title: Abnormal foot pressures alone may not cause ulceration.
abstract: Both rheumatoid arthritis and diabetes have been associated with the development of abnormally high pressures under the feet, and ulceration has been considered to be a problem in both conditions. In order to examine further the relationship between high foot pressure, neurological abnormalities, and ulceration, we have studied two groups of patients: (a) 38 diabetic patients and (b) 37 patients with rheumatoid arthritis who had similar clinical abnormalities of the feet. Thirty-two percent of diabetic patients had a history of plantar ulceration compared with none of the rheumatoid group (p less than 0.01). However, the diabetic group had considerably more severe neuropathy (peroneal nerve motor conduction velocity 35.4 +/- 4.8 m s-1 vs 44.4 +/- 5.2 m s-1 (mean +/- SD), p less than 0.001; vibration perception threshold 33.5 +/- 13.4 vs 16.9 +/- 10.9, p less than 0.001), with a similar frequency of elevated plantar pressures (51% vs 61%, NS). These data emphasize the importance of the loss of sensory awareness in the pathogenesis of diabetic foot ulceration, and suggest that high pressure alone is not a direct cause of ulceration.
authors.affiliation: Department of Medicine, Manchester Royal Infirmary, Sheffield, UK.
authors.forename: E A
authors.initials: EA
authors.lastname: Masson
authors.forename: E M
authors.initials: EM
authors.lastname: Hay
authors.forename: I
authors.initials: I
authors.lastname: Stockley
authors.forename: A
authors.initials: A
authors.lastname: Veves
authors.forename: R P
authors.initials: RP
authors.lastname: Betts
authors.forename: A J
authors.initials: AJ
authors.lastname: Boulton
mesh_terms: D001172:Arthritis, Rheumatoid / Q000150:complications / Q000503:physiopathology*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005530:Foot Deformities / Q000150:complications / Q000503:physiopathology*; D005534:Foot Diseases / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D009046:Motor Neurons / Q000502:physiology; D009431:Neural Conduction; D009460:Neurologic Examination; D011312:Pressure; D012684:Sensory Thresholds; D012883:Skin Ulcer / Q000209:etiology*; D013497:Sural Nerve / Q000503:physiopathology; D014732:Vibration