Abnormalities of plantar pressure distribution in early,intermediate, and late stages of diabetic neuropathy |
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| Institution: | 1. University of São Paulo, School of Medicine, Physical Therapy, Speech and Occupational Therapy Department, São Paulo, SP, Brazil;2. University of São Paulo, School of Medicine, Center of Fuzzy Systems in Health, São Paulo, SP, Brazil;1. Department of Physical Therapy, Central Michigan University, Mt. Pleasant, MI, USA;2. Neuroscience Program, Central Michigan University, Mt. Pleasant, MI, USA;3. School of Engineering and Technology, Central Michigan University, Mt. Pleasant, MI, USA;1. Biomechanics Research Building, University of Nebraska at Omaha, Omaha, NE 68182, USA;2. Department of Physical Therapy & Rehabilitation Science, University of Maryland, Baltimore, Baltimore, MD 21201, USA;1. Department of Neurological, and Movement Sciences, University of Verona, via Casorati, 43, Verona, Italy;2. Service de Médecine physique et Réadaptation, Cliniques universitaires Saint-Luc, Avenue Hippocrate, 10–1200 Brussels, Belgium;3. Service de Médecine physique et Réadaptation, Cliniques universitaires Saint-Luc, Avenue Hippocrate, 10–1200 Brussels, Belgium;4. Service de Chirurgie orthopédique, Cliniques universitaires Saint-Luc, Avenue Hippocrate, 10–1200 Brussels, Belgium;5. Institute of Neurosciences, université catholique de Louvain, Avenue Mounier 53 B1, 5304–1200 Brussels, Belgium;1. Department of Information Engineering, University of Padova, Via Gradenigo 6b I, 35131 Padova, Italy;2. Department of Clinical Medicine and Metabolic Disease, University Polyclinic, Via Giustiniani 2, 35128 Padova, Italy;1. Human Movements and Health Research Unit, Physiotherapy Programme, School of Rehabilitation Science, Faculty of Health Science, Universiti Kebangsaan Malaysia, Malaysia;2. Department of Biomedical Sciences, School of Diagnostic and Applied Health Sciences, Faculty of Health Science, Universiti Kebangsaan Malaysia, Malaysia;3. Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand;4. Department of Orthopaedics and Traumatology, Pusat Perubatan Universiti Kebangsaan Malaysia, Bandar Tun Razak, Kuala Lumpur, Malaysia;1. The University of Sydney, Musculoskeletal Health, Faculty of Health Sciences, Sydney, New South Wales, Australia;2. Department of Sport, Health and Exercise Science, School of Life Sciences, University of Hull, United Kingdom;3. Paediatric Gait Analysis Service of New South Wales, Sydney Children’s Hospitals Network (Randwick and Westmead), New South Wales, Australia |
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| Abstract: | Inconsistent findings with regard to plantar pressure while walking in the diabetic population may be due to the heterogeneity of the studied groups resulting from the classification/grouping criteria adopted. The clinical diagnosis and classification of diabetes have inherent uncertainties that compromise the definition of its onset and the differentiation of its severity stages. A fuzzy system could improve the precision of the diagnosis and classification of diabetic neuropathy because it takes those uncertainties into account and combines different assessment methods. Here, we investigated how plantar pressure abnormalities evolve throughout different severity stages of diabetic polyneuropathy (absent, n = 38; mild, n = 20; moderate, n = 47; severe, n = 24). Pressure distribution was analysed over five areas while patients walked barefoot. Patients with mild neuropathy displayed an increase in pressure–time integral at the forefoot and a lower peak pressure at the heel. The peak and pressure–time integral under the forefoot and heel were aggravated in later stages of the disease (moderate and severe) compared with early stages of the disease (absent and mild). In the severe group, lower pressures at the lateral forefoot and hallux were observed, which could be related to symptoms that develop with the aggravation of neuropathy: atrophy of the intrinsic foot muscles, reduction of distal muscle activity, and joint stiffness. Although there were clear alterations over the forefoot and in a number of plantar areas with higher pressures within each severity stage, they did not follow the aggravation evolution of neuropathy classified by the fuzzy model. Based on these results, therapeutic interventions should begin in the early stages of this disease to prevent further consequences of the disease. |
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| Keywords: | Diabetic neuropathies Diabetes mellitus Plantar pressure Gait Fuzzy logic |
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