Plantar pressure distribution during barefoot gait and somatossensorial sensibility in diabetic neuropathic subjects with and without history of ulceration / Distribuição da pressão plantar durante o andar descalço e sensibilidade somatossensorial de diabéticos neuropatas com e sem história de úlceras

AUTOR(ES)
DATA DE PUBLICAÇÃO

2006

RESUMO

The loss of protective sensation due to the chronic complication of distal peripheral diabetic neuropathy makes absent the trauma and pain protection mechanisms, increasing the chances for ulceration in diabetic foot, which can evolutes to amputation of the lower limbs. The presence of foot deformities can lead to higher loading under the foot when it is associated with sensorial changes. The objective of this study was to evaluate the influence of diabetic neuropathy and history of plantar ulcers in the somatossensorial sensibility and the plantar pressure distribution during the barefoot condition between diabetic neuropathic subjects with (DNU) and without (DN) previous ulcers with non diabetic asymptomatic (CG) to investigate if the presence of plantar ulceration on clinic history of neuropathic diabetics, the incidence of foot deformities and the loss of sensation have influence in dynamic patterns of plantar pressure distribution. The casuistics was composed of 44 subjects: 19 subjects in the CG, 16 subjects in the DN and 9 subjects in the DNU. The tactile sensibility using a 10g monofilament, thermal sensibility and sensitive cronaxie were measured. The plantar pressure distribution was recorded with the subjects walking barefoot using the insoles of Pedar ® (Novel) system at a self-selected speed. The sensibility and the pressure variables were compared between groups in five regions of the feet: rear foot, midfoot, lateral forefoot, medial forefoot and hallux. The groups were compared using the Kruskal-Wallis test and ANOVA one-way, an alpha of 5% was adopted. The time of diabetes and the score on the questionnaire for diabetic symptoms were not different between the neuropathic groups. DNU showed more number of plantar areas with deficit of sensibility for all modalities measured and also showed higher incidence of subjects with abnormal values for sensibility. Both neuropathic groups showed greater contact area in rearfoot in comparison with CG (p=0,0063) and only the DNU had greater contact area under the medial forefoot in comparison with GC (p=0,0384). We found no differences for peak pressure in all areas tested. The pressure time integral (kPa.s) showed significant differences between the three groups for midfoot (CG: 37,4 ± 12,8; DN: 43,4 ± 9; DNU: 69,1 ± 35,5; p=0,0001) and higher values for the neuropathic subjects in relation to CG in the lateral forefoot (CG: 92 ± 25,3; DN: 104,9 ± 25; DNU 108 ± 28; p=0,02) and in the medial forefoot (CG: 98,9 ± 22,6; DN: 113,2 ± 29,7; DNU: 128,1 ± 34,2; p=0,0029). The DNU showed higher relative load in the midfoot in comparison with CG, lower relative load for the lateral forefoot in comparison with other groups and for the hallux in comparison only to CG. In conclusion, neuropathic subjects with prior history of plantar ulcers have worse deficit of sensibility. The presence of ulcer on the clinic history did not interfer in the peak pressure and in the contact area, but the pressure time integral seems to be influenced by the deficit of sensibility and showed higher values among the neuropathic subjects with previous history of ulcers for all plantar regions.

ASSUNTO(S)

Úlcera de pé biomecânica biomechanics foot ulcer marcha neuropatia diabética gait diabetic neuropaties

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