Valutazione funzionale per la prevenzione e il trattamento del piede diabetico mediante un innovativo approccio integrato pressione-cinematica

Diabetic foot biomechanics alterations are well known [1] even though a consensus on the best biomechanical model of pressures developed in different foot segments during gait was not found yet [2]. The aim of this study was to quantify and identify biomechanical and functional alterations of diabetic foot with an integrated approach joints kinematic and plantar pressures during gait. 140 subject were included in the study and evaluated with an integrated pressure-kinematic model during normal gait.This analysis reported a sample of 30 feet equally distributed in three groups:tipe I diabetes (T1), tipe II diabetes (T2) and controls (C). Upper ankle Range of Motion (ROM) on the frontal plane was selected as kinematic variable to be studied while pressure-time integral (PTI) as dynamic variable of the entire foot and of the 5 selected foot regions. Comapred to controls, T1 showed a significant load shift from midfoot and forefoot to toes (T1: 19.2 ± 7.4, 104.3 ± 38.3, 47.0 ± 29.3; C: 24.1 ± 10.1, 118.9 ± 26.3, 34.1 ± 20.8)associated to a non significant ROM reduction. Compared to C, T2 showed significant load changes at forefoot and toes (T2: 150.4 ± 63.3, 28.4 ± 15.6) and a significant ROM reduction. Also, T2 showed a significant lower load at rearfoot and toes and higher load at forefoot compared to T1. These results enlight biomachanical alterations that diabetes by it self, without influence of neuropathy or morphological alterations, can produce in foot during gait. [1] Van Netten JJ, et al, Diab Metab Res Rev 2016, 32(Suppl. 1): 84-98. [2] Bus SA, Diab Metab Res Rev 2012 28(Suppl 1): 54-59.