The role of dynamic plantar pressures in diabetic foot ulcers

OBJECTIVE - The significance of plantar pressure studies in detecting sites of plantar ulceration in diabetic patients was investigated. RESEARCH DESIGN AND METHODS - A total of 97 diabetic patients participated in this study. History and physical data, such as history of smoking, type of diabetes, ankle/brachial indexes, and the presence of protective sensory threshold, were collected. Using the EMED-SF plantar pressure analyzer, dynamic pressure variables, such as normalized peak pressure of maximum pressure picture (MPP), pressure-time integral (PTI), and force-time integral (FTI), were measured in each foot. Statistical analysis included descriptive statistics and analyses of variance. RESULTS - Out of 97 patients, 34 patients had no history of neuropathy and plantar ulceration (the diabetic control [DC] group). Another 14 patients had neuropathy with no previous history of plantar ulcers (the DN group), whereas the remainder of the patients had a history of peripheral neuropathy with plantar ulceration (the DU group). There were significant increases in MPP (P < 0.004) and PTI (P < 0.0004) levels in the DU group when compared with the DC group with the highest pressure present under the 4th and 5th metatarsal heads. No statistical significance existed among groups when comparing FTI levels. CONCLUSIONS - Neuropathic patients have an increase in dynamic plantar foot pressures placing them at risk for plantar ulceration. instruments such as the EMED-SF system can be helpful in detecting possible sites of plantar ulcerations by locating the areas of maximum pressure.