2hPG and HbA1c are independently associated with dynamic plantar pressure in Pre-DM patients, with higher glucose levels associated with increased loading on the medial heel and first metatarsal head, and decreased loading on the fifth metatarsal head and lateral toes.
Key Findings
Results
Two-hour postprandial plasma glucose (2hPG) and HbA1c were independently associated with pressure-time integral (PTI) and peak force (PF) in the left first metatarsal head (MH1) in pre-diabetic patients.
Higher blood glucose levels were associated with increased plantar pressure in the left MH1 region
Both 2hPG and HbA1c showed statistically significant associations (p < 0.05) in the second block of hierarchical linear regression
This association was found after controlling for BMI and age in the first block of the regression model
The study enrolled 55 pre-DM patients assessed via the FreeStep plantar pressure measurement system during walking
Results
2hPG was independently associated with peak force (PF) in the left lateral heel (HL-L), with higher blood glucose levels associated with increased plantar pressure in this region.
The association was statistically significant at p < 0.05 in the second block of hierarchical linear regression
BMI was also independently associated with PF in left HL-L (p < 0.01) in the first block
FBG had no significant effect on plantar pressure in the heel region (p > 0.05)
Results
2hPG and HbA1c were associated with decreased peak force (PF) in the bilateral fifth metatarsal head (MH5) and left toes 2–5 (T2-5), meaning higher blood glucose levels were associated with reduced loading in these regions.
Associations were statistically significant at p < 0.05
This finding represents an inverse relationship between glycemic indicators and plantar pressure, contrasting with findings in MH1 and heel regions
Both postprandial glucose (2hPG) and long-term glycemic control (HbA1c) showed this inverse association independently
Results
Fasting blood glucose (FBG) had no significant association with plantar pressure in any foot zone.
FBG showed no effect on plantar pressure across all 11 plantar zones (p > 0.05)
This contrasts with 2hPG and HbA1c, which were significantly associated with plantar pressure in multiple zones
Three glycemic indicators were measured: FBG, HbA1c, and 2hPG
Results
BMI was independently associated with multiple plantar pressure parameters in the left foot of pre-DM patients.
BMI was associated with PF in left HL-L (p < 0.01), MPP in left MH2 (p < 0.01), and MPP in left HL-M/L (p < 0.01)
BMI was also associated with MPP in left MF-M (p < 0.05)
These associations were identified in the first block of the hierarchical linear regression, prior to entering glycemic variables
Results
Age was independently associated with plantar pressure in the left medial heel and second metatarsal head regions.
Age was associated with MPP in left MH2 (p < 0.01) and MPP in left HL-M (p < 0.05)
Age effects were identified in the first block of the hierarchical regression model as a covariate
Significant associations were found only in the left foot, not explicitly reported for the right foot
Background
This cross-sectional study provides the first reported evidence that postprandial glycemia and HbA1c are independently associated with dynamic plantar pressure distribution in pre-diabetic patients.
The study enrolled 55 pre-DM patients in a cross-sectional design
Plantar pressure was assessed across 11 foot zones using the FreeStep plantar pressure measurement system during walking
Three plantar pressure parameters were measured: pressure-time integral (PTI), peak force (PF), and mean plantar pressure (MPP)
Spearman's rank correlation and hierarchical linear regression were the primary statistical methods
Authors describe this as an 'exploratory study' providing 'first evidence' of these associations
What This Means
This research suggests that in people with prediabetes — a condition where blood sugar is elevated but not yet at diabetic levels — higher blood sugar is linked to changes in how pressure is distributed across the foot while walking. Specifically, higher levels of two-hour post-meal blood sugar (2hPG) and a measure of long-term blood sugar control (HbA1c) were both associated with greater pressure under the inner part of the ball of the foot and the heel, while pressure under the outer ball of the foot and the smaller toes was lower. Interestingly, fasting blood sugar levels showed no significant relationship with foot pressure in any region.
The study measured foot pressure in 55 prediabetic patients across 11 different foot zones during normal walking, using a specialized pressure measurement system. Body weight (BMI) and age also played a role in foot pressure patterns, particularly in the left foot. These uneven pressure distributions — with some areas overloaded and others underloaded — may be important because abnormal foot pressure is known to contribute to foot ulcers and other complications in people with diabetes.
This research suggests that biomechanical changes in how the foot bears weight may begin as early as the prediabetic stage, before a full diabetes diagnosis. This could potentially point toward the importance of monitoring foot mechanics in people with early blood sugar abnormalities, though the cross-sectional design of the study means that cause and effect cannot be established. Further longitudinal research would be needed to understand whether these pressure changes worsen over time or contribute to later foot complications.
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Wang S, Chu Z, Li W, Liang J, Cai B, Liu J, et al.. (2026). Associations between blood glucose and dynamic plantar pressure distribution in pre-DM patients: a cross-sectional study.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1909052