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

Diabetologia. 1992 Jul;35(7):660-3. doi: 10.1007/BF00400259.


Foot ulceration results in substantial morbidity amongst diabetic patients. We have studied prospectively the relationship between high foot pressures and foot ulceration using an optical pedobarograph. A series of 86 diabetic patients, mean age 53.3 (range 17-77) years, mean duration of diabetes 17.1 (range 1-36) years, were followed-up for a mean period of 30 (range 15-34) months. Clinical neuropathy was present in 58 (67%) patients at baseline examination. Mean peak foot pressure was higher at the follow-up compared to baseline (13.5 +/- 7.1 SD vs 11.2 +/- 5.4, p less than 0.001) with abnormally high foot pressures (greater than 12.3) being present in 55 patients at follow-up and 43 at the baseline visit (p = NS). Plantar foot ulcers developed in 21 feet of 15 patients (17%), all of whom had abnormally high pressures at baseline; neuropathy was present in 14 patients at baseline. Non-plantar ulcers occurred in 8 (9%) patients. Thus, plantar ulceration occurred in 35% of diabetic patients with high foot pressures but in none of those with normal pressures. We have shown for the first time in a prospective study that high plantar foot pressures in diabetic patients are strongly predictive of subsequent plantar ulceration, especially in the presence of neuropathy.

MeSH terms

  • Diabetes Mellitus, Type 1 / physiopathology*
  • Diabetes Mellitus, Type 2 / physiopathology*
  • Diabetic Neuropathies / physiopathology*
  • Female
  • Follow-Up Studies
  • Foot Ulcer / epidemiology
  • Foot Ulcer / etiology*
  • Foot*
  • Humans
  • Male
  • Middle Aged
  • Pressure
  • Prospective Studies
  • Reflex
  • Risk Factors
  • Skin Ulcer / epidemiology
  • Skin Ulcer / etiology*