Biofeedback can reduce foot pressure to a safe level and without causing new at-risk zones in patients with diabetes and peripheral neuropathy

Authors

  • D. De León Rodriguez,

    1. Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
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  • L. Allet,

    1. Health Care Directorate, University Hospitals of Geneva, Geneva, Switzerland
    2. Department of Neurosciences, University Hospitals of Geneva, Geneva, Switzerland
    3. Department of Physical Therapy, University of Applied Sciences, Geneva, Switzerland
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  • A. Golay,

    1. Service of Therapeutic Education for Chronic Diseases, WHO Collaborating Centre, Department of Community Medicine, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
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  • J. Philippe,

    1. Service of Endocrinology, Diabetes and Nutrition, University Hospitals of Geneva, Geneva, Switzerland
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  • J.-Ph. Assal,

    1. Foundation for Research and Training in Patient Education, Geneva, Switzerland
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  • C.-A. Hauert,

    1. Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
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  • Z. Pataky

    Corresponding author
    • Service of Therapeutic Education for Chronic Diseases, WHO Collaborating Centre, Department of Community Medicine, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
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Correspondence to: Zoltan Pataky, Service of Therapeutic Education for Chronic Diseases, WHO Collaborating Centre, University Hospitals of Geneva, Gabrielle-Perret-Gentil 4, CH – 1211 Geneva 14, Switzerland.

E-mail: zoltan.pataky@hcuge.ch

Abstract

Background

Plantar pressure reduction is mandatory for diabetic foot ulcer healing. Our aim was to evaluate the impact of a new walking strategy learned by biofeedback on plantar pressure distribution under both feet in patients with diabetic peripheral neuropathy.

Methods

Terminally augmented biofeedback has been used for foot off-loading training in 21 patients with diabetic peripheral sensory neuropathy. The biofeedback technique was based on a subjective estimation of performance and objective visual feedback following walking sequences. The patient was considered to have learned a new walking strategy as soon as the peak plantar pressure (PPP) under the previously defined at-risk zone was within a range of 40–80% of baseline PPP in 70% of the totality of steps and during three consecutive walking sequences. The PPP was measured by a portable in-shoe foot pressure measurement system (PEDAR®) at baseline (T0), directly after learning (T1) and at 10-day retention test (T2).

Results

The PPP under at-risk zones decreased significantly at T1 (165 ± 9 kPa, p < 0.0001) and T2 (167 ± 11, p = 0.001), as compared with T0 (242 ± 12 kPa) without any increase of the PPP elsewhere.

At the contralateral foot (not concerned by off-loading), the PPP was slightly higher under the lateral midfoot at T1 (68 ± 8 kPa, p = 0.01) and T2 (65 ± 8 kPa, p = 0.01), as compared with T0 (58 ± 6 kPa).

Conclusions

The foot off-loading by biofeedback leads to a safe and regular plantar pressure distribution without inducing any new ‘at-risk’ area under both feet. Copyright © 2012 John Wiley & Sons, Ltd.

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