• 1

    Apelqvist J, Larsson J, Agardh CD: Long-term prognosis for diabetic patients with foot ulcers. .J Intern Med 233::485. ,1993. .

  • 2

    Boyko EJ, Ahroni JH, Davignon D, et al: Increased mortality associated with diabetic foot ulcer. .Diabetes Care 13::967. ,1996. .

  • 3

    Veves A, Murray HJ, Boulton AJM, et al: The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study. .Diabetologia 35::660. ,1992. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Murray HJ, Young MJ, Boulton AJM, et al: The association between callus formation, high pressures and neuropathy in diabetic foot ulceration. .Diabet Med 13:: 979. ,1996. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Boyko EJ, Ahroni JH, Smith DG, et al: A prospective study of risk factors for diabetic foot ulcer. .Diabetes Care 22::1036. ,1999. .

  • 6

    Reiber GE, Vileikyte L, Boulton AJM, et al: Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. .Diabetes Care 22::157. ,1999. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Pham H, Armstrong DG, Veves A, et al: Screening techniques to identify people at risk for diabetic foot ulceration: a prospective multicenter trial. .Diabetes Care 23::606. ,2000. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Ahroni JH, Boyko EJ, Forsberg RC: Clinical correlates of plantar pressure among diabetic veterans. .Diabetes Care 22::965. ,1999. .

  • 9

    Suzuki E, Kashiwagi A, Kikkawa R, et al: 1H- and 31P-magnetic resonance spectroscopy and imaging as a new diagnostic tool to evaluate neuropathic foot ulcers in Type II diabetic patients. .Diabetologia 43::165. ,2000. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Brash PD, Foster JE, Vennart W, et al: Magnetic resonance imaging reveals micro-haemorrhage in the feet of diabetic patients with a history of ulceration. .Diabet Med 13::973. ,1996. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Brash PD, Foster J, Vennart W, et al: Magnetic resonance imaging techniques demonstrate soft tissue damage in the diabetic foot. .Diabet Med 16::55. ,1999. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Abouaesha F, van Schie CHM, Boulton AJM: Plantar tissue thickness is related to peak plantar pressure in the high-risk diabetic foot. .Diabetes Care 24::1270. ,2001. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Armstrong DG, Lavery LA, Fleischli JG, et al: Choosing a practical screening instrument to identify patients at risk for diabetic foot ulceration. .Arch Intern Med 158::289. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Young MJ, Breddy JL, Veves A, et al: The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds. .Diabetes Care 16::557. ,1994. .

    • Search Google Scholar
    • Export Citation
  • 15

    Young MJ, Boulton AJ, Sonksen PH, et al: A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. .Diabetologia 36::150. ,1993. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Abbott CA, Vileikyte L, Boulton AJM, et al: Multicenter study of the incidence of and predictive risk factors for diabetic neuropathic foot ulceration. .Diabetes Care 21::1071. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Bygrave CJ, Betts RP: The plantar tissue thickness in the foot: a new ultrasound technique for loadbearing measurements and a metatarsal head depth study. .The Foot 2::71. ,1992. .

    • Search Google Scholar
    • Export Citation
  • 18

    Veves A, Boulton AJM: The optical pedobarograph. .Clin Podiatr Med Surg 10::463. ,1993. .

  • 19

    Armstrong DG, Peters EJ, Lavery LA, et al: Is there a critical level of plantar foot pressures to identify patients at risk for neuropathic foot ulceration?. J Foot Ankle Surg 37::303. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Duckworth T, Betts RP, Burke J, et al: The measurement of pressures under the foot. .Foot Ankle 3::130. ,1982. .

  • 21

    Brink T: Induration of the diabetic foot pad: another risk factor for recurrent neuropathic plantar ulcers. .Biomed Tech 40::205. ,1995. .

    • Search Google Scholar
    • Export Citation
  • 22

    Gooding GA, Stess RM, Grunfeld C, et al: Sonography of the sole of the foot: evidence for loss of foot pad thickness in diabetes and its relationship to ulceration of the foot. .Invest Radiol 21::45. ,1986. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Cavanagh PR: Plantar soft tissue thickness during ground contact in walking. .J Biomech 32::623. ,1997. .

  • 24

    Van Schie CHM, Whalley A, Boulton AJM, et al: Efficacy of injected liquid silicone in the diabetic foot to reduce risk factors for ulceration: a randomized double-blind placebo-controlled trial. .Diabetes Care 23:: 634. ,2000. .

    • PubMed
    • Search Google Scholar
    • Export Citation

Plantar Soft-Tissue Thickness Predicts High Peak Plantar Pressure in the Diabetic Foot

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  • 1 Department of Medicine, Manchester Royal Infirmary, University of Manchester, Manchester, England.
  • | 2 Department of Surgery, Podiatry Section, Southern Arizona Veterans Affairs Medical Center, Tucson.
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The aim of this study was to evaluate whether high plantar foot pressures can be predicted from measurements of plantar soft-tissue thickness in the forefoot of diabetic patients with neuropathy. A total of 157 diabetic patients with neuropathy and at least one palpable foot pulse but without a history of foot ulceration were invited to participate in the study. Plantar tissue thickness was measured bilaterally at each metatarsal head, with patients standing on the same standardized platform. Plantar pressures were measured during barefoot walking using the optical pedobarograph. Receiver operating characteristic analysis was used to determine the plantar tissue thickness predictive of elevated peak plantar pressure. Tissue thickness cutoff values of 11.05, 7.85, 6.65, 6.55, and 5.05 mm for metatarsal heads 1 through 5, respectively, predict plantar pressure at each respective site greater than 700 kPa, with sensitivity between 73% and 97% and specificity between 52% and 84%. When tissue thickness was used to predict pressure greater than 1,000 kPa, similar results were observed, indicating that high pressure at different levels could be predicted from similar tissue thickness cutoff values. The results of the study indicate that high plantar pressure can be predicted from plantar tissue thickness with high sensitivity and specificity. (J Am Podiatr Med Assoc 94(1): 39-42, 2004)

Corresponding author: Frag Abouaesha, MRCP, Department of Medicine, Manchester Royal Infirmary, Oxford Rd, Manchester, M13 9WL, England.