Reliability of peak foot pressure in patients with previous diabetic foot ulceration

BackgroundPrevious reliability studies on peak plantar pressure measurements in patients with previous diabetic foot ulceration (DFU) did not stratify their analyses according to whether the foot had a previous ulcer.Research questionDoes test-retest reliability of peak foot pressure measurements from the various foot regions differ between the ulcerated and non-ulcerated feet?MethodsData from 23 participants with peripheral neuropathy and healed plantar DFU were analysed in this test-retest reliability comparison study. Plantar pressure was evaluated on two sessions using Pedar^®-X in-shoe system, with a mean of 7.2 days (SD = 1.6) between sessions.ResultsThe intraclass correlation coefficient (ICC) and coefficient of variation (CV) were calculated for 10 foot regions. Overall, test-retest reliability was excellent (ICCs, 0.82 to 0.95) for all peak pressure variables. CV ranged between 6.3% and 18.3%, and exceeded 15% over the hallux and medial forefoot regions in the ulcer foot (18.3% and 16.4%, respectively). Hallux peak pressure CV was significantly higher over the ulcer foot than over the non-ulcer foot (5.7%, 95% CI, 1.7%–10.2%). Peak pressure CV over the forefoot also tended to be higher over the ulcer foot (medial forefoot: 6.1%, 95% CI, -0.5%–14.5%; lateral forefoot: 4.1%, 95%CI, -0.7%–11.1%).SignificancePeak plantar foot pressure may be useful to distinguish between groups of patients with peripheral neuropathy and healed plantar DFU. However, clinical decisions based on ulcer foot hallux and forefoot peak pressure measurements should be interpreted with caution.     

Regional plantar pressure during walking, stair ascent and descent

Regional plantar pressures during stair walking may be injurious in at risk populations. However, limited data are available examining the reliability of plantar pressure data collected during stair walking. The aims of this study were three fold; to assess the reliability of the plantar pressure data recorded during stair walking, to assess the effects of level ground and stair walking on plantar loading, and to develop regression equations to predict regional plantar pressures in stair walking from those collected on level ground. Fifteen subjects without conditions affecting their ability to walk on level surfaces or stairs were recruited. Each participant performed at least 10 steps in level ground and stair walking while plantar pressure data were recorded in six foot regions. Reliability was assessed using Intraclass Correlation Coefficient. A repeated measures ANOVA was used to assess the effect of activity on plantar pressure, and a linear regression was used to predict forefoot loading during stair walking. A reliability of 0.9 was achieved within 10 steps in all foot regions, with the forefoot requiring fewer steps. Plantar pressures were influenced by both, foot region and activity, with the heel and forefoot regions generally experiencing lower peak pressures and maximal forces during stair walking than level ground walking. The regression equations predicting peak pressure during stair walking accounted for between 37% and 70% of the variance of the stair walking data. These findings establish the reliability of plantar pressure data collected during stair walking. Future studies should investigate these parameters in clinical populations.     

Characteristic plantar pressure distribution patterns during soccer-specific movements

PURPOSE: To characterize in-shoe pressure measurements during different soccer-specific maneuvers on two playing surfaces to identify the main loading areas of the foot. METHODS: Twenty-one experienced male soccer players participated in the study (25.5 +/- 1.8 years, 78.7 +/- 5.4 kg, and 182.9 +/- 5.7 cm). The Pedar Mobile system was used to collect plantar pressure information inside the soccer shoe. Four soccer-specific movements were performed (normal run, cutting maneuver, sprint, and goal shot) on both a grass and a red cinder surface. RESULTS: Results showed characteristic pressure distribution patterns with specific loading areas of the foot that correspond to the evaluated movements. In addition, loading patterns with higher pressure values than those observed during normal run were found. In cutting, the medial part of the foot; in sprinting, the first and second ray; and in kicking, the lateral part of the foot are predominantly loaded. No global effect of the two surfaces on pressure parameters was found. CONCLUSION: The results of the present investigation suggest that the high load in soccer in combination with a high repetition may have an important influence in the development of overuse injuries.     

