Plantar pressure and diabetes mellitus_West China Medical Journal

Authors：

ZHA Panpan , Raju Bista ,  WANG Chun

Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

WANG Chun, Email: snoopywc@163.com

Keywords：

Plantar pressure; Diabetes mellitus; Diabetic foot ulcer

DOI：

10.7507/1002-0179.201803146

Video：

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Abstract Full text Figures/Tables Video References Cited by

Diabetic foot ulcer is the most serious complication of diabetes. In addition to diabetic peripheral neuropathy and lower extremity vascular disease, diabetic foot pressure abnormality is an independent risk factor for diabetic foot ulcers. This review summarizes the relationship between plantar pressure and diabetes, including the concept of the plantar pressure and its measurement methods, as well as the abnormal changes in the plantar pressure of diabetic patients. In addition, through the explanation of the mechanism of diabetic patients’ plantar pressure changes, the methods of releasing the abnormal plantar pressure are discussed, so as to prevent and treat the diabetic foot ulcers, and improve our understanding of it.

Citation： ZHA Panpan, Raju Bista, WANG Chun. Plantar pressure and diabetes mellitus. West China Medical Journal, 2018, 33(5): 593-597. doi: 10.7507/1002-0179.201803146 Copy

1.	Xu Y, Wang LM, He J, et al. Prevalence and control of diabetes in Chinese adults. JAMA, 2013, 310(9): 948-958.
2.	Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA, 2005, 293(2): 217-228.
3.	Khanolkar MP, Bain SC, Stephens JW. The diabetic foot. QJM, 2008, 101(9): 685-695.
4.	Driver VR, Hanft J, Fyling CP, et al. A prospective, randomized, controlled trial of autologous platelet-rich plasma gel for the treatment of diabetic foot ulcers. Ostomy Wound Manage, 2006, 52(6): 68-70, 72, 74 passim.
5.	Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, et al. The global burden of diabetic foot disease. Lancet, 2005, 366(9498): 1719-1724.
6.	Amemiya A, Noguchi H, Oe M, et al. Elevated plantar pressure in diabetic patients and its relationship with their gait features. Gait Posture, 2014, 40(3): 408-414.
7.	Stokes IA, Faris IB, Hutton WC. The neuropathic ulcer and loads on the foot in diabetic patients. Acta Orthop Scand, 1975, 46(5): 839-847.
8.	Pham H, Armstrong DG, Harvey C, et al. Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. Diabetes Care, 2000, 23(5): 606-611.
9.	van Acker K, Léger P, Hartemann A, et al. Burden of diabetic foot disorders, guidelines for management and disparities in implementation in Europe: a systematic literature review. Diabetes Metab Res Rev, 2014, 30(8): 635-645.
10.	Bakker K, Apelqvist J, Schaper NC. International Working Group on Diabetic Foot Editorial Board. Practical guidelines on the management and prevention of the diabetic foot 2011. Diabetes Metab Res Rev, 2012, 28(Suppl 1): 225-231.
11.	Ahmad J. The diabetic foot. Diabetes Metab Syndr, 2016, 10(1): 48-60.
12.	孙皎, 白姣姣, 曹文群, 等. 社区糖尿病患者足底压力的调查. 上海医学, 2010(9): 857-859.
13.	Shen J, Liu F, Zeng H, et al. Vibrating perception threshold and body mass index are associated with abnormal foot plantar pressure in type 2 diabetes outpatients. Diabetes Technol Ther, 2012, 14(11): 1053-1059.
14.	Hastings MK, Gelber JR, Isaac EJ, et al. Foot progression angle and medial loading in individuals with diabetes mellitus, peripheral neuropathy, and a foot ulcer. Gait Posture, 2010, 32(2): 237-241.
15.	王立平, 李建设. 足底压力测量技术的发展现状与应用研究. 浙江体育科学, 2004(1): 43-46, 90.
16.	Welton EA. The harris and beath footprint: interpretation and clinical value. Foot Ankle, 1992, 13(8): 462-468.
17.	Bus SA, Haspels R, Busch-Westbroek TE. Evaluation and optimization of therapeutic footwear for neuropathic diabetic foot patients using in-shoe plantar pressure analysis. Diabetes Care, 2011, 34(7): 1595-1600.
18.	严励, 王永慧, 杨川, 等. 非糖尿病人群足底压力的研究. 中山大学学报: 医学科学版, 2006, 27(2): 197-199, 202.
