Correlations between weight-bearing 3D bone architecture and dynamic plantar pressure measurements in the diabetic foot
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(2020) 13:64
RESEARCH
Open Access
Correlations between weight-bearing 3D bone architecture and dynamic plantar pressure measurements in the diabetic foot Claudio Belvedere1†, Claudia Giacomozzi2*† , Claudio Carrara1, Giada Lullini1, Paolo Caravaggi1, Lisa Berti1, Giulio Marchesini3, Luca Baccolini3, Stefano Durante4 and Alberto Leardini1
Abstract Background: Measurements of plantar loading reveal foot-to-floor interaction during activity, but information on bone architecture cannot be derived. Recently, cone-beam computer tomography (CBCT) has given visual access to skeletal structures in weight-bearing. The combination of the two measures has the potential to improve clinical understanding and prevention of diabetic foot ulcers. This study explores the correlations between static 3D bone alignment and dynamic plantar loading. Methods: Sixteen patients with diabetes were enrolled (group ALL): 15 type 1 with (N, 7) and without (D, 8) diabetic neuropathy, and 1 with latent autoimmune diabetes. CBCT foot scans were taken in single-leg upright posture. 3D bone models were obtained by image segmentation and aligned in a foot anatomical reference frame. Absolute inclination and relative orientation angles and heights of the bones were calculated. Pressure patterns were also acquired during barefoot level walking at self-selected speed, from which regional peak pressure and absolute and normalised pressure-time integral were worked out at hallux and at first, central and fifth metatarsals (LOAD variables) as averaged over five trials. Correlations with 3D alignments were searched also with arch index, contact time, age, BMI, years of disease and a neuropathy-related variable. Results: Lateral and 3D angles showed the highest percentage of significant (p < 0.05) correlations with LOAD. These were weak-to-moderate in the ALL group, moderate-to-strong in N and D. LOAD under the central metatarsals showed moderate-to-strong correlation with plantarflexion of the 2nd and 3rd phalanxes in ALL and N. LOAD at the hallux increased with plantarflexion at the 3rd phalanx in ALL, at 1st phalanx in N and at 5th phalanx in D. Arch index correlated with 1st phalanx plantarflexion in ALL and D; contact time showed strong correlation with 2nd and 3rd metatarsals and with 4th phalanx dorsiflexion in D. (Continued on next page)
* Correspondence: [email protected]; [email protected] † Claudio Belvedere and Claudia Giacomozzi contributed equally to this work. 2 Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità (Italian National Institute of Health), Viale Regina Elena 299, 00161 Rome, Italy Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the C
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