Intra and intersession repeatability and reliability of the S-Plate® pressure platform

AimThe aim of this study was to assess the repeatability and reliability of the S-Plate® pressure platform in a group of healthy subjects.Material and methodsForty subjects, free from physical conditions that would affect normal gait, walked along a five-meter corridor while data were recorded from the pressure platform. A total of 10 steps (five each side) were obtained as well as five static trials; the same measurements were repeated one week later. Peak and mean plantar pressures and contact area were recorded for both dynamic and static trials. Additionally, weight supported on each limb was documented during static trials. To assess intrasession and intersession repeatability and reliability, the intraclass correlation coefficients (ICCs) and coefficient of variation (CoV) were calculated.ResultsTaking the ICC values into account, every static and dynamic variable analysed showed moderate to excellent reliability and the CoV values were all below 12%.ConclusionMeasurements of either static or dynamic plantar pressure variables with the S-Plate® pressure platform show good repeatability and reliability, and so it is useful for comparing steps within and between sessions.     

足踝部反复损伤青少年足球运动员FootScan足底压力分析

目的:探讨足底压力分析在青少年运动损伤领域的应用价值。方法:2008年1月～2009年10月期间,在上海市普陀区青少年运动训练基地将40名16～19岁足踝部损伤3次以上的青少年足球运动员分为左足损伤和右足损伤两组,采用美国Tekscan公司的F-Scan三维动态足底压力步态分析系统,进行静、动态足底压力测试,测试数据与前期120名足踝部未损伤的健康青少年足球运动员正常数据进行对比分析。所有受试者均脱鞋袜,以个人正常步态自然行走,测量双脚各3次静、动态足底压力,测量指标为足底每个区域的压强峰值、接触时间负荷,计算足底各区域的压强峰值和负荷分布、重心轨迹特征。结果:青少年足球运动员损伤侧足底压力分布特征:(1)足底压强峰值最大区域在第5跖骨、足跟外侧;(2)足前区跖骨部的内侧与外侧比值低于正常参考值,差异具有统计学意义,足前区存在内翻倾向;(3)足部压力重心变化有向足前区转移的趋势,双足压强变化不对称;(4)足踝反复损伤者前足撑地时间延长,后足撑地时间减少。结论:足踝反复损伤青少年足球运动员足底压强变化不稳定,双足压强变化不对称;损伤足与正常对照差异显著,足部压力重心变化有向足前区转移的趋势,前足撑地时间延长,后足撑地时间减少,可能是为了减少损伤侧足踝关节的载荷而采取的保护性机制。足底压力分析在预防青少年足球运动员足踝反复损伤方面有临床价值。     

The influence of body weight, body mass index and gender on plantar pressures: results of a cross-sectional study of healthy children's feet

The purpose of this study was to determine if plantar pressure data in 4-7 year old children with normal development: (1) required normalising by body mass and/or body mass index and (2) should be separated or pooled for boys and girls. The outcome will guide the management of plantar pressure data in future work investigating changes in plantar pressure distribution with increasing age. In a cross-sectional design, 98 British children (45 girls) with no orthopaedic, neurological or developmental disorders provided plantar pressure measurements during walking. Peak plantar pressure and plantar pressure time integrals were obtained from nine areas under the foot: calcaneus, medial and lateral midfoot, each of the five metatarsals and the hallux. Body weight and body mass index demonstrated low and weak degrees of association (r≤0.48, p<0.05) with plantar pressure data. Boys and girls showed no difference in plantar pressures (p<0.05). Plantar pressure data for 4-7 year olds does not require normalisation with body mass or body mass index, and can be pooled for boys and girls.     

Footsteps required for reliable and valid in-shoe plantar pressure assessment during gait per foot region in people with hallux valgus

BackgroundPlantar pressure assessment is commonly performed to identify pathognomonic gait characteristics and evaluate therapeutics against them in people with various foot disorders. Little is known about the reliability and validity of this assessment in people with hallux valgus (HV) per foot region.Research questionThis study aimed to assess the reliability and validity of the in-shoe plantar pressure measurement method during gait in people with HV and the required number of footsteps, as an intra-subject sample size, to ensure a reliable and valid use of this method.MethodsWith an inserted disposable insole plantar pressure sensor in shoes, 17 females with HV (HV angle > 15°) completed three gait trials over the ground at a comfortable speed. Peak plantar pressure data and its distribution in 15 stance phases on the foot clinically diagnosed with HV in each participant were extracted by dividing the foot into eight regions. The intraclass correlation coefficient per foot region and the number of footsteps required to produce a valid peak plantar pressure and distribution (intraclass correlation coefficient > 0.90) were used to measure reliability. Based on the limit of agreement analysis, the coefficient of variation between the averaged value from each incremental footstep (2–14 footsteps) and 15 reference footsteps was calculated.ResultsThe intraclass correlation coefficient of plantar pressure assessment with the in-shoe sensor was 0.606–0.847 in the eight foot regions in people with HV. Additionally, the number of steps required for a valid assessment ranged from two to nine. Hence, the application of averaged values from more than nine footsteps is recommended for this evaluation.SignificanceThis reference sample size is intended to be used in future studies and clinical settings to determine the efficacy of HV treatment.     

