Diabetic foot ulcer incidence in relation to plantar pressure magnitude and measurement location

J Diabetes Complications. Nov-Dec 2013;27(6):621-6. doi: 10.1016/j.jdiacomp.2013.07.004. Epub 2013 Sep 4.


Aims: We prospectively examined the relationship between site-specific peak plantar pressure (PPP) and ulcer risk. Researchers have previously reported associations between diabetic foot ulcer and elevated plantar foot pressure, but the effect of location-specific pressures has not been studied.

Methods: Diabetic subjects (n=591) were enrolled from a single VA hospital. Five measurements of in-shoe plantar pressure were collected using F-Scan. Pressures were measured at 8 areas: heel, lateral midfoot, medial midfoot, first metatarsal, second through fourth metatarsal, fifth metatarsal, hallux, and other toes. The relationship between incident plantar foot ulcer and PPP or pressure-time integral (PTI) was assessed using Cox regression.

Results: During follow-up (2.4years), 47 subjects developed plantar ulcers (10 heel, 12 metatarsal, 19 hallux, 6 other). Overall mean PPP was higher for ulcer subjects (219 vs. 194kPa), but the relationship differed by site (the metatarsals with ulcers had higher pressure, while the opposite was true for the hallux and heel). A statistical analysis was not performed on the means, but hazard ratios from a Cox survival analysis were nonsignificant for PPP across all sites and when adjusted for location. However, when the metatarsals were considered separately, higher baseline PPP was significantly associated with greater ulcer risk; at other sites, this relationship was nonsignificant. Hazard ratios for all PTI data were nonsignificant.

Conclusions: Location must be considered when assessing the relationship between PPP and plantar ulceration.

Keywords: Diabetic foot ulcer; Epidemiology; Hallux; Heel; Metatarsal; Plantar pressure.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / physiopathology*
  • Diabetic Foot / diagnosis
  • Diabetic Foot / epidemiology*
  • Diabetic Foot / physiopathology*
  • Female
  • Follow-Up Studies
  • Foot / pathology
  • Foot / physiology*
  • Heel / physiopathology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Pressure*
  • Prognosis
  • Toes / physiopathology