Foot Pressures during Level Walking Are Strongly Associated with Pressures during Other Ambulatory Activities in Subjects with Diabetic Neuropathy

Objective: To assess the relationship between foot pressures measured during level walking and other types of ambulatory activity in subjects with diabetes mellitus (DM) and peripheral neuropathy (PN). Design: Descriptive survey with repeated measures. Setting: University medical center. Participants: Convenience sample of 16 ambulatory subjects with DM and PN. Interventions: Not applicable. Main Outcome Measures: Peak pressure and pressure-time integral (PTI) at the heel, great toe, first metatarsal head (MT1), and third metatarsal head (MT3) during level walking, ramp climbing, stair climbing, and turning at a self-selected speed. Results: Peak pressure and PTI during level walking correlated highly with pressures during ramp climbing (r range. .85-.97) and turning (r range, .75-.96) at all regions examined and with pressures during stair climbing at MT1 and MT3 (r range, .84-.91). Correlations between pressures during level walking and stair climbing were moderate at the great toe (r range, .46-.57) and poor at the heel (r range, -.12 to -.06). With few exceptions, pressures during ramp climbing, stair climbing and turning were less than (P<.008) or equal to pressures during level walking. We found no activity-related differences in peak pressure or PTI independent of the effects of preferred walking speed. Conclusions: Results support the clinical evaluation of peak pressure during level walking as an efficient method to screen for maximum levels of stress on the foot as patients with DM and PN perform their daily activities.