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.
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http://dx.doi.org/10.1177/1932296819849092 | DOI Listing |
J Vasc Surg Cases Innov Tech
April 2025
Hospital Universitário Professor Edgard Santos, Federal University of Bahia, Salvador, Bahia, Brazil.
Objective: The integrity of the plantar flap is important for transmetatarsal amputation (TMA) classic closure. However, in ischemic wounds, the plantar flap can be compromised, making the TMA coverage difficult. The aim of this study was to compare the outcomes of rotational vs long plantar flaps for transmetatarsal amputation closure in patients with dysvascular partial foot amputations.
View Article and Find Full Text PDFBMJ Open
December 2024
Department of Vascular Surgery, Leids Universitair Medisch Centrum, Leiden, The Netherlands.
Introduction: Foot ulcers are one of the most serious complications of diabetes, leading to significant risks on amputation and mortality. Peripheral arterial disease (PAD) is an important factor for the development and the outcome of diabetic foot ulcers (DFU). Although prompt and accurate detection of PAD is critical to reduce complications, its diagnosis can be challenging with currently used bedside tests (such as ankle-brachial index and toe pressure) due to medial arterial calcification.
View Article and Find Full Text PDFClin Teach
February 2025
Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Purpose: The development of the Diabetic Wound Assessment Learning Tool (DiWALT) has previously been described. However, an examination of its application to a larger, more heterogeneous group of participants is lacking. In order to allow for a more robust assessment of the psychometric properties of the DiWALT, we applied it to a broader group of participants.
View Article and Find Full Text PDFACS Appl Mater Interfaces
January 2025
Institute of Nano and Biopolymeric Materials, School of Materials Science and Engineering, Tongji University, Shanghai 201804, China.
The treatment of diabetic foot ulcers (DFUs) represents a significant challenge due to the complexity of the wound microenvironment. Several factors, including infection, inflammation, and impaired angiogenesis, can complicate the healing process and reduce the effectiveness of current clinical treatments. To address these challenges, this work develops a multifunctional sponge containing a zeolitic imidazolate framework-8/bacterial cellulose (ZIF-8/BC) matrix loaded with the antioxidant naringin (Nar).
View Article and Find Full Text PDFActa Dermatovenerol Croat
November 2024
Khalid Al Aboud King Faisal Hospital P.O Box 5440, Makkah, Saudi Arabia;
parts of the world (1,2). CL is characterized by significant clinical variability. An ulcerated nodule on the exposed parts of the body (corresponding to the parasite inoculation site by the vector insect) is the classic presentation.
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