An Investigation into the Role of Plantar Foot Pressures in the Development of Diabetic Foot Ulcers

Chatwin, Katie Elaine (2021) An Investigation into the Role of Plantar Foot Pressures in the Development of Diabetic Foot Ulcers. Doctoral thesis (PhD), Manchester Metropolitan University.

Preview

Available under License Creative Commons Attribution Non-commercial No Derivatives. Download (6MB) | Preview

Abstract

Diabetic foot ulcers (DFUs) remain a costly public health concern. A key risk factor for DFU development is abnormally high plantar pressure. However, several constraints are identified in the literature supporting the link between plantar pressure and DFUs, with little research considering pressure experienced throughout daily life. Providing feedback on plantar pressure to patients with diabetic peripheral neuropathy has shown promising results, however, little is known of its prolonged and continued use outside the laboratory setting. This thesis investigated the use of an intelligent insole system that provided continuous pressure feedback during daily life, to diabetes patients who were at high risk of DFU. An aim of the thesis was to investigate whether the provision of pressure feedback could reduce plantar pressure. In addition, through continuous pressure measurement and monitoring, the thesis aimed to examine pressure in the lead up to ulceration and establish which daily activities contributed to high pressure sustained. Diabetes patients who received pressure-feedback had reduced number of bouts of high plantar pressure compared to the control group, which became evident after a minimum learning period of 12 weeks. For those feet that ulcerated during the study, pressure was significantly greater (P < 0.05) at the forefoot in the three months leading up to DFU development compared to those remaining ulcer-free. Diabetes patients spent significantly more time being sedentary (66% vs 55%, P = 0.03) and significantly less time undertaking physical activity (27% vs 34%, P = 0.04) than non-diabetic controls. Furthermore, sedentary behaviour accounted for the highest proportion (56%) of sustained high pressure. This thesis provided a unique insight into plantar pressure experienced during the day-to-day life of diabetes patients at high risk of DFU development. Through continuous monitoring, the thesis was able to capture for the first time, increased plantar pressure in the lead up to ulceration and identify long periods of sedentary behaviour as a risk factor for DFU development. Continuous pressure-feedback was an effective intervention to reduce plantar pressure and the associated risk of ulceration.