The Toe-to-Forefoot Plantar Pressure Ratio Is Increased in Severe Diabetic Neuropathy
Abstract Number: 1001-P
Authors: YOUHEI FUJIOKA, SHIN-ICHI TANIGUCHI, HIROSHI KINOSHITA, KEISUKE SUMI, HIDEKI SHIOCHI, NAOYA YAMAMOTO, KAZUHIKO MATSUZAWA, SHOICHIRO IZAWA, TSUYOSHI OHKURA, HIROKO OHKURA, CHIAKI SHIGEMASA
Institutions: Yonago, Japan
Results: Diabetic peripheral neuropathy (DPN) is associated with progressive loss of sensation, autonomic impairment and gait alterations. These impairments are the significant risk for diabetic plantar ulcer. The aim of the present study is to evaluate the relationship between neuropathy and plantar pressure profile in diabetic patients with different degrees of peripheral neuropathy.
Twenty six patients of type2 diabetes with DPN were enrolled and classified into 3 groups according to the severity of neuropathy, Ι(mild, n=6), ΙΙ(moderate, n=12), ΙΙΙ(severe, n=8). We estimated foot CPT (Current Perception Threshold) values by Neurometer, metatarsophalangeal joint (toe joint) flexibility by goniometer, and peak plantar pressure by F-scan2. Plantar area was divided into 4 regions: toe, forefoot, midfoot and rearfoot. Then, the peak pressure ratio of toe/fore (T/F ratio) and fore/rear (F/R ratio) were calculated. To prevent the extreme variation, patients with callositas were excluded. Then, we evaluated the correlation among the severity of DPN, CPT value, toe joint flexibility, and plantar pressure profile.
CPT values, peak pressure of toe and T/F ratio were increased in proportion to DPN. In contrast, toe joint flexibility was significantly decreased (table).
T/F ratio was correlated with CPT values (p<0.01,R=0.54) and tended to be inversely correlated with toe joint flexibility (p=0.08,R=0.34).
These results indicate that increasing degrees of DPN restricts the toe joint flexibility and thereby converts plantar pressure distribution from forefoot to toe area. Our observation leads to the concept that increased relative toe pressures during gait may contribute to the plantar ulcer formation in diabetes.
| Severity of neuropathy
(vs. severity of neuropathy)
| CPT of 2000Hz (Neurometer)
| Range of toe joint flexibility
| Peak pressure of toe
| T/F ratio (F-scan2)
| T/R ratio (F-scan2)