Plantar pressure and daily cumulative stress in persons affected by leprosy with current, previous and no previous foot ulceration

Not only plantar pressure but also weight-bearing activity affects accumulated mechanical stress to the foot and may be related to foot ulceration. To date, activity has not been accounted for in leprosy. The purpose was to compare barefoot pressure, in-shoe pressure and daily cumulative stress between persons affected by leprosy with and without previous or current foot ulceration.Nine persons with current plantar ulceration were compared to 15 with previous and 15 without previous ulceration. Barefoot peak pressure (EMED-X), in-shoe peak pressure (Pedar-X) and daily cumulative stress (in-shoe forefoot pressure time integral × mean daily strides (Stepwatch™ Activity Monitor)) were measured.Barefoot peak pressure was increased in persons with current and previous compared to no previous foot ulceration (mean ± SD = 888 ± 222 and 763 ± 335 vs 465 ± 262 kPa, p < 0.05). In-shoe peak pressure was only increased in persons with current compared to without previous ulceration (mean ± SD = 412 ± 145 vs 269 ± 70 kPa, p < 0.05). Daily cumulative stress was not different between groups, although persons with current and previous foot ulceration were less active.Although barefoot peak pressure was increased in people with current and previous plantar ulceration, it did not discriminate between these groups. While in-shoe peak pressure was increased in persons with current ulceration, they were less active, resulting in no difference in daily cumulative stress. Increased in-shoe peak pressure suggests insufficient pressure reducing footwear in persons with current ulceration, highlighting the importance of pressure reducing qualities of footwear.

► Different foot pressure parameters were assessed in persons affected by leprosy. ► Persons with current and previous foot ulceration had higher barefoot pressure. ► Persons with current foot ulceration had higher in-shoe pressure than persons with previous ulceration. ► High in-shoe pressure suggests insufficient pressure reducing footwear in those with current foot ulceration. ► The importance of paying attention to pressure reducing properties of footwear is highlighted.