Introduction: Physical stress is a key factor in diabetic foot ulcer (DFU) formation and healing. However, knowledge on the association of stress with DFU is still limited due to the complexities in quantifying the magnitude of stress imparted on feet over 24hr periods. This project utilized novel methods to quantify the daily cumulative stress (CS) applied to active DFU.
Methods: Plantar pressures were measured in participants with DFU while walking offloaded with a removable cast walker and while walking unshod (Figure 1). Similar measurements were made while participants stood still. Pressure values (pressure time integral) were paired with steps/day & standing time/day over a one-month period during which adherence with the cast walker was objectively monitored via accelerometry.
Results: For a sample of 5 DFU patients the following median and ranges were found for the 4 components to CS: offloading adherent walking 80.9 MPa*s/day (9.9 - 126.7); non-adherent walking 69.0 MPa*s/day (28.5 - 156.5; offloading adherent standing 313.8 MPa*s/day (25.5 - 649.6); non-adherent standing 341.8 MPa*s/day (165.6 - 500.2).
Conclusion: The methodology developed is the most comprehensive assessment of foot loading in patients’ daily lives to date. In accordance with past work showing DFU patients spend more time standing than walking each day, standing contributed more to the daily CS than walking.
R.T. Crews: Other Relationship; OPED Medical. S. Jhaveri: None. S.V. Yalla: None. A.E. Fleischer: None. S.A. Miller: None. A.J. Boulton: None. N.J. Rosenblatt: None.
National Institutes of Health Award Number (R01DK131303)
