title: Quantifying Dynamic Changes in Plantar Pressure Gradient in Diabetics with Peripheral Neuropathy.
abstract: Diabetic foot ulcers remain one of the most serious complications of diabetes. Peak plantar pressure (PPP) and peak pressure gradient (PPG) during walking have been shown to be associated with the development of diabetic foot ulcers. To gain further insight into the mechanical etiology of diabetic foot ulcers, examination of the pressure gradient angle (PGA) has been recently proposed. The PGA quantifies directional variation or orientation of the pressure gradient during walking and provides a measure of whether pressure gradient patterns are concentrated or dispersed along the plantar surface. We hypothesized that diabetics at risk of foot ulceration would have smaller PGA in key plantar regions, suggesting less movement of the pressure gradient over time. A total of 27 participants were studied, including 19 diabetics with peripheral neuropathy and 8 non-diabetic control subjects. A foot pressure measurement system was used to measure plantar pressures during walking. PPP, PPG, and PGA were calculated for four foot regions - first toe (T1), first metatarsal head (M1), second metatarsal head (M2), and heel (HL). Consistent with prior studies, PPP and PPG were significantly larger in the diabetic group compared with non-diabetic controls in the T1 and M1 regions, but not M2 or HL. For example, PPP was 165% (P = 0.02) and PPG was 214% (P < 0.001) larger in T1. PGA was found to be significantly smaller in the diabetic group in T1 (46%, P = 0.04), suggesting a more concentrated pressure gradient pattern under the toe. The proposed PGA may improve our understanding of the role of pressure gradient on the risk of diabetic foot ulcers.
authors.affiliation: Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA; Department of Creative Product Design, Asia University, Taichung, Taiwan.
authors.forename: Chi-Wen
authors.initials: CW
authors.lastname: Lung
authors.affiliation: Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign , Urbana, IL , USA.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Hsiao-Wecksler
authors.affiliation: Department of Physical Therapy, Langston University , Langston, OK , USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Burns
authors.affiliation: Center for Lower Extremity Ambulatory Research, Rosalind Franklin University , North Chicago, IL , USA.
authors.forename: Fang
authors.initials: F
authors.lastname: Lin
authors.affiliation: Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign , Champaign, IL , USA.
authors.forename: Yih-Kuen
authors.initials: YK
authors.lastname: Jan
keywords: diabetes; diabetic foot ulcers; peripheral neuropathy; plantar pressure; pressure gradient