Plantar pressure and shear stress during gait in people with diabetic neuropathy

Aims: Diabetic foot ulcers are a leading cause of lower extremity amputations, significantly affecting the quality of life. Excessive plantar surface pressure and shear stress are key factors in ulcer development and aggravation. This study aimed to determine the association of these forces with the progression of diabetic peripheral neuropathy to help in foot-ulcer treatment and prevention. Methods: Participants were categorized into four groups: individuals with no diabetes (NS), people with diabetes without peripheral neuropathy or foot-ulcer history (DM), those with diabetes with peripheral neuropathy but no foot-ulcer history (DPN), and people with diabetes with active or past foot ulcers (DFU). Plantar pressure and shear stress were measured during walking. Results: The study included 47 participants. The DFU group demonstrated significantly higher pressure peak value and plantar pressure time integral value at the fifth metatarsal head compared to the DPN and DM groups. The DPN group exhibited significantly higher shear-stress time integral and shear stress time compared to the NS group. Conclusions: In the DPN group, an increase in shear stress was observed. In the DFU group, an increase in plantar pressure and a tendency for an increase in shear stress were noted. Further research is needed to understand how these changes trigger the onset of foot ulcers.