The role of foot pressure measurement in the prediction and prevention of diabetic foot ulceration-A comprehensive review

Katie E Chatwin, Caroline A Abbott, Andrew J M Boulton, Frank L Bowling, Neil D Reeves, Katie E Chatwin, Caroline A Abbott, Andrew J M Boulton, Frank L Bowling, Neil D Reeves

Abstract

The predominant risk factor of diabetic foot ulcers (DFU), peripheral neuropathy, results in loss of protective sensation and is associated with abnormally high plantar pressures. DFU prevention strategies strive to reduce these high plantar pressures. Nevertheless, several constraints should be acknowledged regarding the research supporting the link between plantar pressure and DFUs, which may explain the low prediction ability reported in prospective studies. The majority of studies assess vertical, rather than shear, barefoot plantar pressure in laboratory-based environments, rather than during daily activity. Few studies investigated previous DFU location-specific pressure. Previous studies focus predominantly on walking, although studies monitoring activity suggest that more time is spent on other weight-bearing activities, where a lower "peak" plantar pressure might be applied over a longer duration. Although further research is needed, this may indicate that an expression of cumulative pressure applied over time could be a more relevant parameter than peak pressure. Studies indicated that providing pressure feedback might reduce plantar pressures, with an emerging potential use of smart technology, however, further research is required. Further pressure analyses, across all weight-bearing activities, referring to location-specific pressures are required to improve our understanding of pressures resulting in DFUs and improve effectiveness of interventions.

Keywords: diabetic ulcer; peripheral neuropathy; plantar pressure; pressure feedback; pressure-time integral.

Conflict of interest statement

The authors declare no potential conflict of interest.

© 2019 The Authors. Diabetes/Metabolism Research and Reviews published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Examples of equipment used to measure plantar pressure. A, AMTI force platform (Advanced Medical Technology, Inc. Watertown, MA). B, BTS P‐walk pressure plate (MA). C, PressureStat (Medical Gait Technology BY, Emmen, The Netherlands). D, F‐scan pressure assessment system insole (Tekscan, Inc., Boston, MA). The equipment A‐C are typically used to collect barefoot pressure data, whereas D is placed in‐shoe

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