Clinical foot measurements as a proxy for plantar pressure testing in people with diabetes

Vivienne H Chuter,Michael David,Sean Lanting,Angela Searle,Martin J Spink

doi:10.1186/s13047-021-00494-4

Vivienne H Chuter, Michael David + Show 3 more

Open Access

https://doi.org/10.1186/s13047-021-00494-4

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Abstract

BackgroundHigh plantar pressures are associated with increased foot ulcer risk in people with diabetes. Identification of high plantar pressures in people with diabetes is clinically challenging due to time and cost constraints of plantar pressure testing. Factors affecting foot biomechanics, including reduced joint range of motion and foot deformity, are implicated in the development of high plantar pressures and may provide a method to clinically identify those at risk of pressure related complications. The aim of this study was to investigate the contribution of joint range of motion and foot deformity measures on plantar pressures in a community dwelling group with diabetes.MethodsBarefoot (Tekscan HR Mat™) and in-shoe (Novel Pedar-X®) plantar pressure variables, weight bearing ankle dorsiflexion, hallux range of motion, lesser toe deformities and hallux abductus (HAV) scale were assessed in 136 adults with diabetes (52.2% male; mean age 68.4 years). Multivariate multiple linear regression was used to assess the effect of the four biomechanical factors plus neuropathy and body mass index on plantar pressure variables. Non-parametric bootstrapping was employed to determine the difference in plantar pressure variables for participants with two or more foot biomechanical pathologies compared to those with less than two pathologies.ResultsAlmost one third (32%) of the cohort had two or more foot biomechanical pathologies. Participants with two or more foot biomechanical pathologies displayed significant increases in all barefoot plantar pressure regions (except forefoot), compared to those with less than two pathologies. No significant changes were found for the in-shoe plantar pressure variables. The regression model explains between 9.9% (95%CI: 8.4 to 11.4%) and 29.6% (95% CI: 28.2 to 31%), and between 2.5% (1.0 to 4.0%) and 43.8% (95% CI: 42.5–44.9%), of the variance in the barefoot and in-shoe plantar pressure variables respectively.ConclusionsParticipants presenting with two or more factors affecting foot biomechanics displayed higher peak pressures and pressure time integrals in all foot regions compared to those with less than two factors. The tests used in this study could help clinicians detect elevated plantar pressures in people with diabetes and present an opportunity for early preventative interventions.

Highlights

High plantar pressures are associated with increased foot ulcer risk in people with diabetes
The majority of participants had a diagnosis of Type 2 diabetes (90.4%) and were predominantly a low risk cohort based on the low reported levels of diabetes-related complications including a history of Diabetes-related foot ulcer (DFU) (3.7%), retinopathy (2.9%), nephropathy (2.2%) or loss of protective foot sensation (LOPS) with foot deformity (11.8%) [28]
The results of the multivariate multiple linear regression, used to identify which of the four biomechanical factors plus neuropathy and Body mass index (BMI) contributed to the plantar pressure changes in different foot regions are shown in Figs. 1 and 2

Summary

Introduction

High plantar pressures are associated with increased foot ulcer risk in people with diabetes. Identification and subsequent early treatment of clinical factors that contribute to increased risk of foot ulcer and amputation in people with diabetes should be a high priority for primary care clinicians. Peripheral neuropathy is widely recognised as a critical factor in the development of DFU [5], and considerable effort has been dedicated to developing tests that allow clinicians to detect neuropathy with minimal time and cost. These include a 10-g Semmes-Weinsten monofilament, 128-Hz tuning fork, pinprick sensation, ankle reflexes and vibration perception threshold testing using a neurothesiometer [8]. Identification of risk of elevated plantar pressures, by clinic based measures where plantar pressure testing is unavailable, will assist clinicians in determining treatment plans

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