糖尿病患者足底压力变化研究进展
Research Progress on Plantar Pressure Alterations in Diabetic Patients
DOI: 10.12677/acm.2025.1551410, PDF,   
作者: 黄依心, 张 弛*：湖南师范大学附属第一医院内分泌科，湖南 长沙
关键词: 糖尿病；足部压力；压力分布；Diabetes； Plantar Pressure； Pressure Distribution
摘要: 糖尿病是一种普遍存在的慢性代谢性疾病，它引发的继发性病变对患者健康状态造成了严重损害。在众多并发症里，糖尿病因其明显的发病率以及致残性受到了广泛关注，常常会造成截肢等严重后果。研究显示足底生物力学参数的改变在这个病理过程中起到了关键作用。本文详细阐述了糖尿病及其足部并发症的基本特点，研究了足底生物力学指标和糖尿病足的相关性，还分析了致使足底压力异常的危险因素，基于此本研究收集了当前主流的足底力学检测技术，并且梳理了相关的干预策略，通过整合分析现有文献，本文想要为糖尿病足的临床防治工作提供科学依据和实践方面的参考，同时也为该领域的研究明确方向。
Abstract: Diabetes is a prevalent chronic metabolic disorder that induces secondary complications causing severe damage to patients’ health. Among various complications, diabetes has attracted widespread attention due to its notable incidence and disabling nature, often leading to severe consequences such as amputations. Studies have demonstrated that alterations in plantar biomechanical parameters play a pivotal role in this pathological process. This paper elaborates on the fundamental characteristics of diabetes and its foot complications, investigates the correlation between plantar biomechanical indicators and diabetic foot pathogenesis, and analyzes risk factors contributing to abnormal plantar pressure. Based on these findings, this study compiles current mainstream plantar pressure measurement technologies and systematically reviews related intervention strategies. Through a comprehensive analysis of existing literature, this research aims to provide a scientific basis and practical references for clinical prevention and management of diabetic foot, while also clarifying future research directions in this field.
文章引用：黄依心, 张弛. 糖尿病患者足底压力变化研究进展[J]. 临床医学进展, 2025, 15(5): 587-596. https://doi.org/10.12677/acm.2025.1551410

参考文献

[1] American Diabetes Association (2014) Diagnosis and Classification of Diabetes Mellitus. Diabetes Care, 37, S81-S90. [Google Scholar] [CrossRef] [PubMed]
[2] Hippisley-Cox, J. and Coupland, C. (2016) Diabetes Treatments and Risk of Amputation, Blindness, Severe Kidney Failure, Hyperglycaemia, and Hypoglycaemia: Open Cohort Study in Primary Care. British Medical Journal, 352, i1450. [Google Scholar] [CrossRef] [PubMed]
[3] Ong, K.L., Stafford, L.K., McLaughlin, S.A., et al. (2021) Global, Regional, and National Burden of Diabetes from 1990 to 2021, with Projections of Prevalence to 2050: A Systematic Analysis for the Global Burden of Disease Study 2021. The Lancet, 402, 203-234.
[4] Lewis, J.E., Morris, K., Powell, T., Thomas, R.L. and Owens, D.R. (2020) Combining Diabetic Foot and Retinopathy Screening: A Step in the Right Direction—A Feasibility Study. SAGE Open Medicine, 8, Article 2050312120946244. [Google Scholar] [CrossRef] [PubMed]
[5] 赵婷丽, 高妍, 贾兴泽, 等. 糖尿病周围神经病变患者足底压力参数变化与神经传导速度的关系[J]. 卒中与神经疾病, 2023, 30(4): 388-394.
[6] 董晶晶, 魏玉龙, 胡庆川, 等. 基于足底压力探讨调息训练对人体平衡能力的影响[J]. 中华中医药杂志, 2022, 37(8): 4856-4859.
