Analysis of Clinical Profiles, Deformities, and Plantar Pressure Patterns in Diabetic Foot Syndrome

Abstract

Diabetic foot syndrome refers to heterogeneous clinical and biomechanical profiles, which render predictive models unsatisfactory. A valuable contribution may derive from identification and descriptive analysis of well-defined subgroups of patients. Clinics, biology, function, gait analysis, and plantar pressure variables were assessed in 78 patients with diabetes. In 15 of them, the 3D architecture of the foot bones was characterized by using weight-bearing CT. Patients were grouped by diabetes type (T1, T2), presence (DN) or absence (DNN) of neuropathy, and obesity. Glycated hemoglobin (HbA1c) and plantar lesions were monitored during a 48-month follow-up. Statistical analysis showed significant differences between the groups for at least one clinical (combined neuropathy score, disease duration, HbA1c), biological (age, BMI), functional (joint mobility, foot alignment), or biomechanical (regional peak pressure, pressure-time integral, cadence, velocity) variable. Twelve patients ulcerated during follow-up (22 lesions in total), distributed in all groups but not in the DNN T2 non-obese group. These showed biomechanical alterations, not always occurring at the site of lesion, and HbA1c and neuropathy scores higher than the expected range. Three of them, who also had weight-bearing CT analysis, showed >40% of architecture parameters outside the 95%CI. Appropriate grouping and profiling of patients based on multi-instrumental clinical and biomechanical analysis may help improve prediction modelling and management of diabetic foot syndrome.

The effects of the use of customized silicone digital orthoses on pre-ulcerative lesions and plantar pressure during walking in people with diabetic neuropathy: A study protocol for a randomized controlled trial

“…DPN is caused by damage to the somatic fibers, which leads to reduced or absent foot sensitivity, decreased proprioception, muscle loss, and postural instability [ 6 ]. Another major finding in people with DPN is motor impairments, such as decreased foot-ankle range of motion [ 7 , 8 ]; atrophy of the intrinsic and extrinsic foot-ankle muscles [ [9] , [10] , [11] ]; alteration of the biomechanical properties of connective tissue, such as increased hardness of plantar tissue [ 12 ] and increased soft tissue thickness and stiffness [ 13 ]; alterations in the lower limbs’ muscle activation [ 14 ]; decreased conduction velocity of the tibialis anterior [ 15 ]; changes in torque generation strategy from the ankle to the hip [ 16 ]; alteration of the plantar arches [ 17 ]; decrease or displacement of fat pads from the hallux and toes [ 18 ]; forefoot and toe deformities, such as claw, hammer, and mallet toe and hallux valgus [ 19 ]; prominences of the metatarsal heads [ 20 ]; and changes in foot rollover and gait biomechanics [ 21 ].…”