Summary
Foot ulceration results in substantial morbidity amongst diabetic patients. We have studied prospectively the relationship between high foot pressures and foot ulceration using an optical pedobarograph. A series of 86 diabetic patients, mean age 53.3 (range 17–77) years, mean duration of diabetes 17.1 (range 1–36) years, were followed-up for a mean period of 30 (range 15–34) months. Clinical neuropathy was present in 58 (67%) patients at baseline examination. Mean peak foot pressure was higher at the follow-up compared to baseline (13.5 kg·cm−2±7.1 SD vs 11.2±5.4, p<0.001) with abnormally high foot pressures (>12.3) being present in 55 patients at follow-up and 43 at the baseline visit (p=NS). Plantar foot ulcers developed in 21 feet of 15 patients (17%), all of whom had abnormally high pressures at baseline; neuropathy was present in 14 patients at baseline. Non-plantar ulcers occurred in 8 (9%) patients. Thus, plantar ulceration occurred in 35% of diabetic patients with high foot pressures but in none of those with normal pressures. We have shown for the first time in a prospective study that high plantar foot pressures in diabetic patients are strongly predictive of subsequent plantar ulceration, especially in the presence of neuropathy.
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References
Levy LA (1991) Epidemiology and prevention of diabetic foot disease. In: Frykberg RG (ed) The high risk foot in diabetes mellitus. Churchill Livingstone, New York, pp23–30
Assal JP, Muhlhauser I, Permat A, Gfeller R, Jorgens V, Berger M (1985) Patient education as the basis for diabetes care in clinical practice and research. Diabetologia 28: 602–613
Thomson FJ, Veves A, Ashe H et al. (1991) A team approach to diabetic foot care — the Manchester experience. The Foot 1: 75–82
Boulton AJM, Hardisty CA, Betts RP et al. (1983) Dynamic foot pressures and other studies as diagnostic and management aids in diabetic neuropathy. Diab Care 6: 26–33
Boulton AJM (1990) The diabetic foot: neuropathic in aetiology? Diab Med 7: 852–858
Fernando DJS, Masson EA, Veves A, Boulton AJM (1991) Relationship of limited joint mobility to abnormal foot pressures and diabetic foot ulceration. Diab Care 14: 8–11
Ctercteko GC, Dhanendran M, Hutton WC, LeQuesne LP (1981) Vertical forces acting on the feet of diabetic patients with neuropathic ulceration. Br J Surg 68: 608–614
Masson EA, Hay EM, Stockley I, Veves A, Betts RP, Boulton AJM (1989) Abnormal foot pressures alone may not cause ulceration. Diab Med 6: 426–428
Cavanagh PR, Ulbrecht JS (1991) Plantar pressure in the diabetic foot. In: Sammarco GJ (ed) The foot in diabetes. Lea & Febiger, Philadelphia, pp 54–70
Dyck PJ (1988) Detection, characterization, and staging of polyneuropathy: assessed in diabetics. Muscle Nerve 11: 21–32
Masson EA, Boulton AJM (1991) Pressure assessment methods in the foot. In: Frykberg RG (ed) The high risk foot in diabetes mellitus. Churchill Livingstone, New York, pp 139–149
Veves A, Fernando DJS, Walewski P, Boulton AJM (1991) A study of plantar pressures in a diabetic clinic population. The Foot 1: 89–91
Bloom S, Till S, Sonksen P, Smith S (1984) Use of a biothesiometer to measure individual vibration thresholds and their variation in 519 non-diabetic subjects. Br Med J 288: 233–235
Kosiak M (1959) Etiology and pathology of ischemic ulceration. Arch Phys Med Rehab 40: 62–69
Lord M (1981) Foot pressure measurement: a review of methodology. J Biomed Engl 3: 91–99
Boulton AJM (1991) The importance of abnormal foot pressure and gait in the causation of foot ulceration. In: Bakker K, Kruseman ACN (eds) The Diabetic Foot. Excerpta Medica, Amsterdam, pp 35–50
Stokes IAF, Faris IB, Hutton WC (1975) The neuropathic ulcer and loads on the foot in diabetic patients. Acta Orthop Scand 46: 839–847
Boulton AJM, Betts RP, Franks CI, Ward JD, Duckworth T (1987) The natural history of foot pressure abnormalities in neuropathic diabetic subjects. Diab Res 5: 73–77
Veves A, Masson EA, Fernando DJS, Boulton AJM (1990) Studies of experimental hosiery in diabetic neuropathic patients with high foot pressures. Diab Med 7: 324–326
Boulton AJM, Kubrusly DB, Bowker JH et al. (1986) Impaired vibratory perception and diabetic foot ulceration. Diab Med 3: 335–337
Coleman WC (1985) The relief of forefoot pressures using outer shoe sole modifications. In: Proceedings of the international congress on biomechanics and kinesiology of the hand and foot. Madras, India, pp 18–31
Tovey FE, Moss MJ (1987) Specialist shoes for the diabetic foot. In: Connor H, Boulton AJM, Ward JD (eds) The foot in diabetes. Wiley, Chichester, pp97–108
Schaff P, Kirsch D, Hauser W, Mehnert H (1986) Eine gerateentwicklung zur messung der druckverteilung unter der fuß-sohle im schuh under deren undvendbarkeit in der diabetologie. Akt Endokr Stoffw 7: 129–136
Veves A, Masson EA, Fernando DJS, Boulton AJM (1989) Use of experimental padded hosiery to reduce abnormal foot pressures in diabetic neuropathy. Diab Care 12: 653–655
Young MJ, Cavanagh PR, Thomas G, Johnson MM, Murray H, Boulton AJM (1992) The effect of callus removal on dynamic plantar foot pressures in diabetic patients. Diab Med 9: 55–57
Edmonds ME, Blundell MP, Morris ME, Maelor Thomas E, Cotton LT, Watkins PJ (1986) Improved survival of the diabetic foot: the role of a specialist foot clinic. Quart J Med 232: 763–771
Macleod AF, Williams DRR, Sonksen PH, Boulton AJM (1991) Risk factors for foot ulcers in diabetic patients attending a hospital clinic. Diabetologia 34 [Suppl 2]: A39 (Abstract)
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Veves, A., Murray, H.J., Young, M.J. et al. The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. Diabetologia 35, 660–663 (1992). https://doi.org/10.1007/BF00400259
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DOI: https://doi.org/10.1007/BF00400259