Role of Neuropathy and High Foot Pressures in Diabetic Foot Ulceration

Frykberg, Robert G.; Lavery, Lawrence A.; Pham, Hau; Harvey, Carolyn; Harkless, Lawrence B.; Veves, Aristidis

doi:10.2337/diacare.21.10.1714

Cited by 390 publications

(288 citation statements)

References 30 publications

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“…Several studies have found that increased contact area reduces plantar pressure in the forefoot by 35-44% (3,4,(13)(14)(15)(16)(17). Although in our study the use of an individualized EVA insole inside an Xtra depth shoe increased the effective contact area between foot and insole, this did not result in significant pressure reductions underneath the forefoot.…”

Section: Vas Scorescontrasting

confidence: 46%

“…Inclusion criteria included the following: 1) presence of peripheral sensory neuropathy (objectified using Semmes-Weinstein monofilaments as described by Frykberg et al [4]), 2) absence of important foot deformity (i.e., able to wear manufactured shoes), 3) having no present foot ulceration, 4) having sufficient walking capacity, and 5) having no other diseases of the lower extremity. All patients were informed about the goal of the study in detail and gave their written consent to participate.…”

Section: Subjectsmentioning

confidence: 99%

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The Influence of Shoe Design on Plantar Pressures in Neuropathic Feet

2003

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OBJECTIVE -The aim of this study was to investigate the effect of shoe design on the plantar pressure dynamics of patients with diabetic neuropathy during walking.RESEARCH DESIGN AND METHODS -Three shoe design categories were tested. Total contact area and biomechanical variables in multiple areas under the foot were measured.RESULTS -Shoes with a rocker bottom principle reduced pressure 35-65% underneath the heel and the central metatarsal heads. Increased contact area did not result in significant pressure reductions underneath the forefoot. Pressure dynamics underneath the heel and medial forefoot (first metatarsal head and hallux) on average showed no significant differences among the different shoes with a cushioning insole.CONCLUSIONS -The most effective way to offload the forefoot of patients with neuropathic feet is through the use of the rocker sole principle. In general, the effect of an insole depends on the design characteristics of a shoe. Predicting the effect of therapeutic footwear on an individual scale, however, remains difficult. Therefore, in-shoe pressure measurements seem to be necessary to evaluate a therapeutic shoe prescription in certain individual cases. Diabetes Care 26:441-445, 2003B auman et al. (1) were among the first researchers who published their study on the relationship between high-pressure areas and plantar ulceration in the insensitive foot. They appreciated the effect of both a total contact cast and certain orthopedic shoes on the healing process of neuropathic ulcers. They investigated the effect of shoe sole design on plantar pressure reduction using small pressure sensors taped to specific areas underneath the sole of the foot.Using similar equipment 25 years later, Nawoczenski et al. (2) showed that certain pivotal and curved rocker bottom shoes were able to effectively reduce forefoot pressure in normal subjects. Many studies have followed since then (rev. in 3). However, despite all the pioneering work, different disciplines dealing with the neuropathic foot often still disagree about which therapeutic shoe modalities to prescribe. In the Netherlands, also, this is a continuing topic of dispute. Although some strongly propagate the use of custom made (orthopedic) shoes with a stiff sole and rocker bar to prevent recurrence of a neuropathic ulcer, others recommend the use of an extra depth shoe. It has been argued that these less heavy, more cosmetically attractive shoes would be at least as effective in preventing recurrence of neuropathic ulcers.According to Spencer, "There is a need to measure the effectiveness of the range of pressure relieving interventions for the prevention and treatment of diabetic foot ulcers as there is a small amount of poor quality research in this area" (3). The present study was performed to investigate the relation between shoe design and pressure reduction in the context of the above discussion. Three shoe design categories were tested. Total contact area and biomechanical variables in multiple areas under the foot were measured usin...

