The Effect of Weight‐bearing Pressure on the Plantar Circulation in Diabetes Mellitus

Proano, E.; Määttänen, Hannu; Perbeck, L.; Solders, Göran; Turan, İşıl Özkoçak

doi:10.1111/j.1464-5491.1992.tb01880.x

Cited by 8 publications

(3 citation statements)

References 21 publications

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“…This is in line with previous suggestions by Smith et al [20]. Decreased shock absorption capacity may be crucial to the development of neuropathic foot ulcers, since neither impaired circulation [17] during plantar pressure application, nor abnormally high plantar pressure alone [15,20] was found to be associated to foot ulceration. Insiduous plantar induration in a subgroup of patients would also explain the observation that not every diabetic with early polyneuropathy may develop increased plantar pressures over the metatarsal heads.…”

Section: Discussionsupporting

confidence: 90%

Induration of the Diabetic Foot Pad: Another Risk Factor for Recurrent Neuropathic Plantar Ulcers - Verhärtung der diabetischen Fußsohle - eine Prädisposition für rezidivierende neuropathische Fußgeschwüre

Brink¹

1995

Biomedizinische Technik/Biomedical Engineering

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Key words: Diabetic foot -neuropathic ulcer -hyperkeratosis -callus -energy absorption -therapeutic f ootwear -amputation -sof t tissue Ten diabetic feet with polyneuropathy and a history of recurrent plantar ulcers were assessed for soft tissue abnormalities of the plantar pad, in comparison with non-diabetic control feet. Plantar pad thickness and hardness were measured at the metatarsal heads. In addition, joint mobility was assessed by measuring the passive dorsal flexion of the metatarsophalangeal joints, and peak plantar pressures were studied during walking. The results showed slightly less joint mobility and thinner plantar pads in the diabetics äs compared with control subjects; however, the differences failed to reach statistical significance. Soft tissue hardness at the heel was also comparable in patients and controls. At the sites of previous plantar ulcers over the metatarsal joints, soft tissue was significantly harder than at other sites in the same feet or in the control feet; peak plantar pressure at two metatarsal heads was higher in the diabetic feet than in the control feet (p < 0.05). Induration of the periarticular soft tissue may predispose to recurrent foot ulcers in diabetics by decreasing the shock-absorption capacity of the plantar pad.Schlüsselwörter: Diabetischer Fuß, Neuropathie, Schwiele, Hyperkeratose, Stoßdämpfung, therapeutische Schuhe, Amputation An zehn diabetischen Füßen mit rezidivierenden neuropathischen Plantargeschwüren wurden folgende Parameter zur Auffindung potentieller Risikofaktoren untersucht: die Dicke und Härte der Fußsohle, der Bodendruck während des Gehens und die passive Gelenkbeweglichkeit im Vorfußbereich. Verglichen wurden die Ergebnisse mit Befunden bei nichtdiabetischen Personen. Es zeigte sich, daß Gelenkbeweglichkeit und Fußsohlendicke bei den diabetischen Füßen nicht signifikant herabgesetzt waren. Die Fußsohlenhärte an den Fersen war ebenfalls vergleichbar.

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Section: Discussionsupporting

confidence: 90%

Induration of the Diabetic Foot Pad: Another Risk Factor for Recurrent Neuropathic Plantar Ulcers - Verhärtung der diabetischen Fußsohle - eine Prädisposition für rezidivierende neuropathische Fußgeschwüre

Brink¹

1995

Biomedizinische Technik/Biomedical Engineering

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“…The focal nature of the lesion beneath the first metatarsal head would certainly be consistent with increased plantar pressures seen in this region in the presence of diabetic neuropathy[2]. However, it has been demonstrated that increased vertical plantar pressures are insufficiently raised to impair nutritional blood flow in patients with diabetic neuropathy[13]. It has been suggested that shear forces are increased in the neuropathic foot[14], although definitive studies of their relative contribution await the development of sufficiently accurate shear force transducers.…”

Section: Discussionmentioning

confidence: 89%

Magnetic resonance imaging techniques demonstrate soft tissue damage in the diabetic foot

Brash

Foster²,

Vennart³

et al. 1999

Diabet Med

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“… 49 However, the clinical significance of standing for ulcer prevention and healing is not yet established. On the one hand, plantar pressure when standing often exceeds 3 N/cm 2 (30 kPa), needed to arrest nutritional blood flow in the skin, 50 especially when barefooted. 51 – 53 It may be speculated that because people with sensory neuropathy do not feel discomfort if blood flow is arrested, they would not shift their weight when standing to improve circulation.…”

Section: Methods To Measure Adherencementioning

confidence: 99%

Methodological considerations of investigating adherence to using offloading devices among people with diabetes

Jarl¹

2018

PPA

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Foot ulcers are a diabetic complication associated with significant morbidity, mortality, and amputation risk. Offloading devices prevent and heal foot ulcers, but adherence to using these devices is low. The reasons for nonadherence are unclear, and study results are difficult to compare due to methodological heterogeneity. This paper explores aspects of investigating adherence to using offloading devices among people with diabetes and provides recommendations for future studies, focusing on study designs, definitions of adherence, measurement methods, and conceptual frameworks. Most studies use a cross-sectional observational study design, limiting the potential to establish the temporal sequence between predictors and adherence, rule out confounding factors, and establish causality. Studies defining adherence as the length of time the device is worn have often used self-report to measure adherence, which may be unreliable. Studies using activity monitors to measure adherence have defined adherence as the number of steps taken with the device, which excludes weight-bearing activities where no steps are taken. Conceptual frameworks are not made explicit in the current quantitative research. It is concluded that future studies should use a longitudinal design with observational studies to identify patient groups prone to nonadherence and factors that influence adherence and experimental studies to evaluate interventions to improve adherence, focusing on these patient groups and factors. Furthermore, adherence should be defined in terms of relative adherence to using offloading devices during all weight-bearing activities, and objective measurement of adherence (using accelerometers and temperature monitors) should be used whenever possible. Clearly defined conceptual frameworks should guide the choice of factors to include in the study and the analysis of their interactions. By implementing these recommendations, research could provide a stronger evidence base in the future, supporting interventions to increase adherence and thereby improve outcomes for people with diabetic foot complications.

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The Effect of Weight‐bearing Pressure on the Plantar Circulation in Diabetes Mellitus

Cited by 8 publications

References 21 publications

Induration of the Diabetic Foot Pad: Another Risk Factor for Recurrent Neuropathic Plantar Ulcers - Verhärtung der diabetischen Fußsohle - eine Prädisposition für rezidivierende neuropathische Fußgeschwüre

Induration of the Diabetic Foot Pad: Another Risk Factor for Recurrent Neuropathic Plantar Ulcers - Verhärtung der diabetischen Fußsohle - eine Prädisposition für rezidivierende neuropathische Fußgeschwüre

Magnetic resonance imaging techniques demonstrate soft tissue damage in the diabetic foot

Methodological considerations of investigating adherence to using offloading devices among people with diabetes

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