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ORIGINAL ARTICLE
Year : 2017  |  Volume : 44  |  Issue : 2  |  Page : 76-79

A study of dynamic foot pressure measurement in diabetic patients


1 Department of Nursing Sciences, KLE University's Institute of Nursing Sciences, Belagavi, Karnataka, India
2 Department of Surgery, J. N. Medical College, Belagavi, Karnataka, India
3 Department of Epidemiology and Biostatistics, KLE University, Belagavi, Karnataka, India

Date of Web Publication11-Oct-2017

Correspondence Address:
Milka D Madhale
KLE University's Institute of Nursing Sciences, Belagavi, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.JSS_23_17

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  Abstract 

Introduction: Diabetic foot ulcer is a major source of morbidity and a leading cause of hospitalization. It is estimated that approximately 20% of hospital admissions among patients with diabetes mellitus are due to diabetic foot ulcer. It can lead to infection, gangrene, amputation, and even death if appropriate care is not provided. Overall, the lower limb amputation in diabetic patients is 15 times higher than in non-diabetics. In the majority of cases, the cause for the foot ulcer is the altered architecture of the foot due to neuropathy resulting in abnormal pressure points on the soles. Purpose: The aim of this study is to develop low cost, lightweight foot pressure scanner and check its reliability and validity which can help to prevent foot ulceration. Design/Methodology/Approach: In the present study, a low cost, lightweight foot pressure scanner is developed, and dynamic plantar pressures in a group of 110 Indian patients with diabetes with or without neuropathy and foot ulcers are measured. Practical Implications: If these pressure points can be detected, ulcers can be prevented by providing offloading footwear. Originality/Value: Differences are found in dynamic foot pressures in different study groups, namely, diabetic patients, patients with diabetic peripheral neuropathy, patients with foot ulcers, and nondiabetics. The differences are significant (P < 0.01), which showed the validity of the tool. Reliability and consistency of the tool was checked by test–retest method. Paper Type: Original Research work. Conclusion: Based on the results of the present study, it is concluded that the scanner is successfully developed and it can measure foot pressures. It is a novel device to proactively monitor foot health in diabetics in an effort to prevent and reduce diabetic foot complications.

Keywords: Dynamic foot pressure, foot pressure scanner, reliability, validity


How to cite this article:
Madhale MD, Godhi AS, Tyagi NK. A study of dynamic foot pressure measurement in diabetic patients. J Sci Soc 2017;44:76-9

How to cite this URL:
Madhale MD, Godhi AS, Tyagi NK. A study of dynamic foot pressure measurement in diabetic patients. J Sci Soc [serial online] 2017 [cited 2017 Oct 22];44:76-9. Available from: http://www.jscisociety.com/text.asp?2017/44/2/76/216493


  Introduction Top


Diabetes mellitus is one of the major problems in global public health today. The threat has increased dramatically over the past two decades. According to epidemiological studies, the number of patients with diabetes mellitus increased from about 30 million cases in 1985 to 177 million in 2000, 285 million in 2010, and it is estimated, if the situation continues, that more than 360 million people by 2030 will have diabetes mellitus.[1]

Patients with diabetes mellitus are prone to have multiple complications.[2] One of the major complications is foot ulcer.[3] It is a common complication which has shown an increasing trend over previous decades.[4] Fifteen percent of diabetic patients will suffer from foot ulcer during their lifetime.[5] Although the accurate figures are difficult to obtain, the prevalence of this complication ranges from 4% to 27%.[6],[7]

Diabetic foot ulcer is a major source of morbidity and a leading cause of hospitalization.[8] Approximately 20% of hospital admissions among diabetic patients are due to foot ulcers.[9] Once diabetic foot ulcer has developed, there is an increased risk of ulcer progression, leading to infection, gangrene, amputation, and even death if necessary care is not provided.[10] Overall, the rate of lower limb amputation in diabetic patients is 15 times higher than those without diabetes.[11] About 50%–70% of all lower limb amputations are due to diabetic foot ulcers. Furthermore, diabetic foot ulcer is responsible for substantial emotional and physical distress,[12] loss of productivity,[13] and financial loss that lower the quality of life.[14]

Dynamic function of the foot is considered the risk factor for lower limb injuries including Achilles tendinopathy, patellofemoral pain, and stress fractures of the bones of the foot.[15] This has attracted considerable attention by researchers in biomedical and sport medicine who have tried to study plantar pressure distributions in the interface between the plantar surface and the shoe sole.[16] Plantar ulcers in diabetics are due to excessive pressure on the soles exerted during normal activities such as walking and running (dynamic foot pressure).[17] Plantar pressures in a static person (static pressures) are much less than the dynamic foot pressures.[18] Therefore, this study to develop dynamic foot pressure scanner has been carried out.[19]

