Comparative Clustering of Plantar Pressure Distributions in Diabetics with Polyneuropathy May Be Applied to Reveal Inappropriate Biomechanical Stress

PLoS One. 2016 Aug 16;11(8):e0161326. doi: 10.1371/journal.pone.0161326. eCollection 2016.

Abstract

In diabetic patients, excessive peak plantar pressure has been identified as major risk factor for ulceration. Analyzing plantar pressure distributions potentially improves the identification of patients with a high risk for foot ulceration development. The goal of this study was to classify regional plantar pressure distributions. By means of a sensor-equipped insole, pressure recordings of healthy controls (n = 18) and diabetics with severe polyneuropathy (n = 25) were captured across eight foot regions. The study involved a controlled experimental protocol with multiple sessions, where a session contained several cycles of pressure exposure. Clustering was used to identify subgroups of study participants that are characterized by similar pressure distributions. For both analyzed groups, the number of clusters to best describe the pressure profiles was four. When both groups were combined, analysis again led to four distinct clusters. While three clusters did not separate between healthy and diabetic volunteers the fourth cluster was only represented by diabetics. Here the pressure distribution pattern is characterized by a focal point of pressure application on the forefoot and low pressure on the lateral region. Our data suggest that pressure clustering is a feasible means to identify inappropriate biomechanical plantar stress.

Publication types

  • Comparative Study

MeSH terms

  • Biomechanical Phenomena
  • Case-Control Studies
  • Cluster Analysis
  • Diabetic Neuropathies / physiopathology*
  • Female
  • Foot / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Pressure*
  • Stress, Mechanical*

Grants and funding

DS, PRM and TS are co-founders of mediXmind GmbH and received funding in the form of salaries. UN is an employee of ifak system GmbH and received funding in the form of a salary. JK and PRM are supported by the German Research Foundation (Grant No. SFB-854-TP1); SFB = Special Research Field of the German Research Foundation (http://www.sfb854.de/). AM is supported by the Chinese Scholarship Council (CSC) (http://en.csc.edu.cn/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.