The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study

Veves, Aristidis; Murray, H. J.; Young, Matthew J.; Boulton, Andrew J.M.

doi:10.1007/bf00400259

Cited by 606 publications

(384 citation statements)

References 17 publications

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“…Boulton et al (1983) first concluded plantar pressure in the diabetic could increase with time. This is supported by the findings of Veves et al (1992) who measured plantar pressure in three subject types over a thirty-month period. They found average peak plantar pressure increased by 21% in a neuropathic diabetic group, 20% in a nonneuropathic diabetic group and by 2.5% in a non-diabetic control group.…”

Section: Optical Properties Of the Skin And Bloodsupporting

confidence: 71%

An in-shoe laser Doppler sensor for assessing plantar blood flow in the diabetic foot

Cobb¹,

Claremont²

2001

Medical Engineering & Physics

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An in-shoe laser Doppler sensor for assessing plantar blood flow in the diabetic foot. Jonathan Edwin CobbPlantar ulceration is a complication of the diabetic foot prevalent in adults with type 11 diabetes mellitus. Although neuropathy, microvascular disease and biornechanical factors are all implicated, the mechanism by which the tissue becomes pre-disposed to damage remains unclear. Recent theories suggest that the nutritional supply to the tissue is compromised, either by increased flow through the arteriovenous anastomoses ('capillary steal' theory) or through changes in the micro vascu I ature (haemodynamic hypothesis). Clinical data to support these ideas has been limited to assessment of the unclad foot under rest conditions. A limitation of previous studies has been the exclusion of static and dynamic tissue loading, despite extensive evidence that these biornechanical factors are essential in the development of plantar ulceration. The present study has overcome these problems by allowing assessment of plantar blood flow, in-shoe, during standing and walking.The system comprises a laser Doppler blood flux sensor operating at 780nm, load sensor, measurement shoe, instrumentation, and analysis software. In-vitro calibration was performed using standard techniques. An in-vivo study of a small group of diabetic subjects indicated differences in the blood flux response between diabetic neuropaths, diabetics with vascular complications and a control group. For example, following a loading period of 120s, relative increases in response from rest to peak were: Control (150% to 259%), Vascular (-70% to 242%), Neuropathic (109%-174%) and recovery times to 50% of the peak response were: Control (33s to 45s), Vascular (43s to >120s), Neuropathic (>120s). Dynamic re-perfusion rates (arbitrary units per millisecond) obtained for the swing phase of gait were: Control (6.1 a. u/ms to 7.9 a. u/ms), Vascular (4 a. u/ms to 6.2 a. u/ms), Neuropathic (2.3 a. u/ms to 4.5 a. u/ms).

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Section: Optical Properties Of the Skin And Bloodsupporting

confidence: 71%

An in-shoe laser Doppler sensor for assessing plantar blood flow in the diabetic foot

Cobb¹,

Claremont²

2001

Medical Engineering & Physics

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“…Finally, a prospective study confirmed that high foot pressures predict ulcer development in the insensate foot [56].…”

Section: Foot Pressure Studies In Diabetesmentioning

confidence: 64%

The diabetic foot: from art to science. The 18th Camillo Golgi lecture

2004

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Diabetic foot ulceration represents a major medical, social and economic problem all over the world. While more than 5% of diabetic patients have a history of foot ulceration, the cumulative lifetime incidence may be as high as 15%. Ethnic differences exist in both ulcer and amputation incidences, with both being less common in patients of Indian subcontinent origin living in the UK. Foot ulceration results from the interaction of several contributory factors, the most important of which is neuropathy. With respect to the management of acute Charcot neuroarthropathy in diabetes, recent studies suggest that bisphosphonates reduce disease activity as judged not only by differences in skin temperature, but also by assessing markers of bone turnover. The use of the total-contact cast is demonstrated in the treatment of acute Charcot feet and of plantar neuropathic ulcers. Histological evidence suggests that pressure relief results in chronic foot ulcers changing their morphological appearance by displaying some features of an acute wound. Thus, repetitive stresses on the insensate foot appear to play a major role in maintaining ulcer chronicity. It is hoped that increasing research activity in foot disease will ultimately result in fewer ulcers and less amputation in diabetes.

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“…The most increased pressure measurement in one defined region represented the maximal peak pressure. According to previous studies, maximal peak pressure directly correlates with the risk for developing mechanicalinduced forefoot complaints [2,16]. Maximal force was the most increased force in one defined anatomic region (F = p/A).…”

Section: Methodsmentioning

confidence: 79%

Metatarsal Length does not Correlate with Maximal Peak Pressure and Maximal Force

Kaipel

Krapf

Wyss

2011

Clinical Orthopaedics &Amp; Related Research

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Background Primary metatarsalgia of the lesser metatarsals is common and caused by mechanical overload of the affected metatarsal heads. Increased metatarsal length generally is believed to be a factor in the development of primary metatarsalgia. However, there is no clear biomechanical evidence supporting this theory. Questions/purposes We asked whether metatarsal length correlated with plantar-loading parameters under the corresponding metatarsal heads. Patients and Methods We prospectively followed two groups of patients 46 (51 feet) with and 45 (51 feet) without metatarsalgia. Each foot was physically examined and underwent standardized full-weightbearing radiography and dynamic pedobarography to assess maximal peak pressure and maximal force under the first, second, and third metatarsal heads. We correlated the relative length of the first and third metatarsals with the corresponding two plantar-loading parameters. We compared maximal peak pressure and maximal force in patients with metatarsalgia with those of symptom-free patients.Results The relative length of the first and third metatarsals did not correlate (r \ 0.13) with the maximal peak pressure or maximal force under the corresponding metatarsal heads. Maximal force under the first metatarsal head was decreased in the metatarsalgia group. There was no difference in maximal peak pressure between the metatarsalgia and nonmetatarsalgia groups. Conclusions Relative metatarsal length had no influence on plantar-loading parameters. Shortening of a symptomatic ray to decrease plantar-loading parameters cannot be supported from a biomechanical rationale.

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The risk of foot ulceration in diabetic patients with high foot pressure: a prospective study

Cited by 606 publications

References 17 publications

An in-shoe laser Doppler sensor for assessing plantar blood flow in the diabetic foot

An in-shoe laser Doppler sensor for assessing plantar blood flow in the diabetic foot

The diabetic foot: from art to science. The 18th Camillo Golgi lecture

Metatarsal Length does not Correlate with Maximal Peak Pressure and Maximal Force

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