Journal of Biomedical and Engineering Research
- ISSN: 3065-8780
Mohsen Jafarzadeh, Ali Tavakoli Golpaygani and Seyyed Farhad Tabatabaei Ghomshe
Aims: Diabetic foot ulceration is a preventable long-term complication of diabetes. In the present study, peak plantar pressures (PPP) and other characteristics were assessed in a group of 90 Egyptian patients with diabetes with or without neuropathy and foot ulcers. the aim of this study was to measure plantar pressure as a risk assessment tool in diabetic patients in order to reduce pressure on active diabetic foot ulcers.
Methods: A total of 90 patients having diabetes were selected. All patients had a comprehensive foot evaluation, including assessment for neuropathy using modified neuropathy disability score (MNDS). High plantar pressure is a common risk factor for diabetic foot ulcers, and patients with a history of diabetic foot ulcers often have higher plantar pressures compared to their uninjured or nondiabetic counterparts. Vertical plantar pressure is commonly assessed; however, there are studies that report shear pressures, which are smaller in magnitude and more difficult to assess than the vertical component. Currently, shear stress is often limited to barefoot assessment, while vertical plantar stress is assessed both barefoot and in shoes. Although the inside of the shoe seems to be most useful for the pressures experienced in everyday life, it still exists.
Results: peak pressure parameters were significantly different between the studied groups, namely, forefoot peak plantar pressure, rearfoot peak plan-tar pressure, forefoot/rearfoot ratio, forefoot peak pressure gradient rearfoot peak pressure gradient, and forefoot peak pressure gradient/rearfoot peak pressure gradient (P < 0.05). Research on activities of daily living in patients with diabetic peripheral neuropathy, although limited, suggests that more time is spent standing and sitting compared to walking. Such findings suggest that measuring cumulative pressure over time may be more relevant than the commonly used peak pressure parameter. Custom shoes and insoles are usually prescribed to relieve pressure on the soles of the feet. While footwear interventions are effective at offloading for the most part, results vary between individuals and are only effective when worn regularly. The provision of plantar pressure feedback provides an alternative approach and shows promising results. However, further research is required to understand the long-term effects of feedback, considering all areas of the diabetic foot.
Conclusion: In conclusion, persons with diabetes having neuropathy and ulcers have elevated peak plantar pressure. Risk of ulceration was highly associated with duration of diabetes, smoking, severity of neuropathy, glycemic control, and high peak pressure variables especially the forefoot peak plantar pressure, forefoot/rearfoot, and forefoot peak pressure gradient. Studies have shown that providing pressure feedback may reduce plantar pressures using emerging smart technology; however, more research is needed. To improve our understanding of the pressures leading to diabetic foot ulcers and to improve the effectiveness of interventions, further analysis of pressure is needed in all weight-bearing activities with reference to site-specific pressures.