Foot ulcer recurrence, plantar pressure and footwear adherence in people with diabetes and Charcot midfoot deformity: A cohort analysis
View/ Open
File version
Version of Record (VoR)
Author(s)
Keukenkamp, R
Busch‐Westbroek, TE
Barn, R
Woodburn, J
Bus, SA
Griffith University Author(s)
Year published
2020
Metadata
Show full item recordAbstract
Aims To investigate people with Charcot midfoot deformity with regard to plantar pressure, footwear adherence and plantar foot ulcer recurrence. Methods Twenty people with diabetes, Charcot midfoot deformity, plantar foot ulcer history and custom‐made footwear were assessed with regard to barefoot and in‐shoe plantar pressures during walking, footwear adherence (% of daily steps over 7‐day period) and plantar foot ulcer recurrence over 18 months. In a cohort design, they were compared to 118 people without Charcot foot (non‐Charcot foot group) with custom‐made footwear and similar ulcer risk factors. Results Median ...
View more >Aims To investigate people with Charcot midfoot deformity with regard to plantar pressure, footwear adherence and plantar foot ulcer recurrence. Methods Twenty people with diabetes, Charcot midfoot deformity, plantar foot ulcer history and custom‐made footwear were assessed with regard to barefoot and in‐shoe plantar pressures during walking, footwear adherence (% of daily steps over 7‐day period) and plantar foot ulcer recurrence over 18 months. In a cohort design, they were compared to 118 people without Charcot foot (non‐Charcot foot group) with custom‐made footwear and similar ulcer risk factors. Results Median (interquartile range) barefoot midfoot peak pressures were significantly higher in the Charcot foot group than in the non‐Charcot foot group [756 (260–1267) vs 146 (100–208) kPa; P<0.001]. In‐shoe midfoot peak pressures were not significantly higher in the Charcot foot group [median (interquartile range) 152 (104–201) vs 119 (94–160) kPa] and significantly lower for all other foot regions. Participants in the Charcot foot group were significantly more adherent, especially at home, than participants in the non‐Charcot foot group [median (interquartile range) 94.4 (85.4–95.0)% vs. 64.3 (25.4–85.7)%; P=0.001]. Ulcers recurred in 40% of the Charcot foot group and in 47% of the non‐Charcot foot group (P=0.63); midfoot ulcers recurred significantly more in the Charcot foot group (4/8) than in the non‐Charcot foot group (1/55; P=0.001). Conclusions Effective offloading and very high footwear adherence were found in people with diabetes and Charcot midfoot deformity. While this may help protect against plantar foot ulcer recurrence, a large proportion of such people still experience ulcer recurrence. Further improvements in adherence and custom‐made footwear design may be required to improve clinical outcome.
View less >
View more >Aims To investigate people with Charcot midfoot deformity with regard to plantar pressure, footwear adherence and plantar foot ulcer recurrence. Methods Twenty people with diabetes, Charcot midfoot deformity, plantar foot ulcer history and custom‐made footwear were assessed with regard to barefoot and in‐shoe plantar pressures during walking, footwear adherence (% of daily steps over 7‐day period) and plantar foot ulcer recurrence over 18 months. In a cohort design, they were compared to 118 people without Charcot foot (non‐Charcot foot group) with custom‐made footwear and similar ulcer risk factors. Results Median (interquartile range) barefoot midfoot peak pressures were significantly higher in the Charcot foot group than in the non‐Charcot foot group [756 (260–1267) vs 146 (100–208) kPa; P<0.001]. In‐shoe midfoot peak pressures were not significantly higher in the Charcot foot group [median (interquartile range) 152 (104–201) vs 119 (94–160) kPa] and significantly lower for all other foot regions. Participants in the Charcot foot group were significantly more adherent, especially at home, than participants in the non‐Charcot foot group [median (interquartile range) 94.4 (85.4–95.0)% vs. 64.3 (25.4–85.7)%; P=0.001]. Ulcers recurred in 40% of the Charcot foot group and in 47% of the non‐Charcot foot group (P=0.63); midfoot ulcers recurred significantly more in the Charcot foot group (4/8) than in the non‐Charcot foot group (1/55; P=0.001). Conclusions Effective offloading and very high footwear adherence were found in people with diabetes and Charcot midfoot deformity. While this may help protect against plantar foot ulcer recurrence, a large proportion of such people still experience ulcer recurrence. Further improvements in adherence and custom‐made footwear design may be required to improve clinical outcome.
View less >
Journal Title
Diabetic Medicine
Copyright Statement
© 2020 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
Note
This publication has been entered as an advanced online version in Griffith Research Online.
Subject
Clinical sciences
Health services and systems
Public health
Psychology