Dynamic balance and lower limb muscle activation in relation to plantar pressure distribution in patients with type 2 diabetes mellitus

Abstract

Background: Type 2 diabetes mellitus often causes neuromuscular dysfunction, decreased dynamic balance, and changes in plantar pressure distribution in the feet. These conditions contribute to an increased risk of diabetic foot ulcers. Dynamic balance function and lower limb muscle contraction are thought to influence plantar pressure distribution; however, the relationship between these neuromuscular parameters and peak plantar pressure remains unclear, with inconsistent results in previous studies. Methods: This study used a crosssectional design involving 30 patients with type 2 diabetes mellitus who underwent examination at Dr. Soetomo General Hospital in Surabaya. Dynamic balance function was measured using the Y Balance Test and expressed as Composite Reach Length (CRL). Lower limb muscle activity was measured using sEMG, while peak plantar pressure was measured in five areas (M1–M5) on both limbs. The relationships among CRL, sEMG, and peak plantar pressure were analyzed using Spearman's correlation test at a significance level of p ≤ 0.05. Results: In general, there is no relationship between Composite Reach Length and peak plantar pressure in either the right or left leg. In addition, no relationship was found between lower limb muscle activity measured by sEMG and peak plantar pressure. Although one statistically significant correlation was found in a specific plantar segment, the relationship was not consistent across other segments. Conclusion: This study concludes that, in patients with type 2 diabetes mellitus, peak plantar pressure is not related to dynamic balance function or lower limb muscle contraction when measured separately. These findings indicate that plantar pressure distribution in diabetic patients is multifactorial, requiring a comprehensive evaluation and rehabilitation approach to help prevent diabetic foot complications.