Site-Specific, Critical Threshold Barefoot Peak Plantar Pressure Associated with Diabetic Foot Ulcer History: A Novel Approach to Determine DFU Risk in the Clinical Setting
<i>Background and Objectives:</i> Barefoot peak plantar pressures (PPPs) are elevated in diabetes patients with neuropathic foot ulcer (DFU) history; however, there is limited reported evidence for a causative link between high barefoot PPP and DFU risk. We aimed to determine, using a si...
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| Format: | Article |
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MDPI AG
2022-01-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/58/2/166 |
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| author | Caroline A. Abbott Katie E. Chatwin Satyan M. Rajbhandari Kanwal M. John Sushma Pabbineedi Frank L. Bowling Andrew J. M. Boulton Neil D. Reeves |
| author_facet | Caroline A. Abbott Katie E. Chatwin Satyan M. Rajbhandari Kanwal M. John Sushma Pabbineedi Frank L. Bowling Andrew J. M. Boulton Neil D. Reeves |
| author_sort | Caroline A. Abbott |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> Barefoot peak plantar pressures (PPPs) are elevated in diabetes patients with neuropathic foot ulcer (DFU) history; however, there is limited reported evidence for a causative link between high barefoot PPP and DFU risk. We aimed to determine, using a simple mat-based methodology, the site-specific, barefoot PPP critical threshold that will identify a plantar site with a previous DFU. <i>Materials and Methods:</i> In a cross-sectional study, barefoot, site-specific PPPs were measured with normal gait for patients with DFU history (<i>n</i> = 21) and healthy controls (<i>n</i> = 12), using a validated carbon footprint system. For each participant, PPP was recorded at twelve distinct plantar sites (1st–5th toes, 1st–5th metatarsal heads (MTHs), midfoot and heel), per right and left foot, resulting in the analysis of <i>n</i> = 504 distinct plantar sites in the diabetes group, and <i>n</i> = 288 sites in the control group. Receiver operator characteristic curve analysis determined the optimal critical threshold for sites with DFU history. <i>Results:</i> Median PPPs for the groups were: diabetes sites with DFU history (<i>n</i> = 32) = 5.0 (3.25–7.5) kg/cm<sup>2</sup>, diabetes sites without DFU history (<i>n</i> = 472) = 3.25 (2.0–5.0) kg/cm<sup>2</sup>, control sites (<i>n</i> = 288) = 2.0 (2.0–3.25) kg/cm<sup>2</sup>; (<i>p</i> < 0.0001). Diabetes sites with elevated PPP (>6 kg/cm<sup>2</sup>) were six times more likely to have had DFU than diabetes sites with PPP ≤ 6 kg/cm<sup>2</sup> (OR = 6.4 (2.8–14.6, 95% CI), <i>p</i> < 0.0001). PPP > 4.1 kg/cm<sup>2</sup> was determined as the optimal critical threshold for identifying DFU at a specific plantar site, with sensitivity/specificity = 100%/79% at midfoot; 80%/65% at 5th metatarsal head; 73%/62% at combined midfoot/metatarsal head areas. <i>Conclusions:</i> We have demonstrated, for the first time, a strong, site-specific relationship between elevated barefoot PPP and previous DFU. We have determined a critical, highly-sensitive, barefoot PPP threshold value of >4.1 kg/cm<sup>2</sup>, which may be easily used to identify sites of previous DFU occurrence and, therefore, increased risk of re-ulceration. This site-specific approach may have implications for how high PPPs should be investigated in future trials. |
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| issn | 1010-660X 1648-9144 |
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| last_indexed | 2024-03-09T21:29:22Z |
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| spelling | doaj.art-439d9f4329774fa0b33387e8762b4d122023-11-23T20:59:01ZengMDPI AGMedicina1010-660X1648-91442022-01-0158216610.3390/medicina58020166Site-Specific, Critical Threshold Barefoot Peak Plantar Pressure Associated with Diabetic Foot Ulcer History: A Novel Approach to Determine DFU Risk in the Clinical SettingCaroline A. Abbott0Katie E. Chatwin1Satyan M. Rajbhandari2Kanwal M. John3Sushma Pabbineedi4Frank L. Bowling5Andrew J. M. Boulton6Neil D. Reeves7Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UKDepartment of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UKDiabetes Centre, Chorley and South Ribble Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Chorley PR7 1PP, UKDepartment of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UKDepartment of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UKSchool of Medicine, Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester