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Plantar Pressure Research for Diabetic Foot Ulcers
A recent study published in *The Foot* under the title **“Reliability of F-Scan® in-shoe plantar pressure measurements in people with diabetes at risk of developing foot ulcersâ€** has just come out. This caught our attention, so we reached out to Dr. Ulla Hellstrand Tang, one of the authors of this paper, to ask her some questions about her extensive research on preventing diabetic foot ulcers.
You’ve been working in this field for quite some time. What changes have you noticed in research and treatment over the years?
Ulla: Over the years, I’ve observed three main trends that sometimes contradict each other:
1. There’s a growing demand for high-quality prevention and care for diabetic foot issues, but unfortunately, the resources available remain limited.
2. People are increasingly demanding more reliable and valid evaluations of foot conditions, such as accurate pressure measurements.
3. However, making proper pressure measurements takes significant time, something that isn’t often feasible in clinical settings. Additionally, acquiring the necessary equipment requires justification of costs, and professionals need additional time to learn and implement these systems effectively.
With hundreds of millions of people at risk of diabetic foot ulcers, as reported by the World Diabetes Foundation, does this urgency drive your ongoing work? How did you choose this specialty?
I started working as a podiatrist 42 years ago, with the goal of improving the care chain for individuals living with diabetes. Small interventions at the right time can make a big difference for patients. Visualizing pressure maps is a powerful tool in discussions with patients regarding custom orthotics and appropriate footwear. This became clear during my daily work at the Department of Prosthetics and Orthotics.
Why did you decide to use the F-Scan system for your research?
Back in the late 1990s, I met Tekscan representatives at a conference. A few years later, I moved to Gothenburg and began working at the Department of Prosthetics & Orthotics at Sahlgrenska University Hospital. Roy Tranberg and Roland Zügner were already using the F-Scan system in the Gait Lab. Since then, over 500 measurements have been conducted in our research to evaluate plantar pressure in diabetic patients.
Your latest research focuses on the reliability of box placements. Why is Sensel resolution important in diabetic foot analysis?
Higher Sensel precision obviously affects how accurately we can identify box placements.
Do you believe pressure mapping could become a clinical tool for treating diabetic feet and preventing ulcers? How might it be implemented?
Yes, definitely. Integrated solutions—ones that seamlessly integrate with existing medical records—and ease of use would greatly help the adoption of plantar pressure measurement. Being able to easily incorporate results into documentation would be a major step forward. Mobile equipment has also made a significant improvement in usability.
What future topics do you think you might explore in diabetic foot prevention and treatment?
Building an integrated, secure eHealth system that captures various aspects of a patient's standing, movement, lifestyle, and self-monitoring data is an exciting area. These systems could then be reused in new solutions like prediction tools or self-management apps through AI.
However, the first challenge for decision-makers is improving personalization and competence in clinical practices across all professions.
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About Ulla Hellstrand Tang
[Insert Image of Ulla Hellstrand Tang]
Current Research Areas:
- Ten-year follow-up of gait, lower limb function, plantar pressure, and foot status in diabetic patients using different types of insoles.
- D-Foot, an eHealth tool for risk stratification and foot assessment in diabetic patients. [www.dfoot.se]
- Assistive devices – Vision 2025. An innovation project mapping current and future needs for assistive devices, including digital/manual foot screenings, and how they should be provided to diabetic patients.
- Silicon orthoses as treatment for heel fissures: a randomized controlled trial comparing silicon orthoses plus moisturizers versus just moisturizers.
- Sustainable healthcare applications for diabetic foot care.
- Facilitating digital innovations towards "Vision 2025" in Swedish healthcare.
- Establishing a national quality register for the Diabetic Foot.
- MyFootDiabetes, an app for self-screening of the foot by individuals with diabetes. [www.myfootdiabetes.se]
- Hoj17/Bike4DIab, a cycling tour promoting better foot health in diabetes. [www.hoj17.se] Organized by the Göteborgs Diabetes Association, the tour covered 2,500 kilometers over 90 days, with 13 meetings, 4 mini-seminars, and media coverage including newspaper articles and radio interviews.
- Health policy engagement. I’m involved in multiple projects to promote good foot health, collaborating with diabetes associations. I give talks and workshops on sustainable foot health in diabetes—prevention and care.
[Link to profile: https://www.gu.se/en/about/find-staff/c54cf772-f548-4a17-9fc2-85a1124dddb2]
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*Note: This interview has been lightly edited for clarity and length.*