Introduction
Methods
Patients
PNP- | PNP+ | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
n | 49 | 44 | ||||||||||
Gender (female/male) | 30/19 | 29/15 | ||||||||||
Type of DM (1/2) | 18/31 | 9/35 | ||||||||||
female | male | female | male | |||||||||
Mean | SD | Range | Mean | SD | Range | Mean | SD | Range | Mean | SD | Range | |
Age (yr) | 56.3 | 9.1 | 35 | 50.9 | 9.5 | 38 | 64.9 | 8.8 | 26 | 58.8 | 10.4 | 44 |
Duration diabetes (yr) | 13.8 | 10.2 | 36 | 11.6 | 7.7 | 31 | 18.1 | 11.4 | 38 | 16.3 | 11.4 | 42 |
HBa1c (percent) | 8.31 | 1.5 | 4.8 | 8.15 | 1.1 | 46 | 8.25 | 1.3 | 5.5 | 8.16 | 1.3 | 6.3 |
BMI (kg/m2) | 28.9 | 5.2 | 19.8 | 28.2 | 4.8 | 17.9 | 31.2 | 7.4 | 25.7 | 29.6 | 6.5 | 27.3 |
Barefoot plantar pressure measurement
Peripheral neurological assessment
Orthopaedic assessment
Vascular assessment
Radiographic evaluation
Statistical analysis
Results
Differences between feet with and without neuropathy
Plantar pressure
PNP- (106 feet) | PNP+ (80 feet) | |||||
---|---|---|---|---|---|---|
Mean | SD | Min- Max | Mean | SD | Min- Max | |
**Whole forefoot | 551 | 226 | 234–1218 | 689 | 279 | 288–1262 |
Big toe | 455 | 264 | 81–1180 | 405 | 257 | 24–1070 |
**MT-1 | 308 | 138 | 90–801 | 481 | 313 | 132–1260 |
MT-2 | 475 | 226 | 160–1210 | 551 | 271 | 199–1220 |
MT-3 | 429 | 168 | 187–1120 | 462 | 202 | 152–1000 |
MT-4 | 288 | 102 | 140–660 | 311 | 149 | 125–1020 |
*MT-5 | 224 | 147 | 70–782 | 312 | 238 | 66–1060 |
Clinical measurements
PNP- | PNP+ | |||||
---|---|---|---|---|---|---|
Mean | SD | Min-Max | Mean | SD | Min-Max | |
**Vibration Perception Threshold | 13,78 | 5,05 | 4,8–25 | 43,55 | 8,82 | 25,2–50 |
**Valk score | 2,1 | 3,1 | 0–15 | 12,9 | 7,3 | 0–24 |
Ankle-Arm index | 1,06 | 0,19 | 0,52–1,83 | 1,08 | 0,28 | 0,63–2,3 |
Toe pressure | 109,5 | 29,8 | 47,5–200 | 113,8 | 36,9 | 44–255 |
Dorsal flexion ankle joint | 10 | 6,4 | -5–25 | 9 | 6,9 | -5–25 |
**Dorsal flexion motion MT-1 joint | 93 | 16,8 | 45–150 | 78 | 16,0 | 40–110 |
**Hallux valgus angle | 11,1 | 5,6 | 0–25 | 16,4 | 11,4 | 0–50 |
Callus formation and toe deformity
Calcaneal alignment
Arch height
Radiographic evaluation
PNP- | PNP+ | |||||
---|---|---|---|---|---|---|
Lateral radiograph | Mean | SD | Min-Max | Mean | SD | Min-Max |
Sesamoid height (mm) | 4.6 | 2.35 | 0.5–14 | 4.2 | 2.63 | 0–15 |
MT-5 head height (mm) | 8.3 | 2.21 | 3.5–18 | 7.7 | 2.23 | 2–13.5 |
*MT-5 base height (mm) | 15.4 | 3.91 | 4–26 | 14.1 | 4.50 | 5–24 |
**Navicular height (mm) | 40.8 | 8.66 | 10–60 | 37.1 | 8.78 | 12.5–53 |
Calcaneal height (mm) | 9.5 | 2.91 | 3–20 | 9.6 | 3.05 | 3–17 |
**Inferior calcaneal inclination (deg) | 23.4 | 5.18 | 11–36.5 | 20.5 | 5.78 | 3–31 |
superior calcaneal inclination (deg) | 21.7 | 5.52 | 8.5–35 | 20.7 | 7.12 | 2–35.5 |
*Chopart's joint angle (deg) | 63.3 | 4.43 | 47–75.5 | 61.9 | 4.83 | 46–71.5 |
Navicular 1st cuneiform angle (deg) | 64.0 | 5.20 | 49.5–76.5 | 64.7 | 4.47 | 56–77.5 |
