In-shoe pressure thresholds for people with diabetes and neuropathy at risk of ulceration: A systematic review
Jones, Petra Davies, Melanie Webb, David
Jones, Petra
Davies, Melanie
Webb, David
Abstract
Introduction: In-shoe pressure thresholds play an increasingly important role in the prevention of diabetes-related foot ulceration (DFU). The evidence of their effectiveness, methodological consistency and scope for refinement are the subject of this review.
Methods: 1107 records were identified (after duplicate removal) based on a search of five databases for studies which applied a specific in-shoe pressure threshold to reduce the risk of ulceration. 37 full text studies were assessed for eligibility of which 21 were included.
Results: Five in-shoe pressure thresholds were identified, which are employed to reduce the risk of diabetes-related foot ulceration: a mean peak pressure threshold of 200 kPa used in conjunction with a 25% baseline reduction target; a sustained pressure threshold of 35 mm Hg, a threshold matrix based on risk, shoe size and foot region, and a 40-80% baseline pressure reduction target. The effectiveness of the latter two thresholds have not been assessed yet and the evidence for the effectiveness of the other in-shoe pressure thresholds is limited, based only on two RCTs and two cohort studies.
Conclusions: The heterogeneity of current measures precludes meta-analysis and further research and methodological standardisation is required to facilitate ready comparison and the further development of these pressure thresholds.
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Date
2021-03
Type
Article
Subject
Diabetes, Foot, In-shoe, Neuropathy, Pressure, Threshold
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Citation
Jones, P., Davies, M. J., Khunti, K., Fong, D., & Webb, D. (2021). In-shoe pressure thresholds for people with diabetes and neuropathy at risk of ulceration: A systematic review. Journal of diabetes and its complications, 35(3), 107815.
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Publisher
Elsevier Inc