2型糖尿病合并血管与神经病变患者的足底生物力学及步态特征OA

Objective To analyze the plantar biomechanics and gait characteristics in patients with type 2 diabe-tes mellitus(T2DM)complicated by peripheral arterial disease(PAD)and diabetic peripheral neuropathy(DPN).Methods A total of 185 patients with T2DM were recruited and divided into four groups according to diagnostic criteria:PAD group(n=31),DPN group(n=47),PAD+DPN group comprising patients with both conditions(n=35),and T2DM group consisting of patients without PAD or DPN(n=72).Medical record data were collected from all groups,including sex,age,body mass index,duration of diabetes,and ankle-brachial index.Measurements were performed using a plantar pressure and gait analysis system for both the left and right feet across ten specific regions:the first toe(T1),the second to fifth toes(T2-T5),the first through fifth metatarsal bones(M1,M2,M3,M4 and M5),the midfoot(MF),the medial heel(HM),and the lateral heel(HL).The acquired plantar biomechanical parameters included regional plantar pressure,in-stantaneous regional pressure,instantaneous peak pressure,contact area,and pressure-time integral(PTI),and the fol-lowing gait parameters were also recorded:step length,stride length,cadence,gait speed,gait cycle duration,and dou-ble-limb support time.Results The DPN group and PAD+DPN group were older and had a longer duration of diabetes as compared with the T2DM group(all P<0.05).The PAD+DPN group also had a longer diabetes duration than the PAD group(P<0.05).After adjusting for age and diabetes duration,compared with the T2DM group,the PAD group exhibited higher regional plantar pressure in the left MF,the DPN group showed higher pressure in the right HM,and the PAD+DPN group demonstrated higher pressure in the right first metatarsal bone(M1)and the left HM(all P<0.05).No statistically significant differences were observed among the four groups in instantaneous regional pressure,instantaneous peak pres-sure,or contact area across the various plantar regions(all P>0.05).Regarding the PTI,the PAD and DPN groups showed higher values in the right HM than the T2DM group,while the PAD+DPN group had higher values in the left M1 and the left HM(all P<0.05).In gait parameters,compared with the T2DM group,the PAD group had lower cadence and gait speed,along with a longer double-limb support time(all P<0.05);the DPN group showed lower cadence and gait speed(both P<0.05);the PAD+DPN group demonstrated a shorter step length,a lower cadence,and a lower gait speed for the left foot,coupled with longer gait cycle duration and double-limb support time(all P<0.05).Conclusions The coexistence of PAD or DPN increases cumulative plantar load and alters gait in patients with T2DM.Furthermore,the con-current presence of PAD and DPN leads to more pronounced changes,including an increased PTI across multiple plantar regions,elevated pressure in key forefoot areas such as the M1,and more marked gait deterioration.