With the help of the scanner, dynamic foot pressures are measured and abnormal pressure points identified. These measurements can be used to design offloading protective footwear which will possibly equalize the loads and redistribute the pressure under the foot.[6]

Plantar static pressure assessment is commonly used in the clinical evaluation of the foot. The dynamic pressure readings obtained from the scanner which provides insight into the plantar loading characteristics during functional activities such as walking and running can be incorporated into the routine assessment and evaluation of the diabetic foot to help further management and planning.[7],[8],[9]

The scanner is innovative, lightweight, low-cost, easy to use, soft, suitable for research laboratory and outpatient clinic.[10]

The plantar pressure measuring systems available in the market are with high technology and not affordable. In the present study, the aim was to develop low-cost, dynamic foot pressure scanner. Plantar pressures in a group of 110 Indian patients with diabetes with or without neuropathy and foot ulcers are measured, and the reliability and validity of the tool is checked. This instrument will help to prevent the further complications of foot ulcers by providing them offloading shoes.[11]


  Materials and Methods Top


The main objective was to develop a low-cost foot pressure scanner and check its reliability and validity. The components used for the scanner were force sensors with capacity of 0–150 kilopascal with 0.5” sensing area, arm processors, data reader card with digital display, microcontroller, and microcellular rubber. These were assembled to make a prototype in collaboration with Biomedical Engineering Department of KLE College of Engineering and Technology, Belagavi. Three sensors were placed on the rubber sole corresponding to the heads of the 1st (P0), 2nd (P1), and 5th (P2) metatarsals.

The case series research design was adopted and study was carried out in health-care setting of two corporate hospitals of Belagavi city, Karnataka, India. The study was conducted on 110 subjects; out of this, 30 were nondiabetics, 30 were diabetics, 19 were diabetic with peripheral neuropathy, and 31 were with diabetic foot ulcer [Table 1].
Table 1: Gender-wise distribution of study participants (n=110)

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The foot pressure scanner was strapped to the foot; the participants were made to walk on the treadmill with 0.8 mph and the pressure readings were recorded; ten times readings were noted by the same rater on the same scanner.

The pressures were measured in kilopascal units on the P0, P1, and P2. Reliability of the tool was checked by test–retest method. The validity was checked by taking foot pressures on different participants such as diabetic patients,[20] diabetic with peripheral neuropathy,[21] foot ulcer,[21] and nondiabetic participants.[22]


  Results Top


[Table 2] reveled the age-wise distribution of study participants. Study showed that majority (60%) of male belonged to 50–60 years of age group with diabetes mellitus whereas 75% of female belonged to 50–60 years of age group. Majority (38%) of male belonged to 50–60 and above 60 years of age group with diabetes mellitus with peripheral neuropathy whereas 50% of female belonged to above 60 years of age group with diabetes mellitus with peripheral neuropathy. Majority (39%) of male belonged to 50–60 and above 60 years with foot ulcer whereas 37.5% of female belonged to above 60 years of age.
Table 2: Age-wise distribution of study participants (n=110)

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[Table 3] reveled the comparison of dynamic foot pressure in various study groups. The results of our study showed reliability variation between observations within participants: Not significant P > 0.2.
Table 3: Comparison of dynamic foot pressure in various study groups

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Validity variation between diabetic groups including normal: P0; F (df = 3.326) =2.78; P < 0.05, P1; F (df = 3.326) = 27.66; P < 0.001, P2; F (df = 3.326) = 5.39; P < 0.01.


  Discussion Top


Several foot pressure scanners are marketed. They are expensive. Traditionally, foot pressure measurement is performed in the specialized settings such as laboratories and hospitals.

The scanner developed in this study is portable, affordable, having limited circuit, giving linear readings with low hysteresis. It can be used in the outpatient setting.

This scanner is made out of force sensors with capacity of 0–150 kilopascal with 0.5” sensing area, arm processors, data reader card with digital display, microcontroller, and microcellular rubber.[12],[13],[14],[15],[16],[17],[18]

The scanner has been tested on different participants, namely, diabetic patients, patients with diabetic peripheral neuropathy, patients with foot ulcers, and nondiabetics; it has given different readings of dynamic foot pressures in different study groups. The differences were significant (P< 0.01); hence, the scanner has been found to be valid. The scanner has also demonstrated good reliability by test–retest method.


  Conclusion Top


Based on the results of the present study, it is concluded that a simple, affordable, portable foot pressure scanner has been developed; it measures dynamic foot pressures and the readings are valid and reliable. The readings can be used in making offloading footwear. It is a novel instrument to monitor foot health and proactively reduce and prevent diabetic foot complications.

It is a prototype and needs further improvement before it can be applied to clinical practice.