Royal Infirmary, Manchester M13 9PL, UKManchester Diabetes Centre, Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester Royal Infirmary, Manchester M13 9PL, UKDepartment of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK<i>Background and Objectives:</i> Barefoot peak plantar pressures (PPPs) are elevated in diabetes patients with neuropathic foot ulcer (DFU) history; however, there is limited reported evidence for a causative link between high barefoot PPP and DFU risk. We aimed to determine, using a simple mat-based methodology, the site-specific, barefoot PPP critical threshold that will identify a plantar site with a previous DFU. <i>Materials and Methods:</i> In a cross-sectional study, barefoot, site-specific PPPs were measured with normal gait for patients with DFU history (<i>n</i> = 21) and healthy controls (<i>n</i> = 12), using a validated carbon footprint system. For each participant, PPP was recorded at twelve distinct plantar sites (1st–5th toes, 1st–5th metatarsal heads (MTHs), midfoot and heel), per right and left foot, resulting in the analysis of <i>n</i> = 504 distinct plantar sites in the diabetes group, and <i>n</i> = 288 sites in the control group. Receiver operator characteristic curve analysis determined the optimal critical threshold for sites with DFU history. <i>Results:</i> Median PPPs for the groups were: diabetes sites with DFU history (<i>n</i> = 32) = 5.0 (3.25–7.5) kg/cm<sup>2</sup>, diabetes sites without DFU history (<i>n</i> = 472) = 3.25 (2.0–5.0) kg/cm<sup>2</sup>, control sites (<i>n</i> = 288) = 2.0 (2.0–3.25) kg/cm<sup>2</sup>; (<i>p</i> < 0.0001). Diabetes sites with elevated PPP (>6 kg/cm<sup>2</sup>) were six times more likely to have had DFU than diabetes sites with PPP ≤ 6 kg/cm<sup>2</sup> (OR = 6.4 (2.8–14.6, 95% CI), <i>p</i> < 0.0001). PPP > 4.1 kg/cm<sup>2</sup> was determined as the optimal critical threshold for identifying DFU at a specific plantar site, with sensitivity/specificity = 100%/79% at midfoot; 80%/65% at 5th metatarsal head; 73%/62% at combined midfoot/metatarsal head areas. <i>Conclusions:</i> We have demonstrated, for the first time, a strong, site-specific relationship between elevated barefoot PPP and previous DFU. We have determined a critical, highly-sensitive, barefoot PPP threshold value of >4.1 kg/cm<sup>2</sup>, which may be easily used to identify sites of previous DFU occurrence and, therefore, increased risk of re-ulceration. This site-specific approach may have implications for how high PPPs should be investigated in future trials.https://www.mdpi.com/1648-9144/58/2/166diabetesfoot ulcercritical thresholdPressureStat™peak plantar pressurepressure measurement device |
| spellingShingle | Caroline A. Abbott Katie E. Chatwin Satyan M. Rajbhandari Kanwal M. John Sushma Pabbineedi Frank L. Bowling Andrew J. M. Boulton Neil D. Reeves Site-Specific, Critical Threshold Barefoot Peak Plantar Pressure Associated with Diabetic Foot Ulcer History: A Novel Approach to Determine DFU Risk in the Clinical Setting Medicina diabetes foot ulcer critical threshold PressureStat™ peak plantar pressure pressure measurement device |
| title | Site-Specific, Critical Threshold Barefoot Peak Plantar Pressure Associated with Diabetic Foot Ulcer History: A Novel Approach to Determine DFU Risk in the Clinical Setting |
| title_full | Site-Specific, Critical Threshold Barefoot Peak Plantar Pressure Associated with Diabetic Foot Ulcer History: A Novel Approach to Determine DFU Risk in the Clinical Setting |
| title_fullStr | Site-Specific, Critical Threshold Barefoot Peak Plantar Pressure Associated with Diabetic Foot Ulcer History: A Novel Approach to Determine DFU Risk in the Clinical Setting |
| title_full_unstemmed | Site-Specific, Critical Threshold Barefoot Peak Plantar Pressure Associated with Diabetic Foot Ulcer History: A Novel Approach to Determine DFU Risk in the Clinical Setting |
| title_short | Site-Specific, Critical Threshold Barefoot Peak Plantar Pressure Associated with Diabetic Foot Ulcer History: A Novel Approach to Determine DFU Risk in the Clinical Setting |
| title_sort | site specific critical threshold barefoot peak plantar pressure associated with diabetic foot ulcer history a novel approach to determine dfu risk in the clinical setting |
| topic | diabetes foot ulcer critical threshold PressureStat™ peak plantar pressure pressure measurement device |
| url | https://www.mdpi.com/1648-9144/58/2/166 |
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