Abstract
AimsElevated dynamic plantar pressures are a consistent finding in diabetes patients with peripheral neuropathy with implications for plantar foot ulceration. This meta-analysis aimed to compare the plantar pressures of diabetes patients that had peripheral neuropathy and those with neuropathy with active or previous foot ulcers.MethodsPublished articles were identified from Medline via OVID, CINAHL, SCOPUS, INFORMIT, Cochrane Central EMBASE via OVID and Web of Science via ISI Web of Knowledge bibliographic databases. Observational studies reporting barefoot dynamic plantar pressure in adults with diabetic peripheral neuropathy, where at least one group had a history of plantar foot ulcers were included. Interventional studies, shod plantar pressure studies and studies not published in English were excluded. Overall mean peak plantar pressure (MPP) and pressure time integral (PTI) were primary outcomes. The six secondary outcomes were MPP and PTI at the rear foot, mid foot and fore foot. The protocol of the meta-analysis was published with PROPSERO, (registration number CRD42013004310).ResultsEight observational studies were included. Overall MPP and PTI were greater in diabetic peripheral neuropathy patients with foot ulceration compared to those without ulceration (standardised mean difference 0.551, 95% CI 0.290–0.811, p<0.001; and 0.762, 95% CI 0.303–1.221, p = 0.001, respectively). Sub-group analyses demonstrated no significant difference in MPP for those with neuropathy with active ulceration compared to those without ulcers. A significant difference in MPP was found for those with neuropathy with a past history of ulceration compared to those without ulcers; (0.467, 95% CI 0.181– 0.753, p = 0.001). Statistical heterogeneity between studies was moderate.ConclusionsPlantar pressures appear to be significantly higher in patients with diabetic peripheral neuropathy with a history of foot ulceration compared to those with diabetic neuropathy without a history of ulceration. More homogenous data is needed to confirm these findings.
Highlights
One of the most detrimental complications of both Type 1 and Type 2 diabetes mellitus (DM) is foot ulceration [1,2]
Plantar pressures appear to be significantly higher in patients with diabetic peripheral neuropathy with a history of foot ulceration compared to those with diabetic neuropathy without a history of ulceration
diabetes foot ulceration (DFU) is caused by the interplay of several factors, but most notably diabetic peripheral neuropathy (DPN), peripheral arterial disease (PAD) and changes in foot structure, resulting in foot deformity and increased weight bearing pressure [4,5,6]
Summary
One of the most detrimental complications of both Type 1 and Type 2 diabetes mellitus (DM) is foot ulceration [1,2]. The prevalence of diabetes foot ulceration (DFU) in the United States ranges between 4 and 12%, the annual incidence ranges between 1 and 4.1% and the lifetime incidence can be as high as 25% [3]. DFU is caused by the interplay of several factors, but most notably diabetic peripheral neuropathy (DPN), peripheral arterial disease (PAD) and changes in foot structure, resulting in foot deformity and increased weight bearing pressure [4,5,6]. Foot ulceration together with underlying disease processes such as cardiovascular disease impacts on health related quality of life and ambulatory status in people with DM, promoting decline in general health, mental health, physical and social functioning [7,10,11]. Greater understanding of the factors precipitating DFU is urgently needed
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