• 1

    Meeuwisse-Pasterkamp S. van der Klauw M. Wolffenbuttel B. Type 2 diabetes mellitus: prevention of macrovascular complications. Exp Rev Cardiovasc Ther 6: 323, 2008.

  • 2

    Boulton A. Vileikyte L. Ragnarson-Tennvall G. et al: The global burden of diabetic foot disease. Lancet 366: 1719, 2005.

  • 3

    Fernando ME. Crowther RG. Pappas E. et al: Plantar pressure in diabetic peripheral neuropathy patients with active foot ulceration, previous ulceration and no history of ulceration: a meta-analysis of observational studies. PLoS One 9: e99050, 2014.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 4

    Glasoe W. Yack H. Saltzman C. Anatomy and biomechanics of the first ray. J Am Phys Ther Assoc 79: 854, 1999.

  • 5

    Bouchard J. Basic Principles and Techniques of Forefoot Amputations, p 276, The Podiatry Institute Inc, Decatur, GA, 1997. Available at: http://www.podiatryinstitute.com/pdfs/Update_1997/1997_45.pdf. Accessed April 4, 2018.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Paola L. Faglia E. Caminiti M. et al: Ulcer recurrence following first ray amputation in diabetic patients: a cohort prospective study. Diabetes Care 26: 1874, 2003.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Borkosky S. Roukis T. Incidence of repeat amputation after partial first ray amputation associated with diabetes mellitus and peripheral neuropathy: an 11-year review. J Foot Ankle Surg 52: 335, 2013.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 8

    Galea AM. Springett K. Bungay H. et al: Incidence and location of diabetic foot ulcer recurrence. Diabet Foot J 12: 181, 2009.

  • 9

    World Health Organization: Use of Glycated Haemoglobin in the Diagnosis of Diabetes Mellitus, World Health Organization, Geneva, Switzerland, 2011.

  • 10

    Oladeji O. Stackhouse C. Gracely E. et al: Comparison of the two-step and midgait methods of plantar pressure measurement in children. JAPMA 98: 268, 2008.

  • 11

    Hafer JF. Lenhoff MW. Song J. et al: Reliability of plantar pressure platforms. Gait Posture 38: 544, 2013.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 12

    Bus SA. de Lange A. A comparison of the 1-step, 2-step, and 3-step protocols for obtaining barefoot plantar pressure data in the diabetic neuropathic foot. Clin Biomech 20: 892, 2005.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Pham H. Armstrong D. Harvey C. et al: Screening techniques to identify people at high risk for diabetic foot ulceration. Diabetes Care 23: 606, 2000.

  • 14

    Veves A. Murray H. Young M. et al: The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. Diabetologia 35: 660, 1992.

  • 15

    Izumi Y. Satterfield K. Lee S. et al: Risk of reamputation in diabetic patients stratified by limb and level of amputation: a 10-year observation. Diabetes Care 29: 566, 2006.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Borkosky S. Roukis T. Incidence of repeat amputation after partial first ray amputation associated with diabetes mellitus and peripheral neuropathy: an 11-year review. J Foot Ankle Surg 52: 335, 2013.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 17

    Rizzo L. Tedeschi A. Fallani E. et al: Custom-made orthesis and shoes in a structured follow-up program reduces the incidence of neuropathic ulcers in high-risk diabetic foot patients. Int J Low Extrem Wounds 11: 59, 2012.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 18

    American Diabetes Association: Fast facts: data and statistics about diabetes. Available at: http://professional.diabetes.org/ResourcesForProfessionals.aspx?cid=91777&loc=dorg-statistics. Accessed December 1, 2014.

    • PubMed
    • Search Google Scholar
    • Export Citation

Plantar Pressure Distribution in Patients with Diabetic Peripheral Neuropathy and a First-Ray Amputation

Iona Borg Department of Health, Valletta, Malta.
Faculty of Health Sciences, University of Malta, Msida, Malta.

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Stephen Mizzi Faculty of Health Sciences, University of Malta, Msida, Malta.

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Cynthia Formosa Faculty of Health Sciences, University of Malta, Msida, Malta.

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Background:

Elevated dynamic plantar pressures are a consistent finding in diabetic patients with peripheral neuropathy, with implications for plantar foot ulceration. This study aimed to investigate whether a first-ray amputation affects plantar pressures and plantar pressure distribution patterns in individuals living with diabetes and peripheral neuropathy.

Methods:

A nonexperimental matched-subject design was conducted. Twenty patients living with diabetes and peripheral neuropathy were recruited. Group 1 (n = 10) had a first-ray amputation and group 2 (n = 10) had an intact foot with no history of ulceration. Plantar foot pressures and pressure-time integrals were measured under the second to fourth metatarsophalangeal joints, fifth metatarsophalangeal joint, and heel using a pressure platform.

Results:

Peak plantar pressures under the second to fourth metatarsophalangeal joints were significantly higher in participants with a first-ray amputation (P = .008). However, differences under the fifth metatarsophalangeal joint (P = .734) and heel (P = .273) were nonsignificant. Pressure-time integrals were significantly higher under the second to fourth metatarsophalangeal joints in participants with a first-ray amputation (P = .016) and in the heel in the control group (P = .046).

Conclusions:

Plantar pressures and pressure-time integrals seem to be significantly higher in patients with diabetic peripheral neuropathy and a first-ray amputation compared with those with diabetic neuropathy and an intact foot. Routine plantar pressure screening, orthotic prescription, and education should be recommended in patients with a first-ray amputation.

Corresponding author: Cynthia Formosa, PhD, Faculty of Health Sciences, University of Malta, Tal-Qroqq, Msida, Malta. (E-mail: Cynthia.formosa@um.edu.mt)
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