Plantar blood flow response to accumulated pressure stimulus in diabetic people with different peak plantar pressure: a non-randomized clinical trial

AbstractThe aim of this study was to investigate the plantar blood flow response to the same accumulated pressure stimulus in diabetic patients with different peak plantar pressure (PPP), which is important for assessing the risk of diabetic foot ulcer. Eleven diabetic subjects with high PPP (PPP ≥ 207 kPa) and 8 diabetic subjects with low PPP (PPP < 207 kPa) were asked to walk naturally on a treadmill so as to induce an accumulated stimulus of 73,000 kPa·s on their first metatarsal head, which was monitored with a sensorized insole. Blood perfusion (BP) in the first metatarsal head was measured before and after walking. Results showed that blood flow after applying the same walking stimulus was significantly decreased in comparison to the basal BP before walking in both high PPP and low PPP groups (p < 0.05), but no significant differences were found between the two groups in terms of BP parameters and its percentage change (p > 0.05). Moreover, BP parameters were not significantly correlated to PPP and the pressure-time integral (PTI) of the subjects’ gait (p > 0.05). This indicated that, besides PPP and PTI, the accumulated mechanical stimulus should be taken into consideration when assessing the risk of diabetic patients developing foot ulcers. Graphical abstractPlantar blood flow response to a walking stimulus

[1]  C. Nester,et al.  Effect of rollover footwear on metabolic cost of ambulation, lower limb kinematics, kinetics, and EMG related muscle activity during walking , 2012, Journal of Foot and Ankle Research.

[2]  Shuyu Li,et al.  Feedback System Based on Plantar Pressure for Monitoring Toe-Walking Strides in Children with Cerebral Palsy , 2014, American journal of physical medicine & rehabilitation.

[3]  Michael J. Mueller,et al.  A Moderate-Intensity Weight-Bearing Exercise Program for a Person With Type 2 Diabetes and Peripheral Neuropathy , 2011, Physical Therapy.

[4]  L. Cacciari,et al.  Effects of strengthening, stretching and functional training on foot function in patients with diabetic neuropathy: results of a randomized controlled trial , 2014, BMC Musculoskeletal Disorders.

[5]  F. Nollet,et al.  Offloading effect of therapeutic footwear in patients with diabetic neuropathy at high risk for plantar foot ulceration , 2012, Diabetic medicine : a journal of the British Diabetic Association.

[6]  Daniel Zahra,et al.  A comparison of customised and prefabricated insoles to reduce risk factors for neuropathic diabetic foot ulceration: a participant-blinded randomised controlled trial , 2012, Journal of Foot and Ankle Research.

[7]  E. Block,et al.  Increased gait variability in diabetes mellitus patients with neuropathic pain. , 2013, Journal of diabetes and its complications.

[8]  S. Bus,et al.  The interdependency of peak pressure and pressure-time integral in pressure studies on diabetic footwear: no need to report both parameters. , 2012, Gait & posture.

[9]  T. Eigentler,et al.  Pathogenesis of diabetic macro- and microangiopathy. , 2008, Clinical nephrology.

[10]  Pilot study of the effects of local pressure on microvascular function in the diabetic foot , 2005, Diabetic medicine : a journal of the British Diabetic Association.

[11]  K. M. Patil,et al.  Effect of foot sole hardness, thickness and footwear on foot pressure distribution parameters in diabetic neuropathy , 2004, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[12]  M. Chateau‐Degat,et al.  Plantar pressures, plantar forces, and their influence on the pathogenesis of diabetic foot ulcers: a review. , 2013, Journal of the American Podiatric Medical Association.

[13]  H N Mayrovitz,et al.  Blood perfusion hyperaemia in response to graded loading of human heels assessed by laser-Doppler imaging. , 1999, Clinical physiology.

[14]  Michael J. Mueller,et al.  Weight-bearing versus nonweight-bearing exercise for persons with diabetes and peripheral neuropathy: a randomized controlled trial. , 2013, Archives of physical medicine and rehabilitation.

[15]  S. Dixit,et al.  Effect of aerobic exercise on peripheral nerve functions of population with diabetic peripheral neuropathy in type 2 diabetes: a single blind, parallel group randomized controlled trial. , 2014, Journal of diabetes and its complications.

[16]  B. Fernhall,et al.  Exercise and Type 2 Diabetes , 2010, Diabetes Care.

[17]  B. Fernhall,et al.  Exercise and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement. Exercise and type 2 diabetes. , 2010, Medicine and science in sports and exercise.

[18]  Pierre Abraham,et al.  Early decrease of skin blood flow in response to locally applied pressure in diabetic subjects. , 2002, Diabetes.

[19]  Yih-Kuen Jan,et al.  Effect of viscoelastic properties of plantar soft tissues on plantar pressures at the first metatarsal head in diabetics with peripheral neuropathy , 2013, Physiological measurement.

[20]  P. Leffers,et al.  Prediction of peak pressure from clinical and radiological measurements in patients with diabetes , 2008, BMC endocrine disorders.

[21]  D. Armstrong,et al.  The forefoot-to-rearfoot plantar pressure ratio is increased in severe diabetic neuropathy and can predict foot ulceration. , 2002, Diabetes care.

[22]  Paul K. Commean,et al.  Multi-plug insole design to reduce peak plantar pressure on the diabetic foot during walking , 2008, Medical & Biological Engineering & Computing.

[23]  T. M. Owings,et al.  Plantar pressures in diabetic patients with foot ulcers which have remained healed , 2009, Diabetic medicine : a journal of the British Diabetic Association.

[24]  Huei-Ming Chai,et al.  Comparison of Pressure and Time Parameters in Evaluating Diabetic Footwear , 2002, American journal of physical medicine & rehabilitation.

[25]  R. Sigal,et al.  Impairments in local heat loss in type 1 diabetes during exercise in the heat. , 2014, Medicine and science in sports and exercise.

[26]  David G Armstrong,et al.  Predictive value of foot pressure assessment as part of a population-based diabetes disease management program. , 2003, Diabetes care.

[27]  Clare Y L Chao,et al.  Microvascular dysfunction in diabetic foot disease and ulceration , 2009, Diabetes/metabolism research and reviews.

[28]  J. Helgerud,et al.  High-intensity aerobic interval training improves aerobic fitness and HbA1c among persons diagnosed with type 2 diabetes , 2017, European Journal of Applied Physiology.

[29]  Yih-Kuen Jan,et al.  Skin blood flow response to locally applied mechanical and thermal stresses in the diabetic foot. , 2013, Microvascular research.

[30]  J. Petrofsky,et al.  The influence of age and diabetes on the skin blood flow response to local pressure. , 2009, Medical science monitor : international medical journal of experimental and clinical research.

[31]  Sneh Anand,et al.  Investigation of Shore meter in assessing foot sole hardness in patients with diabetes mellitus - a pilot study , 2012, International Journal of Diabetes in Developing Countries.

[32]  D. Swain,et al.  Change in cutaneous perfusion following 10 weeks of aerobic training in Type 2 diabetes. , 2005, Journal of diabetes and its complications.