| BackgroundDiabetic foot ulcer is one of the common chronic complications of diabetic patients.Aaccording to statistics,more than 15%of diabetic patients in their lives will be foot ulcers or gangrene.85%of amputations are caused by diabetic foot ulcers.Foot pressure is one of the important causes of diabetic foot ulcer,and its correlation is as high as 70?90%.Through the mfluence of nerve,muscle,joint and other aspects of diabetes to make the foot biomechanics ehanges,resulting in changes in plantar pressure.Previous studies have shown that plantar pressure in diabetic patients is affected by many factors.As the first barrier to protect the foot,plantar soft tissue has certain correlation with plantar pressure and foot ulcer.With the implementation of limb salvage treatment,most patients with amputation of diabetic foot were partial amputation,and the amputation of diabetic foot patients with high recurrence rate.Prevention and treatment of diabetic foot ulcer 1s an important strategy to reduce diabetic foot ulcer.A comprehensive understanding of the biomechanics and soft tissue changes of the diabetic foot in patients with diabetes mellitus and minor amputations can provide useful data for the prevention of diabetic foot ulcers.ObjectiveObjective to investigate the changes of biomechanics and plantar soft tissue and their influence factors in patients with diabetes mellitus with or without minor amputation.Part one:Analysis of foot biomechanics in patients with type.2 diabetes mellitus MethodA total of 303 patients with type 2 diabetes without diabetic foot ulcer history were enrolled.Demographic characteristics and related biochemical indexes were recorded.Parameters of Plantar pressure and gait were recorded with the FootScan system.The whole foot was divided into 10 regions including the first toe?T1?,the second to fifth toes?T2?,the first to fifth metatarsals?M1,M2,M3,M4,M5?,Midfoot?MF?,the heel medial?HM?.The information of Peak Force?PF?,Peak Pressure?PP?,contact area,force-time integrals?FTI?,Pressure-time integrals?PTI?,total time,speed?Foot axis angle,?FAA?,foot arch index?AI?,gait parameters.The gait cycle is divided into support period and swing phase.According to five key moments,initial foot contact,initial metatarsal contact,initial forefoot flat contact,heel off,last foot contact,support period divided into initial contact phase,forefoot contact phase,foot flat forefoot phase,Push off phase the percentage of the time of the above 4 phases to the support phase were recorded as PI,P2,P3,P4.According to the Diabetic peripheral neuropathy,BMI,foot type and foot axis angle,Divided into several groups and analysed of foot biomechanics among groups.Multiple linear regression was used to analysis of various factors and plantar pressure.Result1.The biomechanical is difference between the left and the right foot in diabetic patients.Compared with the left foot,the total contact area,the total force?T-PF?,the foot axis angle,the total peak pressure?T-PP?,foot arch index on the right foot decreased.The incidence of low arch foot was lower,while the incidence of high arch foot was higher on the right side.There was no significant difference in gait phase,total time,total force-time integral and total pressure-time integral?P>0.05?.PP in M1 of right foot was higher than the left foot?4.90±2.64 vs 5.58±2.86,P<0.05?,and PP in the M3,M4,M5,MF of left foot were higher?12.61±4.12 vs 10.46±3.20;9.73±4.00 vs 7.74±2.96;4.58±2.50 vs 3.68±1.91;2.75±1.26 vs 2.51±1.18,P<0.05?.2.The effect of foot type on plantar pressure.Compared with normal arch,L-PF?T1?M2?MF?,L-FTI?T1?M2?HM?HL?,L-PP?T1?M1??M2?HM?HL),L-PTI?M1?M2,HM?HL?,R-PF?T1?,R-FTI?T1?