Background
Diabetes in the New Zealand context
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What is the response rate among patients invited to take part in pedobarographic testing?
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To what extent does the additional testing interrupt normal clinic time?
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What is the experience of patients who take part in pedobarographic testing?
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What applications of pedobarographic testing are most useful to those clinicians in charge of diabetic foot care?
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What aspects of pedobarography could feasibly be tested in a clinical trial?
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What unique issues exist in NZ that impact the usefulness of pedobarography as a tool in the care of the diabetic foot, and/or will need to be taken into consideration during a full clinical trial? For example, what type of footwear (closed/non-closed) do patients routinely wear to clinical appointments?
Methods
Data collection setting
Participants
Demographic data collection
Pedobarography measurements
Post-pedobarography discussion with participants
Data management and analysis
Results
Participant characteristics
Clinical presentation and pedobarography application
Pedobarography type | Application category | ||||||
---|---|---|---|---|---|---|---|
Clinic type | Patient # | Lower-limb complications | Clinical application of pedobarography | Barefoot | In-Shoe | Single condition | Multi- condition |
High risk/Ulcer | 1 | Current ulcer beneath Left 3rd and 4th metatarsal heads | Assess barefoot plantar loading under healing ulcer site | ● | ● | ||
2 | Not documented | Assess in-shoe plantar loading with orthopaedic shoe and custom insoles | ● | ● | |||
3 | Functional leg length discrepancy, has Left heel raise in shoes | Assess plantar loading, particularly around heel raise | ● | ● | |||
4 | Current ulcer beneath Right forefoot | Compare in-shoe plantar loading between work boots and sports shoes, with offloading insole in both | ● | ● | |||
5 | Current ulcers on medial aspects of Left and Right hallux | Assess barefoot medial plantar loading and centre of pressure line | ● | ● | |||
6 | Peripheral neuropathy | Assess barefoot loading, particularly under 1st and 5th metatarsal heads | ● | ● | |||
7 | Not documented | Compare in-shoe plantar loading between no insole and custom orthotic insole | ● | ● | |||
8 | Peripheral neuropathy, severe burns under feet | General assessment of barefoot pressures, plus compare to in-shoe pressures to show benefit of orthotic shoe and insole | ● | ● | ● | ||
9 | Left hallux amputation | Assessment of in-shoe loading with orthotic footwear, with and without walking frame | ● | ● | |||
10 | Left 3rd toe amputation, Right 2nd toe amputation | Assessment of barefoot pressures, particularly around areas of digit amputation | ● | ● | |||
11 | Current ulcer under Left forefoot; Left 2nd-4th toe amputation | Assessment of plantar offloading within surgical shoes with custom insoles | ● | ● | |||
12 | Right foot 3rd-5th toe amputation; blister on side of Right 2nd toe | Assessment of barefoot pressures, particularly around areas of digit amputation | ● | ● | |||
13 | Current ulcer under Right 1st metatarsal head | Compare in-shoes loading between Pedor (surgical offloading shoe) and ‘Crocs’ non-closed shoes | ● | ● | |||
14 | Current ulcer under Right heel | Assess in-shoe loading, particularly around Right heel wound | ● | ● | |||
15 | Right hip osteoarthritis, Right knee brace, walks with stroller | Assess in-shoe loading within Pedor orthopaedic shoes | ● | ● | |||