A reliability study of biomechanical foot function in psoriatic arthritis based on a novel multi-segmented foot model

The objective of this study was to determine the within-and between-day reliability of spatio-temporal, plantar pressure, kinematic and kinetic measurements based on a novel, seven segment foot model applied in patients with Psoriatic Arthritis (PsA). Nine PsA patients and matched healthy adult controls underwent three-dimensional gait analysis on two occasions, one week apart using a seven segment foot model. A core-set of functional variables including inter-segment kinematics, kinetics, spatio-temporal and plantar pressure distribution were analysed using the coefficient of multiple correlation (CMC), Bland-Altman plots, intraclass correlation coefficients (ICC) and the standard error of measurement (SEM). Results showed excellent within- and between-day reliability for intersegment kinematic and kinetic data patterns with CMC values typically greater than 0.950 in a clinically stable cohort of PsA patients. Between-day reliability ranged from poor to excellent for absolute CMC values. Corrected CMC values were consistently higher across all variables ranging from fair-to-good to excellent. ICC values indicated excellent reliability for discrete spatio-temporal, plantar pressure, and ankle moment and power variables for both groups. Reliability for ground reaction forces and kinematic discrete variables ranged from fair-to-good to excellent. Standard error of measurement values ranged from 0.7° to 3.0° for discrete kinematic variables across both groups with greater variability in the PsA patients. In conclusion, intersegment kinematics and kinetics as well as spatio-temporal and plantar pressure can be reliably measured in PsA patients using a novel seven segment foot model. Some discrete kinematic variables have poor reliability and should not be used in prospective cohort and intervention studies.     

Can the Foot Posture Index or their individual criteria predict dynamic plantar pressures?

The Foot Posture Index (FPI) quantifies foot posture through the evaluation of six individual criteria. The objective of the present study was then to establish the plantar pressure differences between types of feet, and to study the capacity of the whole FPI value and the six individual criteria to predict the pattern of plantar pressures.In a sample of 400 healthy subjects (201 men and 199 women), the FPI was evaluated and plantar pressures were measured in 10 zones using the Footscan^® platform. Five plantar pressures measurements were made for each foot, using for the study the mean of these measurements for each subject's left foot.The hallux and the lesser toes had lower pressure indices in highly supinated feet, with the values increasing progressively toward the highly pronated feet (p < 0.001 and p = 0.019 respectively). The fifth metatarsal head (MTH) values were greater in highly supinated feet, and decreased in the highly pronated feet (p < 0.001). The FPI value predicts low variability of plantar pressures, mainly in the heel and midfoot, while the individual criteria predict higher variability in the forefoot. The talonavicular prominence and the calcaneal frontal plane position was the most influential criterion, explaining 8.5% of the hallux pressure and 11.1% of the fifth MTH pressure. Neither talar head palpation nor the supra and infra malleolar curvature predicted any of the plantar pressures variables.The FPI can distinguish three groups of feet – pronated, neutral, and supinated. Its individual criteria predict moderate or low plantar pressures variability, with the talonavicular prominence being the most influential criterion.     

Plantar pressure distribution during barefoot standing, walking and landing in preschool boys.

The purpose of this study was to examine the pressure distribution under the foot in preschool boys during standing, landing and walking tasks. Fourteen healthy boys (age 3.20+/-0.4 years) performed five activities (standing on one foot, standing on two feet, landing from a height onto one foot and both feet, and walking) on a Musgrave pressure platform system. The peak pressures were determined for eight areas of the foot. One-way analysis of variance (ANOVA) indicated that the total plantar pressures during landings were significantly higher compared to the overall plantar pressure developed during standing on one foot or two-feet and the contact phase of walking (P<0.05). A two-way ANOVA indicated that with the exception of the second to fifth toe area, the pressures were significantly higher elsewhere during landing and walking compared with the pressures during standing on two feet (P<0.05). Neither standing nor the stance phase of walking is fully representative of foot function in children.     

