Podiatrists’ and orthotists’ views and experiences of using plantar pressure measurement in the assessment and treatment of diabetic foot syndrome

Rahimi Toudeshki, A

Abstract

Background: The measurement of plantar pressure is recommended as a clinical tool for risk assessment, prevention and treatment of diabetic foot ulceration. To first assess comprehensively the available evidence on the use of plantar pressure assessment (PPA) to guide footwear and insole design and modification in people with diabetic foot disease, a systematic review was undertaken. Although the current evidence supports the use of PPA in diabetic foot management, the implementation of the technology in a clinical setting faces barriers such as competency, cost, time, etc. Therefore, a qualitative study was conducted to determine the barriers and facilitators of clinical usage of PPA according to podiatrists’ and orthotists’ views and experiences in the assessment and treatment of diabetic foot syndrome.
Method: The literature search for the systematic review utilised Medline/Pubmed, Scopus, Cochrane, Clinical Trials, and CINAHL databases.
In terms of qualitative study, 4 Podiatrists and 2 Orthotists with and without experience of using plantar pressure measurement were recruited. Six semi-structured online interviews were conducted; the audio was recorded and transcribed. Then, inductive thematic analysis was used to analyse transcribed texts.
Result: The systematic review provides support for the use of PPA to optimise footwear and insole for the prevention of ulcer recurrence, and plantar pressure reduction in the diabetic foot.
The qualitative study revealed some barriers and facilitators to improve the clinical implementation of PPA. As a result, six themes have been defined: 1. The importance of training and education in clinical implementation of PPA, 2. Providing evidence for the NHS to prove the benefits of PPA, 3. Time and space, 4. Human resources 5. Specific triage 6. Cost. Clinicians were overwhelmingly in support of plantar pressure measurement to demonstrate high areas of pressure in people with diabetes. However, lack of knowledge, time and space were considered as the main barriers in clinical implementation of PPA.
Conclusion: The advantages of the use of plantar pressure data for insole and footwear modifications in people with diabetes have been supported by the evidence. However, the barriers to implementation of PPA include lack of knowledge and education about the use and interpret of plantar pressure data, shortage of time and space in routine clinical practice, and high cost of purchase and implementation of this technology.
Training in using plantar pressure device and interpreting the data is a key factor. Besides, providing evidence for the NHS is an important thing to bring the effectiveness of PPA into consideration. The NHS can allocate specific clinics and time to facilitate the clinical use of PPA.

Citation

Rahimi Toudeshki, A. (2022). Podiatrists’ and orthotists’ views and experiences of using plantar pressure measurement in the assessment and treatment of diabetic foot syndrome. (Dissertation). University of Salford

• Thesis Type: Dissertation
• Deposit Date: May 2, 2023
• Publicly Available Date: Jun 26, 2023
• Award Date: Nov 25, 2022