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The role of foot pressure measurement in the prediction and prevention of diabetic foot ulceration – a comprehensive review

Chatwin, Katie and Abbott, Caroline and Boulton, Andrew and Bowling, Frank and Reeves, Neil (2019) The role of foot pressure measurement in the prediction and prevention of diabetic foot ulceration – a comprehensive review. Diabetes/Metabolism Research and Reviews. ISSN 1520-7552 (In Press)

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Abstract

Diabetic foot ulcers (DFU) are a costly public health concern. The predominant risk factor, peripheral neuropathy, results in loss of protective sensation and is associated with abnormally high plantar pressures. DFU prevention strategies, including orthotics and footwear, strive to reduce these high plantar pressures. Nevertheless, several constraints should be acknowledged regarding the research supporting the link between plantar pressure and DFUs. 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’ pressure might be applied on the foot over a longer duration. Although further research is needed, this may indicate that an expression of cumulative pressure applied over time, such as pressure-time integral, could be a more relevant parameter than peak pressure. A few studies have indicated that providing pressure feedback to the patient might reduce plantar pressures, with an emerging potential use of smart technology. However, further research is required to determine the efficacy of this approach. Constraints of previous plantar pressure research may explain its low prediction ability for DFU as part of prospective studies. Further vertical and shear pressure analyses, across all weight-bearing activities and referring to location-specific pressures are required to improve our understanding of pressures resulting in DFUs and to help improve effectiveness of interventions, such as therapeutic footwear and pressure-feedback.

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