title: Classification of forefoot plantar pressure distribution in persons with diabetes: a novel perspective for the mechanical management of diabetic foot?
abstract: BACKGROUND
  The aim of this study was to identify groups of subjects with similar patterns of forefoot loading and verify if specific groups of patients with diabetes could be isolated from non-diabetics.
  
  
  RESULTS
  Ninety-seven patients with diabetes and 33 control participants between 45 and 70 years were prospectively recruited in two Belgian Diabetic Foot Clinics. Barefoot plantar pressure measurements were recorded and subsequently analysed using a semi-automatic total mapping technique. Kmeans cluster analysis was applied on relative regional impulses of six forefoot segments in order to pursue a classification for the control group separately, the diabetic group separately and both groups together. Cluster analysis led to identification of three distinct groups when considering only the control group. For the diabetic group, and the computation considering both groups together, four distinct groups were isolated. Compared to the cluster analysis of the control group an additional forefoot loading pattern was identified. This group comprised diabetic feet only. The relevance of the reported clusters was supported by ANOVA statistics indicating significant differences between different regions of interest and different clusters.
  There seems to emerge a new era in diabetic foot medicine which embraces the classification of diabetic patients according to their biomechanical profile. Classification of the plantar pressure distribution has the potential to provide a means to determine mechanical interventions for the prevention and/or treatment of the diabetic foot.
authors.affiliation: Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium ; Laboratory for Clinical Motion Analysis, University Hospitals Leuven, Pellenberg, Belgium ; Multidisciplinary Diabetic Foot Clinic, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Kevin
authors.initials: K
authors.lastname: Deschamps
authors.forename: Giovanni Arnoldo
authors.initials: GA
authors.lastname: Matricali
authors.forename: Philip
authors.initials: P
authors.lastname: Roosen
authors.forename: Kaat
authors.initials: K
authors.lastname: Desloovere
authors.forename: Herman
authors.initials: H
authors.lastname: Bruyninckx
authors.forename: Pieter
authors.initials: P
authors.lastname: Spaepen
authors.forename: Frank
authors.initials: F
authors.lastname: Nobels
authors.forename: Jos
authors.initials: J
authors.lastname: Tits
authors.forename: Mieke
authors.initials: M
authors.lastname: Flour
authors.forename: Filip
authors.initials: F
authors.lastname: Staes
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D016000:Cluster Analysis; D003920:Diabetes Mellitus / Q000503:physiopathology*; D017719:Diabetic Foot / Q000503:physiopathology* / Q000628:therapy; D005545:Forefoot, Human / Q000503:physiopathology*; D005684:Gait; D006801:Humans; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies