Plantar pressures are elevated in people with longstanding diabetes-related foot ulcers during follow-up

Fernando, Malindu E., Crowther, Robert G., Lazzarini, Peter A., Yogakanthi, Saiumaeswar, Sangla, Kunwarjit S., Buttner, Petra, Jones, Rhondda, and Golledge, Jonathan (2017) Plantar pressures are elevated in people with longstanding diabetes-related foot ulcers during follow-up. PLoS ONE, 12 (8). e0181916. pp. 1-17.

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Objective: High plantar pressures are implicated in the development of diabetes-related foot ulcers. Whether plantar pressures remain high in patients with chronic diabetes-related foot ulcers over time is uncertain. The primary aim of this study was to compare plantar pressures at baseline and three and six months later in participants with chronic diabetes-related foot ulcers (cases) to participants without foot ulcers (controls).

Methods: Standardised protocols were used to measure mean peak plantar pressure and pressure-time integral at 10 plantar foot sites (the hallux, toes, metatarsals 1 to 5, mid-foot, medial heel and lateral heel) during barefoot walking. Measurements were performed at three study visits: baseline, three and six months. Linear mixed effects random-intercept models were utilised to assess whether plantar pressures differed between cases and controls after adjusting for age, sex, body mass index, neuropathy status and follow-up time. Standardised mean differences (Cohen's d) were used to measure effect size.

Results: Twenty-one cases and 69 controls started the study and 16 cases and 63 controls completed the study. Cases had a higher mean peak plantar pressure at several foot sites including the toes (p = 0.005, Cohen's d = 0.36) and mid-foot (p = 0.01, d = 0.36) and a higher pressure-time integral at the hallux (p<0.001, d = 0.42), metatarsal 1 (p = 0.02, d = 0.33) and mid-foot (p = 0.04, d = 0.64) compared to controls throughout follow-up. A reduction in pressure-time integral at multiple plantar sites over time was detected in all participants (p<0.05, respectively).

Conclusions: Plantar pressures assessed during gait are higher in diabetes patients with chronic foot ulcers than controls at several plantar sites throughout prolonged follow-up. Long term offloading is needed in diabetes patients with diabetes-related foot ulcers to facilitate ulcer healing.

Item ID: 50998
Item Type: Article (Research - C1)
ISSN: 1932-6203
Additional Information:

Copyright: © 2017 Fernando et al. This is an open access article distributed under the terms of the Creative Commons Attribution License [], which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funders: Queensland Department of Health (QDH), James Cook University Graduate Research School (JCU GRS), National Health and Medical Research Council (NHMRC), Australian Postgraduate Award (APA), College of Medicine and Dentistry, James Cook University (JCU)
Projects and Grants: QDH Health Practitioner Research Grant Scheme (2013-2014), NHMRC Practitioner Fellowship (1019921)
Research Data:
Date Deposited: 04 Oct 2017 07:30
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320101 Cardiology (incl. cardiovascular diseases) @ 50%
42 HEALTH SCIENCES > 4201 Allied health and rehabilitation science > 420107 Podiatry @ 50%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920104 Diabetes @ 50%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920103 Cardiovascular System and Diseases @ 50%
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