The predictive value of cumulative plantar tissue stress on future plantar foot ulceration in people with diabetes—A 12-month prospective observational study

IF 3.4 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine Pub Date : 2025-07-31 DOI:10.1111/dme.70099

Chantal M. Hulshof, Jaap J. van Netten, Tessa E. Busch-Westbroek, Louise W. E. Sabelis, Edgar J. G. Peters, Mirjam Pijnappels, Sicco A. Bus

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引用次数: 0

Abstract

Aims

Plantar foot ulcers are a burdensome complication of diabetes caused by abnormal foot biomechanics. Predicting foot ulcers aids in their prevention, but the value of peak pressure—the most used biomechanical parameter—is only moderate. We aimed to improve prediction based on the more comprehensive load measure cumulative plantar tissue stress (CPTS).

Methods

We prospectively observed 60 participants with diabetes at high foot ulcer risk for 12 months. At baseline, we assessed demographic and clinical characteristics—including plantar pre-ulcers (i.e., abundant callus, haemorrhage, blister, fissure)—and measured barefoot and in-shoe plantar pressures during walking and standing. Daily-life weight-bearing activity and adherence to prescribed footwear were assessed over 7 days after baseline. The primary outcome was plantar foot ulceration during the 12-month follow-up. CPTS was calculated (in GPa^.s/day) from the above foot-loading factors and analysed for predicting foot ulcers and its association with pre-ulcers, using multivariate regression analyses.

Results

Twenty-two participants (37%) developed a plantar forefoot ulcer. CPTS was not a significant predictor (odds ratio (OR) = 0.90 (95% confidence interval (CI): 0.50–1.59)) but pre-ulcers at baseline (OR = 9.97, 95%CI: 1.41–70.65) and walking speed (in m/s) (OR = 0.01, 95%CI: 0.00–0.32) were. CPTS was significantly associated with pre-ulcers (OR = 2.38, 95%CI: 1.02–5.54).

Conclusions

CPTS did not predict plantar foot ulceration in our high-risk participants, but our findings support the mechanical pathway of plantar foot ulceration through pre-ulcer development and indicate lower walking speed as an important predictor. Assessing walking speed and early identifying and treating pre-ulcers will help predict and prevent plantar foot ulcers in high-risk people with diabetes.

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累积足底组织应激对糖尿病患者未来足底足溃疡的预测价值——一项为期12个月的前瞻性观察研究

目的：足底溃疡是由足部生物力学异常引起的糖尿病并发症。预测足部溃疡有助于预防足部溃疡，但最常用的生物力学参数——峰值压力的值只是适度的。我们的目的是改进基于更全面的负荷测量累积足底组织应力（CPTS）的预测。方法：我们前瞻性观察了60例足部溃疡高风险糖尿病患者12个月。在基线上，我们评估了人口统计学和临床特征——包括足底溃疡前期（即大量的老茧、出血、水疱、裂缝）——并测量了步行和站立时赤脚和穿鞋的足底压力。在基线后的7天内评估日常生活负重活动和对规定鞋类的依从性。在12个月的随访中，主要结局是足底溃疡。根据上述足部负荷因素计算CPTS（以gpa / s/天为单位），并使用多变量回归分析分析预测足部溃疡及其与溃疡前期的关系。结果：22名参与者（37%）出现足底前足溃疡。CPTS不是一个显著的预测因子(优势比（OR) = 0.90(95%可信区间（CI）： 0.50-1.59)），但基线溃疡前（OR = 9.97, 95%CI: 1.41-70.65）和步行速度（OR = 0.01, 95%CI: 0.00-0.32）是一个显著的预测因子。CPTS与溃疡前期显著相关（OR = 2.38, 95%CI: 1.02-5.54）。结论：CPTS不能预测高风险受试者的足底溃疡，但我们的研究结果支持足底溃疡通过溃疡前期发展的机械途径，并表明较低的步行速度是一个重要的预测因素。评估步行速度和早期识别和治疗溃疡前期将有助于预测和预防高风险糖尿病患者的足底溃疡。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetic Medicine 医学-内分泌学与代谢

CiteScore

7.20

自引率

5.70%

发文量

229

审稿时长

3-6 weeks

期刊介绍： Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”