糖尿病伴足趾畸形的三维动态足底压力分析

The three-dimensional dynamic plantar pressure distribution analysis in diabetic patients with toe deformity

目的探讨糖尿病伴足趾畸形的足底压力分布特征及其临床意义,评价三维动态足底压力分析技术在该症诊疗中的应用价值。方法选取32例糖尿病伴锤状趾、爪形趾及多发足趾畸形患者及32例健康自愿者,分为病例组和对照组。两组年龄、性别组成、体重指数近似,且经规范的行走训练后,应用三维动态足底压力分析系统(F-scan Mobile,Tekscan,USA),测量对比分析病例组及对照组的足底总峰值压力及足拇趾、第1～5跖骨头、中足、后足等7个解剖区域平均峰值压力分布的差异。结果病例组及对照组在一个步态周期中的足底总峰值压力、第1～5跖骨头及后足的平均峰值压力存在较大差异(P<0.05),其中病例组第1、2跖骨头底部压力(302.5±34.8kPa,375.2±47.1 kPa)较对照组(242.8±19.3 kPa,253.7±22.1 kPa)明显增高;两组中足平均峰值压力差异无明显统计学意义(P>0.05);病例组后足平均峰值压力较对照组明显降低(P<0.05)。结论糖尿病伴足趾畸形可使跖骨头下的压力增高。三维动态足底压力分析技术可早期检测该病理力学变化,从而对预防糖尿病足部溃疡形成及指导治疗具有较大的应用价值。

Objective To evaluate the effect of the three-dimensional dynamic plantar pressure analysis in diabetic patients with toe deformity and investigate the plantar pressure distribution in these cases.Methods Thirty two diabetic patients with claw/hammer toe deformity,and 32 age-,gender-and BMI-matched health volunteers,divided into cases group and controls group.The plantar pressures were measured with three-dimensional dynamic pedography（F-scan Mobile, Tekscan,USA）.Peak pressures of hallux,sub-metatarsal head（MTH）,midfoot and hindfoot were calculated. Results Peak pressures at the hallux and sub-MTH were significantly higher in the diabetic patients with toe deformity when compared with controls（P0.05）,especially in the first and second sub-MTH（cases group：302.5±34.8 kPa, 375.2±47.1 kPa;controls group：242.8±19.3 kPa,253.7±22.1 kPa）.Peak pressures at the midfoot had no significantly difference in two groups（P0.05）,but the lower peak pressures at the hindfoot in cases group compared with controls（P0.05）.Conclusion These results showed that diabetic patients with claw/hammer toe deformity could make pressures at the sub-MTH increased.Monitoring plantar pressures distribution might be a useful tool for detect this pathomechanics in these patients.