[7] Wang, X., Yuan, C., Xu, B. and Yu, Z. (2022) Diabetic Foot Ulcers: Classification, Risk Factors and Management. World Journal of Diabetes, 13, 1049-1065. [Google Scholar] [CrossRef] [PubMed]
[8] Khanolkar, M.P., Bain, S.C. and Stephens, J.W. (2008) The Diabetic Foot. QJM, 101, 685-695. [Google Scholar] [CrossRef] [PubMed]
[9] Deng, H., Li, B., Shen, Q., Zhang, C., Kuang, L., Chen, R., et al. (2023) Mechanisms of Diabetic Foot Ulceration: A Review. Journal of Diabetes, 15, 299-312. [Google Scholar] [CrossRef] [PubMed]
[10] McDermott, K., Fang, M., Boulton, A.J.M., Selvin, E. and Hicks, C.W. (2022) Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes Care, 46, 209-221. [Google Scholar] [CrossRef] [PubMed]
[11] Guerra, F.V., Lee, T.Y.T., Eagers, E.P.S., Marcucci Chakkour, M., Marchi Neto, N.D., Bergamasco, J.M.P., et al. (2024) Estudo Epidemiológico de Pacientes Com Pé Diabético. Journal of the Foot & Ankle, 18, 111-115. [Google Scholar] [CrossRef] 
[12] Cavanagh, P.R., Morag, E., Boulton, A.J.M., Young, M.J., Deffner, K.T. and Pammer, S.E. (1997) The Relationship of Static Foot Structure to Dynamic Foot Function. Journal of Biomechanics, 30, 243-250. [Google Scholar] [CrossRef] [PubMed]
[13] Ahsan, M., Shanab, A. and Nuhmani, S. (2021) Plantar Pressure Distribution among Diabetes and Healthy Participants: A Cross-Sectional Study. International Journal of Preventive Medicine, 12, 88. [Google Scholar] [CrossRef] [PubMed]
[14] Duan, Y., Ren, W., Liu, W., Li, J., Pu, F. and Jan, Y. (2022) Relationship between Plantar Tissue Hardness and Plantar Pressure Distributions in People with Diabetic Peripheral Neuropathy. Frontiers in Bioengineering and Biotechnology, 10, Article 836018. [Google Scholar] [CrossRef] [PubMed]
[15] Lu, Y.C., Mei, Q.C. and Gu, Y.D. (2015) Plantar Loading Reflects Ulceration Risks of Diabetic Foot with Toe Deformation. BioMed Research International, 2015, 1-6. [Google Scholar] [CrossRef] [PubMed]
[16] Lord, M. and Hosein, R. (2000) A Study of In-Shoe Plantar Shear in Patients with Diabetic Neuropathy. Clinical Biomechanics, 15, 278-283. [Google Scholar] [CrossRef] [PubMed]
[17] Cao, Z., Wang, F., Li, X., Hu, J., He, Y. and Zhang, J. (2022) Characteristics of Plantar Pressure Distribution in Diabetes with or without Diabetic Peripheral Neuropathy and Peripheral Arterial Disease. Journal of Healthcare Engineering, 2022, 1-8. [Google Scholar] [CrossRef] [PubMed]
[18] Caselli, A., Pham, H., Giurini, J.M., Armstrong, D.G. and Veves, A. (2002) The Forefoot-to-Rearfoot Plantar Pressure Ratio Is Increased in Severe Diabetic Neuropathy and Can Predict Foot Ulceration. Diabetes Care, 25, 1066-1071. [Google Scholar] [CrossRef] [PubMed]
[19] Menz, H.B., Roddy, E., Marshall, M., Thomas, M.J., Rathod, T., Myers, H., et al. (2015) Demographic and Clinical Factors Associated with Radiographic Severity of First Metatarsophalangeal Joint Osteoarthritis: Cross-Sectional Findings from the Clinical Assessment Study of the Foot. Osteoarthritis and Cartilage, 23, 77-82. [Google Scholar] [CrossRef] [PubMed]
[20] Bus, S.A., Maas, M., de Lange, A., Michels, R.P.J. and Levi, M. (2005) Elevated Plantar Pressures in Neuropathic Diabetic Patients with Claw/Hammer Toe Deformity. Journal of Biomechanics, 38, 1918-1925. [Google Scholar] [CrossRef] [PubMed]
[21] Buldt, A.K., Forghany, S., Landorf, K.B., Levinger, P., Murley, G.S. and Menz, H.B. (2018) Foot Posture Is Associated with Plantar Pressure during Gait: A Comparison of Normal, Planus and Cavus Feet. Gait & Posture, 62, 235-240. [Google Scholar] [CrossRef] [PubMed]
[22] Chang, C., Yang, W., Wu, C. and Chang, L. (2022) Would Foot Arch Development in Children Characterize a Body Maturation Process? A Prospective Longitudinal Study. Biomedical Journal, 45, 828-837. [Google Scholar] [CrossRef] [PubMed]
[23] 曹文群, 沈宇峰, 白姣姣, 等. 上海市社区糖尿病患者足部胼胝现况及影响因素调查[J]. 护理学杂志, 2010, 25(9): 75-76.
