Plantar Pressure Research for Diabetic Foot Ulcers

A new research paper in “The Foot” titled “Reliability of F-Scan® in-shoe plantar pressure measurements in people with diabetes at risk of developing foot ulcers” has just been published. 

We took this opportunity to ask one of the authors of this paper, Dr. Ulla Hellstrand Tang, a few questions about her long history of research into the prevention of diabetic foot ulcers. 

You've been working in this area for a while, what has changed in the state of research and treatment over the years?  

Ulla: I am seeing three trends, which are sometimes in conflict and these are:  

  1. The demand for high quality prevention and care of diabetic foot problems is increasing however the resources are limited. 
  2. The demand for high quality evaluations of the feet, e.g, pressure measurement being assessed as valid and reliable is increasing. 
  3. The time it takes to make proper pressure measure measurements is not in place in clinical practice and the costs for the equipment had to be argued for and finally, professionals need to be allowed to put extra time to learn the system and use it for all patients when being relevant.  

The demand for solutions is enormous. Hundreds of millions of people are at risk for diabetic foot ulcers according to the World Diabetes Foundation. Is that what prompts you to keep working in this area? How did you pick this specialty?  

Forty-two years ago, I began to work as podiatrist and to improve the care chain for persons living with diabetes. That has always been my ambition. Small interventions at the right time can have a major impact for the individual. The visualization of the pressure map is a powerful tool in the dialog with the patients for assessing orthotics and proper footwear. This has been apparent in daily work at the Department of Prosthetics and Orthotics. 

Why did you choose the F-Scan to collect data for your research?  

In the late 1990s I got in contact with Tekscan at a conference. Some years later I moved to Gothenburg and started to work at the Department of Prosthetics & Orthotics at Sahlgrenska University Hospital,Gothenburg, Sweden. In the Gait Lab, Roy Tranberg and Roland Zügner used the F-Scan system.

Thereafter, more than 500 measurements have been performed in our research evaluating planter pressure in patients with diabetes.  

Your new research looks at the reliability of box placements. What is the importance of Sensel resolution or this kind of diabetic foot analysis?  

Of course, more sensel precision effects how the placement of the box can be identified. 

Do you think there is a place for pressure mapping as a clinical tool in diabetic foot treatment and ulcer prevention, and how might it get implemented?  

Yes, see above. In addition, integrated solutions, meaning integrated with the main medical record system, and ease of use would facilitate the use of plantar pressure measurement. To be able to incorporate the results in an easy way in the documentations would be a great improvement. The mobile equipment, is of course, a great improvement in the tool box.  

Any hints as to future topics you might tackle related to diabetic foot prevention and treatments?  

To build an integrated, secure eHealth system being able to capture different aspect of how patient stand, move, live including self-monitoring data, re-used in new solutions (prediction tools, self-management tools....) by using AI is an interesting area.  

However, MORE personal and improved COMPETENCE in clinical practice, of all professions is the first challenge for the decision-makers to solve.


About Ulla Hellstrand Tang

Ulla Hellstrand Tang
Ulla Hellstrand Tang

Current research areas

  • Ten year follow-up of gait, function in the lower extremities, plantar pressure and foot status of patients with diabetes provided with different types of insoles.
  • D-Foot, an eHealth tool to be used in risk stratification and foot assessment in patients with diabetes.
  • Assistive devices – Vision 2025. An innovation project to map the need of assistive devices now and in 2025. What are the needs of digital/manual foot screening? How should the provision of assistive devices be organised for patient with diabetes?
  • Silicon orthoses as treatment of heel crackers: an RCT comparing the treatment with silicon orthoses + moisture with treatment with moisture.
  • Sustainable healthcare with application of the care of the Diabetic Foot,
  • Facilitating and barriers in of digital innovation towards "Vision 2025 digital health care i Sweden"
  • A national quality register – the Diabetic Foot
  • MyFootDiabetes, an application aimed to be used by persons with diabetes for self-screening of the foot.
  • Hoj17/Bike4DIab, en cykeltur för bättre fothälsa, diabetes/a biking tour for better foot health in diabetes, The project was organized by Göteborgs Diabetes Association. The tour was 2 500 km long and lasted for 90 days. During the tour 13 meetings and 4 mini seminars were held. Twenty articles in newspapers were published. Four interviews in local radio was sent. TV4 highlighted the project to minimize amputations rate in patients with diabetes (…, downloaded 20171006).
  • Health politics. I am engaged in several projects to promote good foot health. The work is done in collaboration with the diabetes associations. I hold speeches and workshops with the main theme “sustainable foot health in diabetes- prevention and care”.