An exploratory study on differences in cumulative plantar tissue stress between healing and non-healing plantar neuropathic diabetic foot ulcers

Clinical Biomechanics
Jaap J van NettenSicco A Bus

Abstract

Mechanical stress is important in causing and healing plantar diabetic foot ulcers, but almost always studied as peak pressure only. Measuring cumulative plantar tissue stress combines plantar pressure and ambulatory activity, and better defines the load on ulcers. Our aim was to explore differences in cumulative plantar tissue stress between people with healing and non-healing plantar diabetic foot ulcers. We analyzed a subgroup of 31 patients from a randomized clinical trial, treated with a removable offloading device for their plantar diabetic forefoot ulcer. We measured in-device dynamic plantar pressure and daily stride count to calculate cumulative plantar tissue stress at the ulcer location and associated this with ulcer healing and ulcer surface area reduction at four weeks (Student's t and chi-square test for significance, Cohen's d for effect size). In 12 weeks, 68% (n = 21) of the ulcers healed and 32% (n = 10) did not. No statistically significant differences were found for cumulative plantar tissue stress, plantar pressure or ambulatory activity between people with healed and not-healed ulcers. Cumulative plantar tissue stress was 25% lower for people with healed ulcers (155 vs. 207 MPa·s/day; P = 0.71; Effect size...Continue Reading

Citations

Mar 17, 2020·Diabetes/metabolism Research and Reviews·Peter A LazzariniSicco A Bus
Aug 18, 2020·Journal of Wound Care·Frances R HenshawDeborah E Turner
Jun 28, 2019·Journal of Foot and Ankle Research·Ana Martinez-SantosChristopher J Nester
Feb 8, 2019·Journal of Diabetes Research·R J Molines-BarrosoY García-Álvarez
Apr 30, 2019·Journal of Diabetes Science and Technology·Peter A LazzariniBijan Najafi
Sep 19, 2020·Journal of Tissue Viability·F R HenshawD L Bader

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