19.	王峥, 白姣姣, 孙皎, 等. 社区2型糖尿病患者足底溃疡高风险区域分布的调查. 老年医学与保健, 2014, 20(2): 114-116, 133.
20.	李亚洁, 蒋娅, 薛耀明, 等. 2型糖尿病患者自然步态下赤足足底压力特征分析. 护理学报, 2013(7): 1-4.
21.	董海山, 吕肖峰. 糖尿病合并周围神经病变患者足底压力的研究. 中国医药导报, 2011, 8(14): 36-38.
22.	王爱红, 李家兰, 许樟荣, 等. 2型糖尿病患者的足底压力研究. 中华内分泌代谢杂志, 2005, 21(6): 500-501.
23.	谢翠华, 张倩, 符霞军, 等. 糖尿病病人足底压力峰值与糖尿病足底压力性溃疡发生的相关性研究. 护理研究, 2016(8): 918-921.
24.	连晓芬, 林远, 张帆. 糖尿病患者足底压力的研究. 中国实用医药, 2017(31): 6-8.
25.	Lavery LA, Armstrong DG, Wunderlich RP, et al. Predictive value of foot pressure assessment as part of a population-based diabetes disease management program. Diabetes Care, 2003, 26(4): 1069-1073.
26.	Sacco IC, Hamamoto AN, Tonicelli LM, et al. Abnormalities of plantar pressure distribution in early, intermediate, and late stages of diabetic neuropathy. Gait Posture, 2014, 40(4): 570-574.
27.	Searle A, Spink MJ, Ho A et al. Association between ankle equinus and plantar pressures in people with diabetes. A systematic review and meta-analysis. Clin Biomech (Bristol, Avon), 2017, 3(43): 8-14.
28.	Cheuy VA, Hastings MK, Commean PK, et al. Intrinsic foot muscle deterioration is associated with metatarsophalangeal joint angle in people with diabetes and neuropathy. Clin Biomech (Bristol, Avon), 2013, 28(9/10): 1055-1060.
29.	Barn R, Waaijman R, Nollet F, et al. Predictors of barefoot plantar pressure during walking in patients with diabetes, peripheral neuropathy and a history of ulceration. PLoS One, 2015, 10(2): e0117443.
30.	Sawacha Z, Gabriella G, Cristoferi G, et al. Diabetic gait and posture abnormalities: a biomechanical investigation through three dimensional gait analysis. Clin Biomech (Bristol, Avon), 2009, 24(9): 722-728.
31.	Cerrahoglu L, Koşan U, Sirin TC, et al. Range of motion and plantar pressure evaluation for the effects of self-care foot exercises on diabetic patients with and without neuropathy. J Am Podiatr Med Assoc, 2016, 106(3): 189-200.
32.	Healy A, Naemi R, Chockalingam N. The effectiveness of footwear and other removable off-loading devices in the treatment of diabetic foot ulcers: a systematic review. Curr Diabetes Rev, 2014, 10(4): 215-230.
33.	Ibrahim A. IDF clinical practice recommendation on the diabetic foot: a guide for healthcare professionals. Diabetes Res Clin Pract, 2017, 5(127): 285-287.
34.	Merriwether EN, Hastings MK, Bohnert KL, et al. Impact of foot progression angle modification on plantar loading in individuals with diabetes mellitus and peripheral neuropathy. Edorium J Disabil Rehabil, 2016, 2(1): 15-23.
35.	van Schie CH, Whalley A, Vileikyte L, et al. Efficacy of injected liquid silicone in the diabetic foot to reduce risk factors for ulceration: a randomized double-blind placebo-controlled trial. Diabetes Care, 2000, 23(5): 634-638.
36.	Salsich GB, Mueller MJ, Hastings MK, et al. Effect of Achilles tendon lengthening on ankle muscle performance in people with diabetes mellitus and a neuropathic plantar ulcer. Phys Ther, 2005, 85(1): 34-43.
37.	Mueller MJ, Sinacore DR, Hastings MK, et al. Effect of Achilles tendon lengthening on neuropathic plantar ulcers. A randomized clinical trial. J Bone Joint Surg Am, 2003, 85-A(8): 1436-1445.
38.	Maluf KS, Mueller MJ, Strube MJ, et al. Tendon Achilles lengthening for the treatment of neuropathic ulcers causes a temporary reduction in forefoot pressure associated with changes in plantar flexor power rather than ankle motion during gait. J Biomech, 2004, 37(6): 897-906.
39.	Blume P, Wu S. Updating the diabetic foot treatment algorithm: recommendations on treatment using advanced medicine and therapies. Wounds, 2018, 30(2): 29-35.
40.	Pataky Z, Golay A, Faravel L, et al. The impact of callosities on the magnitude and duration of plantar pressure in patients with diabetes mellitus. A callus may cause 18,600 kilograms of excess plantar pressure per day. Diabetes Metab, 2002, 28(5): 356-361.

