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Measuring Pressure in the Diabetic Foot

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Measurements in Wound Healing

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Abstract

Diabetic foot ulcers remain a common complication due to their multifactorial etiology. A number of advances have been made in the treatment of these chronic wounds, however, the common underlying theme of reducing pressure as paramount to healing persists as a fundamental principle. Measurement of plantar foot pressures have taken many forms, beginning with crude techniques of an ink impregnated mat and evolving into more complex computer technology employing microprocessor recording devices. These devices typically measure peak plantar pressures which are easily determined and quantifiable. What has been more difficult to evaluate, and perhaps more valuable in providing plantar tissue fatigue information and ultimately ulceration, are the shear forces on the foot. Despite this limitation, data from plantar peak pressure forces have yielded several interventions promoted for the reduction of pressures related to wound persistence. These interventions have included socks, insoles, felted foam dressings, removable cast walkers, and total contact casts, Each pressure reducing device varies in terms of effectiveness in wound healing, with total contact cast demonstrating the greatest success, but with the caveat of time intensiveness and secondary complications.

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References

  1. American diabetes association. Consensus development conference on diabetes foot wound care. Diabetes Care. 1999;22:1354–60.

    Article  Google Scholar 

  2. Brand PW. Management of the insensitive limb. Phys Ther. 1979;59(1):8–12.

    PubMed  CAS  Google Scholar 

  3. Reiber GE, Vileikyte L, Boyko EJ, del Aguila M, Smith DG, Lavery LA, et al. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care. 1999;22:157–62.

    Article  PubMed  CAS  Google Scholar 

  4. Temlett JA. An assessment of vibration threshold using a biothesiometer compared to a C128-Hz tuning fork. J Clin Neurosci. 2009;16(11):1435–8.

    Article  PubMed  CAS  Google Scholar 

  5. McNeely MJ, Boyko E, Ahroni JH, Stensel VL, Reiber G, Smith DG, Pecoraro RE. The independent contributions of diabetic neuropathy and vasculopathy in foot ulceration: how great are the risks? Diabetes Care. 1995;18:216–9.

    Article  PubMed  CAS  Google Scholar 

  6. Lavery LA, Armstrong DG, Vela SA. Practical criteria for screening patients at high risk for diabetic foot ulceration. Arch Intern Med. 1998;158:157–62.

    Article  PubMed  CAS  Google Scholar 

  7. Kumar S, Fernando DJS, Veves A, Knowles EA, Young MJ, Boulton AJM. Semmes-Weinstein monofilaments: a simple, effective and inexpensive screening device for identifying diabetic patients at risk of foot ulceration. Diabetes Res Clin Pract. 1991;13:63–8.

    Article  PubMed  CAS  Google Scholar 

  8. Simeone LR, Veves A. Screening techniques to identify the diabetic patient at risk of ulceration. J Am Podiatr Med Assoc. 1997;87:313–7.

    PubMed  CAS  Google Scholar 

  9. Sosenko JM, Kato M, Soto R, Bild DE. Comparison of quantitative sensory-threshold measures for their association with foot ulceration in diabetic patients. Diabetes Care. 1990;13:1057–61.

    Article  PubMed  CAS  Google Scholar 

  10. Armstrong DG, Lavery LA, Vela SA, Quebedeaux TL, Fleischli JG. Choosing a practical neuropathy testing instrument to identify risk for diabetic foot ulceration. Arch Intern Med. 1998;158:289–92.

    Article  PubMed  CAS  Google Scholar 

  11. Birke JA, Sims DS. Plantar sensory threshold in the ulcerative foot. Lepr Rev. 1986;57:261–7.

    PubMed  CAS  Google Scholar 

  12. Mueller MJ. Identifying patients with diabetes who are at risk for lower extremity complications: use of Semmes-Weinstein monofilaments. Phys Ther. 1996;76(1):68–71.