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Section: Vas Scorescontrasting

confidence: 46%

Section: Subjectsmentioning

confidence: 99%

The Influence of Shoe Design on Plantar Pressures in Neuropathic Feet

2003

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“…In summary, all the four groups in this study are already at risk of plantar injury due to the presence of DMPN [33]. Further complications, such as plantar ulceration, PFAs and TTAs, increase the risk of plantar injury in this patient population during walking.…”

Section: Discussionmentioning

confidence: 68%

Walking performance in people with diabetic neuropathy: benefits and threats

et al. 2006

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Aims/hypothesis Walking is recommended as an adjunct therapy to diet and medication in diabetic patients, with the aim of improving physical fitness, glycaemic control and body weight reduction. Therefore we evaluated walking activity on the basis of capacity, performance and potential risk of plantar injury in the diabetic population before it can be prescribed safely. Subjects, materials and methods Twenty-three subjects with diabetic neuropathy (DMPN) were compared with 23 patients with current diabetic foot ulcers, 16 patients with partial foot amputations and 22 patients with trans-tibial amputations. The capacity for walking was measured using a total heart beat index (THBI). Gait velocity and average daily strides were measured to assess the performance of walking, and its impact on weight-bearing was studied using maximum peak pressure. Results THBI increased (p<0.01) and gait velocity and daily stride count fell (p<0.001 for both) with progression of foot complications. The maximum peak pressures over the affected foot of patients with diabetic foot ulcers (p<0.05) and partial foot amputations (p<0.01) were higher than in the group with DMPN. On the contralateral side, the diabetic foot ulcer group showed higher maximum peak pressure over the total foot (p<0.05), and patients with partial foot amputations (p<0.01) and trans-tibial amputations (p<0.05) showed higher maximum peak pressure over the heel. Conclusions/interpretation Walking capacity and performance decrease with progression of foot complications. Although walking is recommended to improve fitness, it cannot be prescribed in isolation, considering the increased risk of plantar injury. For essential walking we therefore recommend the use of protective footwear. Walking exercise should be supplemented by partial or non-weightbearing exercises to improve physical fitness in diabetic populations.

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“…On the other hand, some peoples have hypothesized that flat feet in children, in many cases, can lead to disability in adulthood 11,12) . Increased plantar foot pressures caused by deformity are closely associated with tissue injury and ulceration 13) , and as a source of pain 14,15) .…”

Section: Introductionmentioning

confidence: 99%

Differences in Plantar Foot Pressure and COP between Flat and Normal Feet During Walking

et al. 2011

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Abstract.[Purpose] The purpose of this study was to compare the peak plantar foot pressure and the pathway of the center of pressure (COP) between normal and flat feet. [Subjects and Methods] Nineteen subjects (10 normal feet, 9 flat feet) participated in this study. Plantar foot pressure was recorded by the Matscan system (Tekscan, Boston, USA) while walking upright. Plantar foot surface was divided into seven regions for pressure measurement: two toe regions, three forefoot regions, one midfoot region, and one heel region. The independent t-test was used to compare plantar foot pressures between normal adults and patients with flat feet. The pathway of COP in normal and flat feet was observed macroscopically.[Results] The plantar foot pressures of the 4th-5th metatarsal head and heel regions in the flat feet group were less than those of the normal feet group. The pathway of COP of normal feet group had a tendency to shift medially in the forefoot but the pathway of COP in the flat feet group had a tendency to be straight in the forefoot.[Conclusion] The results indicate that the plantar foot pressure of a flat foot was lower than that of a normal foot and the pathway of COP of a flat foot may be different from that of a normal foot. We believe that reduction of the longitudinal arch of foot in flat feet explains these results.

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Role of Neuropathy and High Foot Pressures in Diabetic Foot Ulceration

Cited by 390 publications

References 30 publications

The Influence of Shoe Design on Plantar Pressures in Neuropathic Feet

The Influence of Shoe Design on Plantar Pressures in Neuropathic Feet

Walking performance in people with diabetic neuropathy: benefits and threats

Differences in Plantar Foot Pressure and COP between Flat and Normal Feet During Walking

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