>,R-PP?T1?M1?HL?,R-PTI?M1?of high arch foot increased?P<0.05?.L,PF?hm?,L-FTI?MF?,R-PF?M2?M3?MF?,-PP?MF?,L-PTI?MF?of high arch foot decreased?P<0.05?.The L-PF?T2?M4?M5?,L-FTI?M4?M5?,L-PP?M5?,L-PTI?M5?,R-PF?M1?M2,M3?HM?,R-FTI?M2?M3?,R-PP?M2?M3?of low arch foot decreased?P<0.05?.L-PF?MF?HM?,L-FTI?MF?,L-PP?MF?,L-PTI?MF?,R-PF?MF?,R-FTI?MF?,R-PP?M5?MF?of low arch foot increased?P<0.05?.3.The effect of foot axis angle on plantar pressure.While the foot axis angle increased,L-PF?T1?MF?HL?,L-FTI?MF?HL?,R-PFcHM),R-FTI?HM?HL?increased?P<0.05?.L-PF?T2?M4,M?,L-FTI?T2?M4?M5?,R-PF?T2?,R-FTI?T1.T2?decreased?P<0.05?.While the foot axis angle increases,L-PP?M1?M3?M4?HM?,l-PTI?MH?M3?M4?,R-PP?HM?increased?P<0.05?.L-PP?M5?,R-PP?T1?,R-PTI?T2?decreased?P<0.05?.4.Changes of plantar pressure and gait in patients with diabetic peripheral neuropathy?1?.Compared with DC group,the FP in M1?90.47±55.74 vs 110.88±54.11,P<0.05?,M2?118.17±8.38 vs 127.35±37.13,P<005?,M3?99.72±33.78 vs 108.43±35.48,P<0.05?of the right foot decreased.The PP in M3?13.15±4.22 vs 11.96±3.94 N/cm2,P<0.05?or M4?10.21±4.22 vs 9.14±3.66 N/cm2,P<0.05?on the left foot and in M1?6.02±2.79 vs 5.04±2.87 N/cm2,P<0.05?,M2?9.95±2.69 vs 9.18±2.77 N/cm2,P<0.05?,M3?10.90±3.23 Vs 9.93±3.09 N/cm2,P<0.05?on the right foot decreased.There was no significant differences in peak pressure and pressure-time intergrals in each region between the two groups?P>0.05?.?2?.In comparison with those in DC group,foot flat phase extended[56.8(50.22?62.45 vs 59.5?54.25?64.15?,P<0.05],forefoot push off phase shorten[31.25?25.475?35.775?vs 29?24.95?33.65?,p<0.05]in stance phase,total contact time[?858±12?vs?900±127?,P<0.05]increased significantly,walking speed decreased[?2.58±0.67?vs?2.28±0.66??km/h?,P<0.05]in DPN group.5.The correlation between peak pressure and walking speed,P3sP4The PP of many regions were positively correlated with the walking speed?P<0.05?.The peak pressure in T1,T2,M3,M4,M5,MF of the left foot and M1,M2,M3,M4 of right foot were negatively correlated with P3?P<0.05?.The peak pressure in most areas was positively correlated with P4?P<0.05?6.The effect of BMI on plantar pressure.?1?.While total plantat pressure>70N/cm2 was definited as hight-risk foot.The percentage of high-risk foot was 34%on left,17.7%on right.With increasing BMI high-risk foot proportion increased significantly,except for right foot in underweight group.?The percentage of high-risk foot of underweight group,normal BMI group,overweight group,Obesity group were respectively 14.3%,20.5%,40.5%,49.1%,P<0.05 on the left and 4.3%?8.9%?19.2%?32.7%,P<0.05 on the right?.?2?.Compared with the normal BMI group,peak force and force-time integral were significantly increased in overweight and obesity group except toe,but there was no significant difference between obesity group and overweight group.The effect of BMI on plantar pressure peak in patients with diabetes mellitus,Ml,M2,M3,MF were more significant,P<0.05.However,there was no significant difference between different BMI groups in pressure-time integral.7.Multiple linear regression analysis of plantar pressure and factors.Multiple linear multiple regression analysis showed that the plantar pressure factors including weight??,0.165?0.788,P<0.05?,height??,-0.214?0.379,P<0.05?,age??,-0.138?0.193,P<0.05?speed??,-0.467?0.353,P<0.05?,foot axis angle??,-253?-0.306,P<0.05?,arch index??,-329?0.465,P<0.05?,duration of diabetes??,-0.097?0.233,P<0.05?,HbAlc??,0.161,P<0.05?,DPN?p,-0.172,P<0.05?.Weight can explain most of the pressure parameter.speed positively was correlated with many parameters peak force?p,0.104?0.353,P<0.05?and force-time integral and negatively correlated with peak pressure pressure-time integral??,-148?-0.467,P<0.05?.Conclusion1.The plantar pressure of diabetes was significantly correlated with the gait,the plantar pressure and walking speed are positively related.2.On the high arch foot,the plantar pressure in T1,forefoot and?or?the heel increased,decreased in MF.On the low arch foot the plantar pressure decrease in forefoot and increased in midfoot.3.With the increasing of foot axis angle,the PF and FTI of big toe and heel increased,decreased in the lateral metatarsal?M4,M5?.The PP,PTI in the central metatarsal?M3,M4?and medial heel?HM?increased.4.There was no increasing of plantar pressure in DPN patients.The percentage of high risk foot in Overweight and obese patients increased significantly.With the increase of BMI,the PF and FTI increased significantly in many regions.The Second Part:Analysis of biomechanics and plantar soft tissue thickness in diabetic foot patients with minor amputation historyMethods:the general data of patients were collected.Bilateral plantar pressure data and foot plantar soft tissue thickness of big toe?A1?,second metatarsal,?A2?,the third metatarsal?A3?,the fourth metatarsal?A4?,mid-foot?A5?,heel?A6?were