title: Predictors of barefoot plantar pressure during walking in patients with diabetes, peripheral neuropathy and a history of ulceration.
abstract: OBJECTIVE
  Elevated dynamic plantar foot pressures significantly increase the risk of foot ulceration in diabetes mellitus. The aim was to determine which factors predict plantar pressures in a population of diabetic patients who are at high-risk of foot ulceration.
  
  
  METHODS
  Patients with diabetes, peripheral neuropathy and a history of ulceration were eligible for inclusion in this cross sectional study. Demographic data, foot structure and function, and disease-related factors were recorded and used as potential predictor variables in the analyses. Barefoot peak pressures during walking were calculated for the heel, midfoot, forefoot, lesser toes, and hallux regions. Potential predictors were investigated using multivariate linear regression analyses. 167 participants with mean age of 63 years contributed 329 feet to the analyses.
  
  
  RESULTS
  The regression models were able to predict between 6% (heel) and 41% (midfoot) of the variation in peak plantar pressures. The largest contributing factor in the heel model was glycosylated haemoglobin concentration, in the midfoot Charcot deformity, in the forefoot prominent metatarsal heads, in the lesser toes hammer toe deformity and in the hallux previous ulceration. Variables with local effects (e.g. foot deformity) were stronger predictors of plantar pressure than global features (e.g. body mass, age, gender, or diabetes duration).
  
  
  CONCLUSIONS
  The presence of local deformity was the largest contributing factor to barefoot dynamic plantar pressure in high-risk diabetic patients and should therefore be adequately managed to reduce plantar pressure and ulcer risk. However, a significant amount of variance is unexplained by the models, which advocates the quantitative measurement of plantar pressures in the clinical risk assessment of the patient.
authors: Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, United Kingdom.
authors: Ruth
authors: R
authors: Barn
authors: Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors: Roelof
authors: R
authors: Waaijman
authors: Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors: Frans
authors: F
authors: Nollet
authors: Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, United Kingdom.
authors: James
authors: J
authors: Woodburn
authors: Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors: Sicco A
authors: SA
authors: Bus
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D017719:Diabetic Foot / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D003929:Diabetic Neuropathies / Q000150:complications; D005260:Female; D005528:Foot / Q000473:pathology*; D005530:Foot Deformities / Q000150:complications; D005545:Forefoot, Human / Q000473:pathology; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D016138:Walking
chemical_list: D006442:Glycated Hemoglobin
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