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Effects of Physical Activity on the Plantar Skin Barrier in People With Diabetes: Protocol for a Prospective Longitudinal Study
ABSTRACT
Background:
Foot thermoregulation, microcirculatory responses, and plantar pressure distribution are key indicators of early physiological alterations in people with diabetes. Despite the availability of infrared thermography (IRT), hyperspectral imaging (HSI), and baropodometry, the combined response of these parameters after walking has not been fully characterized.
Objective:
To analyze acute changes in plantar temperature, skin perfusion indices, and plantar pressure patterns in healthy individuals and people with diabetes to comprehensively characterize the plantar skin response to prolonged walking.
Methods:
We conducted a prospective, within-subject, repeated-measures observational study. Participants completed 2 sequential experimental sessions separated by 1 week. In each session, after 10 minutes of acclimatization, baseline IRT, HSI, and static and dynamic plantar pressure measurements were obtained. Immediately afterward, participants walked at a self-selected speed for 10 minutes (session 1) or 20 minutes (session 2), and measurements were repeated immediately after exercise. Spatial image analysis was performed using regions of interest (ROIs) based on the plantar angiosome model.
Results:
The recruitment and data collection phase began in October 2022 and was completed in April 2026. The final sample comprised 35 participants: 18 with diabetes mellitus and 17 healthy controls. Data analysis using linear mixed models (LMMs) is underway to evaluate intra- and intergroup interactions.
Conclusions:
This protocol provides a standardized, multimodal evaluation framework to characterize the acute physiological response of the foot to mechanical loading. The findings will contribute to establishing noninvasive biomarkers for the early detection of complications of diabetic foot syndrome. Clinical Trial: ClinicalTrials.gov NCT07620379; https://clinicaltrials.gov/study/NCT07620379
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