Comparison of in-shoe foot loading patterns on natural grass and synthetic turf

Synthetic playing surfaces with rubber or sand infill are now used on many athletic fields such as soccer, football and rugby. Although these surfaces may come closer to the mechanical characteristics of a true grass playing surface than the older turf designs, their potential effects on lower extremity biomechanics and related injury rates necessitate further study. The purpose of this study was to examine the effects of two surfaces (natural grass versus turf) on in-shoe foot loading patterns during cutting. Seventeen male football players were tested on a slalom course. An in-shoe pressure distribution measurement insole was used in the right shoe (14 stud, molded cleat) of each athlete. Individual cutting steps were extracted from each slalom trial and peak pressure and relative load calculated in nine distinct plantar regions of the foot. The turf condition had significantly higher peak pressures within the central forefoot (turf: 646.6 ± 172.6 kPa, grass: 533.3 ± 143.4 kPa, P = 0.017) and lesser toes (turf: 429.3 ± 200.9 kPa, grass: 348.1 ± 119.0 kPa, P = 0.043) compared to grass. In contrast, the relative load within the medial forefoot (turf: 27.2 ± 5.3%, grass: 30.2 ± 6.6%, P = 0.031) and lateral midfoot (turf: 3.4 ± 1.8%, grass: 4.1 ± 2.3%, P = 0.029) were higher during the grass condition. No differences between the grass and turf were found in maximal effort sprint times performed prior to the testing trials. This study demonstrates that playing surface significantly affects plantar loading during sport related activities. Further epidemiological investigation is warranted to determine the effects of playing surfaces on sport specific injury mechanisms.     

Elevated plantar pressure in diabetic patients and its relationship with their gait features

PurposeHigh plantar pressure is a major risk factor for diabetic foot ulcers. The relationship between plantar pressure and foot mobility has been investigated in some studies. However, when the foot is in motion, foot mobility is only a small feature of the gait. Therefore, we investigated relationship between high plantar pressure and gait and also studied the motion of the trunk. In addition, we investigated the relationship between gait and patient characteristics to identify patients at high-risk of developing diabetic foot ulcers.MethodsThe relationships between elevated plantar pressure, gait features, and patient characteristics were analyzed. Plantar pressure distribution in the stance phase was divided on the four plantar segments. Elevated plantar pressure was defined as being more than the mean plus one standard deviation of the corresponding segment in non-diabetic subjects. Plantar pressure distribution was measured by an F-scan system, and gait features were measured using wireless motion sensors attached to the sacrum and feet. Patient characteristics were obtained from medical records or by interview.ResultsSmall roll and yaw motions of the body and yaw motion of the foot during the mid-stance phase were related to the elevated plantar pressure in 57 diabetic patients. Furthermore, these gait features were related to sensory neuropathy, diabetes duration, patient weight, toe-gap force, and ankle range of motion.ConclusionGiven our findings, it may be possible to prevent diabetic foot ulcers by increasing foot motion during the mid-stance phase. Passive exercise aimed at expanding ankle range of motion in patients with sensory neuropathy or long-standing diabetes may assist in achieving this.     

Gait functional assessment: Spatio-temporal analysis and classification of barefoot plantar pressure in a group of 11-12-year-old children

Analysis of pedobarographical data requires geometric identification of specific anatomical areas extracted from recorded plantar pressures. This approach has led to ambiguity in measurements that may underlie the inconsistency of conclusions reported in pedobarographical studies. The goal of this study was to design a new analysis method less susceptible to the projection accuracy of anthropometric points and distance estimation, based on rarely used spatio-temporal indices. Six pedobarographic records per person (three per foot) from a group of 60 children aged 11–12 years were obtained and analyzed. The basis of the analysis was a mutual relationship between two spatio-temporal indices created by excursion of the peak pressure point and the center-of-pressure point on the dynamic pedobarogram. Classification of weight-shift patterns was elaborated and performed, and their frequencies of occurrence were assessed. This new method allows an assessment of body weight shift through the plantar pressure surface based on distribution analysis of spatio-temporal indices not affected by the shape of this surface. Analysis of the distribution of the created index confirmed the existence of typical ways of weight shifting through the plantar surface of the foot during gait, as well as large variability of the intrasubject occurrence.This method may serve as the basis for interpretation of foot functional features and may extend the clinical usefulness of pedobarography.     

