Clinical and Biomechanical Predictors of Forefoot Plantar Pressure in Individuals with Type 2 Diabetes and Peripheral Neuropathy.

Background and

Objectives

Abnormal plantar pressure distribution is an important biomechanical risk factor for diabetic foot ulceration in individuals with type 2 diabetes (T2D) and peripheral neuropathy. Although several factors have been linked to increased forefoot plantar pressure, factors associated with the forefoot-to-rearfoot pressure ratio remain unclear. This study aimed to investigate the clinical factors associated with the forefoot-to-rearfoot pressure ratio and peak forefoot pressure in this population. Materials and

Methods

This study was a cross-sectional analysis of 84 individuals with T2D and peripheral neuropathy enrolled in a randomized controlled trial. Vibration perception threshold (VPT), passive ankle dorsiflexion range of motion, ankle stiffness, plantar pressure distribution, body mass index (BMI), HbA1c, duration of diabetes, and foot deformities were assessed. Multiple linear regression analyses were performed to identify factors associated with plantar pressure outcomes.

Results

The model for forefoot-to-rearfoot pressure ratio explained 51.2% of the variance (adjusted R2 = 0.467); ankle stiffness (β = 0.505, p < 0.001), foot deformity (β = 0.194, p = 0.030), and ankle dorsiflexion range of motion (β = -0.363, p = 0.001) were independent predictors. The model for peak forefoot pressure explained 31.4% of the variance (adjusted R2 = 0.251); ankle stiffness (β = 0.337, p = 0.002), foot deformity (β = 0.278, p = 0.009), and BMI (β = 0.226, p = 0.029) were independent predictors. HbA1c, diabetes duration, and VPT were not significant in either model.

Conclusions

In individuals with T2D and peripheral neuropathy, plantar pressure distribution, particularly forefoot loading, appears to be more closely related to biomechanical and structural factors than to metabolic indicators. These findings suggest that assessment of ankle stiffness, joint mobility, and foot posture may provide clinically relevant information for identifying biomechanical factors associated with unfavorable plantar loading in individuals with T2D and peripheral neuropathy.