Pedographic classification and ulcer detection in the diabetic foot.
BACKGROUND
Plantar pressure is a cause of foot ulceration in diabetes. Attempts to determine a pressure threshold have failed. The aim of this study was to determine a pedographic classification to identify patients at risk for a foot ulcer.


METHODS
210 diabetics and controls categorized into 4 groups with deformities of the forefoot were analyzed. For the pedographic measurement peak pressure, force and their integrals were analyzed using a percentage and an anatomic mask. A multivariant logistic regression analysis was performed.


RESULTS
Logistic regression analysis using pedographic variables of a percentage mask revealed a combination of 4 variables (pressure time integral forefoot, peak pressure midfoot, pressure time integral heel, and peak pressure heel) identifying the foot ulcer with a sensitivity of 73% and a specificity of 87%. The analysis using an anatomic mask identified 8 variables (pressure time integral mask 4 (metatarsal 2), force mask 9 (2. toe), force time integral mask 8 (great toe), peak pressure mask 6 (metatarsal 4), pressure time integral mask 6 (metatarsal 4), peak pressure mask 8 (great toe), peak pressure mask 7 (metatarsal 5), and force mask 6 (metatarsal 4)) that characterized a pedal ulcer with a sensitivity of 95% and a specificity of 90%.


CONCLUSIONS
This screening method identifies diabetics who are at risk for a foot ulcer.
Hufeland Klinik, Orthopedic Department, Taunusallee 5, 56130 Bad Ems, Germany. utewaldecker@googlemail.com
Ute
U
Waldecker
D000328:Adult; D000368:Aged; D017719:Diabetic Foot / Q000150:complications* / Q000175:diagnosis; D003937:Diagnosis, Differential; D019937:Diagnostic Techniques and Procedures; D005260:Female; D016523:Foot Ulcer / Q000145:classification* / Q000175:diagnosis* / Q000209:etiology; D005545:Forefoot, Human / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011032:Podiatry / Q000379:methods*; D011312:Pressure; D012372:ROC Curve; D015203:Reproducibility of Results; D012307:Risk Factors; D016138:Walking / Q000502:physiology*