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Plantar pressure in diabetic peripheral neuropathy patients with active foot ulceration, previous ulceration and no history of ulceration: a meta-analysis of observational studies

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dc.contributor.authorFernando, M.E.
dc.contributor.authorCrowther, R.G.
dc.contributor.authorPappas, E.
dc.contributor.authorLazzarini, P.A.
dc.contributor.authorCunningham, M.
dc.contributor.authorSangla, K.S.
dc.contributor.authorButtner, P.
dc.contributor.authorGolledge, J.
dc.contributor.editorSantanelli, F.
dc.date.issued2014
dc.description.abstractAims: Elevated dynamic plantar pressures are a consistent finding in diabetes patients with peripheral neuropathy with implications for plantar foot ulceration. This meta-analysis aimed to compare the plantar pressures of diabetes patients that had peripheral neuropathy and those with neuropathy with active or previous foot ulcers. Methods: Published articles were identified from Medline via OVID, CINAHL, SCOPUS, INFORMIT, Cochrane Central EMBASE via OVID and Web of Science via ISI Web of Knowledge bibliographic databases. Observational studies reporting barefoot dynamic plantar pressure in adults with diabetic peripheral neuropathy, where at least one group had a history of plantar foot ulcers were included. Interventional studies, shod plantar pressure studies and studies not published in English were excluded. Overall mean peak plantar pressure (MPP) and pressure time integral (PTI) were primary outcomes. The six secondary outcomes were MPP and PTI at the rear foot, mid foot and fore foot. The protocol of the meta-analysis was published with PROPSERO, (registration number CRD42013004310). Results: Eight observational studies were included. Overall MPP and PTI were greater in diabetic peripheral neuropathy patients with foot ulceration compared to those without ulceration (standardised mean difference 0.551, 95% CI 0.290-0.811, p<0.001; and 0.762, 95% CI 0.303-1.221, p = 0.001, respectively). Sub-group analyses demonstrated no significant difference in MPP for those with neuropathy with active ulceration compared to those without ulcers. A significant difference in MPP was found for those with neuropathy with a past history of ulceration compared to those without ulcers; (0.467, 95% CI 0.181- 0.753, p = 0.001). Statistical heterogeneity between studies was moderate. Conclusions: Plantar pressures appear to be significantly higher in patients with diabetic peripheral neuropathy with a history of foot ulceration compared to those with diabetic neuropathy without a history of ulceration. More homogenous data is needed to confirm these findings.
dc.identifier.citationPLoS ONE, 2014; 9(6, article no. e99050):e99050-e99050
dc.identifier.doi10.1371/journal.pone.0099050
dc.identifier.issn1932-6203
dc.identifier.issn1932-6203
dc.identifier.urihttps://hdl.handle.net/11541.2/127400
dc.language.isoen
dc.publisherPublic Library of Science
dc.relation.fundingNHMRC 1019921
dc.relation.fundingQueensland Government
dc.relation.fundingTownsville Hospital Private Practice Fund
dc.relation.fundingAustralian Postgraduate Award Scholarship at James Cook University
dc.rightsCopyright 2014 Fernando et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
dc.source.urihttps://doi.org/10.1371/journal.pone.0099050
dc.subjectbody-mass
dc.subjectulcers
dc.subjectdisease
dc.subjectepidemiology
dc.subjectmanagement
dc.subjectquality
dc.subjectrisk
dc.subjectprevention
dc.subjectstability
dc.subjectinsoles
dc.titlePlantar pressure in diabetic peripheral neuropathy patients with active foot ulceration, previous ulceration and no history of ulceration: a meta-analysis of observational studies
dc.typeJournal article
pubs.publication-statusPublished
ror.mmsid9916138276201831

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