title: Efficacy measures associated to a plantar pressure based classification system in diabetic foot medicine.
abstract: The concept of 'classification' has, similar to many other diseases, been found to be fundamental in the field of diabetic medicine. In the current study, we aimed at determining efficacy measures of a recently published plantar pressure based classification system.
  
  
  
  Technical efficacy of the classification system was investigated by applying a high resolution, pixel-level analysis on the normalized plantar pressure pedobarographic fields of the original experimental dataset consisting of 97 patients with diabetes and 33 persons without diabetes. Clinical efficacy was assessed by considering the occurence of foot ulcers at the plantar aspect of the forefoot in this dataset. Classification efficacy was assessed by determining the classification recognition rate as well as its sensitivity and specificity using cross-validation subsets of the experimental dataset together with a novel cohort of 12 patients with diabetes.
  
  
  
  Pixel-level comparison of the four groups associated to the classification system highlighted distinct regional differences. Retrospective analysis showed the occurence of eleven foot ulcers in the experimental dataset since their gait analysis. Eight out of the eleven ulcers developed in a region of the foot which had the highest forces. Overall classification recognition rate exceeded 90% for all cross-validation subsets. Sensitivity and specificity of the four groups associated to the classification system exceeded respectively the 0.7 and 0.8 level in all cross-validation subsets.
  
  
  
  The results of the current study support the use of the novel plantar pressure based classification system in diabetic foot medicine. It may particularly serve in communication, diagnosis and clinical decision making.
authors.affiliation: KU Leuven, Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, Belgium, KU Leuven, Laboratory for Clinical Motion Analysis, University Hospital Pellenberg, Belgium, Parnasse-ISEI, Department of Podiatry, Avenue E. Mounier, 84 - 1200 Bruxelles, Weligerveld 1, 3212 Pellenberg, Belgium. Electronic address: kevin.deschamps@faber.kuleuven.be.
authors.forename: Kevin
authors.initials: K
authors.lastname: Deschamps
authors.affiliation: KU Leuven, Department of Development & Regeneration, Belgium, KU Leuven, Multidisciplinary Diabetic Foot Clinic, University Hospitals Leuven, Belgium, Weligerveld 1, 3212 Pellenberg, Belgium. Electronic address: Giovanni.matricali@uzleuven.be.
authors.forename: Giovanni Arnoldo
authors.initials: GA
authors.lastname: Matricali
authors.affiliation: KU Leuven, Department of Mechanical Engineering, Belgium, Celestijnenlaan 300B bus 2420, Room 01.053, B-3001 Leuven (Heverlee), Belgium. Electronic address: Dirk.desmet@mech.kuleuven.be.
authors.forename: Dirk
authors.initials: D
authors.lastname: Desmet
authors.affiliation: Department of Rehabilitation Sciences and Physiotherapy, Research Group: Musculoskeletal Rehabilitation, University Ghent, Belgium, Campus Heymans (UZ Gent), Blok B3, De Pintelaan 185, 9000 Gent. Electronic address: Philip.Roosen@UGent.be.
authors.forename: Philip
authors.initials: P
authors.lastname: Roosen
authors.affiliation: Sint Maartenskliniek Nijmegen, Research Department, PO box 9011, 6500 GM Nijmegen, The Netherlands. Electronic address: n.keijsers@maartenskliniek.nm.
authors.forename: Noel
authors.initials: N
authors.lastname: Keijsers
authors.affiliation: Department of Internal Medicine- Endocrinology, Multidisciplinary Diabetic Foot Clinic, Onze-Lieve-Vrouw Ziekenhuis Aalst, Belgium, Moorselbaan 164, 9300 Aalst, Belgium. Electronic address: Frank.nobels@olvz-aalst.be.
authors.forename: Frank
authors.initials: F
authors.lastname: Nobels
authors.affiliation: KU Leuven, Department of Mechanical Engineering, Belgium., Celestijnenlaan 300B bus 2420, room 01.053, B-3001 Leuven (Heverlee), Belgium. Electronic address: herman.bruyninckx@mech.kuleuven.be.
authors.forename: Herman
authors.initials: H
authors.lastname: Bruyninckx
authors.affiliation: KU Leuven, Department of Rehabilitation Sciences-Musculoskeletal Rehabilitation Research Group, Belgium., Tervuursevest 101, B-3001 Leuven (Heverlee), Belgium. Electronic address: filip.staes@faber.kuleuven.be.
authors.forename: Filip
authors.initials: F
authors.lastname: Staes
mesh_terms: D000328:Adult; D000368:Aged; D017719:Diabetic Foot / Q000145:classification* / Q000503:physiopathology*; D005260:Female; D005528:Foot / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D012189:Retrospective Studies
keywords: Pedobarography; classification; diabetes mellitus; ulcers; validation