collected.The comparison of plantar pressure and plantar soft tissue between the amputation group and the non-amputation group.Correlation analysis and linear Multiple regression analysis of the thickness of plantar soft tissue.Result1.Comparison of plantar pressure in each region between affected foot and healthy foot of minor amputation patients.Compared with the healthy foot,FTI of M2 in affected foot was higher.?28.22±13.53 vs 20.91±9.82,P<0.05?.There was no significant difference between affected foot and healthy foot in other plantar pressure parameter in each region.However,there is a increasing trend in plantar pressure in M1,M2,M3 in affected foot,and decreacing trend in M4,M5,MF,HM,HL in affected foot.2.Comparison of plantar pressure in each region among non-amputation patients and affected foot or healthy foot of minor amputation patients.Compared with non-amputation patients,PF of M3?6.74±2.54 vs 9.03±2.4,P<0.05?,M4?5.07±2.41 vs 7.65±2.08,P<0.05?in healthy foot and M3?6.74±2.54 vs 9.3±2.63,P<0.05?,M4?5.077±2.41 vs 6.1 ±2.53,P<0.05?in affected foot were significantly increase,PTI of M3?2.57±1.01 vs 441±2.5,P<0.05?,M4?2.06±1.12 vs 4.2±2.81,P<0.05?,M5?1.24±0.88 vs 2.85±2.7,P<0.05?in healthy and M3?2.57±1.01 vs 4.52±2.79,P<0.05?,M4?2.04±0.95 vs 3.25±2.51,P<0.05?in affected foot.There was no significant difference in other plantar pressure parameter in each region·3.Comparison of thickness of plantar soft tissue between affected foot and healthy foot of minor amputation patients.There was no significant difference in thickness of plantar soft tissue between affected foot and healthy foot of minor amputation patients.thickness of plantar soft tissue of A1?A6 in healthy foot were 0.6?0.585?0.8?,0.9?0.645?1?,0.8?0.675?0.95?,0.9?0.45?1.05?,0.8?0.65?0.83?,1.4?0.975?1.5?respectively,the affected foot were 0.6?0.56?0.9?,0.7?0.68?1?,0.8?0.66?0.8?,0.8?0.7?0.89?,0.97?0.8?1.4?,1.3?0.94?1.4?.4.Comparison of thickness of plantar soft tissue among non-amputation patients and affected foot or healthy foot of minor amputation patients.The plantar soft tissue is thickest in A6?heel?,thinnest in A1?great toe?,whether in non-amputation patients or affected foot and healthy foot of minor amputation patients.Compared with non-amputation patients,the thickness of plantar soft tissue of A2[1?0.9?1.2?vs 0.7?0.68?0.7?,P<0.05],A6[1.43?1.3?1.7?vs 1.3?0.941?.4?,P<0.05]in healthy foot and A2[1?0.9?1.2?vs 0.9?0.67?1?5,P<0.05],A5[1.15?1?1.3?vs 0.8?0.68?.82?,P<0.05]in affected foot were decrease significantly.There was no significant difference in thickness of plantar soft tissue in other regions.5.The influencing factors of thickness of plantar soft tissueMultiple linear regression analysis was used in the variables demonstrated to be statistically significantly correlated with thickness of plantar soft tissue Multiple linear regression analysis show that the influencing factor of thickness of plantar soft tissue were sex,age,weight,amputation,foot axis angle,foot arch index.The influencing factors of difference thickness of plantar soft tissue were difference.Amputation affect the thickness of the plantar soft tissue from A1 to A6??-0.037?0.197?.The range of R2 of multiplelinear regression analysis is 0.331?0.562Conclusion1.There was no significant difference in plantar pressure between the healthy and affected side2.Compared with the non-amputation group,the peak pressure and pressure-time integration of middle and lateral metatarsal in both sides of the amputation increased and the thickness of plantar soft tissue decreased3.Thickness of plantar soft tissue is correlated with sex,age,height,weight,amputation,foot axis angle,foot arch index.Summary1.The plantar pressure of diabetic patients was affected by body mass index,walking speed,foot type and foot axis angle foot.2.There was no significant difference in plantar pressure between the healthy and affected side 5 but the peak pressure and pressure-time integration of middle and lateral metatarsal in both sides of the amputation increased,and the thickness of plantar soft tissue decreased,compared with non-amputation group,3.Thickness of plantar soft tissue is correlated with sex,age,height,weight,amputation,foot axis angle,foot arch index. |
PDF Full Text Request