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@article{208684,
        author = {Arshid Rafiq and p.umar farooq baba and Muzzafar Ahanger and SUMMARAH MUSHTAQ and RUTBA MAQBOOL},
        title = {Management of Plantar Pressure Points in Diabetic Peripheral Neuropathy A Narrative Review},
        journal = {International Journal of Innovative Research in Technology},
        year = {2026},
        volume = {13},
        number = {4},
        pages = {2349-2361},
        issn = {2349-6002},
        url = {https://ijirt.org/article?manuscript=208684},
        abstract = {Background: Diabetic peripheral neuropathy (DPN) leads to loss of protective sensation and altered biomechanical loading of the foot, predisposing to focal plantar pressure points, callus formation, and neuropathic ulceration. Concurrent peripheral arterial disease (PAD) further compromises tissue viability under load, and Charcot neuroarthropathy introduces an especially severe, deformity-driven pattern of midfoot overload. Aim: This narrative review synthesizes current evidence on the pathophysiology, assessment, and management of plantar pressure points in DPN, incorporating the 2023 International Working Group on the Diabetic Foot (IWGDF) guideline updates, the ankle-brachial index (ABI) as a vascular screening tool, the concept of a therapeutic “healing pressure” threshold, Charcot-specific considerations, and emerging wearable sensor technology. Methods: A narrative synthesis of peer-reviewed systematic reviews, meta-analyses, cohort studies, contemporary clinical guidelines (IWGDF 2023 offloading and peripheral artery disease guidelines), and recent technology-focused literature (2023–2025) addressing plantar pressure biomechanics, vascular assessment, and offloading interventions in diabetic foot disease. Summary: Peak plantar pressure is consistently higher at the forefoot in patients with DPN and a history of ulceration compared with those without, and is markedly elevated at the midfoot in Charcot deformity. An in-shoe mean peak plantar pressure below 200 kPa remains the most widely supported therapeutic target for both ulcer healing and recurrence prevention. The ABI remains the first-line vascular screen for PAD but has reduced sensitivity in the presence of arterial calcification; the updated IWGDF 2023 guideline now recommends combining ABI with toe-brachial index and Doppler waveform assessment, since no single modality reliably excludes PAD. The 2023 IWGDF offloading guideline formalizes a stepped approach beginning with non-removable knee-high devices, and wearable sensor-embedded insoles are emerging as adjuncts for continuous, real-time pressure feedback and adherence monitoring. Conclusion: Combining biomechanical offloading targets, updated vascular risk stratification, Charcot-specific vigilance, and emerging monitoring technology allows a more individualized and evidence-based approach to preventing and healing plantar pressure-related complications in diabetic peripheral neuropathy.},
        keywords = {},
        month = {September},
        }