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The Effect of Structured Exercise Compared with Education on Neuropathic Signs and Symptoms in People at Risk of Neuropathic Diabetic Foot Ulcers: A Randomized Clinical Trial
Article

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

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Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK
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Institute of Sport, Manchester Metropolitan University, Manchester M1 7EL, UK
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Diabetes Centre, Chorley and South Ribble Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Chorley PR7 1PP, UK
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School of Medicine, Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester Royal Infirmary, Manchester M13 9PL, UK
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Manchester Diabetes Centre, Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester Royal Infirmary, Manchester M13 9PL, UK
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Diabetes Research Institute, University of Miami, Miami, FL 33136, USA
*
Author to whom correspondence should be addressed.
Academic Editors: Nikolaos Papanas and Manfredi Rizzo
Medicina 2022, 58(2), 166; https://doi.org/10.3390/medicina58020166
Received: 15 November 2021 / Revised: 22 December 2021 / Accepted: 11 January 2022 / Published: 21 January 2022
(This article belongs to the Special Issue The Diabetic Foot: Recent Advances and Future Developments)
Background and Objectives: 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. Materials and Methods: In a cross-sectional study, barefoot, site-specific PPPs were measured with normal gait for patients with DFU history (n = 21) and healthy controls (n = 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 n = 504 distinct plantar sites in the diabetes group, and n = 288 sites in the control group. Receiver operator characteristic curve analysis determined the optimal critical threshold for sites with DFU history. Results: Median PPPs for the groups were: diabetes sites with DFU history (n = 32) = 5.0 (3.25–7.5) kg/cm2, diabetes sites without DFU history (n = 472) = 3.25 (2.0–5.0) kg/cm2, control sites (n = 288) = 2.0 (2.0–3.25) kg/cm2; (p < 0.0001). Diabetes sites with elevated PPP (>6 kg/cm2) were six times more likely to have had DFU than diabetes sites with PPP ≤ 6 kg/cm2 (OR = 6.4 (2.8–14.6, 95% CI), p < 0.0001). PPP > 4.1 kg/cm2 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. Conclusions: 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/cm2, 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. View Full-Text
Keywords: diabetes; foot ulcer; critical threshold; PressureStat™; peak plantar pressure; pressure measurement device diabetes; foot ulcer; critical threshold; PressureStat™; peak plantar pressure; pressure measurement device
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MDPI and ACS Style

Abbott, C.A.; Chatwin, K.E.; Rajbhandari, S.M.; John, K.M.; Pabbineedi, S.; Bowling, F.L.; Boulton, A.J.M.; Reeves, N.D. 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 2022, 58, 166. https://doi.org/10.3390/medicina58020166

AMA Style

Abbott CA, Chatwin KE, Rajbhandari SM, John KM, Pabbineedi S, Bowling FL, Boulton AJM, Reeves ND. 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. 2022; 58(2):166. https://doi.org/10.3390/medicina58020166

Chicago/Turabian Style

Abbott, Caroline A., Katie E. Chatwin, Satyan M. Rajbhandari, Kanwal M. John, Sushma Pabbineedi, Frank L. Bowling, Andrew J.M. Boulton, and Neil D. Reeves. 2022. "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 58, no. 2: 166. https://doi.org/10.3390/medicina58020166

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