1. Xu Y, Wang LM, He J, et al. Prevalence and control of diabetes in Chinese adults. JAMA, 2013, 310(9): 948-958.
2. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA, 2005, 293(2): 217-228.
3. Khanolkar MP, Bain SC, Stephens JW. The diabetic foot. QJM, 2008, 101(9): 685-695.
4. Driver VR, Hanft J, Fyling CP, et al. A prospective, randomized, controlled trial of autologous platelet-rich plasma gel for the treatment of diabetic foot ulcers. Ostomy Wound Manage, 2006, 52(6): 68-70, 72, 74 passim.
5. Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, et al. The global burden of diabetic foot disease. Lancet, 2005, 366(9498): 1719-1724.
6. Amemiya A, Noguchi H, Oe M, et al. Elevated plantar pressure in diabetic patients and its relationship with their gait features. Gait Posture, 2014, 40(3): 408-414.
7. Stokes IA, Faris IB, Hutton WC. The neuropathic ulcer and loads on the foot in diabetic patients. Acta Orthop Scand, 1975, 46(5): 839-847.
8. Pham H, Armstrong DG, Harvey C, et al. Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. Diabetes Care, 2000, 23(5): 606-611.
9. van Acker K, Léger P, Hartemann A, et al. Burden of diabetic foot disorders, guidelines for management and disparities in implementation in Europe: a systematic literature review. Diabetes Metab Res Rev, 2014, 30(8): 635-645.
10. Bakker K, Apelqvist J, Schaper NC. International Working Group on Diabetic Foot Editorial Board. Practical guidelines on the management and prevention of the diabetic foot 2011. Diabetes Metab Res Rev, 2012, 28(Suppl 1): 225-231.
11. Ahmad J. The diabetic foot. Diabetes Metab Syndr, 2016, 10(1): 48-60.
12. 孙皎, 白姣姣, 曹文群, 等. 社区糖尿病患者足底压力的调查. 上海医学, 2010(9): 857-859.
13. Shen J, Liu F, Zeng H, et al. Vibrating perception threshold and body mass index are associated with abnormal foot plantar pressure in type 2 diabetes outpatients. Diabetes Technol Ther, 2012, 14(11): 1053-1059.
14. Hastings MK, Gelber JR, Isaac EJ, et al. Foot progression angle and medial loading in individuals with diabetes mellitus, peripheral neuropathy, and a foot ulcer. Gait Posture, 2010, 32(2): 237-241.
15. 王立平, 李建设. 足底压力测量技术的发展现状与应用研究. 浙江体育科学, 2004(1): 43-46, 90.
16. Welton EA. The harris and beath footprint: interpretation and clinical value. Foot Ankle, 1992, 13(8): 462-468.
17. Bus SA, Haspels R, Busch-Westbroek TE. Evaluation and optimization of therapeutic footwear for neuropathic diabetic foot patients using in-shoe plantar pressure analysis. Diabetes Care, 2011, 34(7): 1595-1600.
18. 严励, 王永慧, 杨川, 等. 非糖尿病人群足底压力的研究. 中山大学学报: 医学科学版, 2006, 27(2): 197-199, 202.
19. 王峥, 白姣姣, 孙皎, 等. 社区2型糖尿病患者足底溃疡高风险区域分布的调查. 老年医学与保健, 2014, 20(2): 114-116, 133.
20. 李亚洁, 蒋娅, 薛耀明, 等. 2型糖尿病患者自然步态下赤足足底压力特征分析. 护理学报, 2013(7): 1-4.
21. 董海山, 吕肖峰. 糖尿病合并周围神经病变患者足底压力的研究. 中国医药导报, 2011, 8(14): 36-38.
22. 王爱红, 李家兰, 许樟荣, 等. 2型糖尿病患者的足底压力研究. 中华内分泌代谢杂志, 2005, 21(6): 500-501.
23. 谢翠华, 张倩, 符霞军, 等. 糖尿病病人足底压力峰值与糖尿病足底压力性溃疡发生的相关性研究. 护理研究, 2016(8): 918-921.
24. 连晓芬, 林远, 张帆. 糖尿病患者足底压力的研究. 中国实用医药, 2017(31): 6-8.
25. Lavery LA, Armstrong DG, Wunderlich RP, et al. Predictive value of foot pressure assessment as part of a population-based diabetes disease management program. Diabetes Care, 2003, 26(4): 1069-1073.
