INCREASED FEET PRESSURES AFTER GREAT TOE AMPUTATION IN DIABETES

OBJECTIVE - To compare peak pressures on the sole of the foot in non-i nsulin-dependent diabetic patients with isolated, unilateral amputatio ns of the great toe and first metatarsal with the patients' contralate ral, intact foot. RESEARCH DESIGN AND METHODS - Eleven patients with a unilateral great toe and partial first metatarsal amputation of at le ast 6 months duration were evaluated with the F-Scan in-shoe pressure measurement system. Patients were studied in the same brand and style of footwear-a thin, rubber-soled, canvas boar shoe. We compared mean p eak plantar foot pressures under the first metatarsal, lesser metatars als, lesser toes, and heel in feel with and without a great toe amputa tion using the Wilcoxon's matched pairs signed-rank test. RESULTS - Pe ak fool pressures were significantly higher under the first metatarsal head (P = 0.046), lesser metatarsal heads (P < 0.001), and toes (P < 0.001) in feet with a great toe amputation compared with the contralat eral foot without an amputation. Pressure under the heel was higher on the contralateral foot (P < 0.01). CONCLUSIONS - After a great toe am putation pressure distribution of the foot is significantly altered. B ecause preamputation risk factors such as peripheral neuropathy, foot deformity, and limited joint mobility for many of these patients remai n unchanged, an increase in foot pressures contributes to an increased risk of reulceration and reamputation in these patients.