    PubMed  CAS  Google Scholar 

  13. Klenerman L, McCabe C, Cogley D, Crerand S, Laing P, White M. Screening for patients at risk of diabetic foot ulceration in a general diabetic outpatient clinic. Diabet Med. 1996;13:561–3.

    Article  PubMed  CAS  Google Scholar 

  14. McGill M, Molyneaux L, Spencer R, Heng LF, Yue DK. Possible sources of discrepancies in the use of the Semmes-Weinstein monofilament. Impact on prevalence of insensate foot and workload requirements. Diabetes Care. 1999;22:598–602.

    Article  PubMed  CAS  Google Scholar 

  15. Pham H, Harkless JB, Armstrong D, Giurini JM, Harvey C, Veves A. Screening techniques to identify people at high risk for diabetic foot ulceration. A prospective multicenter trial. Diabetes Care. 2000;23:606–11.

    Article  PubMed  CAS  Google Scholar 

  16. Lee S, Kim H, Choi S, Park Y, Kim Y, Cho B. Clinical usefulness of the two-site Semmes-Weinstein monofilament test for detecting diabetic peripheral neuropathy. J Korean Med Sci. 2003;18:103–7.

    PubMed  Google Scholar 

  17. Smieja M, Hunt DL, Edelman D, Etchells E, Cornuz J, Simel DL. Clinical examination for the detection of protective sensation in the feet of diabetic patients. International Cooperative Group for Clinical Examination Research. J Gen Intern Med. 1999;14(7):418–24.

    Article  PubMed  CAS  Google Scholar 

  18. Kumar S, Ashe HA, Parnell LN, Fernando DJS, Tsigos C, Young RJ, Ward JD, Boulton AJM. The prevalence of foot ulceration and its correlates in type 2 diabetic patients: a population-based study. Diabet Med. 1994;11:480–4.

    Article  PubMed  CAS  Google Scholar 

  19. Young MJ, Breddy JL, Veves A, Boulton AJM. The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds: a prospective study. Diabetes Care. 1994;17:557–60.

    Article  PubMed  CAS  Google Scholar 

  20. Boulton AJ, Hardisty CA, Betts RP, Franks CI, Worth RC, Ward ID. Dynamic foot pressure and other studies as diagnostic and management aids in diabetic neuropathy. Diabetes Care. 1983;6:26–33.

    Article  PubMed  CAS  Google Scholar 

  21. Lavery LA, Armstrong DG, Wunderlich RP, Tredwell J, Boulton AJM. Predictive value of foot pressure assessment as part of a population-based diabetes disease management program. Diabetes Care. 2003;26(4):1069–73.

    Article  PubMed  Google Scholar 

  22. Murray HJ, Young MJ, Hollis S, Boulton AJ. The association between callus formation, high pressures and neuropathy in diabetic foot ulceration. Diabet Med. 1996;13(11):979–82.

    Article  PubMed  CAS  Google Scholar 

  23. Mueller MJ, Zou D, Lott DL. Pressure gradient as an indicator of plantar skin injury. Diabetes Care. 2005;28(12):2908–12.

    Article  PubMed  Google Scholar 

  24. Yavuz M, Erdemir A, Botek G, Hischman GB, Bardsley L, Davis BL. Peak plantar pressure and shear locations. Diabetes Care. 2007;30:2643–5.

    Article  PubMed  Google Scholar 

  25. Davis BL. Foot ulceration: hypotheses concerning shear and vertical forces acting on adjacent regions of skin. Med Hypotheses. 1993;40:44–7.

    Article  PubMed  CAS  Google Scholar 

  26. Brand PW. Tenderizing the foot. Foot Ankle Int. 2003;24:457–61.

    PubMed  Google Scholar 

  27. Yavuz M, Tajaddini A, Botek G, Davis BL. Temporal characteristics of plantar shear distribution: Relevance to diabetic patients. J Biomech. 2008;41(3):556–9.

