The relationship between obesity and foot plantar pressure in people living with type 2 diabetes in Malta.

Abstract

Aim: The aim of this study was to determine whether BMI increases peak plantar pressures in subjects living with Type 2 Diabetes. This study was also meant to investigate whether other factors have a role in increasing peak plantar pressures in diabetic patients during walking. Research Method: The study employed is a designed experiment between 15 obese (mean age 57.3 yrs and BMI 34.02) and 15 non-obese participants (mean age 58.9 yrs and BMI 24.19) selected from the Diabetic Clinic Outpatients department at Mater Dei Hospital. Selected subjects were assessed for the presence of neuropathy, while values of diabetes duration and Hba1c were obtained from their medical records. Dynamic plantar pressure measurements of the dominant foot were recorded for Hallux, 1st MPJ, 2nd to 4th MPJ, 5th MP J and heel for both groups using the HR Mat system. Three trials were recorded while patients walked at their self-selected speed. Three plantar pressure parameters were recorded for all subjects being Peak Pressures (kg/cm2 ), Pressure-time Integral (kg/cm2 s) and Maximum Force (Kg). Results: Non-significant difference was found in any area studied between peak plantar pressures of obese and non-obese subjects with increase in BMI. A positive correlation between BMI and peak plantar pressures was found in the obese group at the Hallux (p=0.022) and heel (p= 0.047. Pressure time Integral was found to be positively correlated with increase in BMI in the obese group with a p-value of 0.017, while a positive correlation was obtained between Maximum Force and increase in BMI at the 2nd to 4th MPJ (p=0.019) and heel (p=0.012). When BMI was studied with other variables through a Linear Regression BMI was found to contribute most in increasing peak plantar pressures at the 1st MPJ and 2nd to 4th MPJ. Conclusions and Recommendations: From this study it has been concluded that increase in BMI is not directly linked to increase in peak plantar pressures among diabetic subjects. Thus other factors such as limited joint mobility and foot deformities could have had effected peak plantar pressures during dynamic walking. It is recommended to podiatrists that any biomechanical problems which arise among diabetic patients, should be accomodated to prevent increased peak plantar pressures as these may increase the risk of complications. More research investigating the relationship between BMI and other variables with peak plantar pressures should be implemented among diabetic subjects.