Toe Pressure in Predicting Diabetic Foot Ulcer Healing: A Systematic Review and Meta-analysis

Background: Foot ulceration is the most frequently recognized lower extremity complication in diabetic patients. Predicting wound healing is an essential step in the management of diabetic foot ulcers (DFUs), as it is estimated that early detection and appropriate treatments may prevent up to 85% of amputations. Toe systolic blood pressure (TBP) is a quick and portable bedside assessment and is less affected by medial sclerosis of arteries present in the diabetic population compared to other measurements like ankleebrachial index. This systematic review seeks to evaluate the sensitivity and specificity of toe pressure in prediction of DFU wound healing. Methods: PubMed/MEDLINE and EMBASE databases were systematically searched up to September 20, 2017 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All randomized control, prospective and retrospective trials were considered for inclusion if they reported healing rates of DFUs with respect to different TBP readings. Healing was defined to be intact skin for at least 6 months or at time of death. Quality assessment of articles was performed using the RevMan Quality Assessment. Information on healing rates with respect to different TBP values was extracted. Summary estimates of sensitivity and specificity of TBP in predicting healing of DFU wounds were obtained using a bivariate model. Results: A total of 580 articles were screened. Eight studies (6 prospective and 2 retrospective) inclusive of 909 patients were eligible for inclusion. It was found that a TBP of more than 30 mm Hg is associated with a sensitivity and specificity of 0.86 and 0.58 respectively for healing of DFUs. Conclusions: A TBP of more than 30 mm Hg is sensitive but not specific in the prediction of healing of DFUs. Due to its portability and quick analysis, TBP may be used as a bedside assessment to complement current clinical parameters to aid in predicting the healing of diabetic foot ulcers.