title: Diabetic foot ulcer incidence in relation to plantar pressure magnitude and measurement location.
abstract: OBJECTIVE
  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.
authors.affiliation: RR&D Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, VA Puget Sound Health Care System, Seattle, WA, USA; Department of Mechanical Engineering, University of Washington, Seattle, WA, USA; Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA. Electronic address: wrledoux@u.washington.edu.
authors.forename: William R
authors.initials: WR
authors.lastname: Ledoux
authors.forename: Jane B
authors.initials: JB
authors.lastname: Shofer
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Cowley
authors.forename: Jessie H
authors.initials: JH
authors.lastname: Ahroni
authors.forename: Victoria
authors.initials: V
authors.lastname: Cohen
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Boyko
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000503:physiopathology*; D017719:Diabetic Foot / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000473:pathology / Q000502:physiology*; D006365:Heel / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011379:Prognosis; D014034:Toes / Q000503:physiopathology
keywords: Diabetic foot ulcer; Epidemiology; Hallux; Heel; Metatarsal; Plantar pressure