Reliability of plantar pressure platforms

Plantar pressure measurement is common practice in many research and clinical protocols. While the accuracy of some plantar pressure measuring devices and methods for ensuring consistency in data collection on plantar pressure measuring devices have been reported, the reliability of different devices when testing the same individuals is not known. This study calculated intra-mat, intra-manufacturer, and inter-manufacturer reliability of plantar pressure parameters as well as the number of plantar pressure trials needed to reach a stable estimate of the mean for an individual. Twenty-two healthy adults completed ten walking trials across each of two Novel emed-x^® and two Tekscan MatScan^® plantar pressure measuring devices in a single visit. Intraclass correlation (ICC) was used to describe the agreement between values measured by different devices. All intra-platform reliability correlations were greater than 0.70. All inter-emed-x^® reliability correlations were greater than 0.70. Inter-MatScan^® reliability correlations were greater than 0.70 in 31 and 52 of 56 parameters when looking at a 10-trial average and a 5-trial average, respectively. Inter-manufacturer reliability including all four devices was greater than 0.70 for 52 and 56 of 56 parameters when looking at a 10-trial average and a 5-trial average, respectively. All parameters reached a value within 90% of an unbiased estimate of the mean within five trials. Overall, reliability results are encouraging for investigators and clinicians who may have plantar pressure data sets that include data collected on different devices.     

Pressure distribution and perceived comfort in casual footwear

The aim of this investigation was to establish the relationship between short-term perceived comfort and pressure distribution on the dorsal and plantar surfaces of the foot, while walking in a range of commercially available casual footwear. The study was carried out in the biomechanics laboratory of Manchester Metropolitan University using 15 male subjects without foot pathology. Perceived upper and plantar comfort were measured using a specially designed questionnaire, while dorsal and plantar pressure distributions were measured using a rectangular sensor pad recording at 30 Hz and a Mikro-EMED insole recording at 100 Hz respectively. Analysis of variance tests were used to determine differences in perceived comfort and pressure distribution between three pairs of shoes. The findings of this study suggest that an increase in total plantar force and force-time integral may relate to a decrease in perceived plantar comfort. For the three shoes examined in this study, overall peak plantar pressure, the pressure-time integral, and total plantar area did not appear to be linked to perceived plantar comfort. Findings for the shoe upper indicate that decreased dorsal forces and pressures may be related to decreased upper comfort. These findings suggest that the measurement of pressure distribution at the foot-shoe interface could be a useful tool in identifying the causes of discomfort in footwear.     

In-shoe plantar pressure measurements for the evaluation and adaptation of foot orthoses in patients with rheumatoid arthritis: A proof of concept study

ObjectivesImproving foot orthoses (FOs) in patients with rheumatoid arthritis (RA) by using in-shoe plantar pressure measurements seems promising. The objectives of this study were to evaluate (1) the outcome on plantar pressure distribution of FOs that were adapted using in-shoe plantar pressure measurements according to a protocol and (2) the protocol feasibility.MethodsForty-five RA patients with foot problems were included in this observational proof-of concept study. FOs were custom-made by a podiatrist according to usual care. Regions of Interest (ROIs) for plantar pressure reduction were selected. According to a protocol, usual care FOs were evaluated using in-shoe plantar pressure measurements and, if necessary, adapted. Plantar pressure–time integrals at the ROIs were compared between the following conditions: (1) no-FO versus usual care FO and (2) usual care FO versus adapted FO. Semi-structured interviews were held with patients and podiatrists to evaluate the feasibility of the protocol.ResultsAdapted FOs were developed in 70% of the patients. In these patients, usual care FOs showed a mean 9% reduction in pressure–time integral at forefoot ROIs compared to no-FOs (p = 0.01). FO adaptation led to an additional mean 3% reduction in pressure–time integral (p = 0.05). The protocol was considered feasible by patients. Podiatrists considered the protocol more useful to achieve individual rather than general treatment goals. A final protocol was proposed.ConclusionsUsing in-shoe plantar pressure measurements for adapting foot orthoses for patients with RA leads to a small additional plantar pressure reduction in the forefoot. Further research on the clinical relevance of this outcome is required.     

