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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)