**Lisfranc's joint angle (deg) | 63.3 | 4.03 | 52.5–74 | 65.3 | 5.09 | 56–86 |
**MT-5 inclination (deg) | 12.8 | 3.97 | 3.5–23.5 | 11.3 | 3.63 | 1–18.5 |
*MT-1 inclination (deg) | 23.7 | 3.70 | 11.5–33 | 22.1 | 4.23 | 6.5–30 |
**Talar inclination (deg) | 25.0 | 4.86 | 12.5–43 | 28.0 | 6.22 | 16–49.5 |
*1st PIP joint inclination (deg) | 10.9 | 4.82 | -3.5–25 | 8.8 | 7.01 | -14–31.5 |
Anterior-posterior radiograph
|
Mean
|
SD
|
Min-Max
|
Mean
|
SD
|
Min-Max
|
*Hallux valgus (deg) | 14.3 | 5.22 | 4–29 | 16.7 | 10.96 | 1.5–56.5 |
Intermetatarsal 1–5 angle (deg) | 26.1 | 3.25 | 19–36.5 | 25.4 | 5.65 | 9.5–41 |
Intermetatarsal 1–2 angle (deg) | 10.9 | 2.66 | 6–25 | 10.4 | 3.40 | 5–22 |
MTP-1 angle (deg) | 14.3 | 5.22 | 4–29 | 16.7 | 10.96 | 1.5–56.5 |
Interphalangeal 1 angle (deg) | 9.7 | 5.06 | 0–23.5 | 10.3 | 5.99 | -10–26 |
Medial sesamoid X deviation (mm) | 2.3 | 1.97 | -2.5–7 | 1.8 | 3.32 | -8–8.5 |
Medial sesamoid Y deviation (mm) | 12.3 | 2.45 | 6–21 | 12.2 | 2.40 | 5.5–17.5 |
Lateral sesamoid X deviation (mm) | 9.2 | 1.67 | 3.5–16 | 9.7 | 1.90 | 5–13.5 |
Lateral sesamoid Y deviation (mm) | 15.4 | 2.45 | 7.5–21.5 | 16.0 | 3.11 | 8–24 |
Morton's index (mm) | 1.5 | 2.94 | -6–6.5 | 1.2 | 3.80 | -5.5–17 |
MT-1 thickness (mm) | 13.9 | 1.79 | 10.5–19.5 | 14.0 | 1.71 | 11–19 |
*MT-2 thickness (mm) | 7.3 | 0.85 | 5.5–10 | 7.7 | 1.07 | 6–12.5 |
*MT- 3 thickness (mm) | 6.4 | 0.71 | 5–8 | 6.8 | 1.11 | 5–12 |
MT-1 lenght (mm) | 65.2 | 5.04 | 56–83.5 | 66.6 | 4.76 | 55–76.5 |
MT- 2 lenght (mm) | 77.4 | 4.96 | 67.5–95.5 | 78.3 | 5.36 | 64.5–88 |
MT- 3 lenght (mm) | 75.1 | 4.96 | 64.5–93 | 75.9 | 5.74 | 64–90 |
MT-4 lenght (mm) | 73.3 | 4.93 | 61–88 | 74.3 | 5.32 | 54–83 |
MT- 5 lenght (mm) | 72.9 | 5.24 | 61–84.5 | 73.3 | 5.02 | 57–82 |
Prediction of barefoot plantar peak pressure
Regression models
Clinical predictors | Radiological predictors | Comprehensive model | ||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Region | Variable |
R
|
R
2
| β | SE | Beta | Variable |
R
|
R
2
| β | SE | Beta | Variable |
R
|
R
2
| β | SE | Beta |
Fore foot
| model | 0,37†
|
0,14
| model | 0,42†
|
0,18
| model | 0,51†
|
0,26
| |||||||||
Intercept | 3,863†
| 0,038 | Intercept | 4,039†
| 0,200 | Intercept | 3,605†
| 0,065 | ||||||||||
Valk score | 0,019†
| 0,004 | 0,35 | MT-1 phalan angle | 0,019†
| 0,005 | 0,40 | Valk score | 0,028†
| 0,006 | 0,31 | |||||||
Toe deformity sum | 0,017†
| 0,076 | 0,29 | Sesamoid height | -0,043* | 0,015 | -0,20 | Callus sum | 0,018* | 0,006 | 0,21 | |||||||
Med sesam Y dev | -0,053* | 0,015 | -0,24 | Moton's index | 0,027* | 0,008 | 0,22 | |||||||||||
Deviation hallux rx | 0,010* | 0,003 | 0,20 | |||||||||||||||
Hallux
| model | 0,49†
|
0,24
| model | 0,38†
|
0,14
| model | 0.38†
|
0.14
| |||||||||
Intercept | 3,886†
| 0,149 | Intercept | -0,128†
| 0,708 | Intercept | -0,175†
| 0,704 | ||||||||||
Callus formation | 0,176†
| 0,036 | 0,32 | Nav 1st cuneiform | 0,040†
| 0,010 | 0,28 | Nav 1st cuneiform | 0,040†