Integrated kinematics-kinetics-plantar pressure data analysis: a useful tool for characterizing diabetic foot biomechanics

The fundamental cause of lower-extremity complications in diabetes is chronic hyperglycemia leading to diabetic foot ulcer pathology. While the relationship between abnormal plantar pressure distribution and plantar ulcers has been widely investigated, little is known about the role of shear stress. Moreover, the mutual relationship among plantar pressure, shear stress, and abnormal kinematics in the etiology of diabetic foot has not been established. This lack of knowledge is determined by the lack of commercially available instruments which allow such a complex analysis. This study aims to develop a method for the simultaneous assessment of kinematics, kinetics, and plantar pressure on foot subareas of diabetic subjects by means of combining three commercial systems. Data were collected during gait on 24 patients (12 controls and 12 diabetic neuropathics) with a motion capture system synchronized with two force plates and two baropodometric systems. A four segment three-dimensional foot kinematics model was adopted for the subsegment angles estimation together with a three segment model for the plantar sub-area definition during gait. The neuropathic group exhibited significantly excessive plantar pressure, ground reaction forces on each direction, and a reduced loading surface on the midfoot subsegment (p<0.04). Furthermore the same subsegment displayed excessive dorsiflexion, external rotation, and eversion (p<0.05). Initial results showed that this methodology may enable a more appropriate characterization of patients at risk of foot ulcerations, and help planning prevention programs.     

Pressure characteristics in painful pes cavus feet resulting from Charcot-Marie-Tooth disease

Charcot–Marie–Tooth (CMT) disease often presents with peripheral muscle imbalance associated with a painful cavus (medial high-arched) foot deformity which becomes increasingly severe and rigid as the disease progresses. The purpose of this study was to investigate the effect of pes cavus on foot pain and dynamic plantar pressure in CMT, and to explore the relationships between plantar pressure and pain. Sixteen participants diagnosed with CMT and painful pes cavus were assessed for foot posture, ankle dorsiflexion range of motion, levels of foot pain, functional impairment, health-related quality of life and plantar pressure distribution while walking. Plantar pressure parameters (mean pressure, peak pressure, pressure–time integral) and contact duration were measured using the Novel Pedar^® in-shoe capacitance transducer system and the foot was divided into rearfoot, midfoot and forefoot regions for analysis. Increasing cavus foot deformity was associated with more widespread foot pain and increased pressure under the forefoot and midfoot regions. In contrast, peak pressure decreased under the rearfoot. Neither relationship was found between foot pain intensity and any of the pressure variables, nor was ankle dorsiflexion range of motion correlated with pain location, intensity or degree of pes cavus. Although pes cavus in CMT is associated with substantial pain and dysfunction, there is no clear link between foot pain and plantar pressure. The more severe the degree of pes cavus, however, the more pressure develops under the lateral margin of the foot; probably as a result of the changed foot–ground contact seen during gait.     

The reliability of the Adelaide in-shoe foot model

Understanding the biomechanics of the foot is essential for many areas of research and clinical practice such as orthotic interventions and footwear development. Despite the widespread attention paid to the biomechanics of the foot during gait, what largely remains unknown is how the foot moves inside the shoe. This study investigated the reliability of the Adelaide In-Shoe Foot Model, which was designed to quantify in-shoe foot kinematics and kinetics during walking. Intra-rater reliability was assessed in 30 participants over five walking trials whilst wearing shoes during two data collection sessions, separated by one week. Sufficient reliability for use was interpreted as a coefficient of multiple correlation and intra-class correlation coefficient of >0.61. Inter-rater reliability was investigated separately in a second sample of 10 adults by two researchers with experience in applying markers for the purpose of motion analysis. The results indicated good consistency in waveform estimation for most kinematic and kinetic data, as well as good inter-and intra-rater reliability. The exception is the peak medial ground reaction force, the minimum abduction angle and the peak abduction/adduction external hindfoot joint moments which resulted in less than acceptable repeatability. Based on our results, the Adelaide in-shoe foot model can be used with confidence for 24 commonly measured biomechanical variables during shod walking.     

Peak pressure curve: an effective parameter for early detection of foot functional impairments in diabetic patients

A clinical investigation was conducted on 61 diabetic patients and 22 healthy volunteers. Joint mobility, muscular function of the foot–ankle complex and plantar pressure measurements were characterised. A clustering algorithm was applied to obtain patient classification based on the shape and amplitude of the time curve of the instantaneous maximum pressure the foot experienced during gait. Results indicate that a screening test based on the peak pressure curve might be an effective way to detect diabetic patients at risk of foot ulceration.