    Article  PubMed  Google Scholar 

  28. Harris RI, Beath T. Army foot survey—an investigation of foot ailments in Canadian soldiers. Ottawa: National Research Council of Canada; 1947 (N.R.C. #1574).

    Google Scholar 

  29. Silvino N, Evanski PM, Waugh TR. The Harris and Beath footprinting mat: diagnostic validity and clinical use. Clin Orthop Relat Res. 1980;151:262–9.

    Google Scholar 

  30. Van Schie CH, Abbott CA, Vileikyte L, Shaw JE, Hollis S, Boulton AJ. A comparative study of the Podotrack, a simple semiquantitative plantar pressure measuring device, and the optical pedobarograph in the assessment of pressures under the diabetic foot. Diabet Med. 1999;16(2):154–9.

    Article  PubMed  Google Scholar 

  31. Duckworth T, Boulton AJM, Betts RP, Franks CI, Ward ID. Plantar pressure measurements and the prevention of ulceration in the diabetic foot. J Bone Joint Surg Br. 1985;67:79–85.

    PubMed  CAS  Google Scholar 

  32. Veves A, Murray HJ, Young MJ, Boulton AJM. The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. Diabetologia. 1992;35:660–3.

    Article  PubMed  CAS  Google Scholar 

  33. Fernando DJS, Masson EA, Veves A, Boulton AJM. Relationship of limited joint mobility to abnormal foot pressures and diabetic foot ulceration. Diabetes Care. 1991;14:8–11.

    Article  PubMed  CAS  Google Scholar 

  34. Owings TM, Woerner JL, Frampton JD, Cavanagh PR, Botek G. Custom Therapeutic Insoles based on foot shape and pressure. Diabetes Care. 2008;31:5.

    Article  Google Scholar 

  35. Lorei TJ, Rosenbaum D, et al. Pedographic, clinical, and functional outcome after scarf osteotomy. Clin Orthop Relat Res. 2006;451:161–6.

    Article  PubMed  Google Scholar 

  36. Favre P. The contralateral foot in children with unilateral clubfoot: a study of pressures and forces involved in gait. J Pediatr Orthop. 2007;27(1):54–9.

    Article  PubMed  Google Scholar 

  37. Woodburn J, Helliwell PS. Observations on the F-Scan in-shoe pressure measuring system. Clin Biomech (Bristol, Avon). 1996;11(5):301–4.

    Article  Google Scholar 

  38. Young CR. The F-SCAN system of foot pressure analysis. Clin Podiatr Med Surg. 1993;10(3):455–61.

    PubMed  CAS  Google Scholar 

  39. Rose N, Feiwell LA, Cracchiolo AC. A method for measuring foot pressures using a high resolution, computerized insole sensor: the effect of heel wedges on plantar pressure distribution and center of force. Foot Ankle. 1992;13(5):263–70.

    PubMed  CAS  Google Scholar 

  40. Bus SA, Valk GD, van Deursen RW, Armstrong DG, Caravaggi C, Hlavácek P, Bakker K, Cavanagh PR. The effectiveness of footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review. Diabetes Metab Res Rev. 2008;24:S162–80.

    Article  PubMed  Google Scholar 

  41. Guldemond NA, Leffers P, Nieman FH. Testing the proficiency to distinguish locations with elevated plantar pressure within and between professional groups of foot therapists. BMC Musculoskelet Disord. 2006;7:93.

    Article  PubMed  Google Scholar 

  42. Veves A, Masson EA, Fernando DJ, Boulton AJ. The use of experimental padded hosiery to reduce abnormal foot pressures in diabetic neuropathy. Diabetes Care. 1989;12:653–5.

    Article  PubMed  CAS  Google Scholar 

  43. Veves A, Masson EA, Fernando DJ, Boulton AJ. Studies of experimental hosiery in diabetic neuropathic patients with high foot pressures. Diabet Med. 1990;7:324–6.

