Healthy Aging Research Series II
Every week, hundreds of research articles are published containing keywords such as ‘gait’, ‘balance’, and ‘falls’. As the CEO and founder of a company in the mobility assessment space, I spend a lot of time reviewing these scientific journals. Every once in a while, I come across a ‘golden’ article – one that presents scientific evidence that sums up my anecdotal beliefs about healthy aging. When this happens, I think, “My customers need to know this!”
In this new blog series, I will share the most recent and relevant publications about human mobility and summarize the ‘golden nuggets’ that I believe could improve your business operations.
For the full introduction you can look back at my first post in this series.
Otherwise, read on to hear about this week’s research topic: plantar pressure.
Plantar Pressure Analysis and Its Potential Role Within Long Term and Senior Care Facilities
Did you know that the daily steps we take add up to hundreds of tons of foot pressure every day?
When we are healthy, and our feet are healthy, we are able to withstand these pressures and recuperate day to day.
As we age, we become more at risk for foot problems. Why? Well, first, as we age our feet can change size and shape; sole padding thins and becomes drier, leading to care issues.
As we age, we also experience more medical issues that can impact our walking ability and/or damage our feet directly. For example, arthritis, gout inflammation, peripheral vascular disease and the side effects from certain medications all cause damage to the feet. Obesity is another risk factor for foot problems, as an excess of weight applied to the feet over an extended period of time can wear them down and cause damage.
A third risk factor that impacts our overall foot health is infections, which often coincide or result from diabetes. Diabetic foot ulceration is a preventable long-term complication of diabetes that is caused mainly by skin breakdown due to repetitive mechanical stress and loss of protective sensation on the plantar surface of the foot. For most people, the first sign of problems is foot pain. However, sometimes signs of foot ulcers are not so obvious and a person may not show symptoms of ulcers until the ulcer has become infected.
Therefore, it is critically important to screen for foot problems among elderly patients and senior-care residents, both for risk management and general well-being purposes.
Protocols for foot care screening and care have been in place for quite some time and you may have a practice in place. However, today I wanted to talk you you about a newer approach to measuring foot health. One which involves including an examination of foot plantar pressure characteristics.
What is plantar pressure analysis and why is it important?
Plantar pressure analysis, just like it sounds, is an analysis of the pressure distribution under your feet. It requires the use of equipment (a pressure sensitive flooring platform) that is able to accurately quantify the underfoot pressures and display them for interpretation. The computerized assessment provides both a visual and quantitative screen of:
- Pressure distribution under support areas of the foot,
- Overloaded areas (areas of high pressure that could be of concern),
- Feet asymmetry (and how the body is compensating),
- Weight distribution on each leg, and;
- Areas at risk of injury or ulceration in diabetics.
In preparing for writing of this article, I searched the PubMed database for articles on the subject of “plantar pressure and diabetic foot ulcers”. There were 630 records presented! Of the 630, 75 publications looked specifically at elevated plantar pressures and the correlation to diabetic foot ulcerations. The leading consensus is that high plantar pressure is a major risk factor for diabetic foot ulcers.
Some other major findings in the research included the following interesting facts:
- There is an imbalance in pressure distribution that exists between the forefoot and rear foot during walking in persons with diabetes.
- Neuropathic patients (patients with limited feeling in their feet) have an increase in dynamic plantar foot pressures placing them at risk for plantar ulceration.
- A cut-off point of 355 kPa for forefoot plantar pressures denotes high risk for ulceration.
- Foot plantar pressures of approximately 600 kPa or higher was considered an indicative pressure threshold (ulceration was certain to occur), as at this level soft tissue damage during walking could occur among high risk diabetic patients.
- Peak plantar pressures in diabetic patients with claw or hammertoe deformities measured 621 kPa under the second and third metatarsal heads, compared to 363 kPa in the control groups.
- A forefoot-to-rear foot peak plantar ratio greater than 2 has been shown to be able to predict foot ulceration. (This ratio was 2.3 times higher in diabetic patients with severe neuropathy but only 1.3 times higher in a mild neuropathic group.)
See the reference list below for links to the full articles.
How can Stepscan help?
Peak plantar pressures have been studied extensively as a contributing factor to skin breakdown leading to diabetic foot ulcers. Instruments such as the Stepscan system can be helpful in detecting possible sites of plantar ulcerations by locating the areas of maximum pressure.
If you want to learn more about how Stepscan could work for your long-term or senior care facility, contact us at 1.833.552.4248 or click here to speak to a Product Specialist.
The Study of Plantar Pressure Distribution in Normal and Pathological Foot, Polish Journal of Medical Physics and Engineering
Plantar pressure as a risk assessment tool for diabetic foot ulceration in egyptian patients with diabetes, Clinical Medicine Insights: Endocrinology and Diabetes