The role of diabetic neuropathy and high plantar pressures in the pathogenesis of foot ulceration

Diabetic foot ulceration is currently a serious medical problem and has, therefore, attracted much research attention during the last two decades. Previous foot ulceration, diabetic neuropathy, limited joint mobility, high plantar pressures, microangiopathy, macroangiopathy and diabetic nephropathy have already been identified as risk factors for future foot ulceration. Neuropathy has clearly been shown to be an essential permissive factor in the development of ulceration in the non-ischaemic foot. Moreover, the pathogenetic role of high plantar pressures is crucial in the presence of established clinical neuropathy. Nowadays, our therapeutic efforts clearly aim to prevent than treat foot ulcers. This demands specialist and team work in the setting up of a diabetic foot clinic in an attempt to identify and educate the diabetic patients at risk and, where possible to use suitable plantar pressure-reducing systems (footwear, hosiery etc.). Then only would it be reasonable to postulate that a significant reduction in amputations of diabetic aetiology could be achieved in the near future.