Foot pressure abnormalities in the diabetic foot

Abstract

For decades, foot pressure measurements have been used to evaluate many medical conditions. Early techniques to assess plantar foot pressure were simple, yet innovative, methods that provided investigators with semiquantitative data. The introduction of the optical pedobarograph signifi- cantly improved the accuracy of foot pressure measurements. Measurement of foot pressures has advanced over the years and now includes computer technology that allows for accurate and reproducible measurements. Foot pressure measurements and plantar ulceration have been extensively researched in the insensate foot (Wagner Orthopedics 10:163-72, 1987; Pollard et al. J Biomed Eng 5:37-41, 1983; Lang-Stevenson et al. J Bone Joint Surg 67B:438-42, 1985; Boulton et al. Diabetes Care 7:73-7, 1987; Boulton et al. Diabetes Care 6:26-33, 1983; Betts and Duckworth J Bone Joint Surg 67:79-85, 1985; Boulton et al. Etiopathogenesis and management of abnormal foot pressures. In: Levin et al. editors. The diabetic foot, 5th ed. St. Louis: Mosby; 1993. p. 233-46; Fernando et al. Diabetes Care 14:8-11, 1991; Veves Foot 2:89-92, 1991; Young et al. Diabet Med 5:55-7, 1992; Cavanagh et al. Diabetes Care 14:750-5, 1991; Donaghue and Veves Orthop Phys Ther Clin N Am 6:1-16, 1997; Rich and Veves Wounds 12(4):82-7, 2000; Sarnow et al. Diabetes Care 17:1002-6, 1994; Veves et al. Diabetologia 35:660-3, 1992; Veves et al. Diabet Med 12:585-9, 1995; Ctercteko et al. Br J Surg 68:608-14, 1981; Stokes et al. Acta Orthop Scand 46:839-47, 1975; Brand Insensitive feet, a practical handbook of foot problems in leprosy. The Leprosy Mission: London; 1984). In western societies, the principal cause of the insensate foot is diabetes mellitus though in other regions of the world, leprosy remains an important contributing factor (Brand Insensitive feet, a practical handbook of foot problems in leprosy. The Leprosy Mission: London; 1984). In fact, the study and work of patients with Hansen's disease have allowed for an understanding of the pathophysiology of the insensate foot and its principles of treatment (Brand Insensitive feet, a practical handbook of foot problems in leprosy. The Leprosy Mission: London; 1984). Off-loading plantar pressure ulcerations is a fundamental key in the treatment of these lesions and yet it is a feature that is often underappreciated and therefore underutilized. Even in this day and age, off-loading a plantar ulceration with a dressing, padding, or even a total contact cast is considered bourgeois and even proletarian by some who care for these wounds using only debridement instruments and dressings. An understanding of foot pressures, shear, and motion about a plantar foot ulceration should be a prerequisite for one practicing in this area. Moreover, the measurement of foot pressures can be clinically valuable in other settings, such as in the evaluation and treatment of the foot in patients with inflammatory arthritic deformities, posttraumatic foot deformities, congenital foot deformities, acquired foot deformities such as hallux valgus, and postsurgical changes as well as dynamic foot evaluation in the setting of sports medicine.