To evaluate plantar pressure in type 2 diabetic patients. Subjects and methods: 126 type 2 diabetic patients were treated in the National Hospital of Endocrinology (diabetic group); 40 non-diabetic patients (control group).
Trang 1EVALUATING PLANTAR PRESSURE IN TYPE 2 DIABETIC PATIENTS WHO VISITED TO THE NATIONAL HOSPITAL OF
ENDOCRINOLOGY
Pham Tuan Phuong 1 ; Nguyen Thi Phi Nga 2 ; Phan Viet Nga 2
SUMMARY
Objectives: To evaluate plantar pressure in type 2 diabetic patients Subjects and methods:
126 type 2 diabetic patients were treated in the National Hospital of Endocrinology (diabetic group); 40 non-diabetic patients (control group) Results: Right foot: Peak pressure index in control group was 334.06 ± 104.06 kpa which was significantly lower than in case group (386.39
± 123.64 kpa) (p < 0.05); 21.4% of study subjects increased peak pressure The most increase
of the peak pressure was found at the bone foundation of the 1 st toe: (79.45%) and the lowest in the 2 nd toe (15.1%) Left foot: Peak pressure index in control group was 316.43 ± 282.14 kpa which was significantly lower than in case group (392.85 ± 369.85 kpa) (p < 0.05); 33.3% of study subjects increased peak pressure, the most increase of the peak pressure in bone foundation of 3 rd toe (44.4%), the lowest in bone foundation of 2 nd toe (2.4%). Conclusion: Peak
pressure of foot in 2 sides in the position of total pressure in case group was significantly higher than that in control group with p < 0.05 Peak pressure index: the most increasing positions were the bone foundation of the 1 st toe on the right side (79.4%) and the bone foundation of the
3 rd toe on the left (44.4%)
* Keywords: Type 2 diabetes; Plantar pressure
INTRODUCTION
Diabetic disease has increased with
time of prolonged disease, accompanied
by increasing in complications of disease
Foot ulcer complication is one of the most
serious complications, affecting the life
quality of patients Global rate of foot
ulcer caused by diabetes was 6.3% In
Vietnam, there were a lot of researches
showed that percentage of diabetic
patient with foot complication admitted to
the hospital at the late period and
percentage of amputating limbs was high,
approximately 40% among the diabetic patients with foot disease Plantar injuries caused by diabetic disease are the consequence of many causes such as nervous wounds, blood vessel wounds, trauma and infection and they are closely combined sometimes injuries are able to take place independently Some studies showed that high pressured points in feet are closely related to the foot ulcer injuries Therefore, plantar pressure is a raised factor given to predict the foot injuries early in the diabetic patients
1 National Hospital of Endocrinology
2 103 Military Hospital
Date received: 15/06/2019
Date accepted: 05/08/2019
Trang 2SUBJECTS AND METHODS
1 Subjects
126 type 2 diabetic patients (diabetic
group) and 40 healthy people (control
group); study duration: from 2015 to 2018
2 Methods
* Techniques used in research:
- Interview, history question, clinical
examination; blood pressure measurement,
height and weight measurement; BMI, measuring waist and hip sizes
- Routine biochemistry tests: Blood glucose; HbA1c; liver function; kidney function; blood lipid
- Using the plantar pressure measuring
by machine of Emed A50 to measure 10 sections in feet (measuring indexes: Peak pressure; maximum force)
RESULTS
Table 1: Age distribution by study groups
Age group
< 0.05
- Case group: Study subjects were distributed in age groups and the group accounting for the highest percentage was 50 to 59 years old and no one was less than 30 years old
- Control group: Study subjects in group from 30 to 39 years old accounted for the highest percentage and no one was above 60 years old
Diagram 1: Gender distribution by study groups
Proportion of male was higher than female in control group and study group and this proportion was equivalent
Percent %
Trang 3Table 2: Features of the right plantar pressure by the study groups
The right plantar peak
