The forefoot-to-rearfoot plantar pressure ratio is increased in severe diabetic neuropathy and can predict foot ulceration

Antonella Caselli, Hau Pham, John M. Giurini, David G Armstrong, Aristidis Veves

Research output: Contribution to journalArticle

168 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1066-1071
Number of pages6
JournalDiabetes Care
Volume25
Issue number6
DOIs
StatePublished - Jun 2002
Externally publishedYes

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Diabetic Neuropathies
Foot
Pressure
Diabetic Foot
Peripheral Nervous System Diseases
Foot Ulcer
Ulcer
Research Design
Logistic Models
Odds Ratio
Regression Analysis
Prospective Studies

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

The forefoot-to-rearfoot plantar pressure ratio is increased in severe diabetic neuropathy and can predict foot ulceration. / Caselli, Antonella; Pham, Hau; Giurini, John M.; Armstrong, David G; Veves, Aristidis.

In: Diabetes Care, Vol. 25, No. 6, 06.2002, p. 1066-1071.

Research output: Contribution to journalArticle

Caselli, Antonella ; Pham, Hau ; Giurini, John M. ; Armstrong, David G ; Veves, Aristidis. / The forefoot-to-rearfoot plantar pressure ratio is increased in severe diabetic neuropathy and can predict foot ulceration. In: Diabetes Care. 2002 ; Vol. 25, No. 6. pp. 1066-1071.
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title = "The forefoot-to-rearfoot plantar pressure ratio is increased in severe diabetic neuropathy and can predict foot ulceration",
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.",
author = "Antonella Caselli and Hau Pham and Giurini, {John M.} and Armstrong, {David G} and Aristidis Veves",
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T1 - The forefoot-to-rearfoot plantar pressure ratio is increased in severe diabetic neuropathy and can predict foot ulceration

AU - Caselli, Antonella

AU - Pham, Hau

AU - Giurini, John M.

AU - Armstrong, David G

AU - Veves, Aristidis

PY - 2002/6

Y1 - 2002/6

N2 - 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.

AB - 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.

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