10 years follow-up study of plantar pressure, kinetics and kinematics in a cohort of patients diagnosed with diabetes

Conditions: Diabetes; Diabetic Foot; Plantar Ulcer; Neuropathy; Gait Disorder, Sensorimotor; Motor Neuropathy; Foot Deformities; Foot Ulcer

Summary: a combination of diabetes and neuropathy can cause an altered gait, increased tissue stiffness, limited joint mobility, muscle weakness, foot deformities, thus leading to excessive plantar pressure. the presence of an increased plantar pressure and the loss of sensation is a serious risk factor in the risk of development of diabetic foot ulcers (dfu). therefore, appropriate shoes and insoles are recommended to redistribute high peak pressure (pp) and reduce pressure time integral (pti) . shoe modifications and insoles, when used, is effective to prevent the recurrence of plantar ulcer. the primary aim of the study was to: explore gait characteristics, kinetics and kinematics in a cohort of patients diagnosed with diabetes, with and without neuropathy, assigned to use different types of insoles. the second aim was to assess the relation between gait characteristics, kinetics and kinematics to high plantar pp and pti. the third aim was to compare gait characteristics, kinetics and kinematics of patients with diabetes and healthy controls.

a combination of diabetes and neuropathy can cause an altered gait, increased tissue stiffness, limited joint mobility, muscle weakness, foot deformities, thus leading to excessive plantar pressure . the presence of an increased plantar pressure and the loss of sensation is a serious risk factor in the risk of development of diabetic foot ulcers (dfu). therefore, appropriate shoes and insoles are recommended to redistribute high peak pressure (pp) and reduce pressure time integral (pti). shoe modifications and insoles, when used, is effective to prevent the recurrence of plantar ulcer. patients presenting with mild or absence of neuropathy have lower pp compared to those having more severe stages of neuropathy. however, these findings are not unambiguous. in a study patients walked in a standardize speed of 1.2 m/s, and it was only under the first metatarsal phalangeal joint that the group with neuropathy had higher pp compared to patients with diabetes without neuropathy. in the remaining parts of the foot sole, there was no difference. in a study comparing custom-made insoles and prefabricated insoles used in a walking shoe, a cohort of patients with no history of foot ulcers was studied and there were no differences in pp for the sub groups with and without neuropathy. more knowledge is needed regarding risk factors such as neuropathy, gait deviation and differences in kinematics and kinetics in order to prevent the onset of the "first" plantar ulcer.

Eligibility criteria:
inclusion criteria: intervention groups: * to be a participant in the original rct * to be aged 18 years or more * to walk without walking aid * to understand the swedish language * no presence of foot ulcer exclusion criteria: * presence of foot ulcers control group * to be first-time visitors to the dpo * to be aged 18 years or more * to walk without walking aid * to understand the swedish language * no presence of foot ulcer exclusion criteria: * presence of foot ulcers

Keywords: orthotics kinematics kinetics