26. Sacco IC, Hamamoto AN, Tonicelli LM, et al. Abnormalities of plantar pressure distribution in early, intermediate, and late stages of diabetic neuropathy. Gait Posture, 2014, 40(4): 570-574.
27. Searle A, Spink MJ, Ho A et al. Association between ankle equinus and plantar pressures in people with diabetes. A systematic review and meta-analysis. Clin Biomech (Bristol, Avon), 2017, 3(43): 8-14.
28. Cheuy VA, Hastings MK, Commean PK, et al. Intrinsic foot muscle deterioration is associated with metatarsophalangeal joint angle in people with diabetes and neuropathy. Clin Biomech (Bristol, Avon), 2013, 28(9/10): 1055-1060.
29. Barn R, Waaijman R, Nollet F, et al. Predictors of barefoot plantar pressure during walking in patients with diabetes, peripheral neuropathy and a history of ulceration. PLoS One, 2015, 10(2): e0117443.
30. Sawacha Z, Gabriella G, Cristoferi G, et al. Diabetic gait and posture abnormalities: a biomechanical investigation through three dimensional gait analysis. Clin Biomech (Bristol, Avon), 2009, 24(9): 722-728.
31. Cerrahoglu L, Koşan U, Sirin TC, et al. Range of motion and plantar pressure evaluation for the effects of self-care foot exercises on diabetic patients with and without neuropathy. J Am Podiatr Med Assoc, 2016, 106(3): 189-200.
32. Healy A, Naemi R, Chockalingam N. The effectiveness of footwear and other removable off-loading devices in the treatment of diabetic foot ulcers: a systematic review. Curr Diabetes Rev, 2014, 10(4): 215-230.
33. Ibrahim A. IDF clinical practice recommendation on the diabetic foot: a guide for healthcare professionals. Diabetes Res Clin Pract, 2017, 5(127): 285-287.
34. Merriwether EN, Hastings MK, Bohnert KL, et al. Impact of foot progression angle modification on plantar loading in individuals with diabetes mellitus and peripheral neuropathy. Edorium J Disabil Rehabil, 2016, 2(1): 15-23.
35. van Schie CH, Whalley A, Vileikyte L, et al. Efficacy of injected liquid silicone in the diabetic foot to reduce risk factors for ulceration: a randomized double-blind placebo-controlled trial. Diabetes Care, 2000, 23(5): 634-638.
36. Salsich GB, Mueller MJ, Hastings MK, et al. Effect of Achilles tendon lengthening on ankle muscle performance in people with diabetes mellitus and a neuropathic plantar ulcer. Phys Ther, 2005, 85(1): 34-43.
37. Mueller MJ, Sinacore DR, Hastings MK, et al. Effect of Achilles tendon lengthening on neuropathic plantar ulcers. A randomized clinical trial. J Bone Joint Surg Am, 2003, 85-A(8): 1436-1445.
38. Maluf KS, Mueller MJ, Strube MJ, et al. Tendon Achilles lengthening for the treatment of neuropathic ulcers causes a temporary reduction in forefoot pressure associated with changes in plantar flexor power rather than ankle motion during gait. J Biomech, 2004, 37(6): 897-906.
39. Blume P, Wu S. Updating the diabetic foot treatment algorithm: recommendations on treatment using advanced medicine and therapies. Wounds, 2018, 30(2): 29-35.
40. Pataky Z, Golay A, Faravel L, et al. The impact of callosities on the magnitude and duration of plantar pressure in patients with diabetes mellitus. A callus may cause 18,600 kilograms of excess plantar pressure per day. Diabetes Metab, 2002, 28(5): 356-361.

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