TY - JOUR
T1 - American Society of Biomechanics Clinical Biomechanics Award 2012
T2 - Plantar shear stress distributions in diabetic patients with and without neuropathy
AU - Yavuz, Metin
N1 - Funding Information:
This research was possible due to support from the National Institutes of Health ( 1R15DK082962 ). The author would like to thank Andrew Franklin, Rebecca McGaha, Joseph Stuto, Vinai Prakash, Garneisha Torrence, Jessica Rispoli, Vincent Hetherington, DPM, and Leo Mallias of the Kent State University College of Podiatric Medicine. The author is also thankful for the efforts of Alan Glaros, PhD of the Kansas City University of Medicine and Biosciences, Brian L Davis of the University of Akron, Andrea Hartis and Venita Lovelace-Chandler of the UNT Health Science Center.
PY - 2014/2
Y1 - 2014/2
N2 - Background The exact pathology of diabetic foot ulcers remains to be resolved. Evidence suggests that plantar shear forces play a major role in diabetic ulceration. Unfortunately, only a few manuscripts exist on the clinical implications of plantar shear. The purpose of this study was to compare global and regional peak plantar stress values in three groups; diabetic patients with neuropathy, diabetic patients without neuropathy and healthy control subjects. Methods Fourteen diabetic neuropathic patients, 14 non-neuropathic diabetic control and 11 non-diabetic control subjects were recruited. Subjects walked on a custom-built stress plate that quantified plantar pressures and shear. Four stress variables were analyzed; peak pressure, peak shear, peak pressure-time and shear-time integral. Findings Global peak values of peak shear (p = 0.039), shear-time integral (p = 0.002) and pressure-time integral (p = 0.003) were significantly higher in the diabetic neuropathic group. The local peak shear stress and shear-time integral were also significantly higher in diabetic neuropathic patients compared to both control groups, in particular, at the hallux and central forefoot. The local peak pressure and pressure-time integral were significantly different between the three groups at the medial and lateral forefoot. Interpretation Plantar shear and shear-time integral magnitudes were elevated in diabetic patients with peripheral neuropathy, which indicates the potential clinical significance of these factors in ulceration. It is thought that further investigation of plantar shear would lead to a better understanding of ulceration pathomechanics, which in turn will assist researchers in developing more effective preventive devices and strategies.
AB - Background The exact pathology of diabetic foot ulcers remains to be resolved. Evidence suggests that plantar shear forces play a major role in diabetic ulceration. Unfortunately, only a few manuscripts exist on the clinical implications of plantar shear. The purpose of this study was to compare global and regional peak plantar stress values in three groups; diabetic patients with neuropathy, diabetic patients without neuropathy and healthy control subjects. Methods Fourteen diabetic neuropathic patients, 14 non-neuropathic diabetic control and 11 non-diabetic control subjects were recruited. Subjects walked on a custom-built stress plate that quantified plantar pressures and shear. Four stress variables were analyzed; peak pressure, peak shear, peak pressure-time and shear-time integral. Findings Global peak values of peak shear (p = 0.039), shear-time integral (p = 0.002) and pressure-time integral (p = 0.003) were significantly higher in the diabetic neuropathic group. The local peak shear stress and shear-time integral were also significantly higher in diabetic neuropathic patients compared to both control groups, in particular, at the hallux and central forefoot. The local peak pressure and pressure-time integral were significantly different between the three groups at the medial and lateral forefoot. Interpretation Plantar shear and shear-time integral magnitudes were elevated in diabetic patients with peripheral neuropathy, which indicates the potential clinical significance of these factors in ulceration. It is thought that further investigation of plantar shear would lead to a better understanding of ulceration pathomechanics, which in turn will assist researchers in developing more effective preventive devices and strategies.
KW - Diabetic foot
KW - Diabetic foot biomechanics
KW - Diabetic foot ulcers
KW - Foot biomechanics
KW - Neuropathic foot ulcers
KW - Plantar pressure
KW - Plantar shear
KW - Plantar shear forces
KW - Plantar shear stresses
KW - Plantar ulcers
UR - http://www.scopus.com/inward/record.url?scp=84896724019&partnerID=8YFLogxK
U2 - 10.1016/j.clinbiomech.2013.11.003
DO - 10.1016/j.clinbiomech.2013.11.003
M3 - Article
C2 - 24332719
AN - SCOPUS:84896724019
SN - 0268-0033
VL - 29
SP - 223
EP - 229
JO - Clinical Biomechanics
JF - Clinical Biomechanics
IS - 2
ER -