The effect of Type 2 Diabetes Mellitus on plantar pressure and contact area within the Maltese population

Abstract

Aim : The aim of this study was to determine whether plantar pressure and contact area in participants living with Type 2 Diabetes are affected by the duration of Type 2 Diabetes Mellitus. Research Design and Method : The study employed a non-experimental quantitative matched subject design. A group of 36 participants were recruited and divided into three groups (Group 1: 0-5 years, Group 2: 6- 10 years, Group 3: 11-15 years) matched for age, gender, weight and duration of diabetes. Foot pressure mapping utilizing the 2-step protocol was employed to obtain the mean peak plantar pressure, mean pressure-time integral and mean contact area for the hallux, 1st metatarsophalangeal joint region, 2nd - 4th metatarsophalangeal joint region, 5th metatarsophalangeal joint region and heel for both feet. Results : The results indicate that there was a significant difference in mean peak plantar pressure between the three groups under the left (p=0.012) and right 2nd - 4th metatarsophalangeal joint (MPJ) region of interest (ROI) (p=0.022) and left heel (p=0.049), as well as a significant difference in mean pressure-time integral under the left 2nd - 4th MPJ ROI (p=0.021) and right heel (p=0.048). There was also a significant difference between Group 1 and Group 2 (p=0.044) for left 2nd – 4th MPJ ROI and (p=0.028) right left 2nd – 4th MPJ ROI and between Group 1 and Group 3 (p=0.016) for mean peak plantar pressure of the left 2nd – 4th MPJ ROI. No significant difference was found in contact area for both left (p=0.893) and right feet (p=0.800) between the three groups. Conclusion As the duration of diabetes increases, peak plantar pressure increases significantly under the left and right 2nd - 4th metatarsophalangeal joint region of interest. The highest peak plantar pressure at the right 2nd - 4th metatarsophalangeal joint region of interest was 348.93 kPa which is very near to the threshold peak plantar pressures quoted in other research. These findings demonstrate that podiatrists should be encouraged to make more use of pressure mapping technology as part of their clinical treatment plan in patients living with Type 2 Diabetes Mellitus without any complications or deformities.