Boyko EJ, Ahroni JH, Smith DG, et al: Increased mortality associated with diabetic foot ulcer. .Diabet Med 13::967. ,1996. .
Apelqvist J, Larsson J, Agardh CD: Long-term prognosis for diabetic patients with foot ulcers. .J Intern Med 233::485. ,1993. .
Harrington C, Zagari MJ, Corea J, et al: A cost analysis of diabetic lower-extremity ulcers. .Diabetes Care 23::1333. ,2000. .
Birke JA, Sims DS: Plantar sensory threshold in the ulcerative foot. .Lepr Rev 57::261. ,1986. .
Ctercteko GC, Dhanendran M, Hutton WC, et al: Vertical forces acting on the feet of diabetic patients with neuropathic ulceration. .Br J Surg 68::608. ,1981. .
Veves A, Van Ross ER, Boulton AJ: Foot pressure measurements in diabetic and nondiabetic amputees. .Diabetes Care 15::905. ,1992. .
Veves A, Murray HJ, Young MJ, et al: The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. .Diabetologia 35::660. ,1992. .
Boulton AJ, Hardisty CA, Betts RP, et al: Dynamic foot pressures and other studies as diagnostic and management aids in diabetic neuropathy. .Diabetes Care 6::26. ,1983. .
Armstrong DG, Peters EJ, Athanasiou KA, et al: Is there a critical level of plantar foot pressure to identify patients at risk for neuropathic foot ulceration. ?J Foot Ankle Surg 37::303. ,1998. .
Frykberg RG, Lavery LA, Pham H, et al: Role of neuropathy and high foot pressures in diabetic foot ulceration. .Diabetes Care 21::1714. ,1998. .
Mayfield JA, Reiber GE, Sanders LJ, et al: Preventive foot care in people with diabetes. .Diabetes Care 21::2161. ,1998. .
Cavanagh PR, Sims DS Jr, Sanders LJ: Body mass is a poor predictor of peak plantar pressure in diabetic men. .Diabetes Care 14::750. ,1991. .
Mueller MJ, Diamond JE, Delitto A, et al: Insensitivity, limited joint mobility, and plantar ulcers in patients with diabetes mellitus. .Phys Ther 69::453. ,1989. .
Fernando DJ, Masson EA, Veves A, et al: Relationship of limited joint mobility to abnormal foot pressures and diabetic foot ulceration. .Diabetes Care 14::8. ,1991. .
Birke JA, Franks BD, Foto JG: First ray joint limitation, pressure, and ulceration of the first metatarsal head in diabetes mellitus. .Foot Ankle Int 16::277. ,1995. .
Ahroni JH, Boyko EJ, Forsberg RC: Clinical correlates of plantar pressure among diabetic veterans. .Diabetes Care 22::965. ,1999. .
Kaufman A: Veterans Administration launches external peer review program. .QRC Advis 12::1. ,1996. .
European Society of Vascular Surgery: Chronic critical leg ischaemia. .Eur J Vasc Surg 6: (suppl):1. ,1992. .
Holewski JJ, Stess RM, Graf PM, et al: Aesthesiometry: quantification of cutaneous pressure sensation in diabetic peripheral neuropathy. .J Rehabil Res Dev 25::1. ,1988. .
Veves A, Sarnow MR, Giurini JM, et al: Differences in joint mobility and foot pressures between black and white diabetic patients. .Diabet Med 12::585. ,1995. .
Dananberg HJ: Gait style as an etiology to chronic postural pain: part I. Functional hallux limitus. .JAPMA 83::433. ,1993. .
Dananberg HJ: Gait style as an etiology to chronic postural pain: part II. Postural compensatory process. .JAPMA 83::615. ,1993. .
Dananberg HJ: Sagittal plane biomechanics. .JAPMA 90::47. ,2000. .
Walker M, Fan HJ: Relationship between foot pressure pattern and foot type. .Foot Ankle Int 19::379. ,1998. .
Bates B: A Guide to Physical Examination, 3rd Ed, JB Lippincott, Philadelphia, 1983..
Lord M: Spatial resolution in plantar pressure measurement. .Med Eng Phys 19::140. ,1997. .
Donaghue VM, Veves A: Foot pressure measurement. .Orthop Phys Ther Clin N Am 6::1. ,1997. .
Hosmer DW, Lemeshow S: Applied Logistic Regression, John Wiley & Sons, New York, 1989..
Swets JA: Measuring the accuracy of diagnostic systems. .Science 240::1285. ,1988. .
Hanley JA, McNeil BJ: The meaning and use of the area under a receiver operating characteristic (ROC) curve. .Radiology 143::29. ,1982. .
Pham H, Armstrong DG, Harvey C, et al: Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. .Diabetes Care 23::606. ,2000. .
Young MJ, Cavanagh PR, Thomas G, et al: The effect of callus removal on dynamic plantar foot pressures in diabetic patients. .Diabet Med 9::55. ,1992. .
Katoulis EC, Ebdon-Parry M, Hollis S, et al: Postural instability in diabetic neuropathic patients at risk of foot ulceration. .Diabet Med 14::296. ,1997. .
Lavery LA, Vela SA, Fleischli JG, et al: Reducing plantar pressure in the neuropathic foot: a comparison of footwear. .Diabetes Care 20::1706. ,1997. .
Ashry HR, Lavery LA, Murdoch DP, et al: Effectiveness of diabetic insoles to reduce foot pressures. .J Foot Ankle Surg 36::268. ,1997. .
van Schie C, Ulbrecht JS, Becker MB, et al: Design criteria for rigid rocker shoes. .Foot Ankle Int 21::833. ,2000. .
Wolf SL, Barnhart HX, Ellison GL, et al: The effect of Tai Chi Quan and computerized balance training on postural stability in older subjects. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies on Intervention Techniques. .Phys Ther 77::371. ,1997. .
Hu MH, Woollacott MH: Multisensory training of standing balance in older adults: part II. Kinematic and electromyographic postural responses. .J Gerontol 49::M62. ,1994. .
Hu MH, Woollacott MH: Multisensory training of standing balance in older adults: part I. Postural stability and one-leg stance balance. .J Gerontol 49::M52. ,1994. .
Elevated plantar pressures are an important predictor of diabetic foot ulceration. The objective of this study was to determine which clinical examination variables predict high plantar pressures in diabetic feet. In a cross-sectional study of 152 male veterans with diabetes mellitus, data were collected on demographics, comorbid conditions, disease severity, neuropathy status, vascular disease, and orthopedic and gait examinations. Univariate predictors included height, weight, body surface area, body weight per square inch of foot surface area, bunion deformity, hammer toe, Romberg’s sign, insensitivity to monofilament, absent joint position sense, decreased ankle dorsiflexion, and fat pad atrophy. Variables that remained significantly associated with high plantar pressures (≥4 kg/cm2) in multivariate analysis included height, body weight per square inch of foot surface area, Romberg’s sign, and insensitivity to monofilament. These results may be useful in identifying patients who would benefit from interventions designed to decrease plantar foot pressures. (J Am Podiatr Med Assoc 93(5): 367-372, 2003)
The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the US Department of Veterans Affairs.