16 | Left 2nd toe amputation, Left 3rd toe deformity | Assess barefoot loading, particularly around area of amputation | ● | ● | |||
17 | Current ulcers on medial side of Left and Right hallux | Assess barefoot loading, particularly around Left and Right hallux | ● | ● | |||
18 | Current ulcer under medial aspect of Right hallux | Assess barefoot loading under healing ulcer site | ● | ● | |||
19 | Peripheral neuropathy | General assessment of barefoot loading | ● | ● | |||
20 | Acute Charcot foot | Assess in-shoe loading with shoes and orthotic insoles | ● | ● | |||
21 | Current ulcer under Right hallux, painful and swollen Left foot | Assess barefoot loading under healing ulcer site | ● | ● | |||
Mod risk/Non-ulcer | 22 | Both knees partial amputation following car accident | Assess loading patterns with and without custom insoles | ● | ● | ||
23 | Severely enlarged Left and Right hallux (congenital deformity) | Assess barefoot loading, particularly hallux region | ● | ● | |||
24 | Charcot deformity | Compare barefoot and in-shoe loading, show patient benefit of wearing offloading footwear | ● | ● | ● | ||
25 | None | General assessment of barefoot loading | ● | ● | |||
26 | Gout | Compare old orthotic insoles with new custom orthotic insole | ● | ● | |||
27 | Flat feet | General assessment of barefoot loading | ● | ● | |||
28 | Severe recurrent callous under metatarsal heads | Compare barefoot loading pre- and post-callous debridement | ● | ● | |||
29 | Charcot deformity; former ulcers under Right forefoot and hallux | Assess in-shoe loading under former ulcer sites and Charcot deformity | ● | ● | |||
30 | Veruca on medial aspect of Right heel | Compare barefoot and in-shoe loading, show patient benefit of wearing offloading footwear | ● | ● | ● | ||
31 | Left midfoot deformity | Assess barefoot loading, particularly around Left midfoot deformity | ● | ● | |||
Low risk/General | 32 | Peripheral neuropathy | General assessment of barefoot loading | ● | ● | ||
33 | None | General assessment of barefoot loading | ● | ● | |||
34 | None | General assessment of barefoot loading | ● | ● | |||
35 | Arthritic pain in feet | General assessment of barefoot loading | ● | ● | |||
36 | None | General assessment of barefoot loading | ● | ● | |||
37 | Right foot pain under forefoot, callus under Right metatarsal heads | General assessment of barefoot loading | ● | ● | |||
38 | Pain under Left and Right Forefoot | Assess barefoot loading under painful Left and Right forefoot | ● | ● |
Participant experience
Measure of patient experience | Patients | |
---|---|---|
n | % | |
Time taken to perform pedobarography (minutes)a
| ||
Median (IQR) | 25 (20–30) | |
Range | 15–40 | |
Post-Testing Questions to Participants | ||
Did the patient enjoy the test? | ||
Yes | 38 | 100% |
No | 0 | 0% |
Don’t know | 0 | 0% |
Were there any parts that were annoying or frustrating? | ||
Yes | 5 | 13% |
No | 30 | 79% |
Don’t know | 3 | 8% |
If this test was offered to you again, would you do it? | ||
Yes | 31 | 82% |
No | 0 | 0% |
Don’t know | 7 | 18% |
Did you find the information useful?b
| ||
Yes | 34 | 89% |
No | 0 | 0% |
Don’t know | 3 | 8% |
Footwear behaviour
Patients, by clinic type | ||||||||
---|---|---|---|---|---|---|---|---|
Footwear behaviour | Total patients | High risk/ulcer | Mod. risk/non-ulcer | Low risk/general | ||||
n | % | n | % | n | % | n | % | |
Patient wearing closed footwear to clinic | 27 | 71% | 16 | 76% | 7 | 70% | 4 | 57% |
Cushioned sports shoes | 9 | 24% | 4 | 19% | 4 | 40% | 1 | 14% |
Surgical/Orthopaedic shoesa
| 11 | 29% | 10 | 48% | 1 | 10% | 0 | 0% |
Work boots | 3 | 8% | 1 | 5% | 1 | 10% | 1 | 14% |
Casual/non-cushioned sneakers | 4 | 11% | 1 | 5% | 1 | 10% | 2 | 29% |
Patient wearing non-closed footwear to clinicb
| 11 | 29% | 5 | 24% | 3 | 30% | 3 | 43% |