[24] 谢玉生, 黄蓉蓉, 罗玉红, 等. 糖尿病足溃疡复发风险预测模型的系统评价[J]. 中华现代护理杂志, 2024, 30(11): 1414-1421.
[25] Jorgetto, J.V., Oggiam, D.S., Gamba, M.A. and Kusahara, D.M. (2022) Factors Associated with Changes in Plantar Pressure of People with Peripheral Diabetic Neuropathy. Journal of Diabetes & Metabolic Disorders, 21, 1577-1589. [Google Scholar] [CrossRef] [PubMed]
[26] Sutkowska, E., Sutkowski, K., Sokołowski, M., Franek, E. and Dragan, S. (2019) Distribution of the Highest Plantar Pressure Regions in Patients with Diabetes and Its Association with Peripheral Neuropathy, Gender, Age, and BMI: One Centre Study. Journal of Diabetes Research, 2019, 1-11. [Google Scholar] [CrossRef] [PubMed]
[27] Zimny, S., Schatz, H. and Pfohl, M. (2004) The Role of Limited Joint Mobility in Diabetic Patients with an At-Risk Foot. Diabetes Care, 27, 942-946. [Google Scholar] [CrossRef] [PubMed]
[28] Caravaggi, P., Berti, L., Leardini, A., Lullini, G., Marchesini, G., Baccolini, L., et al. (2017) Biomechanical and Functional Alterations in the Diabetic Foot: Differences between Type I and Type II Diabetes. Gait & Posture, 57, 12-13. [Google Scholar] [CrossRef] 
[29] Payne, C., Turner, D. and Miller, K. (2002) Determinants of Plantar Pressures in the Diabetic Foot. Journal of Diabetes and its Complications, 16, 277-283. [Google Scholar] [CrossRef] [PubMed]
[30] Rojas-Torres, F., Infanzón-Talango, H., García-Ulloa, A.C., Hernández-Jiménez, S. and Rodríguez-Reyes, G. (2024) Exploring Plantar Pressure Distribution in Patients with Newly Diagnosed Diabetes: Implications for Foot Ulcer Prevention in an Overweight Mexican Population. Endocrinología, Diabetes y Nutrición (English Ed.), 71, 340-347. [Google Scholar] [CrossRef] [PubMed]
[31] Mueller, M.J., Zou, D., Bohnert, K.L., Tuttle, L.J. and Sinacore, D.R. (2008) Plantar Stresses on the Neuropathic Foot during Barefoot Walking. Physical Therapy, 88, 1375-1384. [Google Scholar] [CrossRef] [PubMed]
[32] Taş, S., Bek, N., Ruhi Onur, M. and Korkusuz, F. (2017) Effects of Body Mass Index on Mechanical Properties of the Plantar Fascia and Heel Pad in Asymptomatic Participants. Foot & Ankle International, 38, 779-784. [Google Scholar] [CrossRef] [PubMed]
[33] Hsi, W., Chai, H. and Lai, J. (2002) Comparison of Pressure and Time Parameters in Evaluating Diabetic Footwear. American Journal of Physical Medicine & Rehabilitation, 81, 822-829. [Google Scholar] [CrossRef] [PubMed]
[34] Amemiya, A., Noguchi, H., Oe, M., Ohashi, Y., Ueki, K., Kadowaki, T., et al. (2014) Elevated Plantar Pressure in Diabetic Patients and Its Relationship with Their Gait Features. Gait & Posture, 40, 408-414. [Google Scholar] [CrossRef] [PubMed]
[35] Ahroni, J.H., Boyko, E.J. and Forsberg, R.C. (1999) Clinical Correlates of Plantar Pressure among Diabetic Veterans. Diabetes Care, 22, 965-972. [Google Scholar] [CrossRef] [PubMed]
[36] Oh, S., Kim, J., Choi, J., Jeong, W., Chang, H. and Lee, S. (2018) Comparison of Pedal Soft Tissue Thickness between Those with and without Diabetes. The Journal of Foot and Ankle Surgery, 57, 860-864. [Google Scholar] [CrossRef] [PubMed]
[37] Qiu, X., Tian, D., Han, C., Chen, W., Wang, Z., Mu, Z., et al. (2015) Plantar Pressure Changes and Correlating Risk Factors in Chinese Patients with Type 2 Diabetes. Chinese Medical Journal, 128, 3283-3291. [Google Scholar] [CrossRef] [PubMed]