    Article  PubMed  CAS  Google Scholar 

  44. Donaghue VM, Sarnow MR, Giurini JM, Chrzan JS, Habershaw GM, Veves A. Longitudinal in-shoe foot pressure relief achieved by specially designed footwear in high risk diabetic patients. Diabetes Res Clin Pract. 1996;36:28–30.

    Google Scholar 

  45. Postema K, Burm PET, van der Zande ME, van Limbeek J. Primary metatarsalgia: the influence of a custom moulded insole and a rockerbar on plantar pressure. Prosthet Orthot Int. 1998;22:35–44.

    PubMed  CAS  Google Scholar 

  46. Ashry HR, Lavery LA, Murdoch DP, Frolich M, Lavery DC. Effectiveness of diabetic insoles to reduce foot pressures. J Foot Ankle Surg. 1997;36:268–71.

    Article  PubMed  CAS  Google Scholar 

  47. Iswanathan V, Madhavan S, Gnanasundaram S, Gopalakrishna G, Das BN, Rajasekar S, Ramachandran A. Effectiveness of different types of footwear insoles for the diabetic neuropathic foot. Diabetes Care. 2004;27:474–7.

    Article  Google Scholar 

  48. Tsung BY, Zhang M, Mak AF, Wong MW. Effectiveness of insoles on plantar pressure redistribution. J Rehabil Res Dev. 2004;6A:767–74.

    Article  Google Scholar 

  49. Lott DL, Hastings MK, Commean PK, Smith KE, Mueller MJ. Effect of footwear and orthotic devices on stress reduction and soft tissue strain of the neuropathic foot. Clin Biomech (Bristol, Avon). 2007;22(3):352–9.

    Article  Google Scholar 

  50. Bus SA, Ulbrecht JS, Cavanagh PR. Pressure relief and load redistribution by custom-made insoles in diabetic patients with neuropathy and foot deformity. Clin Biomech (Bristol, Avon). 2004;19(6):629–38.

    Article  Google Scholar 

  51. Lavery LA, Vela SA, Fleischli JG, Armstrong DG, Lavery DC. Reducing plantar pressure in the neuropathic foot. A comparison of footwear. Diabetes Care. 1997;20(11):1706–10.

    Article  PubMed  CAS  Google Scholar 

  52. Reiber GE, Smith DG, Wallace C, Sullivan K, Hayes S, Vath C, Maciejewski M, Yu O, Heagerty PJ. Effect of therapeutic footwear on foot reulceration in patients with diabetes: a randomized clinical trial. JAMA. 2002;287(19):2552–8.

    Article  PubMed  Google Scholar 

  53. Kastenbauer T, Sokol G, Auiuger M, et al. Running shoes for relief of plantar pressure in diabetic patients. Diabet Med. 1998;15:518–22.

    Article  PubMed  CAS  Google Scholar 

  54. Fleischli JG, Lavery LA, Vela SA, Ashry H, Lavery DC. Comparison of strategies for reducing pressure at the site of neuropathic ulcers. J Am Podiatr Med Assoc. 1997;87:466–72.

    PubMed  CAS  Google Scholar 

  55. Perry JE, Ulbrecht JS, Derr JA, Cavanaugh PR. The use of running shoes to reduce plantar pressures in patients who have diabetes. J Bone Joint Surg Br. 1995;77A:1819–27.

    Google Scholar 

  56. Chanteleau E, Kushner T, Spraul M. How effective is cushioned therapeutic footwear in protecting diabetic feet. Diabet Med. 1990;7:35–359.

    Article  Google Scholar 

  57. Hutchins S, Bowker P, Geary N, Richards J. The biomechanics and clinical efficacy of footwear adapted with rocker profiles–evidence in the literature. Foot (Edinb). 2009;19(3):165–70.

    CAS  Google Scholar 

  58. Beuker BJ, van Deursen RW, Price P, Manning EA, van Baal JG, Harding KG. Plantar pressure in off-loading devices used in diabetic ulcer treatment. Wound Repair Regen. 2005;13(6):537–42.

