Plantar Pressure and Sensation of the Intact Foot of Lower Limb Prosthesis Users With Diabetes or Vascular Insufficiency: A Scoping Review

Background Prosthesis use alters loading of the intact limb, which may manifest as greater loading of the plantar surface of the intact foot. Increased plantar loading in patients with diabetes could promote ulceration and contribute to the high rates of contralateral amputations. We reviewed the literature to determine if there are differences between the intact foot of lower limb prosthesis users (LLPUs) with diabetes and related etiologies and able-bodied individuals regarding 1) plantar pressure during walking and 2) somatosensation, a second risk factor for diabetic foot ulcerations. Materials and Methods Three databases were searched using terms related to our primary questions. We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to systematically review returned entries for inclusion/exclusion in a two-step process. Ten articles were ultimately included in the review. Results Six studies reported on plantar pressure measures, among which four reported significant or “potentially meaningful” (0.05 < P < 0.10) increases in a pressure measure in at least one region of the intact foot. Two of the three studies that considered light touch sensation reported impairments in LLPUs that were significant or potentially meaningful. One of the two studies evaluating vibratory sensation reported significant differences compared to controls. Conclusions While evidence suggests that somatosensory and loading profiles of the intact foot of some LLPUs may place them at increased risk of developing a foot ulcer, additional studies are needed to better understand generalizability of these findings. Even in absence of clear evidence supporting increased loading or diminished sensation in LLPUs, the evidence overwhelmingly indicates measures are not improved (lower pressures or better sensation) in LLPUs. Clinical relevance Statement Assessment of intact foot function of LLPUs with diabetes and/or vascular disease may be relevant for identifying patients who are at increased risk of ulceration of the intact foot. Even in absence of increased risk, these LLPUs could still benefit from including offloading interventions into standard of care for the intact foot