Foot ulcer recurrence, plantar pressure and footwear adherence in people with diabetes and Charcot midfoot deformity: A cohort analysis

Diabet Med. 2021 Apr;38(4):e14438. doi: 10.1111/dme.14438. Epub 2020 Nov 3.

Abstract

Aims: To investigate people with Charcot midfoot deformity with regard to plantar pressure, footwear adherence and plantar foot ulcer recurrence.

Methods: Twenty people with diabetes, Charcot midfoot deformity, plantar foot ulcer history and custom-made footwear were assessed with regard to barefoot and in-shoe plantar pressures during walking, footwear adherence (% of daily steps over 7-day period) and plantar foot ulcer recurrence over 18 months. In a cohort design, they were compared to 118 people without Charcot foot (non-Charcot foot group) with custom-made footwear and similar ulcer risk factors.

Results: Median (interquartile range) barefoot midfoot peak pressures were significantly higher in the Charcot foot group than in the non-Charcot foot group [756 (260-1267) vs 146 (100-208) kPa; P<0.001]. In-shoe midfoot peak pressures were not significantly higher in the Charcot foot group [median (interquartile range) 152 (104-201) vs 119 (94-160) kPa] and significantly lower for all other foot regions. Participants in the Charcot foot group were significantly more adherent, especially at home, than participants in the non-Charcot foot group [median (interquartile range) 94.4 (85.4-95.0)% vs. 64.3 (25.4-85.7)%; P=0.001]. Ulcers recurred in 40% of the Charcot foot group and in 47% of the non-Charcot foot group (P=0.63); midfoot ulcers recurred significantly more in the Charcot foot group (4/8) than in the non-Charcot foot group (1/55; P=0.001).

Conclusions: Effective offloading and very high footwear adherence were found in people with diabetes and Charcot midfoot deformity. While this may help protect against plantar foot ulcer recurrence, a large proportion of such people still experience ulcer recurrence. Further improvements in adherence and custom-made footwear design may be required to improve clinical outcome.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cohort Studies
  • Diabetic Foot* / epidemiology
  • Diabetic Foot* / pathology
  • Diabetic Foot* / physiopathology
  • Diabetic Foot* / therapy
  • Female
  • Foot / pathology
  • Foot / physiopathology
  • Foot Deformities, Acquired* / epidemiology
  • Foot Deformities, Acquired* / pathology
  • Foot Deformities, Acquired* / physiopathology
  • Foot Deformities, Acquired* / therapy
  • Gait Disorders, Neurologic / epidemiology
  • Gait Disorders, Neurologic / pathology
  • Gait Disorders, Neurologic / physiopathology
  • Gait Disorders, Neurologic / therapy
  • Humans
  • Male
  • Middle Aged
  • Orthopedic Equipment* / statistics & numerical data
  • Patient Compliance / statistics & numerical data*
  • Pressure
  • Recurrence
  • Shoes*
  • Walking / physiology