Foot deformity
We know a patient insensate to the 10g monofilament is 10x more likely to ulcerate. If your patient is unable to feel the 10g monofilament AND has a foot deformity, they are 32x more likely to ulcerate.
Foot deformity creates high pressure areas .In diabetes , the patient may suffer claw toes, dorsal IPJ prominence and prominent plantar MTPJs. Glycosilation of the tissues ( less stretch) create a less mobile foot. Thus the patient may have a stiffer foot with deformity which may not be able to compensate for the deformities by movement.
“In the face of neuropathy, foot pressure is a [key] component in the pathway to diabetic foot ulceration. Clearly identifying and quantifying pressure are the key steps to prevention. Assessing plantar pressure is critical to forming a plan of action to prevent ulceration and amputation. Pressurestat™ is the simplest, most inexpensive way I know of to go about this task in virtually any practice setting”
David G Armstrong DPM MSc PhD Professor of Surgery,Chair of Research and Assistant Dean Dr William M Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine
A diabetic patient is at risk of developing a neuropathic ulcer on an area of the plantar surface of the foot where the pressure per square centimetre exceeds 6Kg.
PressureStat™ clearly identifies and measures areas of high pressure on the plantar surface of the foot enabling preventative action to be taken prior to the likely development of a neuropathic ulcer.
PressureStat™ consists of four layers. A transparent sheet, white protective paper, carbon sheet and light weight card base marked with grid and mm scale.
Lift the transparent sheet, remove the white protective paper and carefully replace the transparent sheet on the underlying carbon sheet.
Place the PressureStat™ on the clinic floor and ask the patient to stand (static) or walk (dynamic) on/across the PressureStat™ so that one foot is placed approximately centrally on the PressureStat™.
Carefully lift the transparent sheet, remove the carbon sheet and replace the transparent sheet on the light weight card base.
An accurate image of the patient’s foot is clearly transposed onto the card base showing:
Foot type.
Pressure exerted on the plantar surface of the foot depicted by differing shades of white/grey/black, where white indicates an area of no pressure.The darker the shade , the more pressure there is on that part of the foot – dark is dangerous.
Measure the areas of pressure using the calibrated card colour scale provided with each box.
Having obtained an image of each foot, PressureStat™ can now be shown and explained to the patient. A white board marker can be used to write on the transparent sheet to emphasise individual areas and cleaned off after use with a damp tissue.
PressureStat™ can be sealed with the self adhesive tabs, folded and placed with the patient notes. Annual or six monthly comparisons can then be made at future visits.
Risk categorisation
Once the patient has been assessed, the clinician may then award a risk category to the patient. The most recent classification is thus:
Low Risk – no foot deformity , neuropathy or vascular impairment
At Risk – either a foot deformity , or neuropathy or vascular impairment
High Risk – current/previous ulcer or amputation
Useful links