What has Changed in the State of Research and Treatment for Diabetic Foot Ulcers Over the Years?
With ten years follow-up of gait, function in the lower extremities, plantar pressure and foot status of patients with diabetes, Dr. Ulla Hellstrand Tang shared with Tekscan her view on the recent trends of research for diabetic foot ulcers. She stated that she has been seeing three trends, which are sometimes in conflict, and these are:
- The demand for high quality prevention and care of diabetic foot problems is increasing however the resources are limited.
- The demand for high quality evaluations of the feet, e.g, pressure measurement being assessed as valid and reliable is increasing.
- The time it takes to make proper pressure measure measurements is not in place in clinical practice and the costs for the equipment had to be argued for and finally, professionals need to be allowed to put extra time to learn the system and use it for all patients when being relevant.
Diabetic Foot Ulcer Treated with Proper Footwear and Orthotic Prescription
This case study shows how a diabetic patient with a long term non-healing ulcer under the left midfoot (Charcot Joint) is successfully treated with the F-Scan system and the F-Mat floor mat.
A diabetic patient with a long term (15 months) non-healing ulcer under the left midfoot (Charcot Joint) was presented to private practice. The F-Scan™ plantar pressure analysis system and the F-Mat™ floor mat were used to assist the podiatrist and the patient to achieve optimal treatment outcomes.
The ulcer site healed within one month of orthotic modification with the assistance of the F-Scan. More importantly, the patient was significantly more compliant with recommended treatments once he could visualise the extremely high and abnormal pressures that his ulcer site was generating while walking barefoot on the F-Mat. The F-Scan’s ability to demonstrate to the patient the importance of footwear and orthotic therapy in this case perhaps outweighs the assistance that it gave to the podiatrist in maximising treatment outcomes.
Presented below are F-Mat pressure profiles of barefoot walking showing peak pressure over ulcer site, and F-Scan pressure profiles showing a reduction in pressure with orthotic and footwear.
F-Scan & F-Mat Pressure Profiles - Before & After
1. F-Mat Screening - Before Orthotic
Above is a barefoot F-Mat pressure profile showing peak pressures over the ulcer site (arrow) and the 1st MTPJ of the left foot. The peak pressure over the ulcer site is 6.8kg/cm2 (102 psi).
2. F-Scan - Before Orthotic Modifications
Above is the left pressure profile for in-shoe with orthotics before modifications. The pressure over the ulcer site is reduced compared with barefoot; however, the ulcer is still present. The peak pressure has reduced to 4.2kg/cm2 (60 psi).
3. F-Scan - After Orthotic
Above is the left pressure profile for in-shoe with modified orthotics. The pressure over the ulcer site is reduced even further to 2.6 kg/cm2 (37 psi) and after 3 weeks of wear, the ulcer has healed completely. The orthotic was modified “on-the-spot” with the assistance of the F-Scan to allow for immediate feedback on the suitability of the modification.
4. Peak Pressure versus Time Curve After Orthotic
The blue curve shows the peak pressure versus time before the orthotic was modified. The red curve shows peak pressure versus time for in-shoe with modified orthotic. Clearly the magnitude of peak pressure with the new modified orthotic is much lower than before the orthotic was modified. This significant reduction in peak pressure has assisted in the healing of the ulcer.
Why F-Scan & F-Scan GO?
When asked about if there is a place for pressure mapping as a clinical tool in diabetic foot treatment and ulcer prevention, and how might it get implemented, Dr. Ulla states, “Yes, the visualisation of the pressure map is a powerful tool in the dialog with the patients for assessing orthotics and proper footwear. In addition, integrated solutions, meaning integrated with the main medical record system, and ease of use would facilitate the use of plantar pressure measurement. To be able to incorporate the results in an easy way in the documentations would be a great improvement. The mobile equipment is, of course, a great improvement in the tool box.”
F-Scan GO is the next generation of the award winning F-Scan in-shoe gait analysis system. The F-Scan In-Shoe system is a compact, new generation technology for clinicians and researchers that provides dynamic pressure, force and timing information for foot function and gait analysis. Information obtained from the F-Scan is used in real-world applications, like designing and testing orthotics, offloading diabetic feet and evaluating footwear and techniques in elite athletes.
The lightweight, cord-free, wearable electronics with onboard storage lets your subject enjoy full freedom of movement while you capture their natural in-shoe gait with the highest resolution data in the market.
To learn more about Tekscan’s newest F-Scan GO, visit our page at https://bmec.asia/my/tekscan
More Information
Jayne Arlett, BSc Pod Med, FASMF, FAAPSM
