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Diabetes Mellitus is a disorder of metabolism. Foot problems are common in diabetes and altered plantar pressures distribution may lead to ulceration in people with Diabetes Mellitus. Therefore the aim of this study was to investigate standing plantar pressure distribution variations in north Asian Indian diabetes mellitus subjects and its association with duration of diabetes. Thirty three subjects with age range from 40 to 75 years are recruited from AIIMS Endocrinology & metabolism lab Delhi, India and divided into three groups: 11 control subjects (non-diabetic), 11 diabetic subjects without neuropathy (DNN) and 11 diabetic subjects with neuropathy (DN). Neuropathy status was assessed by measuring loss of protective sensation to 10gm Semen’s Weinstein monofilament. Plantar pressure distributions parameter-Power ratio (PR) was measured during barefoot standing using portable PedoPowerGraph and results are analyzed using one way analysis of variance to detect significant difference between the groups. We found significant (p<0.05; p<0.01) difference in PR value between DN and CG groups in fore foot and hind foot but no significant (p>0.05) difference in PR value was found between DNN and CG groups in the foot. As compared to DNN, DN group have maximum PR variations in the fore foot. Plantar pressure distribution parameter-PR was higher with longer duration of diabetes among type 2 diabetes subjects. In this study we conclude that plantar pressure distribution parameter-PR was able to distinguish the DN groups from the CG group in hind and fore foot during standing. Increased forefoot PR value is prevalent in the diabetic neuropathic subjects and may be responsible for the occurrence of foot sole ulcers but additional prospective studies are needed. In the future we will investigate the plantar pressure distribution parameter-PR variations in diabetes with obese and osteoarthritis subject. [ABSTRACT FROM AUTHOR]

The aim of this article is to investigate the association of limited joint mobility and foot sole hardness in north Asian Indian type 2 diabetic patients. Limited joint mobility and hardness of the foot sole were measured for 39 subjects attending the AIIMS Endocrinology & Metabolism Clinic. The total subject divided into three groups: 13 control subjects (non-diabetic), 13 diabetic patients without neuropathy and 13 diabetic neuropathy patients. Neuropathy status was assessed using 10 gm Semen’s Weinstein monofilament. Joint mobility parameters, such as ankle dorsiflexion/plantar flexion and metatarsophalangeal–I dorsiflexion/plantar flexion, are measured using a goniometer. Foot sole hardness was measured using a durometer or shore meter. We found that diabetic patients with a neuropathic foot had significantly reduced joint mobility and increased foot sole hardness, placing them at risk for subsequent ulceration. Metatarsophalangeal-I dorsiflexion/plantar flexion of both feet of diabetic patients had significant correlation (at p < 0.05, p < 0.001, p < 0.001 level) over age and body mass index. Also ankle plantar flexion/dorsiflexion and metatarsophalangeal-I dorsiflexion/plantar flexion has a significant correlations (at p < 0.01, p < 0.05, p < 0.001, p < 0.001 level) with foot sole hardness in both feet of diabetic neuropathy subjects. Also linear regression analysis showed that duration of diabetes was significantly associated with the joint mobility parameters. In this study we conclude that joint mobility had reduced further if neuropathy and increased foot sole hardness coexisted owing to high plantar pressures. Hence, both limited joint mobility and increased foot sole hardness appears to be important determinants of foot sole ulceration in diabetic neuropathic subject. [ABSTRACT FROM AUTHOR]

Abstract: Background: Diabetic neuropathy is a family of nerve disorders with progressive loss of nerve function in 15% of diabetes mellitus (DM) subjects. Vibration Perception Threshold (VPT) is one of the modalities of testing loss of protective sensation. Law of mobility for VPT is well known for normal subjects, but not for diabetic subjects. This is a pilot study to evaluate and plot the law of mobility for VPT among DM subjects. Methods: We used biothesiometer to find the VPT of several areas in upper and lower extremities for normal and diabetic subjects. VPT of normal and diabetic subjects for different foot areas from proximal to distal is evaluated for 30 subjects. All the subjects are screened for peripheral artery occlusive disease with ankle brachial pressure index (0.9 or above). VPT values of different areas are arranged in a proximal to distal order for the analysis. Results: VPT values monotonically decrease from proximal to distal areas. Vierodt''s law of mobility holds well for normal subjects in both feet areas. The law of mobility does not hold good for the DM subjects in one or both feet areas. Conclusions: The VPT value of diabetic subjects reveals that the law of mobility do not holds good for diabetic subjects in foot areas. Though the number of subjects is small, all the subjects defied the law. [Copyright &y& Elsevier]

Diabetic neuropathy is one of the most important factors for foot ulceration in diabetes mellitus (DM) patients. Among different sensibility measures of neuropathy, two-point discrimination (TPD) has been suggested as a reliable method; however, the correlation of TPD with other well-known measures is not known. We measured the loss of protective sensation using Semmes-Weinstein Monofilaments (SWMF), hardness of the foot sole using shore meter (sh), power ratio (PR) using pedopowergraph and TPD using esthesiometer in foot areas of both left and right legs in 14 DM subjects. We have found no correlation either between TPD and shore values (sh) or between TPD and PR. The SWMF (10 g) is found not to provide any additional value in measuring loss of sensation in comparison to TPD. The TPD appears to be measuring different property of the foot compared to other measures. The mechanism of this independence is not well understood and more investigation is required to understand the mechanism. [ABSTRACT FROM AUTHOR]