Association of increased plantar pressures with peripheral sensorimotor and peripheral autonomic neuropathy in Type 2...

Diabetic polyneuropathy plays a highly significant role in the pathogenesis of the diabetic foot syndrome. It was the objective of this study to investigate the association of different forms of neuropathy (cardiac autonomic, sensorimotor and peripheral autonomic) with elevated plantar pressures in diabetic patients.

A total of 103 Type 2 diabetic patients was investigated. High plantar pressure was diagnosed when the total peak pressure was greater than 500 N/m2. Thirty-three participants were identified as patients with high-risk pressure and 70 patients had a mean peak pressure lower than 500 N/m2. All patients underwent a complete medical examination including determination of neuropathy, vascular status and foot pressures.

Peripheral sensomotoric (p<0.012) and peripheral autonomic neuropathy (p<0.05) were significantly found more often in patients with high plantar pressures. There was no apparent association between autonomic cardial neuropathy and enhanced foot pressure (p=0.175).

Our data clearly point to a correlation of diabetic neuropathy and higher plantar pressures. Interestingly, while there was a strong association between peripheral measures of neuropathy, no higher incidence of cardiac neuropathy in patients with increased foot pressure profiles was found. We strongly recommend that patients with clinical signs and indices of peripheral neuropathy be monitored by pedobarography for early detection and prophylactic shoe care for preventing the development of a diabetic foot ulcer.