Comparative evaluation of foot plantar pressures in pregnant women with and without gestational diabetes compared to non-pregnant diabetic patients and healthy individuals

Background And Aim: We aimed to evaluate the changes in foot biomechanics during pregnancy with pedobarography, to investigate whether gestational diabetes has an effect on these changes and the relationship of these changes with clinical outcomes Material and method: 30 GDM pregnant women, 30 normal pregnant women, 30 non-pregnant women with diabetes and 30 healthy pregnant women as control group were included in the study. All of the pregnant women had to have completed their 28th gestational week. Age, weight, height, BMI information of all participants were recorded. Gestational week, number of pregnancies and weight gain during pregnancy were recorded in pregnant groups. In all participants, the severity of foot pain during activity and rest was recorded using VAS scores. The DN4 questionnaire was filled to question the presence of neuropathic pain. Semmes-Weinstein monofilament test was applied to investigate the presence of sensory loss. Foot Functional Index(FFI) scale was used to evaluate the person's foot related functional status. In static pedobarographic analysis; During standing, the distribution of the pressure on the feet to the right forefoot, right hind foot, left forefoot and left hindfoot were examined. In dynamic pedobarographic analysis; The peak pressures and foot contact areas occurring in 10 areas of the foot during walking were recorded Results: Average age was calculated as 32.8 ± 5.75 in GDM group, 29.5 ± 5.78 in pregnant group, 31.93 ± 6.50 in diabetes group and 30.23 ± 3.74 in control group. BMI averages were calculated as 32.98 ± 5.58 in the GDM group, 29.25 ± 5.73 in the pregnant group, 27.84 ± 4.74 in the diabetes group, and 20.96 ± 2.06 in the control group. While foot pain VAS scores were higher in all three groups compared to the control group, there was no significant difference between the three groups. While neuropathic pain scores were higher in all three groups compared to the control group, the mean of the GDM group was significantly higher than that of the pregnant group. No sensory loss was observed in any participant. FFI scores in all three groups were higher than the control group in all titles. The highest scores were recorded in the GDM group. FFI pain and disability scores were significantly higher in GDM group and pregnant group. In static pedobarographic analysis, an increase in right posterior foot pressure distribution was observed in all three groups. There was no significant difference between the groups. In dynamic pedobarographic analysis, significant increases in peak pressures were detected in the metatarsal regions and in the midfoot region of the study groups. No significant differences were observed between the GDM group and the pregnant group in terms of these increases. Dynamic pedobarographic analysis showed an increase in the middle foot contact area and a decrease in the front foot contact area in all three groups. There was no difference between GDM group and pregnant group. There was a correlation between the pressure increase in the midfoot region in the metatarsal regions and the BMI values. There was a correlation between the change in the distribution of contact areas and the BMI values. There were correlations between FFI total scores and pressure changes. There was a correlation between FFI total scores and BMI values. Conclusion: In the last period of pregnancy, we observed changes in footpad pressures and in this period, we observed an increase in foot pain and impairment in foot related functionality. Although there is no difference in pressure changes in pregnant women with GDM; we found higher neuropathic pain scores and worse FFI pain and FFI disability scores in this group. We think that the main determining physical factor on all these changes is high VKİ values. Choosing appropriate shoes and using orthoses under the guidance of pedobarographic data may have positive effects on the foot related bad clinical results in the last period of pregnancy.