The Stress of Measuring Plantar Tissue Stress in People with Diabetes-Related Foot Ulcers: Biomechanical and Feasibility Findings from Two Prospective Cohort Studies
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
Affiliations
Chantal M. Hulshof
Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
Madelyn Page
School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia
Sjef G. van Baal
ZGT Academy, ZGT, 7600 SZ Almelo, The Netherlands
Sicco A. Bus
Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
Malindu E. Fernando
Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA
Lisette van Gemert-Pijnen
Department of Psychology, Health & Technology, University of Twente, 7522 NB Enschede, The Netherlands
Kilian D. R. Kappert
Department of Surgery, ZGT, 7600 SZ Almelo, The Netherlands
Scott Lucadou-Wells
Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, QLD 4032, Australia
Bijan Najafi
Interdisciplinary Consortium on Advanced Motion Performance, Baylor College of Medicine, Houston, TX 77030, USA
Jaap J. van Netten
Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
Peter A. Lazzarini
School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia
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.