[38] Sacco, I.C.N., Hamamoto, A.N., Tonicelli, L.M.G., Watari, R., Ortega, N.R.S. and Sartor, C.D. (2014) Abnormalities of Plantar Pressure Distribution in Early, Intermediate, and Late Stages of Diabetic Neuropathy. Gait & Posture, 40, 570-574. [Google Scholar] [CrossRef] [PubMed]
[39] DiLiberto, F.E., Baumhauer, J.F. and Nawoczenski, D.A. (2016) The Prevention of Diabetic Foot Ulceration: How Biomechanical Research Informs Clinical Practice. Brazilian Journal of Physical Therapy, 20, 375-383. [Google Scholar] [CrossRef] [PubMed]
[40] LeMaster, J.W., Mueller, M.J., Reiber, G.E., Mehr, D.R., Madsen, R.W. and Conn, V.S. (2008) Effect of Weight-Bearing Activity on Foot Ulcer Incidence in People with Diabetic Peripheral Neuropathy: Feet First Randomized Controlled Trial. Physical Therapy, 88, 1385-1398. [Google Scholar] [CrossRef] [PubMed]
[41] Maluf, K.S. and Mueller, M.J. (2003) Comparison of Physical Activity and Cumulative Plantar Tissue Stress among Subjects with and without Diabetes Mellitus and a History of Recurrent Plantar Ulcers. Clinical Biomechanics, 18, 567-575. [Google Scholar] [CrossRef] [PubMed]
[42] Leyh, C. and Feipel, V. (2022) Impact of Sex and Velocity on Plantar Pressure Distribution during Gait: A Cross-Sectional Study Using an Instrumented Pressure-Sensitive Walkway. Journal of Functional Morphology and Kinesiology, 7, Article 106. [Google Scholar] [CrossRef] [PubMed]
[43] Hulshof, C.M., van Netten, J.J., Dekker, M.G., Pijnappels, M. and Bus, S.A. (2023) In-Shoe Plantar Pressure Depends on Walking Speed and Type of Weight-Bearing Activity in People with Diabetes at High Risk of Foot Ulceration. Clinical Biomechanics, 105, Article 105980. [Google Scholar] [CrossRef] [PubMed]
[44] Mohammad, G., Siddiquei, M.M. and Abu El-Asrar, A.M. (2013) Poly (ADP-Ribose) Polymerase Mediates Diabetes-Induced Retinal Neuropathy. Mediators of Inflammation, 2013, 1-10. [Google Scholar] [CrossRef] [PubMed]
[45] Armstrong, D.G., Boulton, A.J.M. and Bus, S.A. (2017) Diabetic Foot Ulcers and Their Recurrence. New England Journal of Medicine, 376, 2367-2375. [Google Scholar] [CrossRef] [PubMed]
[46] van Netten, J.J., Price, P.E., Lavery, L.A., Monteiro-Soares, M., Rasmussen, A., Jubiz, Y., et al. (2016) Prevention of Foot Ulcers in the At-Risk Patient with Diabetes: A Systematic Review. Diabetes/Metabolism Research and Reviews, 32, 84-98. [Google Scholar] [CrossRef] [PubMed]
[47] Xu, L., Zeng, H., Zhao, J., Zhao, J., Yin, J., Chen, H., et al. (2019) Index of Plantar Pressure Alters with Prolonged Diabetes Duration. Diabetes Therapy, 10, 2139-2152. [Google Scholar] [CrossRef] [PubMed]
[48] Hemler, S.L., Ntella, S.L., Jeanmonod, K., Köchli, C., Tiwari, B., Civet, Y., et al. (2023) Intelligent Plantar Pressure Offloading for the Prevention of Diabetic Foot Ulcers and Amputations. Frontiers in Endocrinology, 14, Article 1166513. [Google Scholar] [CrossRef] [PubMed]
[49] 梁嘉欣. 可穿戴式智能足底压力视觉反馈技术对脑卒中患者步态与平衡功能的影响[D]: [硕士学位论文]. 广州: 南方医科大学, 2019.
[50] Ntella, S.L., Jeanmonod, K., Civet, Y., Koechli, C. and Perriard, Y. (2022) Pressure Offloading Device for Diabetic Footwear Based on Magnetorheological Fluids. 2022 25th International Conference on Electrical Machines and Systems (ICEMS), Chiang Mai, 29 November-2 December 2022, 1-5. [Google Scholar] [CrossRef] 
[51] 王梦囡, 陈宇, 陈康桂. 智能鞋垫的研发及在跑步中应用研究[J]. 科技创新与应用, 2022, 12(4): 46-48.

为你推荐