RESEARCH ARTICLE
Plantar pressures are elevated in people with longstanding diabetes-related foot ulcers during follow-up Malindu E. Fernando1,2,3,4*, Robert G. Crowther3,5, Peter A. Lazzarini2,6, Saiumaeswar Yogakanthi7, Kunwarjit S. Sangla8, Petra Buttner9, Rhondda Jones10, Jonathan Golledge1,11
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1 Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia, 2 School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia, 3 Movement Analysis Laboratory, Sports and Exercise Science, James Cook University, Townsville, Australia, 4 Podiatry Service, Kirwan Community Health Campus, Townsville, Queensland, Australia, 5 School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia, 6 Allied Health Research Collaborative, Metro North Hospital & Health Service, Queensland Health, Brisbane, Australia, 7 Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia, 8 Department of Diabetes and Endocrinology, The Townsville Hospital, Townsville, Queensland, Australia, 9 Centre for Chronic Disease Prevention, James Cook University, Cairns, Queensland, Australia, 10 Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia, 11 Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia
OPEN ACCESS Citation: Fernando ME, Crowther RG, Lazzarini PA, Yogakanthi S, Sangla KS, Buttner P, et al. (2017) Plantar pressures are elevated in people with longstanding diabetes-related foot ulcers during follow-up. PLoS ONE 12(8): e0181916. https://doi. org/10.1371/journal.pone.0181916 Editor: Yih-Kuen Jan, University of Illinois at Urbana-Champaign, UNITED STATES Received: March 28, 2017 Accepted: June 9, 2017 Published: August 31, 2017 Copyright: © 2017 Fernando et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: Data are available at http://dx.doi.org/10.4225/28/58ffdc3d4403f, Digital Object Identifier (DOI): 10.4225/28/58ffdc3d4403f. Funding: Funding from the Department of Health, Queensland Government under the Health Practitioner Research Grant Scheme (2013-2014), funding from the Graduate Research School, James Cook University and funding from the National Health and Medical Research Council supported this work. JG holds a Practitioner Fellowships from the National Health and Medical
* [email protected]
Abstract Objective High plantar pressures are implicated in the development of diabetes-related foot ulcers. Whether plantar pressures remain high in patients with chronic diabetes-related foot ulcers over time is uncertain. The primary aim of this study was to compare plantar pressures at baseline and three and six months later in participants with chronic diabetes-related foot ulcers (cases) to participants without foot ulcers (controls).
Methods Standardised protocols were used to measure mean peak plantar pressure and pressuretime integral at 10 plantar foot sites (the hallux, toes, metatarsals 1 to 5, mid-foot, medial heel and lateral heel) during barefoot walking. Measurements were performed at three study visits: baseline, three and six months. Linear mixed effects random-intercept models were utilised to assess whether plantar pressures differed between cases and controls after adjusting for age, sex, body mass index, neuropathy status and follow-up time. Standardised mean differences (Cohen’s d) were used to measure effect size.
Results Twenty-one cases and 69 controls started the study and 16 cases and 63 controls completed the study. Cases had a higher mean peak plantar pressure at several foot sites
PLOS ONE | https://doi.org/10.1371/journal.pone.0181916 August 31, 2017
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Plantar pressures during follow-up in people with foot ulcers
Research Council, Australia (1019921). JG holds a Senior Clinical Research Fellowship from the Queensland Government. MF is currently supported by an Australian Postgraduate Award Scholarship at James Cook University and a scholarship from College of Medicine, James Cook University.
including the toes (p = 0.005, Cohen’s d = 0.36) and mid-foot (p = 0.01, d = 0.36) and a higher pressure-time integral at the hallux (p
Plantar pressures are elevated in people with longstanding diabetes-related foot ulcers during follow-up Malindu E. Fernando1,2,3,4*, Robert G. Crowther3,5, Peter A. Lazzarini2,6, Saiumaeswar Yogakanthi7, Kunwarjit S. Sangla8, Petra Buttner9, Rhondda Jones10, Jonathan Golledge1,11
a1111111111 a1111111111 a1111111111 a1111111111 a1111111111
1 Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia, 2 School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia, 3 Movement Analysis Laboratory, Sports and Exercise Science, James Cook University, Townsville, Australia, 4 Podiatry Service, Kirwan Community Health Campus, Townsville, Queensland, Australia, 5 School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia, 6 Allied Health Research Collaborative, Metro North Hospital & Health Service, Queensland Health, Brisbane, Australia, 7 Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia, 8 Department of Diabetes and Endocrinology, The Townsville Hospital, Townsville, Queensland, Australia, 9 Centre for Chronic Disease Prevention, James Cook University, Cairns, Queensland, Australia, 10 Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia, 11 Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia
OPEN ACCESS Citation: Fernando ME, Crowther RG, Lazzarini PA, Yogakanthi S, Sangla KS, Buttner P, et al. (2017) Plantar pressures are elevated in people with longstanding diabetes-related foot ulcers during follow-up. PLoS ONE 12(8): e0181916. https://doi. org/10.1371/journal.pone.0181916 Editor: Yih-Kuen Jan, University of Illinois at Urbana-Champaign, UNITED STATES Received: March 28, 2017 Accepted: June 9, 2017 Published: August 31, 2017 Copyright: © 2017 Fernando et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: Data are available at http://dx.doi.org/10.4225/28/58ffdc3d4403f, Digital Object Identifier (DOI): 10.4225/28/58ffdc3d4403f. Funding: Funding from the Department of Health, Queensland Government under the Health Practitioner Research Grant Scheme (2013-2014), funding from the Graduate Research School, James Cook University and funding from the National Health and Medical Research Council supported this work. JG holds a Practitioner Fellowships from the National Health and Medical
* [email protected]
Abstract Objective High plantar pressures are implicated in the development of diabetes-related foot ulcers. Whether plantar pressures remain high in patients with chronic diabetes-related foot ulcers over time is uncertain. The primary aim of this study was to compare plantar pressures at baseline and three and six months later in participants with chronic diabetes-related foot ulcers (cases) to participants without foot ulcers (controls).
Methods Standardised protocols were used to measure mean peak plantar pressure and pressuretime integral at 10 plantar foot sites (the hallux, toes, metatarsals 1 to 5, mid-foot, medial heel and lateral heel) during barefoot walking. Measurements were performed at three study visits: baseline, three and six months. Linear mixed effects random-intercept models were utilised to assess whether plantar pressures differed between cases and controls after adjusting for age, sex, body mass index, neuropathy status and follow-up time. Standardised mean differences (Cohen’s d) were used to measure effect size.
Results Twenty-one cases and 69 controls started the study and 16 cases and 63 controls completed the study. Cases had a higher mean peak plantar pressure at several foot sites
PLOS ONE | https://doi.org/10.1371/journal.pone.0181916 August 31, 2017
1 / 17
Plantar pressures during follow-up in people with foot ulcers
Research Council, Australia (1019921). JG holds a Senior Clinical Research Fellowship from the Queensland Government. MF is currently supported by an Australian Postgraduate Award Scholarship at James Cook University and a scholarship from College of Medicine, James Cook University.
including the toes (p = 0.005, Cohen’s d = 0.36) and mid-foot (p = 0.01, d = 0.36) and a higher pressure-time integral at the hallux (p
