Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M1 5GD, UK.
Institute of Sport, Manchester Metropolitan University, Manchester M1 7EL, UK.
Medicina (Kaunas). 2022 Jan 21;58(2):166. doi: 10.3390/medicina58020166.
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. In a cross-sectional study, barefoot, site-specific PPPs were measured with normal gait for patients with DFU history ( = 21) and healthy controls ( = 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 = 504 distinct plantar sites in the diabetes group, and = 288 sites in the control group. Receiver operator characteristic curve analysis determined the optimal critical threshold for sites with DFU history. Median PPPs for the groups were: diabetes sites with DFU history ( = 32) = 5.0 (3.25-7.5) kg/cm, diabetes sites without DFU history ( = 472) = 3.25 (2.0-5.0) kg/cm, control sites ( = 288) = 2.0 (2.0-3.25) kg/cm; ( < 0.0001). Diabetes sites with elevated PPP (>6 kg/cm) were six times more likely to have had DFU than diabetes sites with PPP ≤ 6 kg/cm (OR = 6.4 (2.8-14.6, 95% CI), < 0.0001). PPP > 4.1 kg/cm 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. 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/cm, 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.
足底压力峰值（PPPs）在有神经性足部溃疡（DFU）病史的糖尿病患者中升高；然而，高足底 PPP 与 DFU 风险之间存在因果关系的证据有限。我们旨在使用一种简单的基于垫子的方法来确定特定部位的足底 PPP 临界阈值，该阈值将确定以前有 DFU 的足底部位。 在一项横断面研究中，使用经过验证的碳足迹系统，对有 DFU 病史的患者（n=21）和健康对照组（n=12）进行了正常步态下的特定部位足底 PPP 测量。对于每个参与者，在右脚和左脚的 12 个不同的足底部位（第 1-5 脚趾、第 1-5 跖骨头（MTH）、中足和脚跟）记录了 PPP，这导致在糖尿病组中分析了 =504 个不同的足底部位，和对照组中 =288 个部位。接收者操作特征曲线分析确定了具有 DFU 病史的部位的最佳临界阈值。 两组的中位数 PPP 为：有 DFU 病史的糖尿病部位（n=21）=5.0（3.25-7.5）kg/cm，无 DFU 病史的糖尿病部位（n=472）=3.25（2.0-5.0）kg/cm，对照组（n=288）=2.0（2.0-3.25）kg/cm；（<0.0001）。PPP 高于 6kg/cm 的糖尿病部位发生 DFU 的可能性是 PPP 低于或等于 6kg/cm 的糖尿病部位的六倍（OR=6.4（2.8-14.6，95%CI），<0.0001）。PPP>4.1kg/cm 被确定为识别特定足底部位 DFU 的最佳临界阈值，中足的敏感性/特异性=100%/79%；第 5 跖骨头为 80%/65%；中足/跖骨头区域联合为 73%/62%。 我们首次证明了高足底 PPP 与以前的 DFU 之间存在强烈的、特定部位的关系。我们确定了一个临界的、高度敏感的、足底 PPP 阈值值>4.1kg/cm，这可能很容易用于识别以前发生 DFU 的部位，从而增加再次溃疡的风险。这种特定部位的方法可能会影响未来试验中如何研究高 PPP。
