{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:14:47Z","timestamp":1783509287282,"version":"3.55.0"},"reference-count":14,"publisher":"MDPI AG","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Studies have shown that personal and economic reasons determine whether clinicians use diagnostic technology in their routine clinical biomechanical practice. This study aimed to identify the biomechanical management plan of local clinicians in relation to management of the diabetic high-risk foot and to investigate whether diagnostic technology is being used to determine the effectiveness of dispensed prescription orthoses in view of ulcer prevention.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    A mixed-methodologic approach was adopted in this study. A retrospective quantitative study was also conducted to access records of patients attending the biomechanics clinic at a local health biomechanics clinic. Outcomes of interest included the number and percentage of patients attending the biomechanics clinic, source of referral to this clinic, age and gender of patients, clinical diagnosis, management plan, and referral pathway. Following a phenomenologic approach, four experienced clinicians working in the private, primary, and tertiary health sectors were interviewed. Thematic analysis was used to analyze and interpret data.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    Only low-risk patients living with diabetes mellitus were referred for a comprehensive biomechanical examination; the majority were referred by podiatrists. There was no record of diabetic high-risk patients being referred for a detailed biomechanical assessment within the health service. This study also confirmed that, because of the expenses and laborious work involved when using diagnostic technology to assess foot pressures, interviewed clinicians based their treatment plan and tested the efficiency of dispensed offloading devices on the basis of clinical experience and visual observation only.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    Waiting for signs of ulceration can be too late for the high-risk foot. A change in clinical practice is recommended where the integration of diagnostic technology, together with standard care, in view of ulcer prevention is warranted.\n                  <\/jats:p>","DOI":"10.7547\/21-141","type":"journal-article","created":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T11:56:13Z","timestamp":1699358173000},"source":"Crossref","is-referenced-by-count":0,"title":["Digital Foot Technology in Ulcer Prevention and Reulceration: A Clinical Perspective"],"prefix":"10.3390","volume":"113","author":[{"given":"Claire Saliba","family":"Thorne","sequence":"first","affiliation":[{"name":"*University of Malta, Msida, Malta."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Gatt","sequence":"additional","affiliation":[{"name":"*University of Malta, Msida, Malta."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Formosa","sequence":"additional","affiliation":[{"name":"*University of Malta, Msida, Malta."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"issue":"suppl 1","key":"B1","series-title":"Diabetes Metab Res Rev","first-page":"16","article-title":"IWGDF guidance on the prevention of foot ulcers in at-risk patients with diabetes","volume":"32","author":"Bus SA","year":"2016","unstructured":"Bus SA, van Netten JJ, Lavery LA: IWGDF guidance on the prevention of foot ulcers in at-risk patients with diabetes. Diabetes Metab Res Rev 32\u2009(suppl 1): 16, 2016."},{"key":"B2","series-title":"Sensors (Basel","first-page":"9884","article-title":"Foot plantar pressure measurement system: a review","volume":"12","author":"Razak AHA","year":"2012","unstructured":"Razak AHA, Zeyegh A, Begg RK: Foot plantar pressure measurement system: a review. Sensors (Basel) 12: 9884, 2012."},{"key":"B3","series-title":"Pediatric Gait: A New Millennium in Clinical Care and Motion Analysis Technology","first-page":"143","article-title":"Clinical Applications of Plantar Pressure Measurement in Pediatric Orthopedics","author":"MacWilliams BA","year":"2000","unstructured":"MacWilliams BA, Armstrong PF: \u201cClinical Applications of Plantar Pressure Measurement in Pediatric Orthopedics,\u201d in Pediatric Gait: A New Millennium in Clinical Care and Motion Analysis Technology, p 143, Chicago, IL, 2000."},{"key":"B4","series-title":"Wounds","first-page":"350","article-title":"Pressure-sensing devices for assessment of soft tissue loading under bony prominences: technological concepts and clinical utilization","volume":"19","author":"Gefen A","year":"2007","unstructured":"Gefen A: Pressure-sensing devices for assessment of soft tissue loading under bony prominences: technological concepts and clinical utilization. Wounds 19: 350, 2007."