Pedobarography - a novel screening tool for diabetic peripheral neuropathy?

AIM To investigate the diagnostic significance of foot plantar pressure distribution abnormalities in patients with diabetic peripheral neuropathy (DPN). PATIENTS AND METHODS A total of 107 patients were divided into normal control (28 participants, 56 feet), non-DPN (56 patients, 112 feet), and DPN groups (23 patients, 46 feet). Foot plantar pressure was measured while patients walked at a constant speed over a flat floor using F-Scan pressure insoles. Recordings of six middle strides were averaged to evaluate the characteristics of foot plantar pressure distribution. RESULTS Compared with the normal group, the time of contact (TOC) was longer in non-DPN (p < 0.05) and DPN groups (p < 0.01). The foot to floor force-time integral (FTI) was increased in DPN group (p < 0.01). The forefoot plantar force ratio increased in non-DPN and DPN patients (p < 0.05). Moreover, in DPN patients, the ratio of lateral foot plantar force increased (p < 0.05). The examination of the correlations between biomechanical parameters of the foot plantar and electrophysiological parameters of the lower limbs showed foot plantar biomechanical abnormalities correlated with abnormal sensory conduction of the sural nerve and motor conduction of the common peroneal nerve. Receiver operating characteristic (ROC) analysis showed the area under FTI curve was 0.714 (p < 0.001). CONCLUSIONS The plantar pressure was shifted towards the side of the forefoot in DPN patients. The foot plantar biomechanical changes were closely correlated with lower limb paresthesia and contraction abnormalities of lower-limb extensor muscles. Foot plantar pressure measurement might be used as a screening tool for early diagnosis of DPN.