The Stress of Measuring Plantar Tissue Stress in People with Diabetes-Related Foot Ulcers: Biomechanical and Feasibility Findings from Two Prospective Cohort Studies

Authors

Chantal M Hulshof
Madelyn Page
Sjef G van Baal
Sicco A Bus
Malindu E Fernando
Lisette van Gemert-Pijnen
Kilian D R Kappert
Scott Lucadou-Wells
Bijan Najafi
Jaap J van Netten
Peter A Lazzarini

Publication Date

4-10-2024

Journal

Sensors

DOI

10.3390/s24082411

PMID

38676030

PMCID

PMC11054765

PubMedCentral® Posted Date

4-10-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, Diabetic Foot, Female, Middle Aged, Male, Prospective Studies, Biomechanical Phenomena, Stress, Mechanical, Aged, Feasibility Studies, Foot, Wound Healing, Pressure, offloading, plantar pressure, shear stress, daily-life activity, adherence, foot ulcer

Abstract

Reducing high mechanical stress is imperative to heal diabetes-related foot ulcers. We explored the association of cumulative plantar tissue stress (CPTS) and plantar foot ulcer healing, and the feasibility of measuring CPTS, in two prospective cohort studies (Australia (AU) and The Netherlands (NL)). Both studies used multiple sensors to measure factors to determine CPTS: plantar pressures, weight-bearing activities, and adherence to offloading treatments, with thermal stress response also measured to estimate shear stress in the AU-study. The primary outcome was ulcer healing at 12 weeks. Twenty-five participants were recruited: 13 in the AU-study and 12 in the NL-study. CPTS data were complete for five participants (38%) at baseline and one (8%) during follow-up in the AU-study, and one (8%) at baseline and zero (0%) during follow-up in the NL-study. Reasons for low completion at baseline were technical issues (AU-study: 31%, NL-study: 50%), non-adherent participants (15% and 8%) or combinations (15% and 33%); and at follow-up refusal of participants (62% and 25%). These underpowered findings showed that CPTS was non-significantly lower in people who healed compared with non-healed people (457 [117; 727], 679 [312; 1327] MPa·s/day). Current feasibility of CPTS seems low, given technical challenges and non-adherence, which may reflect the burden of treating diabetes-related foot ulcers.