Acknowledgment

Authors are grateful to all the patients who participated in this study. Special thanks to Prof. S. B. Kulkarni, Head, Department of E and C, KLE College of Engineering, Belagavi and Prof. (Dr) Ravi Hawaldar, Head, Department of Biomedical Engineering, KLE College of Engineering, Belagavi, for supporting the research project to promote health in the communities we serve.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Boulton AJ, Hardisty CA, Betts RP, Franks CI, Worth RC, Ward JD, et al. Dynamic foot pressure and other studies as diagnostic and management aids in diabetic neuropathy. Diabetes Care 1983;6:26-33.  Back to cited text no. 1
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2.
Bryant AR, Tinley P, Cole JH. Plantar pressure and radiographic changes to the forefoot after the Austin bunionectomy. J Am Podiatr Med Assoc 2005;95:357-65.  Back to cited text no. 2
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3.
Cavanagh PR, Ulbrecht JS. Clinical plantar pressure measurement in diabetes: Rationale and methodology. Foot 1994;4:123-35.  Back to cited text no. 3
    
4.
Duckworth T, Betts RP, Franks CI, Burke J. The measurement of pressures under the foot. Foot Ankle 1982;3:130-41.  Back to cited text no. 4
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5.
Frykberg RG, Bailey LF, Matz A, Panthel LA, Ruesch G. Offloading properties of a rocker insole. A preliminary study. J Am Podiatr Med Assoc 2002;92:48-53.  Back to cited text no. 5
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Grieve DW, Rashdi T. Pressures under normal feet in standing and walking as measured by foil pedobarography. Ann Rheum Dis 1984;43:816-8.  Back to cited text no. 6
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7.
Gross TS, Bunch RP. Measurement of discrete vertical in-shoe stress with piezoelectric transducers. J Biomed Eng 1988;10:261-5.  Back to cited text no. 7
    
8.
Grundy M, Tosh PA, McLeish RD, Smidt L. An investigation of the centres of pressure under the foot while walking. J Bone Joint Surg Br 1975;57:98-103.  Back to cited text no. 8
    
9.
Hennig EM, Rosenbaum D. Pressure distribution patterns under the feet of children in comparison with adults. Foot Ankle 1991;11:306-11.  Back to cited text no. 9
    
10.
Hessert MJ, Vyas M, Leach J, Hu K, Lipsitz LA, Novak V. Foot pressure distribution during walking in young and old adults. BMC Geriatr 2005;5:8.  Back to cited text no. 10
    
11.
Hodge MC, Bach TM, Carter GM. Novel Award First Prize Paper. Orthotic management of plantar pressure and pain in rheumatoid arthritis. Clin Biomech (Bristol, Avon) 1999;14:567-75.  Back to cited text no. 11
    
12.
Hughes J, Clark P, Klenerman L. The importance of the toes in walking. J Bone Joint Surg Br 1990;72:245-51.  Back to cited text no. 12
    
13.
Hughes J, Jagoe JR, Clark P, Klenerman L. Pattern recognition of images of the pressure distribution under the foot from the pedobarograph. J Photogr Sci 1989;37:139-42.  Back to cited text no. 13
    
14.
Hughes J, Kriss S, Klenerman L. A clinician's view of foot pressure: A comparison of three different methods of measurement. Foot Ankle 1987;7:277-84.  Back to cited text no. 14
    
15.
Hughes J, Pratt L, Linge K, Clark P, Klenerman L. Reliability of pressure measurements: The EM ED F system. Clin Biomech (Bristol, Avon) 1991;6:14-8.  Back to cited text no. 15
    
16.
Lehmann JF, de Lateur BJ, Price R. Biomechanics of normal gait. Phys Med Rehabil Clin N Am 1992;3:95-109.  Back to cited text no. 16
    
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Luger E, Nissan M, Karpf A, Steinberg E, Dekel S. Dynamic pressures on the diabetic foot. Foot Ankle Int 2001;22:715-9.  Back to cited text no. 17
    
18.
MacWilliams BA, Armstrong PF. Clinical applications of plantar pressure measurement in pediatric orthopedics. IEEE; 2000. p. 143-50. DOI: 10.1109/PG.2000.858886.  Back to cited text no. 18
    
19.
Merolli A, Uccioli L. Plantar pressure distribution in patients with neuropathic diabetic foot. J Appl Biomater Biomech 2005;3:61-4.  Back to cited text no. 19
    
20.
Minns RJ, Craxford AD. Pressure under the forefoot in rheumatoid arthritis. A comparison of static and dynamic methods of assessment. Clin Orthop Relat Res 1984;(187):235-42.  Back to cited text no. 20
    
21.
Plank MJ, Potter M. The pattern of forefoot pressure distribution in hallux valgus. Foot 1995;5:8-14.  Back to cited text no. 21
    
22.
Praet SF, Louwerens JW. The influence of shoe design on plantar pressures in neuropathic feet. Diabetes Care 2003;26:441-5.  Back to cited text no. 22
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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