Forefoot and rearfoot plantar pressures in diabetic patients: Correlation to foot ulceration

In the setting of diabetes mellitus, high plantar foot pressures are an imp ortant risk factor and can predict foot ulceration. Most studies have used measurements of peak plantar pressures under the whole foot. The purpose of this study was to evaluate forefoot and rearfoot plantar pressures separat ely in diabetic patients and examine their validity in predicting foot ulce ration. A total of 90 patients were enrolled in a prospective study and wer e followed up for a mean period of 36 months. All the patients underwent a complete medical history and lower extremity evaluation for neuropathy, vas cular status, vibration perception threshold (VPT), joint mobility, and foo t pressures. The peak foot pressures under the rearfoot and forefoot were e valuated using the F-scan mot system with patients ambulating without footw ear. Significant correlations were Found between forefoot peak pressures an d age, height, neuropathy disability score (NDS), vibration perception thre shold (VPT), and force applied on the ground during walking. In contrast, r everse correlations were found between rearfoot peak pressures and measurem ents of neuropathic severity. Binary regression analysis showed a higher ri sk of foot ulceration in patients with high forefoot pressures (OR 1.15, CI 1.04-1.28, p=0.005), while no association was found for rearfoot pressures (OR 0.99, CI 0.96-1.03, p=NS). We conclude that peak foot pressure measure ments of the forefoot but not the rearfoot correlate with neuropathy measur ements and con also predict foot ulceration over 36 months. Measurement of forefoot peak pressures rather than the whole foot may therefore be more us eful in identifying at-risk patients.