Contribution of plantar fascia to the increased forefoot pressures in diabetic patients
| Autor: | E. D’Ambrogi, Antonella Caselli, Luigi Uccioli, Claudia Giacomozzi, Laura Giurato, Maria Antonietta D'Agostino, Velio Macellari |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2003 |
| Předmět: |
Male
Metatarsophalangeal Joint Settore MED/16 - REUMATOLOGIA Endocrinology Diabetes and Metabolism Plantar dynamometry Settore MED/13 - Endocrinologia Subcutaneous Tissue Diabetic Neuropathies Reference Values Fasciitis Foot Ulcer plantar fascia adult aged ankle pressure article controlled study diabetes mellitus echography fascia female foot ulcer goniometry human joint mobility major clinical study male metatarsophalangeal joint neuropathy piezoelectricity soft tissue disease Diabetes Complications Diabetes Mellitus Fasciitis Plantar Female Foot Humans Middle Aged Pressure Regression Analysis Stress Mechanical Ultrasound Soft tissue Anatomy Fascia medicine.anatomical_structure Stress Diabetes mellitus Internal Medicine medicine Advanced and Specialized Nursing business.industry Forefoot medicine.disease Mechanical Peripheral neuropathy Plantar fascia business |
| Popis: | OBJECTIVES—Secondary to peripheral neuropathy, plantar hyperpressure is a proven risk factor for foot ulceration. But limited joint mobility (LJM) and soft tissue abnormalities may also contribute. The aim of this study was to evaluate the relationships among thickness of plantar fascia, mobility of the metatarso-phalangeal joint, and forces expressed under the metatarsal heads. RESEARCH DESIGN AND METHODS—We evaluated 61 diabetic patients: 27 without neuropathy (D group), 19 with neuropathy (DN group), and 15 with previous neuropathic foot ulceration (DNPU group). We also examined 21 control subjects (C). Ultrasound evaluation was performed with a high resolution 8- to 10-MHz linear array (Toshiba Tosbee SSA 240). The foot loading pattern was evaluated with a piezo-dynamometric platform. First metatarso-phalangeal joint mobility was assessed with a mechanic goniometer. RESULTS—Diabetic patients presented increased thickness of plantar fascia (D 2.9 ± 1.2 mm, DN 3.0 ± 0.8 mm, DNPU 3.1 ± 1.0 mm, and C 2.0 ± 0.5.mm; P < 0.05), and significantly reduced motion range at the metatarso-phalangeal joint (D 54.0 ± 29.4°, DN 54.9 ± 17.2°, DNPU 46.8 ± 20.7°, and C 100.0 ± 10.0°; P < 0.05). The evaluation of foot-floor interaction under the metatarsal heads showed increased vertical forces in DN and DNPU and increased medio-lateral forces in DNPU. An inverse correlation was found between the thickness of plantar fascia and metatarso-phalangeal joint mobility (r = −0.53). The thickness of plantar fascia was directly correlated with vertical forces under the metatarsal heads (r = 0.52). CONCLUSIONS—In diabetic patients, soft tissue involvement may contribute to the increase of vertical forces under the metatarsal heads. Changes in the structure of plantar fascia may also influence the mobility of the first metatarso-phalangeal joint. |
| Databáze: | OpenAIRE |
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