},{"key":"B5","series-title":"Diabetes Care","first-page":"645","article-title":"Current challenges and opportunities in the prevention and management of diabetic foot ulcers","volume":"41","author":"Jeffcoate WJ","year":"2018","unstructured":"Jeffcoate WJ, Vileikyte L, Boyko EJ: Current challenges and opportunities in the prevention and management of diabetic foot ulcers. Diabetes Care 41: 645, 2018."},{"key":"B6","series-title":"N Engl J Med","first-page":"2367","article-title":"Diabetic foot ulcers and their recurrence","volume":"376","author":"Armstrong DG","year":"2017","unstructured":"Armstrong DG, Boulten AJM, Bus SA: Diabetic foot ulcers and their recurrence. N Engl J Med 376: 2367, 2017."},{"key":"B7","series-title":"Diabetes Care","first-page":"4109","article-title":"Effect of custom-made footwear on foot ulcer recurrence in diabetes: a multicentre randomized controlled trial","volume":"36","author":"Bus SA","year":"2013","unstructured":"Bus SA, Waaijman R, Arts M: Effect of custom-made footwear on foot ulcer recurrence in diabetes: a multicentre randomized controlled trial. Diabetes Care 36: 4109, 2013."},{"key":"B8","article-title":"WMA Declaration of Helsinki\u2014Ethical Principles for Medical Research Involving Human Subjects","year":"2021","unstructured":"World Medical Association: WMA Declaration of Helsinki\u2014Ethical Principles for Medical Research Involving Human Subjects. Available at: https:\/\/www.wma.net\/policies-post\/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects\/. Accessed May 20, 2021."},{"key":"B9","article-title":"Clinical audit: a manual for lay members of the clinical audit team","author":"Hughes M","year":"20","unstructured":"Hughes M: Clinical audit: a manual for lay members of the clinical audit team. Available at: https:\/\/www.hqip.org.uk\/wp-content\/uploads\/2018\/02\/developing-clinical-audit-patient-panels.pdf. Accessed May 20, 2021."},{"key":"B10","series-title":"diabetes. Diabetes Care","first-page":"1041","article-title":"Beyond the monofilament for the insensate diabetic foot: a systematic review of randomized trials to prevent the occurrence of plantar foot ulcers in patients with","volume":"34","author":"Arad Y","year":"2011","unstructured":"Arad Y, Fonseca V, Peters A: Beyond the monofilament for the insensate diabetic foot: a systematic review of randomized trials to prevent the occurrence of plantar foot ulcers in patients with diabetes. Diabetes Care 34: 1041, 2011."},{"key":"B11","series-title":"Global Perspective on Diabetic Foot Ulcerations","article-title":"The Biomechanics of the Diabetic Foot","author":"Shavelson D","year":"2011","unstructured":"Shavelson D: \u201cThe Biomechanics of the Diabetic Foot,\u201d in Global Perspective on Diabetic Foot Ulcerations, edited by T Dinh, Rijeka, Croatia, InTech, 2011."},{"key":"B12","series-title":"Diabetes Care","first-page":"1679","article-title":"Comprehensive foot examination and risk assessment: a report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists","volume":"88","author":"Boulton AJ","year":"2008","unstructured":"Boulton AJ, Armstrong DG, Albert SF: Comprehensive foot examination and risk assessment: a report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care 88: 1679, 2008."},{"key":"B13","series-title":"Diabetes Care","first-page":"1982","article-title":"Prevention of recurrent foot ulcers with plantar pressure-based in-shoe orthoses: the careful prevention multicenter randomized controlled trial","volume":"37","author":"Ulbrecht JS","year":"2014","unstructured":"Ulbrecht JS, Hurley T, Mauger DT: Prevention of recurrent foot ulcers with plantar pressure-based in-shoe orthoses: the careful prevention multicenter randomized controlled trial. Diabetes Care 37: 1982, 2014."},{"key":"B14","series-title":"Plast Reconstr Surg","first-page":"179S","article-title":"The role of pressure offloading on diabetic foot ulcer healing and prevention of recurrence","volume":"138","author":"Bus SA","year":"2016","unstructured":"Bus SA: The role of pressure offloading on diabetic foot ulcer healing and prevention of recurrence. Plast Reconstr Surg 138: 179S, 2016."}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/japmaonline.org\/view\/journals\/apms\/113\/5\/21-141.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/113\/5\/21-141.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/113\/5\/21-141.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:19:23Z","timestamp":1783505963000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/113\/5\/21141"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9]]},"references-count":14,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.7547\/21-141","relation":{},"ISSN":["8750-7315"],"issn-type":[{"value":"8750-7315","type":"print"}],"subject":[],"published":{"date-parts":[[2023,9]]}}}