International Journal of Clinical Research
International Journal of Clinical Research. 2026; 10: (8) ; 10.12208/j.ijcr.20260376 .
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大理大学第二附属医院内分泌科（云南省第三人民医院） 云南昆明
*通讯作者： 李文,单位：大理大学第二附属医院内分泌科（云南省第三人民医院） 云南昆明; ；
2型糖尿病合并肥胖或超重已成为全球重大公共卫生问题，加剧足底压力分布异常风险，易并发神经血管病变，不仅导致足部肌肉萎缩、感觉减退甚至丧失，还会引发下肢循环障碍，进而显著改变足底压力分布。此外，肥胖或超重患者总胆固醇和甘油三酯升高易诱发血管斑块形成，使血管管壁增厚、变硬、管腔狭窄，且下肢脂肪组织异常堆积引起血管外周压力增加、血管受压、血流阻力增大，进一步影响下肢血液供应，加剧足底压力分布的不均匀性。足底压力分布异常是诱发跖痛症、足底筋膜炎、鸡眼及胼胝等足部并发症的重要诱因。神经病变和血管病变的协同作用导致足底压力分布不均，显著提升糖尿病足溃疡发生风险。本文旨在厘清该领域研究空白，为构建“未病先防、既病防变”的防控体系提供理论依据。本文通过检索PubMed、知网及万方等数据库中关于2型糖尿病合并肥胖或超重患者足底压力的相关文献，重点分析病理机制、评估技术及干预策略。结果显示：1）2型糖尿病患者代谢异常与肥胖或超重机械负荷形成“双重打击”，通过神经病变、血管缺血及结构改变三条通路加重足底压力异常；2）体质量指数（BMI）、糖化血红蛋白（HbA1c）>8%的患者足底压力异常风险增加；3）做到“标本兼治”，通过减重5%~10%及严格控制HbA1c，改善神经病变、血管缺血的内环境；4）定制鞋垫或减压鞋具分散足底高压，指导患者进行日常足部护理，实现从被动治疗向主动预防的转变。
Type 2 diabetes mellitus (T2DM) and overweight or obesity represents a global public health burden. The comorbidity exacerbates the risk of abnormal plantar pressure distribution and predisposes individuals to neurovascular complications. The pathologies induce foot muscle atrophy and sensory impairment, while concurrently triggering lower extremity circulatory disturbances that fundamentally alter plantar loading patterns. Furthermore, elevated cholesterol and triglyceride promote vascular plaque formation, resulting in vessel wall thickening, stiffening, and luminal narrowing. Concurrently, lower limb adipose accumulation increases perivascular pressure, compresses vasculature, and elevates flow resistance, thereby compromising peripheral blood supply and worsening pressure heterogeneity. Abnormal plantar pressure serves as a key etiological factor for foot complications, including metatarsalgia, plantar fasciitis, corns, and calluses. The synergistic effect of neuropathy and vasculopathy leads to uneven pressure distribution, significantly elevating the risk of diabetic foot ulcers (DFU). The review aims to identify existing research gaps and provide a theoretical basis for establishing a closed-loop prevention system focused on “prevention before disease onset” and “prevention of progression.” We conducted a literature search across PubMed, CNKI, and Wanfang databases to integrate current evidence regarding plantar pressure in overweight or obese T2DM patients, focusing specifically on pathological mechanisms, assessment technologies, and intervention strategies. The researches reveal key points: 1) The metabolic dysregulation of T2DM and the mechanical overload of obesity constitute a “dual-hit” mechanism, exacerbating plantar pressure abnormalities through neuropathy, vascular ischemia, and structural alterations; 2) Higher body mass index (BMI) and HbA1c > 8% are associated with an increased risk of abnormal plantar pressure in patients with diabetes; 3) Achieving “treating both symptoms and root causes” requires a dual approach: improving the neuro-ischemic microenvironment through 5%-10% weight reduction and strict HbA1c control, coupled with customized insoles or pressure-relief footwear to redistribute plantar loads. Guiding patients in daily self-examination and care facilitates a paradigm shift from passive treatment to active prevention.
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