title: Plantar loading asymmetry in American Indians with diabetes and peripheral neuropathy, with diabetes only, and without diabetes.
abstract: BACKGROUND
  We investigated plantar loading asymmetry during gait in American Indians with and without diabetes and with diabetes and peripheral neuropathy.
  
  
  METHODS
  A convenience sample of 96 American Indians with and without diabetes was divided into three groups: 20 with diabetes and peripheral neuropathy, 16 with diabetes without peripheral neuropathy, and 60 with no history of diabetes (control group). Plantar loading was measured during barefoot walking across a pressure platform. Five trials were collected per foot during level walking at a self-selected speed using the two-step method. Asymmetry in peak pressure-time integral and peak plantar pressure were calculated from ten plantar regions and compared among groups.
  
  
  RESULTS
  Significant pressure-time integral asymmetry occurred across the forefoot regions in American Indians with diabetes and peripheral neuropathy compared with the other two groups. Significant peak plantar pressure asymmetry occurred in the third metatarsal region in both groups with diabetes (with and without peripheral neuropathy) compared with the control group.
  
  
  CONCLUSIONS
  Overall, American Indians with diabetes seemed to show greater asymmetry in plantar loading variables across the forefoot region compared with those in the control group. Specifically, individuals with diabetes and peripheral neuropathy had the greatest amount of forefoot pressure-time integral asymmetry. Significant peak plantar pressure asymmetry occurred in the third metatarsal region of the forefoot in those with diabetes with and without peripheral neuropathy. Loading asymmetry may play a role in the development of foot ulcers in the forefoot region of American Indians with peripheral neuropathy and diabetes.
authors.affiliation: Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Kernozek
authors.forename: John F
authors.initials: JF
authors.lastname: Greany
authors.forename: Cassandra
authors.initials: C
authors.lastname: Heizler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D005260:Female; D005528:Foot / Q000502:physiology*; D005545:Forefoot, Human / Q000502:physiology*; D005684:Gait / Q000502:physiology*; D006801:Humans; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000503:physiopathology*; D011312:Pressure; D016138:Walking / Q000502:physiology*