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Meta-Analysis
. 2014 Jun 10;9(6):e99050.
doi: 10.1371/journal.pone.0099050. eCollection 2014.

Plantar pressure in diabetic peripheral neuropathy patients with active foot ulceration, previous ulceration and no history of ulceration: a meta-analysis of observational studies

Malindu Eranga Fernando  1 , Robert George Crowther  2 , Elise Pappas  3 , Peter Anthony Lazzarini  4 , Margaret Cunningham  5 , Kunwarjit Singh Sangla  6 , Petra Buttner  7 , Jonathan Golledge  8
Affiliations
Meta-Analysis

Plantar pressure in diabetic peripheral neuropathy patients with active foot ulceration, previous ulceration and no history of ulceration: a meta-analysis of observational studies

Malindu Eranga Fernando et al. PLoS One. .

Abstract

Aims: Elevated dynamic plantar pressures are a consistent finding in diabetes patients with peripheral neuropathy with implications for plantar foot ulceration. This meta-analysis aimed to compare the plantar pressures of diabetes patients that had peripheral neuropathy and those with neuropathy with active or previous foot ulcers.

Methods: Published articles were identified from Medline via OVID, CINAHL, SCOPUS, INFORMIT, Cochrane Central EMBASE via OVID and Web of Science via ISI Web of Knowledge bibliographic databases. Observational studies reporting barefoot dynamic plantar pressure in adults with diabetic peripheral neuropathy, where at least one group had a history of plantar foot ulcers were included. Interventional studies, shod plantar pressure studies and studies not published in English were excluded. Overall mean peak plantar pressure (MPP) and pressure time integral (PTI) were primary outcomes. The six secondary outcomes were MPP and PTI at the rear foot, mid foot and fore foot. The protocol of the meta-analysis was published with PROPSERO, (registration number CRD42013004310).

Results: Eight observational studies were included. Overall MPP and PTI were greater in diabetic peripheral neuropathy patients with foot ulceration compared to those without ulceration (standardised mean difference 0.551, 95% CI 0.290-0.811, p<0.001; and 0.762, 95% CI 0.303-1.221, p = 0.001, respectively). Sub-group analyses demonstrated no significant difference in MPP for those with neuropathy with active ulceration compared to those without ulcers. A significant difference in MPP was found for those with neuropathy with a past history of ulceration compared to those without ulcers; (0.467, 95% CI 0.181- 0.753, p = 0.001). Statistical heterogeneity between studies was moderate.

Conclusions: Plantar pressures appear to be significantly higher in patients with diabetic peripheral neuropathy with a history of foot ulceration compared to those with diabetic neuropathy without a history of ulceration. More homogenous data is needed to confirm these findings.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Search Results.
Search results indicating total number of identified records (2730) and the number of articles remaining after duplicate removal (894) and the number of records excluded (827) and the number of full text articles assessed for eligibility according to the inclusion and exclusion criteria listed. This resulted in eight observational studies which were included in the meta-analysis.
Figure 2
Figure 2. Forest Plot.
Forest Plot displaying the Overall Peak Plantar Pressure (MPP) between the PPDFU group (cases) and the DPN group (control). Overall effect is represented by the coloured diagonal. Eight studies are included in total.
Figure 3
Figure 3. Forest Plot.
Forest Plot displaying the Overall Pressure Time Integral (PTI) between the PPDFU group(cases) and the DPN group(control). Overall effect is represented by the coloured diagonal. Three studies are included in total.
Figure 4
Figure 4. Forest Plot.
Forest Plot displaying the Fore Foot Peak Plantar Pressure (MPP) between PPDFU group (cases) and DPN group (control). Overall effect is represented by the coloured diagonal. Six studies are included in total.
See this image and copyright information in PMC

References

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