Authors (including presenting author) :
Lai JTY(1), Kwan YO(1), Ling KKS(2)
Affiliation :
(1)Department of Podiatry, Princess Margaret Hospital, (2)Department of Orthopaedics & Traumatology, the Chinese University of Hong Kong.
Introduction :
Diabetes Mellitus (DM) foot assessment and ulceration prevention contributes to a large proportion of daily cases seen by Podiatrist. Although the risk diabetic foot ulcers can be multifactorial, those complicated with diabetic peripheral neuropathy (DPN) co-existent with plantar callosities are more prone to ulcerations. Plantar callosities can cause excessive local plantar pressure if left untreated and lead to tissue breakdown in an insensate foot. Podiatrist management for this group of patients adopts a holistic approach, apart from usage of topical medications, paddings, insoles, footcare and footwear education, callus sharp debridement is often given as a first line treatment.
Objectives :
This study aimed at quantifying the treatment effect of podiatric sharp debridement of callus in diabetic neuropathic patients using pedobarographic parameters. The immediate and short-term (3-4 weeks) effect of sharp debridement in diabetic neuropathic patients with callus was investigated.
Methodology :
Active patients of the Princess Margaret Hospital Podiatry Department diagnosed with DM were screened. DPN was detected by failing either one of 10g monofilament protective sensation test or exceeding the neurothesiometer vibration perception threshold. Eligible patients were given sharp debridement carried out by the researcher. Barefooted pedobarography was carried out by TekScan MatScan system. Pedobarographic measurements were done before (t0), immediately after (t1) and 3 – 4 weeks after (t3) intervention. Measurements from callus site were drawn for analysis. Primary outcome measurement was peak plantar pressure (PPP), secondary outcome measurements were pressure time integral (PTI).
Result & Outcome :
A total of 16 feet from 10 subjects were recruited. Among recruited subjects, 9 were male and 1 was female, mean age was 68.9±9.43 years, mean duration of DM diagnosis was 20.55±12.59 years. One-way ANOVA analysis reveal PPP (p = 0.009) and PTI (p = 0.007) showed significant change over the study period. PPP decreased from 778.92±365.04 kPa to 657.35±315.63 kPa (-15.61%) at t1 and increased slightly to 670.06±303.10 kPa (+1.93%) at t3, remaining 13.98% lower than t0. PTI decreased from 227.15±121.84 kPa*sec to 180.48±86.81 kPa*sec (- 20.55%) at t1, which reached statistical significance in post hoc pairwise comparison (p = 0.014). Although it then increased to 200.98±100.87 kPa*sec (+11.36%) at t3, it
is still 2.72% lower than t0.
Podiatric sharp debridement in DPN patients has immediate effect in reducing PPP and PTI in callus area. Although treatment effect seems to partially attenuate with time, this desirable outcome can last for 3-4 weeks. Presence of callus in DPN foot without proper treatment can predispose to tissue breakdown. Our study results highlighted the essential role of Podiatric callus debridement in DPN patients. Being part of a multidisciplinary diabetic foot management team, podiatrists contribute to early identification of high-risk patient groups with neuropathy and plantar callus, and provide timely intervention to prevent complications, ultimately reducing risk of foot ulceration, hospitalization and rate of amputation.
