Plantar Pressures During Shod Gait in Diabetic Neuropathic Patients with and without a History of Plantar Ulceration
Plantar Pressures During Shod Gait in Diabetic Neuropathic Patients with and without a History of Plantar Ulceration
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DOI：
10.7547/0980285
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发表时间：
2009-07-01
影响因子：
0.7
通讯作者：
Hennig, Ewald M.
中科院分区：
文献类型：
--
作者：
Sacco, Isabel C. N.;Bacarin, Tatiana Almeida;Hennig, Ewald M.
背景资料：糖尿病性神经病变导致感觉的进行性丧失、下肢远端肌肉萎缩、自主神经损伤和使脚超负荷的步态改变。这种超负荷与足底溃疡有关，即使每天坚持穿鞋。我们试图调查和比较糖尿病神经病变患者临床病史中糖尿病神经病变和足底溃疡对患者穿着日常鞋行走时足底敏感性、症状和足底压力分布的影响。（CG; n = 15）、具有神经性溃疡病史的糖尿病患者（DUG; n = 8）和没有溃疡病史的糖尿病患者（DG; n = 10）。足底压力变量测定Pedar系统鞋垫在五个足底区域在步态，而患者穿着自己的shoes.Results：没有统计学差异的神经病患者和没有足底溃疡的历史被发现在有关的症状，触觉敏感性，和糖尿病的持续时间。无溃疡的糖尿病患者足跟下的压力-时间积分最低（72.1 +/- 16.1 kPa x sec; P= 0.0456）。与对照组相比，有溃疡病史的糖尿病患者中足的压力-时间积分更高（59.6 +/- 23.6 kPa x sec x 45.8 +/- 10.4 kPa x sec; P = 0.099），与无溃疡的糖尿病患者相比，在前足外侧（70.9 +/- 17.7 kPa x 113.2 +/- 61.1 kPa x sec，P = 0.0193）。糖尿病患者溃疡也提出了最低的重量负荷下的拇趾（0.06 +/-0.02%，P = .0042）。结论：虽然提出了一个更大的中足面积，糖尿病神经病变患者提出了更大的压力-时间积分和相对负荷在这一地区。糖尿病患者溃疡提出了一个改变动态足底压力模式的特点是超载，即使每天穿鞋。与足底溃疡的临床病史相关的负荷过重表明未来出现足底溃疡。（J Am Podiatr Med Assumption 99（4）：285-294，2009）
Background: Diabetic neuropathy leads to progressive loss of sensation, lower-limb distal muscle atrophy, autonomic impairment, and gait alterations that overload feet. This overload has been associated with plantar ulcers even with consistent daily use of shoes. We sought to investigate and compare the influence of diabetic neuropathy and plantar ulcers in the clinical history of diabetic neuropathic patients on plantar sensitivity, symptoms, and plantar pressure distribution during gait while patients wore their everyday shoes.Methods: Patients were categorized into three groups: a control group (CG; n = 15), diabetic patients with a history of neuropathic ulceration (DUG; n = 8), and diabetic patients without a history of ulceration (DG; n = 10). Plantar pressure variables were measured by Pedar System shoe insoles in five plantar regions during gait while patients wore their own shoes.Results: No statistical difference between neuropathic patients with and without a history of plantar ulcers was found in relation to symptoms, tactile sensitivity, and duration of diabetes. Diabetic patients without ulceration presented the lowest pressure-time integral under the heel (72.1 +/- 16.1 kPa x sec; P=.0456). Diabetic patients with a history of ulceration presented a higher pressure-time integral at the midfoot compared to patients in the control group (59.6 +/- 23.6 kPa x sec x 45.8 +/- 10.4 kPa x sec; P = .099), and at the lateral forefoot compared to diabetic patients without ulceration (70.9 +/- 17.7 kPa sec x 113.2 +/- 61.1 kPa x sec, P = .0193). Diabetic patients with ulceration also presented the lowest weight load under the hallux (0.06 +/- 0.02%, P = .0042).Conclusions: Although presenting a larger midfoot area, diabetic neuropathic patients presented greater pressure-time integrals and relative loads over this region. Diabetic patients with ulceration presented an altered dynamic plantar pressure pattern characterized by overload even when wearing daily shoes. Overload associated with a clinical history of plantar ulcers indicates future appearance of plantar ulcers. (J Am Podiatr Med Assoc 99(4): 285-294, 2009)