A controlled study investigating plantar pressure in young adults living with type 1 diabetes mellitus within the Maltese population.

Abstract

Aim To investigate whether there are any changes in peak plantar pressure patterns in Maltese young adults living with Type 1 diabetes when compared to healthy controls. The dependent variables considered for analysis were peak plantar pressure and force-time integrals of hallux, 1st metatarsophalangeal joint, 2nd to 4th metatarsophalangeal joints, 5th metatarsophalangeal joint and heel of right foot. Research Design and Method A non-experimental controlled study conducted at Mater Dei Hospital, Diabetes & Endocrine Centre and at the Faculty of Health Sciences, University of Malta from October 2011 to December 2011. A total number of 15 Type 1 diabetic young adults, their age ranging between 18 and 25 years, were selected via convenience sampling from the Diabetes & Endocrine Centre. A total number of 15 healthy controlled participants, their age ranging between 18 and 25 years, were selected via purposive sampling via a poster on the Faculty of Health Sciences' noticeboard. Participants from each group were matched in pairs according to age (within 5 years), gender, and weight (±5 kg). Measurement of dynamic peak plantar pressures and force-time integrals at five masks, namely, hallux, 1st metatarsophalangeal joint, 2nd to 4th metatarsophalangeal joints, 5th metatarsophalangeal joint and heel were measured using a foot pressure mapping system- F-Scan HR Mat™, following the two-step gait initiation protocol. Results This study found a significant difference in 5th metatarsophalangeal joint peak plantar pressure (p = 0.01<0.05) as well as a significant difference at mean force-time integral at three different masks: hallux (p-value = 0.05), 2nd to 4th metatarsophalangeal joints (p-value = 0.025) and 5th metatarsophalangeal joint (p-value = 0.037). Additionally, there was a trend towards an increase in peak plantar pressures and force-time integrals in the other foot masks, with the exception of the hallux, in Type 1 diabetic individuals as compared to control participants. Conclusion It may be hypothesised that the increase in peak plantar pressures and force-time integrals in Type 1 diabetic non-neuropathic Maltese young adults may have resulted from alterations in intrinsic foot muscle morphology demonstrated by muscle atrophy in the subclinical phase of motor neuropathy, that is, even before any observable neuropathic signs and symptoms as well as from already thickened soft tissues namely the plantar fascia. As such, it is recommended to podiatrists that an annual diabetic foot screening programme is started for Type 1 diabetic patients, so that any diabetes-related foot complications are detected at an early stage and thus further progression of such complications is prevented or delayed through podiatric interventions.