TY - JOUR
T1 - Measuring Plantar Tissue Stress in People With Diabetic Peripheral Neuropathy
T2 - A Critical Concept in Diabetic Foot Management
AU - Lazzarini, Peter A.
AU - Crews, Ryan T.
AU - van Netten, Jaap J.
AU - Bus, Sicco A.
AU - Fernando, Malindu E.
AU - Chadwick, Paul J.
AU - Najafi, Bijan
N1 - Funding Information:
The authors would like to very much thank Nytasha Purcell from Diabetic Foot Australia who developed and provided Figure 1. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The contents of this article were developed in part with the support of an Innovation Grant from The Prince Charles Hospital Foundation, Australia (TPCHF Grant INN2018-41). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the granting body.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Excessive stress on plantar tissue over time is one of the leading causes of diabetic foot ulcers among people with diabetic peripheral neuropathy. Plantar tissue stress (PTS) is a concept that attempts to integrate several well-known mechanical factors into one measure, including plantar pressure, shear stress, daily weight-bearing activity, and time spent in prescribed offloading interventions (adherence). Despite international diabetic foot guidelines recommending the measure of each of these individual mechanical factors in people with neuropathy, only recently has technology enabled their combined measurement to determine PTS. In this article we review the concept of PTS, the mechanical factors involved, and the findings of pivotal articles reporting measures of PTS in people with neuropathy. We also discuss key existing gaps in this field, including the lack of standards to measure and report PTS, a lack of practical solutions to measure shear stress, and the lack of PTS thresholds that may indicate benefit or detriment to people with neuropathy. To address some of these gaps, we propose recommended clinical and research standards for measuring and reporting PTS in people with neuropathy. Last, we forecast future clinical, research, and technological advancements that may use PTS to highlight the importance of this critical concept in the prevention and management of diabetic foot ulcers.
AB - Excessive stress on plantar tissue over time is one of the leading causes of diabetic foot ulcers among people with diabetic peripheral neuropathy. Plantar tissue stress (PTS) is a concept that attempts to integrate several well-known mechanical factors into one measure, including plantar pressure, shear stress, daily weight-bearing activity, and time spent in prescribed offloading interventions (adherence). Despite international diabetic foot guidelines recommending the measure of each of these individual mechanical factors in people with neuropathy, only recently has technology enabled their combined measurement to determine PTS. In this article we review the concept of PTS, the mechanical factors involved, and the findings of pivotal articles reporting measures of PTS in people with neuropathy. We also discuss key existing gaps in this field, including the lack of standards to measure and report PTS, a lack of practical solutions to measure shear stress, and the lack of PTS thresholds that may indicate benefit or detriment to people with neuropathy. To address some of these gaps, we propose recommended clinical and research standards for measuring and reporting PTS in people with neuropathy. Last, we forecast future clinical, research, and technological advancements that may use PTS to highlight the importance of this critical concept in the prevention and management of diabetic foot ulcers.
KW - activity
KW - adherence
KW - diabetic foot
KW - plantar pressure
KW - plantar tissue stress
KW - shear stress
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U2 - 10.1177/1932296819849092
DO - 10.1177/1932296819849092
M3 - Article
AN - SCOPUS:85065254672
VL - 13
SP - 869
EP - 880
JO - Journal of diabetes science and technology
JF - Journal of diabetes science and technology
SN - 1932-2968
IS - 5
ER -