    Article  PubMed  Google Scholar 

  59. Wu SC, Jensen JL, Weber AK, Robinson DE, Armstrong DG. Use of pressure offloading devices in diabetic foot ulcers: do we practice what we preach? Diabetes Care. 2008;31(11):2118–9.

    Article  PubMed  Google Scholar 

  60. Baumhauer JR, Wervey R, McWilliams J, Harris GF, Shereff MJ. A comparison study of plantar foot pressure in a standardized shoe, total contact cast, and prefabricated pneumatic walking brace. Foot Ankle Int. 1997;18:26–33.

    PubMed  CAS  Google Scholar 

  61. Faglia E, Caravaggi C, Clerici G, Sganzaroli A, Curci V, Vailati W, Simonetti D, Sommalvico F. Effectiveness of removable walker cast versus nonremovable fiberglass off-bearing cast in the healing of diabetic plantar foot ulcer: a randomized controlled trial. Diabetes Care. 2010;33(7):1419–23.

    Article  PubMed  Google Scholar 

  62. Armstrong DG, Nguyen HC, van Lavery LA, Schie CHM, Boulton AJM, Harkless LB. Offloading the diabetic foot wound. A randomized clinical trial. Diabetes Care. 2001;24:1019–22.

    Article  PubMed  CAS  Google Scholar 

  63. Armstrong DG, Short B, Espensen EH, Abu-Rumman PL, Nixon BP, Boulton AJ. Technique for fabrication of an “instant total-contact cast” for treatment of neuropathic diabetic foot ulcers. J Am Podiatr Med Assoc. 2002;92(7):405–8.

    PubMed  Google Scholar 

  64. Armstrong DG, Lavery LA, Wu S, Boulton AJ. Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: a randomized controlled trial. Diabetes Care. 2005;28(3):551–4.

    Article  PubMed  Google Scholar 

  65. Bus SA, van Deursen RW, Kanade RV, Wissink M, Manning EA, van Baal JG, Harding KG. Plantar pressure relief in the diabetic foot using forefoot offloading shoes. Gait Posture. 2009;29(4):618–22.

    Article  PubMed  Google Scholar 

  66. Zimny S, Meyer MF, Schatz H, Pfohl M. Applied felted foam for plantar pressure relief is an efficient therapy in neuropathic diabetic foot ulcers. Exp Clin Endocrinol Diabetes. 2002;110(7):325–8.

    Article  PubMed  CAS  Google Scholar 

  67. Ritz G, Kushner D, Friedman S. A successful technique for the treatment of diabetic neurotrophic ulcers. J Am Podiatr Med Assoc. 1992;82(9):479–81.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Surgical Department, Beth Israel Deaconess Medical Center, Harvard Medical School, West, BIDMC, 1 Deaconess Road, Boston, MA, 02215, USA

    Thanh Dinh D.P.M. & Aristidis Veves M.D., D.Sc.

  2. Surgical Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Francesco Tecilazich

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  1. Thanh Dinh D.P.M.
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  2. Aristidis Veves M.D., D.Sc.
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  3. Francesco Tecilazich
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Correspondence to Thanh Dinh D.P.M. .

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Editors and Affiliations

  1. School of Medicine, University of Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom

    Raj Mani

  2. Centro SERRA, Università di Pisa, Lungarno Pacinotti 43, Pisa, 56100, Italy

    Marco Romanelli

  3. Banaras Hindu University, Varanasi, New F. Jodhpur Colony 6, Varanasi, 221 005, India

    Vijay Shukla

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Dinh, T., Veves, A., Tecilazich, F. (2012). Measuring Pressure in the Diabetic Foot. In: Mani, R., Romanelli, M., Shukla, V. (eds) Measurements in Wound Healing. Springer, London. https://doi.org/10.1007/978-1-4471-2987-5_10

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