pressure (kpa)
Control group (n = 40)
Diabetic group
(* MH1: Bone foundation of toe 1; MH2: Bone foundation of toe 2; MH3: Bone foundation of toe 3; MH4: Bone foundation of toe 4; MH5: Bone foundation of toe 5)
- Peak pressure of all feet and peak pressure in areas of MH2, MH3, MH4 in diabetic group were higher than those in control group and this difference had statistical significance
- Peak pressure in other areas of feet, the difference between diabetic group and control group was not statistical significant
Table 3: Changing the right plantar pressure in the study group
Diabetic group (n = 126)
Peak pressure on the
right feet
(kpa)
Trang 4MH3 17 13.5 65 51.6 44 34.9
(* MH1: Bone foundation of toe 1; MH2: Bone foundation of toe 2; MH3: Bone foundation of toe 3; MH4: Bone foundation of toe 4; MH5: Bone foundation of toe 5)
In subject group of increasing plantar peak pressure, positions of the bone foundation of the 1st toe and the 2nd toe accounted for the highest percentage and lowest percentage, respectively
Table 4: Features of the left plantar pressure by study groups
The right plantar peak
pressure (kpa)
Control group (n = 40)
Diabetic group
(* MH1: Bone foundation of toe 1; MH2: Bone foundation of toe 2; MH3: Bone foundation of toe 3; MH4: Bone foundation of toe 4; MH5: Bone foundation of toe 5)
- Peak pressure of all feet, peak pressure in areas of foot heel, MH1, MH2 and MH3 in diabetic group were higher than those in control group and this difference had statistical significance
- Peak pressure in other areas of feet in diabetic group were higher than those in control group but this difference had no statistical significance
Trang 5Table 5: Changing the left plantar pressure of study group
Diabetic group (n = 126)
Peak pressure on the
left feet (kpa)
(* MH1: Bone foundation of toe 1; MH2: Bone foundation of toe 2; MH3: Bone foundation of toe 3; MH4: Bone foundation of toe 4; MH5: Bone foundation of toe 5)
In subject group of increasing plantar peak pressure, positions of the bone foundation of the 3rd toe and the 2nd toe accounted for the highest percentage and lowest percentage, respectively
DISCUSSION
Pressure is measured by total force
provided for a unit of square area and
calculated by dividing total number of force
on square affecting area Plantar pressure
is the impact force between the plantar
and contact surface in daily activities In
our research, we evaluated the right plantar
on the peak pressure index as recorded in
total overall in control group (334.06 ±
104.06 kpa) was significantly lower than
that the diabetic group (386.39 ± 123.64
kpa), p < 0.05 The highest peak pressure
in the position of big toe in control group
(270.33 ± 133.57 kpa) was lower than in
case group (287.53 ± 148.65 kpa) and the lowest in the position of toe 3, 4, 5 in control group (85.19 ± 49.09 kpa) also lower than diabetic group (94.97 ± 50.37 kpa), but there was no significant difference with p > 0.05; with 21.4% of subjects in diabetic group, increasing the plantar peak pressure in general increasing the highest increase was in the 1st metatarsus foundation (79.45%) and the lowest was in the 2nd metatarsus foundation (15.1%) Evaluating left the plantar on the peak pressure index
in our research as recorded the total overall
in control group (316.43 ± 282.14 kpa) was significantly lower than that in the
Trang 6diabetic group (392.85 ± 369.85 kpa) with
p < 0.05 The highest peak pressure in
the position of big toe in control group
(237.29 ± 139.22 kpa) was lower than that
in diabetic group (284.64 ± 133.54 kpa)
which was a significant difference (p < 0.05)
and the lowest in the position of toe 3,
4, 5 in control group (96.73 ± 50.14)
which was higher than that in diabetic
group (89.0 ± 51.4 kpa), but there was no
significant difference with p > 0.05; with
33.3% of subject group increased the
plantar peak pressure, increased the most
in the 3rd metatarsus foundation (44.4%),
the lowest in the 2nd metatarsus position
(2.4%)
Therefore, it showed that the diabetic
