Ulcer-risk classification and plantar pressure distribution in patients with diabetic polyneuropathy: an exploration of the factors that can lead to foot ulceration

Authors

Abstract

Plantar pressure is critical in the onset of neuropathic foot ulcers. However, no international risk classifications include it as a stratification parameter. Whether plantar pressure distribution affects ulcer-risk was investigated in a research context and in a clinics-oriented scenario.Totals of 134 and 83 patients from a research study and from a clinics-oriented study, respectively, were categorized by ulcer-risk using the guidelines of the International Working Group on the Diabetic Foot. Patients were divided into one non-neuropathic and three neuropathic groups. Pressure distribution was acquired during gait (Pedar-X System); contact time, peak pressure, maximum force, pressure-time integral, and contact area were assessed for the patients’ hindfoot, midfoot, forefoot and toes. Analyses of variance (P < 0.05) were conducted for all parameters and regions. Groups were also divided into two sub-groups: low or high BMI; the same statistical analysis was conducted on sub-groups as well.Pressure distribution changed with polyneuropathy even in the low-risk groups. Neuropathic patients’ risk classification corresponded poorly with pressure distribution (median p = 0.686 [0.374–0.828]). Pressure integral, contact time and contact area changed (median p = 0.048 [0.001–0.223]). BMI, age and walking speed influenced most parameters (p < 0.05) except for contact area and pressure integral and made the studies almost incomparable (2-way ANOVA factor A > 0.05). The only comparable parameter was PTI which, together with the above factors, may increase ulcer-risk stratification models’ predictive abilities, once stronger evidence is proved through standardized measurement investigations.

Share on

Downloads

Authors

Claudia Giacomozzi

Cristina Sartor - 1) Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, SP, Brazil; 2) Department of Physical Therapy, Ibirapuera University, São Paulo, SP, Brazil;

Rafael Telles - Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, SP, Brazil

Luigi Uccioli - Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy

Isabel C.N. Sacco - Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, SP, Brazil;

How to Cite
Giacomozzi, C., Sartor, C., Telles, R., Uccioli, L., & Sacco, I. C. (2018). Ulcer-risk classification and plantar pressure distribution in patients with diabetic polyneuropathy: an exploration of the factors that can lead to foot ulceration. Annali dell’Istituto Superiore Di Sanità, 54(4), 284–293. Retrieved from https://annali.iss.it/index.php/anna/article/view/696
  • Abstract viewed - 602 times