Cargando…
Plantar pressures are higher in cases with diabetic foot ulcers compared to controls despite a longer stance phase duration
BACKGROUND: Current international guidelines advocate achieving at least a 30 % reduction in maximum plantar pressure to reduce the risk of foot ulcers in people with diabetes. However, whether plantar pressures differ in cases with foot ulcers to controls without ulcers is not clear. The aim of thi...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5024422/ https://www.ncbi.nlm.nih.gov/pubmed/27629263 http://dx.doi.org/10.1186/s12902-016-0131-9 |
_version_ | 1782453795869949952 |
---|---|
author | Fernando, Malindu E. Crowther, Robert G. Lazzarini, Peter A. Sangla, Kunwarjit S. Wearing, Scott Buttner, Petra Golledge, Jonathan |
author_facet | Fernando, Malindu E. Crowther, Robert G. Lazzarini, Peter A. Sangla, Kunwarjit S. Wearing, Scott Buttner, Petra Golledge, Jonathan |
author_sort | Fernando, Malindu E. |
collection | PubMed |
description | BACKGROUND: Current international guidelines advocate achieving at least a 30 % reduction in maximum plantar pressure to reduce the risk of foot ulcers in people with diabetes. However, whether plantar pressures differ in cases with foot ulcers to controls without ulcers is not clear. The aim of this study was to assess if plantar pressures were higher in patients with active plantar diabetic foot ulcers (cases) compared to patients with diabetes without a foot ulcer history (diabetes controls) and people without diabetes or a foot ulcer history (healthy controls). METHODS: Twenty-one cases with diabetic foot ulcers, 69 diabetes controls and 56 healthy controls were recruited for this case-control study. Plantar pressures at ten sites on both feet and stance phase duration were measured using a pre-established protocol. Primary outcomes were mean peak plantar pressure, pressure-time integral and stance phase duration. Non-parametric analyses were used with Holm’s correction to correct for multiple testing. Binary logistic regression models were used to adjust outcomes for age, sex and body mass index. Median differences with 95 % confidence intervals and Cohen’s d values (standardised mean difference) were reported for all significant outcomes. RESULTS: The majority of ulcers were located on the plantar surface of the hallux and toes. When adjusted for age, sex and body mass index, the mean peak plantar pressure and pressure-time integral of toes and the mid-foot were significantly higher in cases compared to diabetes and healthy controls (p < 0.05). The stance phase duration was also significantly higher in cases compared to both control groups (p < 0.05). The main limitations of the study were the small number of cases studied and the inability to adjust analyses for multiple factors. CONCLUSIONS: This study shows that plantar pressures are higher in cases with active diabetic foot ulcers despite having a longer stance phase duration which would be expected to lower plantar pressure. Whether plantar pressure changes can predict ulcer healing should be the focus of future research. These results highlight the importance of offloading feet during active ulceration in addition to before ulceration. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12902-016-0131-9) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5024422 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-50244222016-09-20 Plantar pressures are higher in cases with diabetic foot ulcers compared to controls despite a longer stance phase duration Fernando, Malindu E. Crowther, Robert G. Lazzarini, Peter A. Sangla, Kunwarjit S. Wearing, Scott Buttner, Petra Golledge, Jonathan BMC Endocr Disord Research Article BACKGROUND: Current international guidelines advocate achieving at least a 30 % reduction in maximum plantar pressure to reduce the risk of foot ulcers in people with diabetes. However, whether plantar pressures differ in cases with foot ulcers to controls without ulcers is not clear. The aim of this study was to assess if plantar pressures were higher in patients with active plantar diabetic foot ulcers (cases) compared to patients with diabetes without a foot ulcer history (diabetes controls) and people without diabetes or a foot ulcer history (healthy controls). METHODS: Twenty-one cases with diabetic foot ulcers, 69 diabetes controls and 56 healthy controls were recruited for this case-control study. Plantar pressures at ten sites on both feet and stance phase duration were measured using a pre-established protocol. Primary outcomes were mean peak plantar pressure, pressure-time integral and stance phase duration. Non-parametric analyses were used with Holm’s correction to correct for multiple testing. Binary logistic regression models were used to adjust outcomes for age, sex and body mass index. Median differences with 95 % confidence intervals and Cohen’s d values (standardised mean difference) were reported for all significant outcomes. RESULTS: The majority of ulcers were located on the plantar surface of the hallux and toes. When adjusted for age, sex and body mass index, the mean peak plantar pressure and pressure-time integral of toes and the mid-foot were significantly higher in cases compared to diabetes and healthy controls (p < 0.05). The stance phase duration was also significantly higher in cases compared to both control groups (p < 0.05). The main limitations of the study were the small number of cases studied and the inability to adjust analyses for multiple factors. CONCLUSIONS: This study shows that plantar pressures are higher in cases with active diabetic foot ulcers despite having a longer stance phase duration which would be expected to lower plantar pressure. Whether plantar pressure changes can predict ulcer healing should be the focus of future research. These results highlight the importance of offloading feet during active ulceration in addition to before ulceration. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12902-016-0131-9) contains supplementary material, which is available to authorized users. BioMed Central 2016-09-15 /pmc/articles/PMC5024422/ /pubmed/27629263 http://dx.doi.org/10.1186/s12902-016-0131-9 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Fernando, Malindu E. Crowther, Robert G. Lazzarini, Peter A. Sangla, Kunwarjit S. Wearing, Scott Buttner, Petra Golledge, Jonathan Plantar pressures are higher in cases with diabetic foot ulcers compared to controls despite a longer stance phase duration |
title | Plantar pressures are higher in cases with diabetic foot ulcers compared to controls despite a longer stance phase duration |
title_full | Plantar pressures are higher in cases with diabetic foot ulcers compared to controls despite a longer stance phase duration |
title_fullStr | Plantar pressures are higher in cases with diabetic foot ulcers compared to controls despite a longer stance phase duration |
title_full_unstemmed | Plantar pressures are higher in cases with diabetic foot ulcers compared to controls despite a longer stance phase duration |
title_short | Plantar pressures are higher in cases with diabetic foot ulcers compared to controls despite a longer stance phase duration |
title_sort | plantar pressures are higher in cases with diabetic foot ulcers compared to controls despite a longer stance phase duration |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5024422/ https://www.ncbi.nlm.nih.gov/pubmed/27629263 http://dx.doi.org/10.1186/s12902-016-0131-9 |
work_keys_str_mv | AT fernandomalindue plantarpressuresarehigherincaseswithdiabeticfootulcerscomparedtocontrolsdespitealongerstancephaseduration AT crowtherrobertg plantarpressuresarehigherincaseswithdiabeticfootulcerscomparedtocontrolsdespitealongerstancephaseduration AT lazzarinipetera plantarpressuresarehigherincaseswithdiabeticfootulcerscomparedtocontrolsdespitealongerstancephaseduration AT sanglakunwarjits plantarpressuresarehigherincaseswithdiabeticfootulcerscomparedtocontrolsdespitealongerstancephaseduration AT wearingscott plantarpressuresarehigherincaseswithdiabeticfootulcerscomparedtocontrolsdespitealongerstancephaseduration AT buttnerpetra plantarpressuresarehigherincaseswithdiabeticfootulcerscomparedtocontrolsdespitealongerstancephaseduration AT golledgejonathan plantarpressuresarehigherincaseswithdiabeticfootulcerscomparedtocontrolsdespitealongerstancephaseduration |