| 0,010 | 0,28 | |||||||
Calcaneus varus | -0,266* | 0,094 | -0,19 | MT-5 inclination | 0,033* | 0,013 | 0,18 | MT-5 inclination | 0,033* | 0,013 | 0,18 | |||||||
Dorsal flex ankle | -0,026* | 0,008 | 0,22 | Lat sesam Y dev | 0,046* | 0,018 | 0,18 | Med sesam Y dev | 0,046* | 0,018 | 0,18 | |||||||
Height medial arch | -0,151†
| 0,043 | -0,23 | |||||||||||||||
MT-1
| model | 0,55†
|
0,30
| model | 0,42†
|
0,19
| model | 0,58†
|
0,34
| |||||||||
Intercept | 3,102†
| 0,058 | Intercept | 4,039†
| 0,200 | Intercept | 3,572†
| 0,170 | ||||||||||
Valk score | 0,025†
| 0,004 | 0,36 | Sesamoid height | -0,043†
| 0,015 | -0,20 | Valk score | 0,024†
| 0,004 | 0,35 | |||||||
1st toe deformity | 0,271* | 0,095 | 0,18 | Med sesam Y dev | -0,053* | 0,015 | -0,24 | Callus formation | 0,133†
| 0,025 | 0,33 | |||||||
Callus formation | 0,135†
| 0,026 | 0,33 | MT-1 phalan angle | 0,019* | 0,005 | -0,29 | Deviation hallux rx | 0,012* | 0,004 | 0,20 | |||||||
Med sesam Y dev | -0,051†
| 0,014 | -0,24 | |||||||||||||||
MT-2
| model | 0,46†
|
0,21
| Model | 0,40†
|
0,16
| model | 0,50†
|
0,25
| |||||||||
Intercept | 3,483†
| 0,064 | Intercept | 2,656†
| 0,260 | Intercept | 2,607†
| 0,237 | ||||||||||
Callus formation | 0,126†
| 0,026 | 0,33 | Devi hallux rx | 0,016†
| 0,004 | 0,29 | Callus formation | 0,134†
| 0,025 | 0,35 | |||||||
2nd toe deformity | 0,111* | 0,043 | 0,17 | MT-2 thickness | 0,118†
| 0,032 | 0,25 | MT-2 thickness | 0,133†
| 0,031 | 0,29 | |||||||
Valk | 0,005* | 0,002 | 0,19 | Moton's index | 0,027* | 0,009 | 0,20 | 2nd toe deformity | 0,145* | 0,042 | 0,23 | |||||||
MT-3
| model | 0,35†
|
0,12
| Model | 0,29†
|
0,09
| model | 0.40†
|
0.16
| |||||||||
Intercept | 3,251†
| 0,137 | Intercept | 3,531†
| 0,059 | Intercept | 3,220†
| 0,136 | ||||||||||
Callus formation | 0,102†
| 0,024 | 0,30 | Moton's index Dev | 0,025* | 0,008 | 0,22 | Callus formation | 0,098†
| 0,023 | 0,29 | |||||||
Body Mass Index | 0,013* | 0,005 | 0,20 | hallux | 0,010* | 0,003 | 0,22 | Body Mass Index | 0,013* | 0,004 | 0,18 | |||||||
Moton's index | 0,021* | 0,008 | 0,20 | |||||||||||||||
MT-4
| model | 0,26†
|
0,07
| Model | 0,25†
|
0,06
| model | 0,35†
|
0,13
| |||||||||
Intercept | 3,263†
| 0,030 | Intercept | 2,030†
| 0,371 | Intercept | 2,026†
| 0,359 | ||||||||||
Callus formation | 0,095†
| 0,026 | 0,26 | MT-4 length | 0,018†
| 0,005 | 0,25 | Callus formation | 0,091†
| 0,025 | 0,25 | |||||||
MT-4 length | 0,017†
| 0,005 | 0,24 | |||||||||||||||
MT-5
| model | 0,40†
|
0,16
| Model | 0,47†
|
0,22
| model | 0,54†
|
0,29
| |||||||||
Intercept | 2,833†
| 0,056 | 1,448* | 0,596 | Intercept | 1,933* | 0,575 | |||||||||||
Callus formation | 0,215†
| 0,036 | 0,40 | MT-5 length | 0,033†
| 0,008 | 0,27 | Callus formation | 0,181†
| 0,034 | 0,34 | |||||||
Moton's index | -0,035* | 0,013 | -0,18 | MT-5 length | 0,023* | 0,018 | 0,19 | |||||||||||
MT-5 head height | -0,096†
| 0,019 | -0,34 | MT-5 head height | -0,093†
| 0,008 | -0,33 |