{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T07:28:59Z","timestamp":1793604539735,"version":"4.5.0"},"reference-count":51,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,4,10]],"date-time":"2024-04-10T00:00:00Z","timestamp":1712707200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100018853","name":"Prince Charles Hospital Foundation","doi-asserted-by":"publisher","award":["INN2018-41"],"award-info":[{"award-number":["INN2018-41"]}],"id":[{"id":"10.13039\/501100018853","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Amsterdam Movement Sciences research institute","award":["INN2018-41"],"award-info":[{"award-number":["INN2018-41"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Reducing high mechanical stress is imperative to heal diabetes-related foot ulcers. We explored the association of cumulative plantar tissue stress (CPTS) and plantar foot ulcer healing, and the feasibility of measuring CPTS, in two prospective cohort studies (Australia (AU) and The Netherlands (NL)). Both studies used multiple sensors to measure factors to determine CPTS: plantar pressures, weight-bearing activities, and adherence to offloading treatments, with thermal stress response also measured to estimate shear stress in the AU-study. The primary outcome was ulcer healing at 12 weeks. Twenty-five participants were recruited: 13 in the AU-study and 12 in the NL-study. CPTS data were complete for five participants (38%) at baseline and one (8%) during follow-up in the AU-study, and one (8%) at baseline and zero (0%) during follow-up in the NL-study. Reasons for low completion at baseline were technical issues (AU-study: 31%, NL-study: 50%), non-adherent participants (15% and 8%) or combinations (15% and 33%); and at follow-up refusal of participants (62% and 25%). These underpowered findings showed that CPTS was non-significantly lower in people who healed compared with non-healed people (457 [117; 727], 679 [312; 1327] MPa\u00b7s\/day). Current feasibility of CPTS seems low, given technical challenges and non-adherence, which may reflect the burden of treating diabetes-related foot ulcers.<\/jats:p>","DOI":"10.3390\/s24082411","type":"journal-article","created":{"date-parts":[[2024,4,10]],"date-time":"2024-04-10T06:07:46Z","timestamp":1712729266000},"page":"2411","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The Stress of Measuring Plantar Tissue Stress in People with Diabetes-Related Foot Ulcers: Biomechanical and Feasibility Findings from Two Prospective Cohort Studies"],"prefix":"10.3390","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7941-2320","authenticated-orcid":false,"given":"Chantal M.","family":"Hulshof","sequence":"first","affiliation":[{"name":"Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, 1081 BT Amsterdam, The Netherlands"},{"name":"School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madelyn","family":"Page","sequence":"additional","affiliation":[{"name":"School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sjef G.","family":"van Baal","sequence":"additional","affiliation":[{"name":"ZGT Academy, ZGT, 7600 SZ Almelo, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8357-9163","authenticated-orcid":false,"given":"Sicco A.","family":"Bus","sequence":"additional","affiliation":[{"name":"Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, 1081 BT Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6108-893X","authenticated-orcid":false,"given":"Malindu E.","family":"Fernando","sequence":"additional","affiliation":[{"name":"Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA"},{"name":"Rancho Los Amigos National Rehabilitation Center, Los Angeles, CA 90242, USA"},{"name":"Ulcer and Wound Healing Consortium (UHEAL), Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia"},{"name":"Department of Vascular and Endovascular Surgery, John Hunter Hospital, New Lambton Heights, Newcastle, NSW 2305, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisette","family":"van Gemert-Pijnen","sequence":"additional","affiliation":[{"name":"Department of Psychology, Health & Technology, University of Twente, 7522 NB Enschede, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1278-205X","authenticated-orcid":false,"given":"Kilian D. R.","family":"Kappert","sequence":"additional","affiliation":[{"name":"Department of Surgery, ZGT, 7600 SZ Almelo, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Lucadou-Wells","sequence":"additional","affiliation":[{"name":"Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, QLD 4032, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0320-8101","authenticated-orcid":false,"given":"Bijan","family":"Najafi","sequence":"additional","affiliation":[{"name":"Interdisciplinary Consortium on Advanced Motion Performance, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6420-6046","authenticated-orcid":false,"given":"Jaap J.","family":"van Netten","sequence":"additional","affiliation":[{"name":"Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"},{"name":"Amsterdam Movement Sciences, Ageing & Vitality and Rehabilitation & Development, 1081 BT Amsterdam, The Netherlands"},{"name":"School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8235-7964","authenticated-orcid":false,"given":"Peter A.","family":"Lazzarini","sequence":"additional","affiliation":[{"name":"School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia"},{"name":"Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, QLD 4032, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,10]]},"reference":[{"key":"ref_1","unstructured":"GBD 2019 Diseases and Injuries Collaborators (2020). 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