New Australian research from Mal Fernando and colleagues has again shown the importance of offloading the high plantar pressures found in people with diabetic foot ulcers. The Queensland based researchers measured plantar pressures in 21 persons with diabetic foot ulcers, and compared these with 69 diabetes and 56 healthy controls. When adjusted for a great deal of variables, barefoot plantar pressures were significantly higher in people with diabetic foot ulcers compared to both control conditions.
Another finding was a longer stance phase in the foot ulcer group. This implies that people with a foot ulcer walk slower compared to the diabetes and healthy controls, confirming findings from other studies. Slower walking speed reduces plantar pressure, yet an increased pressure was still found. This points to the magnitude of foot shape changes underlying the increase plantar pressure in people with diabetic foot ulcers.
A limitation of the study concerned the group of diabetes controls. This was a rather heterogeneous group of patients, with various degrees of neuropathy and foot deformity. An important comparison for future research would include two more specific control groups: people at-risk for foot ulceration, but without a history of ulceration (IWGDF risk classification 2: neuropathy with foot deformity or peripheral artery disease), and people with a history of foot ulceration, but without a current foot ulcer. Including these groups might shed more light on the temporal association between foot ulcer development and healing.
The most important message to take to your clinic from this study is the continuous attention required for offloading in daily practice. People with diabetic foot ulcers have significantly different plantar pressures compared to people with diabetes alone. These pressures need to be adequately offloaded for foot ulcers to heal.