dynamometric platform. First metatarso-phalangeal joint mobility was assessed with a mechanic goniometer.Results - Diabetic patients presented increased thickness of plantar fascia (D 2.9 +/- 1.2 mm, DN 3.0 +/- 0.8 mm, DNPU 3.1 +/- 1.0 mm,and C 2.0 +/- 0.5 mm; P < 0.05), and significantly reduced motion range at the metatarso-phalangeal joint (D 54.0 +/- 29.4degrees, DN 54.9 +/- 17 2degrees, DNPU 46.8 +/- 20.7degrees, and C 100.0 +/- 10.0degrees; P < 0.05). The evaluation of foot-floor interaction under the metatarsal heads showed increased vertical forces in DN and DNPU and increased medio-lateral forces in DNPU. An inverse correlation was found between the thickness of plantar fascia and metatarso-phalangeal joint mobility (r = -0.53). The thickness of plantar fascia was directly correlated with vertical forces under the metatarsal heads (r = 0.52).Conclusions - in diabetic patients, soft tissue involvement may contribute to the increase of vertical forces under the metatarsal heads. Changes in the structure of plantar fascia may also influence the mobility of the first metatarso-phalangeal joint.