Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain..
Diabetes Res Clin Pract. 2022 Jul;189:109976. doi: 10.1016/j.diabres.2022.109976. Epub 2022 Jun 27.
To analyze a plantar pressure cut-off point for diabetic foot reulceration beneath the metatarsal heads in patients with previous forefoot amputation.
A one-year prospective study was conducted in a total of 105 patients at high risk for foot ulceration. Peak plantar pressure (PPP) and pressure-time integral (PTI) in the entire foot, the forefoot region, and each metatarsal head separately were registered. ROC curves were used to select the optimal diagnostic pressure cut-off points. Patients were follow-up monthly or until the development of an ulcer event.
A total of 52 (49.5%) patients developed a reulceration. Using ROC analyses for PPP in the full-foot and in the forefoot, did not predict reulceration beneath the metatarsal heads. Analyzing separately each metatarsal head all patients with values greater than or equal to 20.8 N/cm at the 1st, 18.62 N/cm for the 2nd, 18.85 at the 3rd, 17.88 at the 4th, and 12.2 at the 5th metatarsal heads will suffer a reulceration despite the use of orthopedic treatment with optimum values of sensitivity (from 100 to 87.5) and specificity (from 83.2 to 62.8).
Barefoot pressures beneath the metatarsal heads should be analyzed separately to predict the region at risk of reulceration.
分析先前接受前足部截肢的糖尿病患者跖骨头部下足部溃疡复发的足底压力截断值。
对 105 例有发生足部溃疡高风险的患者进行了为期一年的前瞻性研究。记录整个足部、前足部区域和每个跖骨头部的峰值足底压力 (PPP) 和压力时间积分 (PTI)。使用 ROC 曲线选择最佳诊断压力截断值。对患者进行每月或直至溃疡事件发生的随访。
共有 52 例（49.5%）患者发生了溃疡复发。使用 ROC 分析整个足部和前足部的 PPP，并不能预测跖骨头部下的溃疡复发。分别分析每个跖骨头部，所有第 1 跖骨头部 PPP 值大于或等于 20.8 N/cm、第 2 跖骨头部 PPP 值为 18.62 N/cm、第 3 跖骨头部 PPP 值为 18.85 N/cm、第 4 跖骨头部 PPP 值为 17.88 N/cm、第 5 跖骨头部 PPP 值为 12.2 N/cm 的患者，尽管采用了矫形治疗，其最佳敏感度（从 100 到 87.5）和特异性（从 83.2 到 62.8）值，仍会发生溃疡复发。
应单独分析跖骨头部的赤脚压力，以预测溃疡复发的风险区域。
