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

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 4080% 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 (R)) 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 +/- 9kPa, p<0.0001) and T2 (167 +/- 11, p=0.001), as compared with T0 (242 +/- 12kPa) 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 +/- 8kPa, p=0.01) and T2 (65 +/- 8kPa, p=0.01), as compared with T0 (58 +/- 6kPa). 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 (c) 2012 John Wiley & Sons, Ltd.