group had higher plantar pressure index
than that in the control group, it was
equivalent to some researches in the world
Pataky Z et al (2003) reported the
highest peak pressure in the big toe
position was 220 ± 89 kpa and the lowest
was in 5th metatarsus foundation (112 ±
22 kpa) [1] This result was lower than our
research, because of the number of subjects
participating to the study by Pataky Z was
fewer than our research (11 patients) and
their average age was high Lavery L.A,
Armstrong D.G et al (2003) studied 1,666
diabetic disease patients with the peak
pressure index was 86.6 ± 27.4 N/cm2+
[5] This result was higher than our study
result, because study participants had
higher average age and weight and longer
disease detection time than our study
Study by Pataky Z et al (2005) conducted
on 30 diabetic patients and 15 non-diabetics
people showed the result in diabetic
patient group, increased peak pressure in
big toe (the right leg: 205 ± 94 kpa compared with 101 ± 39 kpa; left leg:
165 ± 61 kpa compared with 104 ± 43 kpa)
in the 5th metatarsus foundation (the right plantar: 160 ± 68 kpa compared with 97 ±
32 kpa; the left plantar: 174 ± 65 kpa compared with 91 ± 42 kpa) in the heel of foot, peak pressure in diabetic case group was lower than control group (the right plantar: 187 ± 54 kpa compared with 321 ±
91 kpa; the left plantar: 184 ± 63 kpa compared with 298 ± 110 kpa) [4], and equivalent to our research Qui X, Tian D.H et al (2015) had prospective study on
65 type 2 diabetic patients being monitored
in 2 years, at the time of enrollment, the highest maximum force was 179 (N) and the lowest in the position of toe 2 - toe 5 was 4.5 (N); the highest pressure in the
1st metatarsus foundation (160.7 kpa) and the lowest in position of toe 2 - 5: 5.0 kpa [3] This result was lower than our research Tran Thi Ngoc Bang (2017) enrolled 102 type 2 diabetic patients and the result showed that plantar peak pressure was 427.9 ± 120.9 kpa [6] In comparison with this study, our result was higher, because study subjects of Tran Thi Ngoc Bang had higher BMI In 2017, Halawa M.R et al enrolled 50 type 2 diabetic patients and
30 people who were voluntary to participate, the result showed that static pressure and dynamic pressure in both of left and right feet of diabetic patients with nervous complication was higher than that in control group with p < 0.05 Static pressure and dynamic pressure in the left and right feet of diabetic patient group with nervous complication was higher than patient group without nervous complication with
p < 0.05 [2], equivalent to our research
Trang 7CONCLUSION
- Plantar peak pressure index in 2
sides in the position of total force of
diabetic group was higher than control
group with p < 0.05
- Peak pressure index: positions of
increased mostly in the area of the 1st
metarsus foundation (79.4%) and 44,4%
in the area of the 3rd metarsus foundation
on the left
REFERENCE
1 Pataky Z, Golay A et al Relationship
between peripheral vascular disease and
high plantar pressures in diabetic neuro -
ischemic patients Diabetes Metab 2002, 29,
pp.489-495
2 Halawa M.R, Eid Y.M et al Relationship
of planter pressure and glycemic control in
type 2 diabetic patients with and without
neuropathy Diabetes and metabolic syndrome:
Clinical Research and Review 2017, pp.1-6
3 Qui X, Tian D.H et al Plantar pressure
changes and correlating risk factors in Chinese patients with type 2 diabetes: Preliminary 2 year results of prospective study Chinese
Medical Journal 128 (24), pp.3283-3392
4 Pataky Z, Assal J.P et al Plantar
pressure distribution in type 2 diabetes patients without peripheral and peripheral vascular
disease Diabetes Medicine 2005, 22, pp.762-767
5 Lavery L.A, Armstrong D.G, Wunderlich
R.P Predictive value of foort pressure
assement as part of a population-based diabetes disease management program Diabetes
Care 2003, 26 (4), pp.1069-1073
6 Muthuselvi, Shanthi M, Ethiya N
Comparision of nerve conduction studies in geriatric normal and diabetic subjects IJSR
2015, 4 (4), pp.1084-1086