Plantar Tissue Thickness Is Related to Peak Plantar Pressure in the High-Risk Diabetic Foot

• Published in: Diabetes care Vol. 24; no. 7; pp. 1270 - 1274
• Main Authors: ABOUAESHA, Frag, VAN SCHIE, Carine H. M, GRIFFTHS, Gareth D, YOUNG, Robert J, BOULTON, Andrew J. M
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.07.2001
• Subjects: Associated diseases and complications; Biological and medical sciences; Body Mass Index; Diabetes; Diabetes Mellitus, Type 1 - pathology; Diabetes Mellitus, Type 1 - physiopathology; Diabetes Mellitus, Type 2 - pathology; Diabetes Mellitus, Type 2 - physiopathology; Diabetes. Impaired glucose tolerance; Diabetic Foot - epidemiology; Diabetic Foot - physiopathology; Diabetic Neuropathies - physiopathology; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Feet; Female; Foot - anatomy & histology; Foot Ulcer - epidemiology; Foot Ulcer - physiopathology; Humans; Male; Medical sciences; Middle Aged; Pressure; Regression Analysis; Risk Factors; Sensory Thresholds; Skin - anatomy & histology; Skin - pathology; Ulcers; Endocrinopathy; Human; Nervous system diseases; Callus; Diabetes mellitus; Peripheral neuropathy; Pressure; Thickness; Body mass index; Disease of the foot; Complication; Skin; Peripheral nerve disease; Subcutaneous tissue; Ulceration
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.24.7.1270

Plantar Tissue Thickness Is Related to Peak Plantar Pressure in the High-Risk Diabetic Foot Frag Abouaesha , MRCP 1 , Carine H.M. van Schie , PHD 1 , Gareth D. Griffths , FRCS 2 , Robert J. Young , MD 3 and Andrew J.M. Boulton , MD 1 1 Department of Medicine, Manchester Royal Infirmary, University of Manchester, Manchester 2 Vascular Surgical Unit, Ninewells Hospital, Dundee 3 Diabetes Centre, Hope Hospital, Salford, U.K. Abstract OBJECTIVE —To investigate the relationship among plantar foot pressure, plantar subcutaneous tissue thickness, severity of neuropathy (vibration perception threshold [VPT]), callus, and BMI in a large group of neuropathic diabetic patients at risk of foot ulceration. RESEARCH DESIGN AND METHODS —A total of 157 diabetic neuropathic patients (VPT >25 V) without either peripheral vascular or ulcer history were studied. Plantar foot pressure and plantar tissue thickness were measured at each metatarsal head (MTH) using an optical pedobarograph and an ultrasound scanning platform, respectively. RESULTS —A significant association was observed between peak plantar pressure and plantar tissue thickness at all MTHs (−0.26 < r < −0.61, P < 0.0001), with the least pronounced association at the first MTH. In addition, the pressure time integral was significantly associated with plantar tissue thickness (−0.24 < r < −0.57, P < 0.0001). BMI was significantly related to plantar tissue thickness (0.18 < r < 0.45, P < 0.05), but not to peak forefoot pressures. Subjects with callus had significantly reduced plantar tissue thickness at all MTHs except the first MTH and increased peak pressures at all MTHs ( P < 0.001). CONCLUSIONS —This study confirms a strong inverse relationship between plantar tissue thickness and dynamic foot pressure measurements. Long-term follow-up of this patient population will confirm whether reduced plantar tissue thickness predicts the development of diabetic foot ulcers. MTH, metatarsal head VPT, vibration perception threshold Footnotes Address correspondence and reprint requests to Dr. Frag Abouaesha, Department of Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, U.K. E-mail: frag.abouaesha{at}man.ac.uk . Received for publication 20 December 2000 and accepted in revised form 27 March 2001. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.