Exploring in-shoe plantar pressure differences at the metatarsal pad position for patients with diabetes and toe deformities: A pilot study

Authors

  • Elin Hellgren Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University https://orcid.org/0000-0002-7621-6348
  • Roy Tranberg Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University
  • Magnus Breiner Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University
  • Ulla Tang Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University

DOI:

https://doi.org/10.55067/jifaf.v1i12.40

Keywords:

Metatarsal pad, Insole, Plantar pressure, Diabetes, Diabetic foot ulcer, Prevention

Abstract

Patients with diabetes are often prescribed insoles with metatarsal pads intended to prevent and offload forefoot ulcers. However, to our knowledge, the plantar pressures specifically at the metatarsal pad had not previously been researched. The aim of this study was therefore to explore plantar pressures at the metatarsal pad position by comparing three toe deformity groups, claw toe (CT)/hammer toe (HT) and hallux valgus (HV), with a control group (NONE). In-shoe plantar pressures were measured using F-ScanTM and a polygon region of interest at the metatarsal pad position was created. Mean peak pressure (MPP), pressure-time integral (PTI) and percentage foot-insole contact area at the metatarsal pad position (%CA) were analysed from 24 patients (48 feet) in the metatarsal pad area. No significant difference was found between the groups regarding MPP, PTI or contact area. For MPP, the highest value was found in CT/HT (140kPa ± 61) and the lowest in HV (112kPa ± 33). In PTI, the highest value was for CT/HT (2.0 Ns/cm2 ± 1.0) and the lowest for HV (1.3 Ns/cm2 ± 0.4). The %CA was highest in CT/HT/HV (95%) and lowest in NONE (70%). A new quantitative approach was presented, assessing the metatarsal pad pressure effect on its corresponding plantar area of the foot. Further studies are needed to identify the conditions in which a metatarsal pad affects different foot statuses with regard to plantar pressure. 

References

Bus SA. Foot structure and footwear prescription in diabetes mellitus. Diabetes Metab Res Rev. 2008;24 Suppl 1:S90-5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18386782.

van Netten JJ, et al. Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review. Diabetes Metab Res Rev. 2020;36 Suppl 1:e3270. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31957213.

Orlin MN, McPoil TG. Plantar pressure assessment. Phys Ther. 2000;80(4):399-409. Available from: https://www.ncbi.nlm.nih.gov/pubmed/10758524.

Owings TM, et al. Custom therapeutic insoles based on both foot shape and plantar pressure measurement provide enhanced pressure relief. Diabetes Care. 2008;31(5):839-44. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18252899.

Bus SA, et al. Effect of custom-made footwear on foot ulcer recurrence in diabetes: a multicenter randomized controlled trial. Diabetes Care. 2013;36(12):4109-16. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24130357.

Koenraadt KL, et al. Effect of a metatarsal pad on the forefoot during gait. J Am Podiatr Med Assoc. 2012;102(1):18-24. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22232317.

Suzuki J, et al. Axial radiographic evaluation in hallux valgus: evaluation of the transverse arch in the forefoot. J Orthop Sci. 2004;9(5):446-51. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15449119.

Wen J, et al. Adaptive changes of foot pressure in hallux valgus patients. Gait Posture. 2012;36(3):344-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22555063.

Tang UH, et al. Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers. Diabetic Foot Ankle. 2015;6(1):27593. Available from: https://pubmed.ncbi.nlm.nih.gov/26087865/.

Bus SA, et al. Elevated plantar pressures in neuropathic diabetic patients with claw/hammer toe deformity. J Biomech. 2005;38(9):1918-25. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16023481.

Hastings MK, et al. Effect of metatarsal pad placement on plantar pressure in people with diabetes mellitus and peripheral neuropathy. Foot Ankle Int. 2007;28(1):84-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17257544.

Martinez-Santos A, Preece S, Nester CJ. Evaluation of orthotic insoles for people with diabetes who are at-risk of first ulceration. J Foot Ankle Res. 2019;12:35. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31244900.

Hellstrand Tang U, et al. Comparison of plantar pressure in three types of insole given to patients with diabetes at risk of developing foot ulcers - A two-year, randomized trial. J Clin Transl Endocrinol. 2014;1(4):121-132. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29159093.

Hellstrand Tang U, et al. The D-Foot, for prosthetists and orthotists, a new eHealth tool useful in useful in risk classification and foot assessment in diabetes. 2017;10(2):4. Available from: http://faoj.org/2017/06/30/the-d-foot-for-prosthetists-and-orthotists-a-new-ehealth-tool-useful-in-useful-in-risk-classification-and-foot-assessment-in-diabetes/.

World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24141714.

TekScan. F-Scan F-Scan® User Manual. 2014.

Melai T, et al. Calculation of plantar pressure time integral, an alternative approach. Gait Posture. 2011;34(3):379-83. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21737281.

Price C, Parker D, Nester C. Validity and repeatability of three in-shoe pressure measurement systems. Gait Posture. 2016;46:69-74. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27131180.

Hsiao H, Guan J, Weatherly M. Accuracy and precision of two in-shoe pressure measurement systems. Ergonomics. 2002;45(8):537-55. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12167198.

Spooner SK, Smith DK, Kirby KA. In-shoe pressure measurement and foot orthosis research: a giant leap forward or a step too far? J Am Podiatr Med Assoc. 2010;100(6):518-29. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21084541.

Bus SA, R Waaijman. The value of reporting pressure-time integral data in addition to peak pressure data in studies on the diabetic foot: a systematic review. Clin Biomech (Bristol, Avon) 2013;28(2):117-21. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23273847.

Downloads

Published

2022-12-01

How to Cite

1.
Hellgren E, Tranberg R, Breiner M, Tang U. Exploring in-shoe plantar pressure differences at the metatarsal pad position for patients with diabetes and toe deformities: A pilot study. J Int Foot Ankle [Internet]. 2022 Dec. 1 [cited 2023 Jan. 29];1(12). Available from: https://internationalfootankle.org/journal/index.php/JIFAF/article/view/40