Barefoot pressure distribution of diabetic patients and non-diabetic volunteer subjects after sensorimotor training with an unstable shoe construction

• Published in: Foot (Edinburgh, Scotland) Vol. 60; p. 102102
• Main Authors: Maetzler, M., Bochdansky, T., Wang, W., Abboud, R.J.
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.09.2024
• Subjects: Adult; Aged; Barefoot; Diabetic; Diabetic Foot - physiopathology; Emed® ST2; Female; Foot - physiology; Foot - physiopathology; Forefoot, Human - physiology; Forefoot, Human - physiopathology; Humans; Male; Middle Aged; Pressure; Sensorimotor training; Shoes; Barefoot; Pressure; Diabetic; Emed® ST2; Sensorimotor training
• ISSN: 0958-2592; 1532-2963; 1532-2963
• DOI: 10.1016/j.foot.2024.102102

Forty-three percent of all diabetic foot ulcers occur under the medial forefoot due to a medial deviation of elevated pressures and premature forefoot ground contact in neuropathic diabetic patients. A 6-week sensorimotor training period with an unstable shoe construction reduces in-shoe peak pressures and contact times under the medial aspect of the forefoot. The study was designed as a Randomised Control Trial with two diabetic groups (one served as intervention group and one as control group) and one non-diabetic intervention group. Measurements for barefoot pressure distribution and contact times were taken by means of an Emed® pressure measurement platform (Novel GmbH, Munich) before and after 6 weeks. During this time the diabetic and the non-diabetic intervention groups were required to wear an unstable shoe construction (Masai Barefoot Technology, MBT®) for at least four hours per day. Results for the non-diabetic intervention group showed significantly later contact times for the medial portion of the forefoot, resulting in shorter contact times. Peak pressure was also reduced under the medial aspect of the foot while it was increased under the lateral aspect of the foot. Changes for the diabetic intervention group followed the same pattern while the values of the diabetic control group shifted away from the reference values. A 6-week sensorimotor training period with an unstable shoe construction can change barefoot peak pressures and contact times in non-diabetic subjects and in diabetic patients in the most endangered area, i.e. the medial forefoot. •Results show that the foot reaches the foot-flat stage in a more ordered manner.•Forefoot loading is redistributed from medial to lateral after sensorimotor training.•Forefoot pressure and duration of forefoot loading is reduced in both intervention groups.•Results are supported by reduction of medial pressure-time and force-time integrals.•Effects can be reached through sensorimotor training with an USC during activities of daily living.