Peripheral neuropathy, the main risk factor for diabetic foot ulcers (DFU), causes loss of protective feeling and is linked to very high plantar pressures. The goal of DFU preventive techniques is to lower these elevated plantar pressures. However, there are a number of limitations to the evidence that supports the connection between plantar pressure and DFUs, which could account for the poor prediction accuracy found in prospective studies. Most research measures the vertical, as opposed to the shear, barefoot plantar pressure in lab settings as opposed to in real-world activities. Previous DFU location-specific pressure was not well studied. Prior research has mostly concentrated on walking; however activity tracking studies indicate that more time is spent on other weight-bearing tasks, when a longer duration of lower "peak" plantar pressure may be applied. This suggests that a measure of the cumulative pressure applied over time might be more pertinent than peak pressure, however more investigation is required. Further research is needed, however studies have shown that delivering pressure feedback may lessen plantar pressures. This is an emerging potential use of smart technology. To increase our knowledge of the pressures that lead to DFUs and the efficacy of therapies, more pressure assessments pertaining to location-specific pressures pertaining to all weight-bearing activities are needed.
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