The Forefoot-to-Rearfoot Plantar Pressure Ratio Is Increased in Severe Diabetic Neuropathy and Can Predict Foot Ulceration
- 1 June 2002
- journal article
- Published by American Diabetes Association in Diabetes Care
- Vol. 25 (6), 1066-1071
- https://doi.org/10.2337/diacare.25.6.1066
Abstract
OBJECTIVE—We have previously demonstrated that high plantar pressures can predict foot ulceration in diabetic patients. The aim of the present study was to evaluate both the relationship between forefoot and rearfoot plantar pressure in diabetic patients with different degrees of peripheral neuropathy and their role in ulcer development. RESEARCH DESIGN AND METHODS—Diabetic patients of a 30-month prospective study were classified according to the neuropathy disability score: scores of 0, 1–5, 6–16, and 17–28 are defined as absent (n = 20), mild (n = 66), moderate (n = 95), and severe (n = 57) neuropathy, respectively. The F-Scan mat system was used to measure dynamic plantar pressures. The peak pressures under the forefoot and the rearfoot were selectively measured for each foot, and the forefoot-to-rearfoot ratio (F/R ratio) was calculated. RESULTS—Foot ulcers developed in 73 (19%) feet. The peak pressures were increased in the forefoot of the severe and moderate neuropathic groups compared with the mild neuropathic and nonneuropathic groups (6.2 ± 4.5 and 3.8 ± 2.7 vs. 3.0 ± 2.1 and 3.3 ± 2.1 kg/cm2 [mean ± SD], respectively; P < 0.0001). The rearfoot pressures were also higher in the severe and moderate neuropathic groups compared with the mild neuropathic and nonneuropathic groups (3.2 ± 2.0 and 3.2 ± 1.9 vs. 2.5 ± 1.3 and 2.3 ± 1.0, respectively; P < 0.0001). The F/R ratio was increased only in the severe group compared with the moderate and mild neuropathic and nonneuropathic groups (2.3 ± 2.4 vs. 1.5 ± 1.2, 1.3 ± 0.9, and 1.6 ± 1.0, respectively; P < 0.0001). In a logistic regression analysis, both forefoot pressure (odds ratio 1.19 [95% CI 1.11–1.28], P < 0.0001) and the F/R ratio (1.37 [1.16–1.61], P < 0.0001) were related to risk of foot ulceration, whereas rearfoot pressure was not. CONCLUSIONS—Both the rearfoot and forefoot pressures are increased in the diabetic neuropathic foot, whereas the F/R ratio is increased only in severe diabetic neuropathy, indicating an imbalance in pressure distribution with increasing degrees of neuropathy. This may lend further evidence toward the concept that equinus develops in the latest stages of peripheral neuropathy and may play an important role in the etiology of diabetic foot ulceration.This publication has 26 references indexed in Scilit:
- Clinical correlates of plantar pressure among diabetic veterans.Diabetes Care, 1999
- Muscular atrophy in diabetic neuropathy: a stereological magnetic resonance imaging studyDiabetologia, 1997
- The Role of Footwear in the Prevention of Foot Lesions in Patients With NIDDM: Conventional wisdom or evidence-based practice?Diabetes Care, 1997
- Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications StudyDiabetologia, 1996
- Variability in function measurements of three sensory foot nerves in neuropathic diabetic patientsDiabetes Research and Clinical Practice, 1995
- In-Shoe Foot Pressure Measurements in Diabetic Patients With At-Risk Feet and in Healthy SubjectsDiabetes Care, 1994
- Ulceration, unsteadiness, and uncertainty: The biomechanical consequences of diabetes mellitusJournal of Biomechanics, 1993
- The risk of foot ulceration in diabetic patients with high foot pressure: a prospective studyDiabetologia, 1992
- The Effect of Callus Removal on Dynamic Plantar Foot Pressures in Diabetic PatientsDiabetic Medicine, 1992
- Relationship of Limited Joint Mobility to Abnormal Foot Pressures and Diabetic Foot UlcerationDiabetes Care, 1991