Article

Inconsistent findings with regard to plantar pressure while walking in the
diabetic population may be due to the heterogeneity of the studied groups
resulting from the classification/grouping criteria adopted. The clinical
diagnosis and classification of diabetes have inherent uncertainties that
compromise the definition of its onset and the differentiation of its severity
stages. A fuzzy system could improve the precision of the diagnosis and
classification of diabetic neuropathy because it takes those uncertainties into
account and combines different assessment methods. Here, we investigated how
plantar pressure abnormalities evolve throughout different severity stages of
diabetic polyneuropathy (absent, n=38; mild, n=20; moderate, n=47; severe, n=24).
Pressure distribution was analysed over five areas while patients walked
barefoot. Patients with mild neuropathy displayed an increase in pressure-time
integral at the forefoot and a lower peak pressure at the heel. The peak and
pressure-time integral under the forefoot and heel were aggravated in later
stages of the disease (moderate and severe) compared with early stages of the
disease (absent and mild). In the severe group, lower pressures at the lateral
forefoot and hallux were observed, which could be related to symptoms that
develop with the aggravation of neuropathy: atrophy of the intrinsic foot
muscles, reduction of distal muscle activity, and joint stiffness. Although there
were clear alterations over the forefoot and in a number of plantar areas with
higher pressures within each severity stage, they did not follow the aggravation
evolution of neuropathy classified by the fuzzy model. Based on these results,
therapeutic interventions should begin in the early stages of this disease to
prevent further consequences of the disease.
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