Plantar Pressure Research for Diabetic Foot Ulcers
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A recent study published 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 come out. This paper caught my attention, so I reached out to one of its authors, Dr. Ulla Hellstrand Tang, to discuss her extensive work on preventing diabetic foot ulcers.
You’ve been in this field for quite some time—what changes have you seen in research and treatment over the years?
Ulla: Over the years, I’ve noticed three significant trends, though they often seem to conflict with each other. First, there’s an increasing demand for high-quality prevention and care for diabetic foot issues, yet resources remain limited. Second, there’s growing pressure for valid and reliable evaluations of foot conditions, such as pressure measurement. Third, making accurate pressure measurements in a clinical setting takes time, which isn’t always feasible given the current setup. Additionally, the cost of the equipment can be challenging to justify, and professionals need more time to learn how to use it effectively.
With hundreds of millions of people at risk for diabetic foot ulcers globally, as per the World Diabetes Foundation, what drives you to continue working in this area? How did you decide to focus on this specialty?
I began my career as a podiatrist 42 years ago, with the goal of improving the care chain for people living with diabetes. I believe small interventions at the right time can make a big difference for individuals. Seeing the impact of visualizing pressure maps in discussions with patients about orthotics and proper footwear has been incredibly rewarding. It’s something we’ve observed firsthand in our department.
Why did you choose the F-Scan system for your research?
Back in the late 1990s, I met representatives from Tekscan at a conference. Later, when I moved to Gothenburg and joined the Department of Prosthetics & Orthotics at Sahlgrenska University Hospital, I learned about the F-Scan system through colleagues like Roy Tranberg and Roland Zügner. Since then, we’ve conducted over 500 measurements using the F-Scan 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 clearly impacts how accurately boxes can be placed. It’s crucial for precise data collection and analysis.
Do you think pressure mapping could become a standard clinical tool for treating diabetic feet and preventing ulcers, and if so, how might it be implemented?
Absolutely. Integrated solutions that connect seamlessly with existing electronic health records and are user-friendly would greatly enhance adoption. Having the ability to easily incorporate results into documentation would be transformative. The portability of the equipment is also a huge advantage.
What future topics do you think you might explore related to diabetic foot prevention and treatment?
Building an integrated eHealth system capable of capturing various aspects of a patient's movement, posture, and lifestyle—including self-monitoring data—is fascinating. Using AI to repurpose this data into predictive tools or self-management apps holds immense potential. However, the primary challenge remains improving personalization and boosting professional competence across all fields involved in clinical practice.
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**About Ulla Hellstrand Tang**
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*Current Research Areas*
- A ten-year follow-up study examining gait, lower limb function, plantar pressure, and foot status in diabetic patients using different types of insoles.
- D-Foot—an eHealth tool designed for risk stratification and foot assessment in diabetic patients. [www.dfoot.se]
- Assistive devices—Vision 2025. An innovation project mapping the need for assistive devices now and in 2025. Questions include: What are the needs for digital/manual foot screenings? How should the provision of assistive devices be organized for diabetic patients?
- Silicone orthoses as a treatment for heel fissures: A randomized controlled trial comparing silicone orthoses plus moisturizers versus moisturizers alone.
- Sustainable healthcare applications in diabetic foot care.
- Barriers and facilitators in digital innovation toward "Vision 2025 digital healthcare in Sweden."
- Establishing a national quality registry for the diabetic foot.
- MyFootDiabetes, an app aimed at helping people with diabetes perform self-foot screenings. [www.myfootdiabetes.se]
- Hoj17/Bike4DIab, a cycling tour promoting better foot health in diabetes. Organized by Göteborgs Diabetesföreningen, the tour covered 2,500 km over 90 days, featuring 13 meetings, four mini-seminars, and media coverage. [www.hoj17.se]
- Health policy advocacy. I’m involved in several projects promoting sustainable foot health in diabetes through prevention and care. Collaborating with diabetes associations, I deliver speeches and workshops focusing on "sustainable foot health in diabetes."
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[Additional Notes]
While working on these projects, I’ve realized that addressing the needs of diabetic patients requires multidisciplinary collaboration. From clinicians to engineers, everyone plays a vital role. As we move forward, integrating technology into routine care will be key—but only if it complements human expertise rather than replacing it.