Hulshof, Chantal A., Page, Madelyn, van Baal, Sjef G., Bus, Sicco A., Fernando, Malindu, van Gemert-Pijnen, Lisette, Kappert, Kilian D. R., Lucadou-Wells, Scott, Najafi, Bijan, Van Netten, Jaap J., and Lazzarini, Peter A. (2024) The Stress of Measuring Plantar Tissue Stress in People with Diabetes-Related Foot Ulcers: Biomechanical and Feasibility Findings from Two Prospective Cohort Studies. Sensors, 24. 2411.

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Abstract

Reducing high mechanical stress is imperative to heal diabetes-related foot ulcers. We explored the association of cumulative plantar tissue stress (CPTS) and plantar foot ulcer healing, and the feasibility of measuring CPTS, in two prospective cohort studies (Australia (AU) and The Netherlands (NL)). Both studies used multiple sensors to measure factors to determine CPTS: plantar pressures, weight-bearing activities, and adherence to offloading treatments, with thermal stress response also measured to estimate shear stress in the AU-study. The primary outcome was ulcer healing at 12 weeks. Twenty-five participants were recruited: 13 in the AU-study and 12 in the NL-study. CPTS data were complete for five participants (38%) at baseline and one (8%) during follow-up in the AU-study, and one (8%) at baseline and zero (0%) during follow-up in the NL-study. Reasons for low completion at baseline were technical issues (AU-study: 31%, NL-study: 50%), non-adherent participants (15% and 8%) or combinations (15% and 33%); and at follow-up refusal of participants (62% and 25%). These underpowered findings showed that CPTS was non-significantly lower in people who healed compared with non-healed people (457 [117; 727], 679 [312; 1327] MPa·s/day). Current feasibility of CPTS seems low, given technical challenges and non-adherence, which may reflect the burden of treating diabetes-related foot ulcers.

Item ID:	85967
Item Type:	Article (Research - C1)
ISSN:	1424-8220
Copyright Information:	© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Date Deposited:	25 Jun 2025 01:34
FoR Codes:	32 BIOMEDICAL AND CLINICAL SCIENCES > 3206 Medical biotechnology > 320602 Medical biotechnology diagnostics (incl. biosensors) @ 60% 42 HEALTH SCIENCES > 4207 Sports science and exercise > 420701 Biomechanics @ 40%
SEO Codes:	20 HEALTH > 2004 Public health (excl. specific population health) > 200499 Public health (excl. specific population health) not elsewhere classified @ 100%
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